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Twice a month we Email you a brief abstract of several new studies on various supplements and natural medicine topics and their practical interpretation by Ray Sahelian, M.D. We will mention research updates on Anxiety Herbs as we come across them.

 

Good Night Rx reduces anxiety and helps you sleep better. It is available as a natural herbal sleep aid. See below.

Anxiety disorders are the most common types of psychiatric disorder. The diagnosis of an anxiety disorder is based largely on its symptoms. However, symptoms identical to those of an anxiety disorder, or an anxiety attack, can be caused by a medical condition (for example, an overactive thyroid gland) or by the use of drugs (for example, corticosteroids, amphetamines, cocaine, or excess caffeine).

What about a natural stress and anxiety treatment?
There are several supplements and herbs that may help reduce anxiety and stress. Please discuss with your health care provider before using these natural anxiety treatment options to make sure they are appropriate for you. Do not expect these anti-anxiety nutrients to be as powerful as Valium and Xanax, however their side effect profile is generally much safer. Consider yoga. Practicing yoga does more than increase flexibility, strength and muscle tone. Yoga improves concentration and motivation and lessens anxiety.

5-HTP  reduces anxiety by increasing levels of serotonin, often works within hours, and one study says 5-HTP may be helpful in panic attacks. 5-HTP, or 5HTP is a good anxiety treatment for those whose depression is associated with anxiety, restlessness, or racing thoughts.
Passionflower helps to calm nerves and is a good anxiety treatment for those whose anxiety is mild or moderate.
Valerian is able to reduce anxiety as demonstrated in a few studies
Hops helps relax and induces sleep. Hops is a good option for nighttime
Ashwagandha is an Ayurvedic herb with relaxation and mood balancing properties.
Tryptophan is an amino acid that helps form serotonin.
Kava Kava is from the South Pacific islands. Anti-anxiety effects usually noticed within a couple of hours. Kava is good for both stress and anxiety and also social anxiety. Kava should not be used more than three times a week and a full week off needs to be taken after every two weeks of use. Kava is not recommended for children or teenagers, only for adults who do not have liver problems or taking medicines that harm the liver.
Fish Oils help stabilize mood, takes several days of high doses to have an effect
St. John's Wort in low doses works within days. High doses can cause restlessness.
GABA - some people like the amino acid GABA although I personally have not noticed much of an effect from this neurotransmitter supplement based on limited experimentation.
We had an email from someone who mentioned that Mucuna Pruriens was helpful to him as a means to overcome social phobia.
Skullcap herb

SAM-e is used for depression. In high doses, SAM-e may increase anxiety and restlessness. There are several herbs with stimulant properties that may also induce anxiety or restlessness, including tongkat ali and ginseng.

High Quality products formulated by Ray Sahelian, M.D.
These include Mind Power Rx for better mental focus, concentration, and mood; Diet Rx which helps you eat less. It really works to curb appetite; Good Night Rx for better sleep; Eyesight Rx with lots of antioxidants for better vision; MultiVit Rx a daily comprehensive multivitamin for more energy and vitality; Joint Power Rx for healthy joints; Prostate Power Rx for a healthy prostate gland; Passion Rx for sexual enhancement in men and women; and Veg Rx with Coq10 and carnitine supplies the missing nutrients in a vegetarian diet.

Anxiety symptom
Patients with generalized anxiety disorder experience worry or anxiety and a number of physical and psychological symptoms. Anxiety may often coexist with depression. Anxiety disorder is frequently difficult to diagnose because of the variety of presentations and the common occurrence of other medical or psychiatric conditions. The lifetime prevalence is approximately 4 to 6 percent in the general population and is more common in women than in men. Anxiety is often chronic, and patients with this disorder are more likely to be seen by family physicians than by psychiatrists. Anxiety medication consists of pharmacotherapy and various forms of psychotherapy. The benzodiazepines are used for short-term treatment, but because of the frequently chronic nature of generalized anxiety disorder, they may need to be continued for months to years. Buspirone and antidepressants are also used for the pharmacologic management of patients with generalized anxiety disorder. Anxiety and depression often coexist.

Anxiety Attack symptom
An anxiety attack leads to several symptoms that include: rapid heart beat, pounding heart or palpitations, sweating, shaking visibly or inside, choking sensations or lump in throat, shortness of breath, chest pain or discomfort, nausea, bloating, or abdominal discomfort, dizziness or unsteadiness. Other anxiety attack symptoms include fear of losing control or a feeling of going crazy, chills and sweats, and numbness in extremities. 

Anti Anxiety Medication
The medications used in anxiety  treatment have changed over the last few years. A lot of the anxiety treatment medications that were used caused a number of problems including psychological dependence such as withdrawal symptoms including anxiety, irritability, anorexia nervosa, confusion and nausea. These are also the symptoms of anxiety that the medications are meant to relieve. These days anxiety treatment usually involves either anxiolytics (anti- anxiety medication) or the more modern antidepressant medications. This is understandable as depression and anxiety are closely linked. Common anxiety medication options include SSRIs drugs such as Prozac, benzodiazepines such as Xanax, beta blockers such as propranolol, and tricyclic antidepressants.

Generalized Anxiety Disorder Research Update
Kava treatment in patients with anxiety.
Phytother Res. 2004 Apr;18(4):297-300.
In several clinical trials, mainly conducted with a dose of 300 mg kava extract per day, kava has been employed successfully for the treatment of anxiety disorders. The goal of the placebo-controlled double-blind outpatient trial was to obtain more information on the dosage range and efficacy of a kava special extract WS 1490 in patients with non-psychotic anxiety. 50 patients were treated with a daily dose of 3 x 50 mg kava extract during a 4-week treatment period followed by a 2-week safety observation phase. In the active treatment group, the total score of the Hamilton anxiety scale (primary efficacy variable), showed a therapeutically relevant reduction in anxiety versus placebo (more than 4 points). In the secondary variables studied, HAMA 'somatic and psychic anxiety' subscales, the Erlangen anxiety, tension and aggression scale, the adjective checklist and clinical global impressions scale (CGI), a trend in favour of the active treatment was detectable. Kava extract WS 1490 was well tolerated and showed a safety profile with no drug-related adverse events or post-study withdrawal symptoms. It can be concluded that the applied 150 mg kava extract  per day is an effective and safe treatment of non-psychotic anxiety disorder syndromes in the described population.

Long-term goals in the management of acute and chronic anxiety disorder.
Can J Psychiatry. 2004 Mar;49(3 Suppl 1):51S-63S.
Many anxiety disorders are not treated to remission (symptom-free state); however, this should be the minimum goal of therapy. Antidepressant therapies have shown significant beneficial effects in the management of anxiety disorder, with some variability in results in specific disorders. In social anxiety disorder, selective serotonin reuptake inhibitors and venlafaxine extended release have demonstrated efficacy, with response rates varying between 40% and 68%. Monoamine oxidase inhibitors and cognitive-behavioural therapies are also effective. In patients with generalized anxiety disorder, benzodiazepines, paroxetine, and venlafaxine have demonstrated remission rates that are 15% to 25% higher than placebo. In patients with posttraumatic stress disorder, about 60% to 70% of patients experienced a response with antidepressant therapy, compared with about 40% on placebo, while remission rates in one study were 30% with venlafaxine, 24% with sertraline, and 20% with placebo. In patients with obsessive-compulsive disorder, a 25% to 35% improvement in symptom scores was reported in 20% to 65% of patients. In the management of panic disorder, paroxetine and venlafaxine doubled the percentage of patients who were panic-free, compared with placebo. Ongoing antidepressant therapy further improved remission rates, and many patients with anxiety disorders required extended treatment trials before experiencing benefit. In most clinical trials, some benefits were seen within 3 to 4 weeks but continued to accrue throughout the 3- to 6-month duration of the trial. In the acute phase, patients with anxiety disorders should be treated aggressively with antidepressants for extended periods and may require long-term therapy to maintain benefits. Cognitive-behavioral therapy is another mainstay in the treatment of all anxiety disorders.

Panic disorders, phobias and other childhood anxiety disorder conditions should be treated during childhood so that they won't be carried over into adulthood, according to advice in Harvard Mental Health Letter. Various studies show that anxiety disorders are among the most common psychiatric conditions present during childhood. In many instances, adults with anxiety disorders experienced their first symptoms during their early childhood years. Yet many parents may not be aware that their child is experiencing such symptoms. Since children's minds and emotions change over time, it may be difficult to distinguish between normal, age-appropriate fears -- such as a 2-year-old's fear of strangers, or a preschooler's fear of the dark -- and real anxiety disorders. Real anxiety disorders in children are similar to those experienced by adults. What's more, like adults, a child with an anxiety disorder such as social phobia is likely to have other anxiety disorders as well. Children with social phobia, or social anxiety disorder, are extremely shy and fear unfamiliar people or surroundings. They may, for example, be afraid to initiate a conversation or to attend a birthday party. Children with generalized anxiety disorder, previously referred to as overanxious disorder of childhood, experience the same uncontrolled worry that adults afflicted with the disorder experience. Other anxiety disorders experienced by children include obsessive-compulsive disorder, panic disorder, separation anxiety, simple phobias -- such as fear of water, fear of choking, or fear of insects, and post-traumatic stress disorder, which is often the result of severe child abuse.  The cause of such disorders can be both genetic and environmental. Studies suggest that some anxiety disorders may be hereditary. Some children can show signs of extreme shyness, for example, as early as 4 months; their heart rate increases and they cry and "shrink back" around strangers, according to the health letter. Yet, children usually grow out of such fears or can be treated for them through a variety of means, including play therapy or cognitive behavioral treatment, the best-known treatment for anxiety disorders in children and adolescents.

The social anxiety disorder spectrum.
J Clin Psychiatry. 2004;65 Suppl 14:27-33; quiz 34-6.
Current diagnostic classifications emphasize the categorical nature of disorders such as social anxiety disorder. Nevertheless, phenomenological and psychobiological data have led to the hypothesis that social anxiety symptoms and disorders lie on various dimensions. A MEDLINE search (1966-2003) for relevant articles on the social anxiety disorder spectrum was undertaken using the terms shyness, behavioral inhibition, social phobia, social anxiety disorder, avoidant personality, dimension, and spectrum to aim at objective coverage, but references for this article were chosen more subjectively to illustrate data and themes in description, pathogenesis, pharmacotherapy, and psychotherapy of the social anxiety disorder spectrum. RESULTS: Several different approaches to delineating a social anxiety disorder spectrum of conditions have been described. These include (1) a spectrum of social fear and avoidance, (2) a spectrum of body-focused concerns, (3) a spectrum of anxiety disorders and affective dysfunction, and (4) a spectrum of social deficits. CONCLUSIONS: Social anxiety symptoms and disorders do appear to lie on a number of different dimensions. Nevertheless, additional research is necessary to determine the clinical utility of assessing these different dimensions and to investigate their underlying psychobiology.

5HTP
Obsessive Compulsive Disorder
 

Anxiety emails
Q. I feel that I have depression and anxiety. Is this common?
   A. Yes, anxiety and depression often coexist. In this case, 5HTP works better than SAM-e since SAM-e can cause anxiety in high doses.

Q. Thank you for the wealth of great info posted on your website. I have been looking into purchasing an anti- anxiety supplement due to my personal bouts with anxiety. There seems to be a large number of anti-anxiety supplements on the market and was wondering if you have a particular recommendation. Also, there is one supplement that appears to combine three active herbs into one formulation (passion flower {200mg}, ashwagandha {500mg} and valerian root {300mg}). Is it ok to combine these three ingredients in such large doses?
   A. We don't make recommendations on anxiety products or other products that Dr. Sahelian has not formulated, he does not comment on other products. We suggest starting with low doses of anti anxiety supplements individually, learning full well on how they work one at a time, and then mixing two together, learning about this combo, and then 3, etc.

Q. I have recently begun the process of tapering from clonazapam. Has any of your research has addressed the use of supplements to facilitate withdrawal from anti-depressant and anti-anxiety medications?
   A. Basically a generalization is to gradually reduce the drug and gradually increase the dosage of an anti-anxiety supplement. Each person is unique and hence no definite dosages or particular supplements can be suggested with any certainty. It may be a process of trial and error along with medical supervision. We wish you good luck.

Q. Is there a supplement you recommend for morning anxiety? The anxiety seems to fade as as the day progresses.
   A. There are many supplements that can be used for anxiety, including ashwagandha or passionflower.