Living in the Anxiety Age

We live in the Anxiety Age. Most of us suffer from chronic anxiety to some extent because modern life is jagged, fast-paced, and divorced from the natural rhythms that tend to create a harmonious inner life. The calming cycles of farming, the instinctive satisfactions of hunting and gathering, and pure faith in religion gave our ancestors inner resources that few of us possess today.

People who suffer from the emotional illness called anxiety disorder, however, go a step beyond this common feeling. The quality of their lives is significantly diminished by the pervading presence of fear, which is often unrelated to any obvious cause. Even if a cause can be identified, the magnitude of anxiety they experience is greater than the actual degree of stress.

Typical symptoms of anxiety disorder include feelings of tension, irritability, worry, frustration, turmoil, and hopelessness, along with insomnia, restless sleep, grinding of teeth, jaw pain, an inability to sit still, and an inability to cope. Physical sensations frequently arise as well, including a characteristic feeling of being unable to take a full breath, dry mouth, rapid heartbeat, heart palpitations, a lump in the throat, tightness in the chest, and cramping in the bowels.

Anxiety can also give rise to panic attacks. These may be so severe that they are mistaken for heart attacks. The heart pounds and palpitates, the chest feels tight and painful, and the whole body tenses with unreasonable fear. Such attacks can be triggered by anxiety-provoking situations. But they can also come out of nowhere, even awakening you from sleep. If you suffer more from panic attacks than generalized anxiety, you probably have panic disorder.

Treating anxiety medically primarily involves anti-anxiety drugs. Some, such as Xanax®, are effective immediately. Others, such as BuSpar®, take a week or more to reach full effect. Antidepressant drugs may also be helpful. Panic attacks are generally more difficult to treat than other aspects of anxiety.

Medications are best used in the short term, and it is advisable to seek more permanent help through psychotherapy.

There are also some herbal remedies [and natural vitamin and mineral supplements] for anxiety that have shown some promise. [Deficiency in certain vitamins and minerals in particular can often be a cause of anxiety.]

Herbal Remedies

Valerian. The herb valerian is best known as a remedy for insomnia. However, because many drugs useful for insomnia also reduce anxiety, valerian has been proposed as an anxiety treatment as well.

In a double-blind, placebo-controlled study, 36 people with generalized anxiety disorder were given either valerian extract, valium, or placebo for a period of 4 weeks.1 The study failed to find statistically significant differences between the groups, presumably due to its small size. However, a careful analysis of the results hints, at least, that valerian was helpful.

In addition, a preliminary double-blind study found that valerian may produce calming effects in stressful situations.2 Again, though, this study was too small to provide definitive results.

Kava. Up until 2002, the herb kava was widely used in Europe as a medical treatment for anxiety, based on the evidence of several double-blind, placebo-controlled studies. However, because of recent concerns involving its potential effects on the liver, it has been withdrawn from the market in many countries.

Passionflower. A 4-week, double-blind study of 36 individuals with anxiety (specifically, generalized anxiety disorder) compared the herb passionflower to the standard drug oxazepam.3 Oxazepam worked more quickly, but by the end of the 4-week trial, both treatments proved equally effective. Furthermore, passionflower showed a comparative advantage in terms of side-effects: use of oxazepam was associated with more impairment of job performance. However, because this study lacked a placebo group, it would be premature to conclude from it that passionflower has been shown to be an effective treatment for anxiety. The only other supporting evidence for passionflower comes from animal studies.4

Other Herbs. Several small double-blind studies by a single research group have found preliminary evidence that oral use of lemon balm (Melissa officinalis) may reduce anxiety levels.5,6 Like other anti-anxiety agents, it may also impair mental function to some degree.

A double-blind, placebo-controlled trial of 40 individuals found that gotu kola reduced the "startle" response to sudden loud noises.7 This suggests, but doesn't prove, that gotu kola may be helpful for anxiety.

A very small double-blind, placebo-controlled crossover study found that use of the herb skullcap reduced general anxiety levels.8

Other herbs that are frequently recommended for anxiety include chamomile, hops, and suma. Two studies suggest that Bach flower remedies are not helpful for anxiety.9,10

Supplements

Combination Supplements. A large (264 participant) 3-month, double-blind, placebo-controlled study tested the possible anti-anxiety benefits of a combination therapy containing the mineral magnesium (150 mg twice daily), the herb hawthorn (150 mg twice daily of a standardized extract), and the seldom-studied herb Eschscholtzia californica (California poppy, 40 mg twice daily).11 Study participants all suffered from generalized anxiety disorder of mild-to-moderate intensity. The results indicated that the combination treatment was more effective than placebo. No significant side effects were seen. This particular combination therapy is currently used in France.

A double-blind, placebo-controlled trial of 80 healthy male volunteers found that 28 days of treatment with a multivitamin and mineral supplement (containing calcium, magnesium, and zinc) significantly reduced anxiety and the sensation of stress.12

5-HTP. Best known as a remedy for depression, 5-HTP may also help ease anxiety—which often precedes depression. Read more about how 5-HTP raises serotonin levels.

Melatonin. Based on its ability to promote sleep, melatonin has been tried as a treatment for reducing anxiety while waiting for surgery to begin. A double-blind, placebo-controlled study of 75 women waiting for surgery compared melatonin against the standard drug midazolam13 and found it effective. Benefits were also seen in a subsequent double-blind trial of 84 women about to receive anesthesia, conducted by the same researcher. Whether melatonin is effective for other forms of anxiety has not been determined.

Other Supplements. Supplementation with selenium (200 mcg daily) or flaxseed oil (2 to 6 tablespoons daily) is said to help relieve anxiety symptoms in some people.

Because GABA (gamma-aminobutyric acid) is known to play a central role in anxiety, some healthcare professionals suggest taking this amino acid. However, no scientific evidence suggests that orally ingested GABA will be effective in every case. Find out about other amino acid therapies.

[Since anxiety can be triggered by common nutritional deficiencies, it's usually a good idea to begin addressing the issue by supplementing with high-quality vitamins, minerals, and essential fatty acids every day to insure you are getting what your body needs for optimal health.]

Alternative Therapies

Various alternative therapies have shown some promise for the treatment of anxiety, including acupuncture14,15, aromatherapy (either alone or combined with massage)16,17, biofeedback18, massage (either alone or combined with aromatherapy)16,19, and relaxation therapies (such as meditation and guided imagery).20,21 However, the supporting evidence to indicate that these treatments actually work remains weak.



This article has been brought to you courtesy of EBSCO Publishing. Last reviewed April 2005 by EBSCO CAM Review Board. All EBSCO Publishing proprietary, consumer health, and medical information is accredited by URAC. URAC's Health Web Site Accreditation Program requires compliance with 53 rigorous standards of quality and accountability, verified by independent audits.

Cited Sources:

1) Andreatini R, Sartori VA, Seabra ML, et al. Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study. Phytother Res. 2002;16:650–654.

2) Kohnen R, Oswald WD. The effects of valerian, propranolol, and their combination on activation, performance and mood of healthy volunteers under social stress conditions. Pharmacopsychiatry. 1988;21:447–448.

3) Akhondzadeh S, Naghavi HR, Vazirian M, et al. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther. 2001;26:363-367.

4) Dhawan K, Kumar S, Sharma A. Comparative anxiolytic activity profile of various preparations of Passiflora incarnata Linneaus: a comment on medicinal plants’ standardization. J Altern Complement Med. 2002;8:283-91.

5) Kennedy DO, Wake G, Savelev S, et al. Modulation of mood and cognitive performance following acute administration of single doses of Melissa officinalis (lemon balm) with human CNS nicotinic and muscarinic receptor-binding properties. Neuropsychopharmacology. 2003. [Epub ahead of print].

6) Kennedy DO, Little W, Scholey AB. Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (lemon balm). Psychosom Med. 2004;66:607-13.

7) Bradwejn J, Zhou Y, Koszycki D, et al. A double-blind, placebo-controlled study on the effects of Gotu Kola (Centella asiatica) on acoustic startle response in healthy subjects. J Clin Psychopharmacol. 2000;20:680–684.

8) Wolfson P, Hoffmann DL. An investigation into the efficacy of Scutellaria lateriflora in healthy volunteers. Altern Ther Health Med. 2003;9:74–78.

9) Walach H, Rilling C, Engelke U. Efficacy of Bach-flower remedies in test anxiety: a double-blind, placebo-controlled, randomized trial with partial crossover. J Anxiety Disord. 2001;15:359–366.

10) Armstrong NC, Ernst E. A randomized, double-blind placebo-controlled trial of a Bach Flower Remedy. Complement Ther Nurs Midwifery. 2001;7:215–221.

11) Hanus M, Lafon J, Mathieu M. Double-blind, randomised, placebo-controlled study to evaluate the efficacy and safety of a fixed combination containing two plant extracts (Crataegus oxyacantha and Eschscholtzia californica) and magnesium in mild-to-moderate anxiety disorders. Curr Med Res Opin. 2004;20:63-71.

12) Carroll D, Ring C, Suter M, et al. The effects of an oral multivitamin combination with calcium, magnesium, and zinc on psychological well-being in healthy young male volunteers: a double-blind placebo-controlled trial. Psychopharmacology (Berl). 2000;150:220–225.

13) Naguib M, Samarkandi AH. Premedication with melatonin: a double-blind, placebo-controlled comparison with midazolam. Br J Anaesth. 1999;82:875–880.

14) Wang SM, Kain ZN. Auricular acupuncture: a potential treatment for anxiety. Anesth Analg. 2001;92:548–553.

15) Eich H, Agelink MW, Lehmann E, et al. Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study [in German; English abstract]. Fortschr Neurol Psychiatr. 2000;68:137–144.

16) Cooke B, Ernst E. Aromatherapy: a systematic review. Br J Gen Pract. 2000;50:493–496.

17) Morris N, Birtwistle S, Toms M. Anxiety reduction by aromatherapy: anxiolytic effects of inhalation of geranium and rosemary. Int J Aromatherapy. 1995;7:33–39.

18) Moore NC. A review of EEG biofeedback treatment of anxiety disorders. Clin Electroencephalogr. 2000;31:1–6.

19) Field T, Morrow C, Valdeon C, et al. Massage reduces anxiety in child and adolescent psychiatric patients. Am Acad Child Adolesc Psychiatry. 1992;31:125–131.

20) Wachelka D, Katz RC. Reducing test anxiety and improving academic self-esteem in high school and college students with learning disabilities. J Behav Ther Exp Psychiatry. 1999;30:191–198.

21) Kabat-Zinn J, Massion AO, Kristeller J, et al. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry. 1992;149:936–943.





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