Are there any over-the-counter (OTC) supplements that effectively reduce anxiety?

Over-the-Counter Supplements for Anxiety Reduction

Several over-the-counter supplements have shown effectiveness for anxiety reduction, with lavender, passionflower, and melatonin having the strongest evidence for safety and efficacy. 1, 2, 3

Evidence-Based OTC Supplements for Anxiety

Strongly Supported Options:

1. Lavender

   • Demonstrated efficacy and safety in treating anxiety, including preoperatively 1
   • Recommended for anxiety disorders with moderate support (++) 3
   • No clinical evidence suggesting it potentiates anesthetic effects 1

2. Passionflower

   • Primarily known for anxiolytic effects 1
   • Has been studied in perioperative settings with demonstrated reduction in anxiety 1
   • Shows good safety profile in clinical studies 1

3. Melatonin

   • A Cochrane review concluded it can reduce anxiety compared to placebo in adults 1
   • May be as effective as midazolam for anxiety reduction 1
   • Available evidence demonstrates safety in the perioperative period 1
   • May also decrease delirium in hospitalized elderly patients 1

Moderately Supported Options:

1. German Chamomile

   • RCTs found modest but significant reductions in anxiety with chamomile extract 1
   • No data suggesting CNS effects that would interfere with anesthesia 1
   • Consider continuing during perioperative periods 1

2. Ashwagandha

   • Moderately supported (++) for treatment of anxiety disorders 3
   • Shows promise in clinical studies for anxiety reduction 3

3. Saffron

   • Provisionally recommended (++) for treatment of unipolar depression 3
   • May help with anxiety symptoms associated with depression 3

Supplements with Weak or Mixed Evidence

1. Kava

   • Not recommended for generalized anxiety disorder according to recent guidelines 3
   • Hold 2 weeks before surgery due to potential interactions 1
   • May act additively with anesthetics, benzodiazepines, and opiates 1
   • Risk of excessive sedation in perioperative setting 1

2. Lemon Balm

   • Hold 2 weeks before surgery 1
   • Some evidence suggests combination with sedatives may result in additive CNS depression 1

3. L-tryptophan

   • Essential amino acid that may influence serotonin production 1
   • Hold 24 hours before surgery 1
   • Risk of serotonin syndrome when combined with other serotonergic medications 1

Important Considerations and Cautions

1. Safety and Quality Concerns

   • Quality and standardization of supplements vary significantly 3
   • Use products from reputable manufacturers with third-party testing

2. Potential Interactions

   • Many supplements can interact with prescription medications
   • Always discuss supplement use with healthcare providers
   • Particular caution needed with serotonergic medications 1

3. Clinical Context

   • Supplements should generally be considered as adjuncts to standard medical care 3
   • For moderate to severe anxiety, evidence-based treatments like SSRIs/SNRIs and cognitive behavioral therapy remain first-line 2, 4

Recommendations Based on Anxiety Severity

• Mild anxiety: Consider lavender, passionflower, or melatonin as first options 1, 2, 3
• Moderate anxiety: These supplements may be used as adjuncts to cognitive behavioral therapy 2
• Severe anxiety: Supplements alone are likely insufficient; professional medical care with evidence-based treatments is recommended 2, 4

Remember that while these supplements show promise for anxiety reduction, they should not replace professional medical care for diagnosed anxiety disorders, especially in cases of severe symptoms or functional impairment.