From the Guidelines
Natural and over-the-counter medications like melatonin, passionflower, and lavender can be used to manage anxiety, as they have shown efficacy and safety in reducing anxiety symptoms 1. When considering natural and over-the-counter options for anxiety management, it's essential to evaluate the evidence for each supplement.
- Melatonin has been found to reduce anxiety compared with placebo in adults and may be as effective as midazolam, with a good safety profile 1.
- Passionflower has been studied in the perioperative setting and demonstrated a reduction in anxiety with a good safety profile 1.
- Lavender supplementation has shown to be efficacious and safe in the treatment of anxiety, including preoperatively, with no clinical evidence to suggest it may potentiate anesthetic effects 1. Other options like L-arginine, L-tryptophan, lemon balm, licorice root, marijuana, N-acetylcysteine, nettle, and Panax ginseng may have potential interactions or side effects, and their use should be approached with caution or avoided altogether 1. It's crucial to consult with a healthcare provider before starting any supplement regimen, especially if you take prescription medications, as interactions can occur. Regular exercise, adequate sleep, meditation, and breathing exercises are also effective non-medication approaches to managing anxiety. However, for moderate to severe anxiety, professional treatment with physician-prescribed medications like SSRIs or anxiolytics may be necessary, with consideration of side effect profiles, interactions, response, patient age, and preference 1.
From the Research
Natural Medications for Anxiety
- Phytochemicals such as alkaloids, terpenes, flavonoids, phenolic acids, lignans, cinnamates, and saponins have been shown to possess anxiolytic effects in animal models of anxiety 2
- Plant extracts with a mixture of different phytochemicals have also been found to have anxiolytic effects 2
- Kava (Piper methysticum) has been shown to be effective in the treatment of anxiety, with its biological effects including sedative, anxiolytic, antistress, analgesic, local anaesthetic, anticonvulsant, and neuroprotective properties 3
- Omega-3 fatty acids have been found to reduce anxiety symptoms, with possible mechanisms including inflammatory response, brain-derived neurotrophic factor (BDNF), cortisol, and cardiovascular activity 4, 5
Over-the-Counter (OTC) Medications for Anxiety
- Kava is available as an OTC preparation, but its use should be approached with caution due to potential liver toxicity 3
- Omega-3 fatty acids are also available as an OTC supplement, with a strong theoretical rationale for their use in anxiety disorders 5
Other Non-Pharmacological Treatments for Anxiety
- Cognitive behavioral therapy (CBT) is a recommended psychotherapy for anxiety disorders, with brief and focused CBT provided within primary care settings being effective 6
- Exercise, such as aerobic training, has been studied in anxiety and can be systematically recommended as an adjunctive treatment 6
- Deep breathing, exposition, cognitive restructuring, problem solving, relaxation, and mindfulness can also be practiced in a self-help format as part of psychoeducation and psychosocial support 6