Last updated by Dr Sarah Brewer on
Do you feel apprehensive, panicky or experience feelings of dread and impending doom? If so, you could have an anxiety disorder – and you are not alone. Surveys suggest that as many as one in six people have felt anxious within the previous week, and it’s estimated that one in ten people will have a disabling anxiety disorder at some time during their life. While prescription-only anti-anxiety medicines are available, many people find that herbal remedies have a more gentle action with fewer side effects and no risk of becoming addictive. The most effective herbs for anxiety symptoms are Valerian, Ashwagandha, Rhodiola, Lavender Oil, Cannabidiol Oil (CBD), St John’s Wort, Black Cohosh, Chamomile and Lemon Balm. Which one to choose will depend on your balance of symptoms and any identifiable underlying cause.
- Anxiety disorders
- Anxiety attack symptoms
- Valerian for anxiety with sleep problems
- Ashwagandha for anxiety and overwork
- Rhodiola for anxiety with exhaustion
- Lavender oil for stress-related anxiety
- Cannabidiol Oil (CBD) for anxiety, pain, panic attacks and general wellbeing
- Passion flower for stress-related anxiety
- St John’s wort for anxiety associated with low mood or menopause
- Black Cohosh for anxiety associated with menopause
- Chamomile for anxiety and muscle spasm
- Lemon Balm for exam stress and premenstrual syndrome (PMS)
Anxiety is a common response to stress, triggering unpleasant feelings of apprehension, dread, panic and impending doom. While short-lived anxiety is appropriate in some situations (such as when anticipating an interview) if you worry excessively about everyday problems and are always anticipating disaster you could have an anxiety disorder.
Anxiety is not a one-size fits all diagnosis – several different anxiety profiles exist and different people will have different experiences.
A phobia is an irrational, morbid fear of a particular object, person, situation or activity. Just the thought of what triggers your phobia makes you start to sweat, tremble, feel sick and panicky, and you typically go to any lengths to avoid the object or situation you fear. Phobias are usually divided into three groups: simple, or specific fears of a particular thing and the more complex types of social phobia and agoraphobia. When a phobia interferes with your life, then it is classed as an anxiety disorder.
Generalised anxiety disorder is diagnosed when you spend at least six months worrying excessively about a number of everyday problems. You are always anticipating disaster and unable to relax through worry about health, finances, family, career – or just the thought of having to get through the day. Depression can also occur, with feelings of sadness, hopelessness, loss of appetite and early morning waking.
Social anxiety disorder is an extreme fear of being the centre of attention, and of becoming humiliated or embarrassed in front of others. You tend to think everyone is more competent in public than you are, and the thought of forgetting someone’s name, blushing, having to introduce yourself to strangers, or just walking into a crowded room is a major ordeal. The most common social phobia is a fear of public speaking, but other fears such as of using a public toilet, or eating in front of others, can also occur. Someone with a social anxiety disorder will go out of their way to avoid social interactions, which will severely curtail their lifestyle and career.
Obsessive-compulsive disorder (OCD) is an anxiety-driven condition in which persistent unwelcome thoughts (obsessions) force you to carry out certain rituals (compulsions). There is no pleasure in carrying out these rituals, only temporary relief from the anxiety caused by the obsession. Many people can think of times when they have experienced an obsession or a compulsion and these are often a normal response to stress. The disorder is only diagnosed when the behaviour dominates at least an hour of every day, and is distressing enough to interfere with daily life. A common obsession is with germs and dirt, which compels you to keep washing your hands.
Severe anxiety can also follow on from a traumatic event when it is associated with post-traumatic stress disorder.
Anxiety attack symptoms
Anxiety can trigger a variety of symptoms, including rapid pulse, palpitations, sweating, clamminess, tremor, flushing, restlessness, irritability and difficulty sleeping. Breathing problems are also common, and you may experience a sensation like a lump in the throat. Researchers have found this sensation can be triggered by over-breathing. This changes the ratio of gases in the lungs and affects blood acidity, which in turn interferes with muscle contraction in the throat. Rebreathing air you have just blown out (traditionally using a paper bag, or via your cupped hands) will help to correct the situation.
Over-breathing is also thought to trigger panic attacks by affecting the transmission of nerve signals leading to dizziness, faintness and pins and needles. These symptoms heighten your sense of panic so you tend to breathe even faster, blowing off even more carbon dioxide, and triggering a panic attack.
There is an ongoing debate about whether anxiety disorders are mainly the result of biological changes in the brain, and therefore likely to respond to drug treatments, or whether they are psychological in nature and more likely to improve with cognitive behaviour therapy. It seems that both physical and psychological processes are at work, so that combined therapy is often the most effective approach. Relaxation techniques and breathing exercises can also help you cope, and lower any associated rise in blood pressure.
If you are not taking anti-anxiety medication, then herbal supplements can improve your symptoms. If you are taking medication, however, seek advice from a pharmacist or doctor before taking any herbal remedies as interactions can occur.
Valerian for anxiety with sleep problems
Valerian is a calming herb that relieves anxiety, muscle tension and promotes tranquillity. It is particularly helpful when anxiety and whirling thoughts affect your ability to sleep.
Valerian roots contain a number of unique substances (such as valeric acid, valepotriates) that have positive effects on stress and anxiety. Valerian raises levels of an inhibitory brain chemical, gamma-aminobutyric acid (GABA), to damp down over-stimulation, and contains natural sedatives (eg homobaldrinal) that promote sleep. It also contains a substance (hydroxypinoresinol) which interacts with benzodiazepine receptors in the brain to calm anxiety, but without the addictive effect of anti-anxiety drugs such as diazepam, or sleeping tablets such as oxazepam. Valerian has even been used to improve rebound insomnia in people withdrawing from benzodiazepine medication.
In those with stress-related anxiety, valerian improves low mood, loss of initiative, ability to socialise, irritability and difficulty in sleeping.
Taking valerian root extracts help you fall asleep more quickly, wake less frequently during the night, and wake feeling more refreshed (with no hangover effect) compared with placebo. The results of 6 studies found that taking valerian root extracts increased the chance of experiencing a good night’s sleep by 80% compared with placebo.
Ashwagandha for anxiety and overwork
Ashwagandha – also known as winter cherry or Indian ginseng – is an adaptogenic herb used in Ayurvedic medicine as a restorative tonic to improve resistance to stress.
Ashwagandha roots contain a series of unique steroidal lactones known as withanolides which reduce anxiety and promotes serenity and deep sleep, especially in those suffering from overwork or nervous exhaustion.
Ashwagandha can also improve oxygen processing and energy production in cells to help overcome physical stress and improve mental acuity.
In studies, Ashwagandha reduced anxiety scores on the Perceived Stress Scale by 44% compared with only 5.5% for placebo.
The results from five clinical trials also show that Ashwagandha is more effective than psychotherapy for improving anxiety, with Ashwagandha decreasing anxiety scores by 56.5% compared with 30.5% for psychotherapy.
Rhodiola for anxiety with exhaustion
Rhodiola rosea is an adaptogenic herb with a dual action. Rhodiola root extracts help to combat anxiety and have an energising effect to improve associated symptoms such as fatigue and exhaustion. This makes Rhodiola a great choice when you feel both anxious and drained of energy.
Rhodiola root extracts contain a number of active ingredients (eg rosavin, rhodioflavonoside) which also lift mood by increase serotonin levels, and reduces adrenal secretion of stress hormones via effects on the hypothalamus gland.
Rhodiola increases resistance to a variety of physical and emotional stress and is particularly helpful when anxiety is associated with burn out, reduced work performance and fatigue, as well as associated sleep difficulties, poor appetite, irritability and headaches.
Rhodiola root extracts help to reduce anxiety while enhancing alertness, concentration, memory, stamina and sleep quality.
A pilot study, involving people with generalised anxiety disorder, found that taking 340mg Rhodiola extract for 10 weeks significantly improved anxiety and depression rating scores.
Pharmaceutical-grade lavender oil capsules are one of the latest herbal medicines to gain a license for the treatment of symptoms of anxiety, stress and nervousness. The results from 15 clinical trials involving 2,200 people show it produces significant effects within two weeks.
Brain scan studies confirm that lavender oil works via specific serotonin-1A receptors in the brain. This raises levels of serotonin and other neurotransmitters involved in regulating mood and anxiety while suppressing the release of other neurotransmitters associated with over-stimulation and anxious thought.
Clinical trials show that lavender oil is as effective as medications (eg lorazepam, paroxetine) prescribed to treat generalised anxiety disorder, but it does not produce the same unwanted sedative effects.
The most common side effect is fragrant belching.
Cannabidiol Oil (CBD) for anxiety, pain, panic attacks and general wellbeing
Cannabidiol oil (CBD) is extracted from selected strains of the cannabis plant, known as industrial hemp. These strains do not contain psychoactive substances but have enhanced levels of beneficial cannabidiol.
Cannabidiol (CBD) interacts with the brain’s own endocannabinoid system to damp down over-stimulation of brain receptors, and reduce pain perception, anxiety and promote relaxation. CBD also generates positive feelings of general well-being, enhances memory and has been used to suppress food and other cravings.
Cannabidiol does not produce a psychoactive ‘high’ and its use is not legally regulated in the UK as long as products do not make medical claims. The CBD extracts are combined with olive oil, coconut oil or hemp seed oil to enhance absorption.
Cannabidiol has been shown to reduce anxiety, muscle tension, restlessness and fatigue, while improving concentration in people with generalized anxiety and social anxiety. Taking a single dose (600mg CBD) an hour and a half before a public speaking test, was found to significantly reduce anxiety and muddled thoughts so that, compared with placebo, people with generalised social anxiety performed as well as if they were not affected.
NB The dose used in this trial should only be taken under medical supervision. For general well-being the recommended dose of CBD is 10mg to 200mg per day as a food supplement. Always follow manufacturer’s guidance on how much of their product to take, which will vary depending on concentration.
Cannabidiol extracts are available as capsules, gummies, drops and oral sprays.
If you prefer to take cannabidiol in the form of a capsule, then Healthspan (for whom I act as a medical consultant) offer two strengths of pharmaceutical-grade capsule which are easy to take:
- High strength CBD oil (6.4mg cannabidiol) with added olive oil to aid absorption. Dose: one to three capsules daily with water.
- Super Strength CBD Oil (15mg cannabidiol per capsule) with added food grade hemp oil to increase absorption. Dose: one to two capsules daily with water.
Passionflower is a traditional herbal medicine used to relieve stress-related symptoms such as mild anxiety, and to aid sleep. Passion Flower contains one of the highest plant levels of an amino acid called GABA (gama-aminobutryic acid). Passionflower is believed to work via GABA receptors in the brain, which damp down over-excitability in the central nervous system that is associated with racing thoughts and the effects of the fight or flight stress response.
Passion flower extracts can relieve short-term acute stress, such as that associated with undergoing surgery, and has been used as a pre-medication to reduce anxiety. Passionflower is also helpful for chronic stress in people with generalised anxiety disorder, in whom it was at least as effective as the prescribed drug, oxazepam, but with less impairment of job performance.
St John’s wort for anxiety associated with low mood or menopause
St John’s wort is best known for its ability to treat low mood and depression, which are often associated with anxiety. St John’s wort contains natural antidepressants (eg hypericin, hyperforin) which increased brain levels of serotonin, noradrenaline, dopamine, gamma-aminobutyric acid (GABA) and L-glutamate. This wide-ranging action also helps to improve anxiety, compulsive behaviour, and withdrawal symptoms.
The results from 27 studies, involving over 3800 people, show that St John’s wort is as effective as prescribed SSRI antidepressant medication for improving low mood and anxiety, but with significantly fewer side effects. Improvements in low mood occur within two weeks of starting treatment and continue to improve for at least 6 weeks after.
For women with menopausal symptoms that include anxiety, low mood and low sex drive, St John’s Wort can help. Taking St John’s Wort for three months helped 60% of menopausal women regain their sex drive, while 82% experienced significantly less anxiety, irritability, low mood, hot flushes, sweating and disturbed sleep. Those taking St John’s wort also experienced increased self-confidence, self-esteem and self-respect.
NB If you are taking prescribed medications, check with a pharmacist before starting St John’s wort as numerous drug interactions are recognised.
Black Cohosh for anxiety associated with menopause
Black Cohosh is one of the most widely used herbal alternatives to menopausal hormone replacement therapy (HRT).
Several comparison studies show that standardized extracts are more effective in relieving hot flushes, vaginal thinning and dryness, depression and anxiety compared to standard HRT (conjugated oestrogens).
A German trial has shown that black cohosh plus St John’s Wort was effective in treating 78 per cent of women with hot flushes and other menopausal problems. Most women experience significant improvement in symptoms within two to four weeks.
In another study, black cohosh out-performed diazepam and oestrogen HRT in relieving depressive moods and anxiety in menopausal women.
If your anxiety is associated with menopause, then this is a great herbal medicine to consider if you are not taking prescribed hormones.
Chamomile for anxiety and muscle spasm
German chamomile has been used since ancient times for its soothing and relaxing properties. Chamomile flowers contain substances (eg chamazulene, alpha-bisabolol) which have anti-inflammatory, antispasmodic and sedative actions.
Chamomile helps to relieve anxiety associated with intestinal spasms, irritable bowel syndrome and menstrual cramps. It is one of the most popular herbal teas for calming racing thoughts, nervous tension and to promote sleep.
In a fascinating hospital study, chamomile tea was used to reduce anxiety in patients undergoing a produced to introduce a catheter into their heart. Twelve patients agreed to drink a cup of chamomile tea before the medical procedure as their only premedication.
Within ten minutes of drinking the chamomile tea, ten of the patients fell into a deep sleep. They could be aroused but immediately fell asleep again, until the end of the cardiac catheterization procedure, which lasted around 90 minutes. Doctors described this hypnotic effect as ‘striking’ given the high level of anxiety involved.
Lemon Balm for exam stress and premenstrual syndrome (PMS)
Lemon balm (Melissa officinalis) has soothing, calming properties and is traditionally known as the ‘scholar’s herb’ as it was taken by students suffering from the stress of impending exams.
Lemon balm is widely used to ease a number of stress-related symptoms including digestive problems, nausea, flatulence, depression, tenseness, restlessness, irritability, anxiety, headache and insomnia.
Research suggests that lemon balm inhibits enzymes that break down an inhibitory brain chemical, gamma-aminobutyric acid (GABA) to damp down the over-stimulation associated with acute anxiety. Preclinical studies suggest that lemon balm may be more effective than valerian or chamomile. When combined with valerian, the two herbs work in synergy to reduce symptoms of anxiety, tension, stress and mild depression.
Lemon balm was recently tested in 100 teenagers with premenstrual syndrome (PMS) associated with anxiety and sleep difficulties. Taking lemon balm (600mg per day) for three months produced significant improvements in anxiety, low mood and sleeping disorders and improved social functioning compared with placebo.
NB if you experience significant anxiety symptoms, or symptoms that do not improve with herbal medicines, seek advice from your doctor as referral for psychotherapy can help.
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