Stress and anxiety

The evidence for things you can buy over the counter for relieving anxiety is not very good. A herb called kava can help generalised anxiety, but because it is not available at the moment due to concerns about possible side-effects from a concentrated extract of the plant, we have not included it in this information.

Generally for the safe use of over-the-counter medicines, herbal remedies and supplements, consult a qualified person (such as a doctor or pharmacist) before buying or taking any medicine, remedy or supplement:
– if you have a serious medical condition
– if you are breast-feeding, pregnant or planning to become pregnant
– if you are already taking other medicines
– if you suffer from allergies

Always read the package insert before taking any product.
Avoid taking the product if you think you may be allergic to any of the ingredients.

Seek advice from your doctor or pharmacist:
– If your symptoms do not get better
– if your symptoms get worse
– if you get new symptoms or have a side effect

The information here, including dosages, only applies to adults (over 16 years). Keep all medicines out of the reach of children.

Summary
Inositol is present in all animal tissue, with the highest levels in the heart and brain. It is part of the membranes (outer coverings) of all cells. It helps the liver process fats is important for proper function of muscles and nerves. In addition, inositol is involved in the action of serotonin, a chemical that transmit messages between nerve cells (neurotransmitter) and known to be a factor in depression.

Evidence
There is some evidence that inositol may help with some anxiety problems such as phobias and obsessive compulsive disorder.

Safety
Large doses of inisitol may cause diarrhoea.

Cost
Inositol is generally inexpensive and can be bought from many high street pharmacies or health food shops.

Summary
Lemon balm has been a family favourite for calming tensions and anxieties, particularly among children. There is now some modern research to support this tradition.

Evidence
There is some research that shows lemon balm reduces negative stress responses and improves relaxation.

Safety
Lemon balm is very safe and generally well tolerated.

Cost
The easiest way to use lemon balm is as a tea from the familiar garden herb. This will cost almost nothing.

Summary
Bibliotherapy involves using books, leaflets, or self-help programmes on the Internet, CDs, downloads and DVDs to manage problems such as depression and anxiety.

Many public libraries run schemes using books to help people with stress problems and anxiety. These ‘Books on Prescription’ schemes have proved very popular with medical professionals and patients alike.

Evidence
There is some evidence that bibliotherapy helps with problems like phobias but not other types of anxiety problems. It is not clear exactly which type of information works best, or whether bibliotherapy works for people who try this for themselves without help.

Safety
There are generally no safety problems.

Cost
This approach can be almost free if the aids are found in your library.

Summary
The concepts of stress and anxiety were not generally recognised in the past as they are now. Day-to-day survival was consistently stressful and humans probably lived with higher levels of alertness and adrenaline. One difference between then and now was that most of the stresses involved physical responses, and activity is generally good at mopping up adrenaline.

However people knew about the agitation that might accompany illnesses or fatigue, the restlessness of children and other vulnerable people, and most cultures understood what we would now call generalised anxiety states.

Calming ‘relaxant’ remedies were therefore a feature of most traditions, often used by women for their children, or by carers and nurses. Some like lemon balm have modern research evidence for benefit. Most however do not and are listed here only because they were widely used. The following are prominent in various cultures and may be worth exploring.

Brahmi (Bacopa monnieri) – a highly valued calming tonic from India.

Cramp bark (Viburnum opulus) – a native American remedy for muscle and visceral spasm associated with nervous tension.

Gotu kola (Centella asiatica) – a wide ranging remedy, including as restorative tonic, tissue healer, and also for reducing anxiety.

Holy basil (Ocimum tenuiflorum) – a sacred calming remedy from India.

Passionflower (Passiflora spp) – a relaxant remedy used in North America and Europe.

St John’s wort (Hypericum perforatum) – better known for its effects in depression this was traditionally used when low mood came with anxiety, and also as a restorative tonic. Be careful in using this if you are on some prescribed medicines.

Scullcap (Scutellaria lateriflora) – from the USA – maybe best sourced through a western herbal practitioner as there has ben much confusion of species on the market.

Safety
There are few known risks in taking most of the herbs above. However you should avoid St John’s wort alongside other prescription medicines.

It is also advisable not to buy herbs online unless from suppliers with prominent reputation (they will be concerned to protect this by ensuring quality for their products). Unfortunately there are few controls on herbal sales and many cases of adulterated or wrong products. It is always a good policy to look for a registered herbal medicine, with the THR logo on the pack. This will have its quality independently assured.

A good approach in choosing traditional herbal approaches for stress and anxiety is to see a qualified herbal practitioner. You will find well trained practitioners from a number of traditions from the website of the main umbrella body the European Herbal and Traditional Practitioners Association. This will entail extra costs but will allow you to have herbs you might not find elsewhere, and tailored to your needs.

Cost
Most herbs should be inexpensive and can be bought from specialist suppliers. A registered herbal medicine (THR) if available, will cost more – round £15 per month.  Seeing a practitioner may cost around £50 for a first visit.

Further information

There is a wide ranging review of the evidence for many of the herbs listed above in anxiety in the following papers.

Herbal medicine for depression, anxiety and insomnia: a review of psychopharmacology and clinical evidence.
Sarris J, Panossian A, Schweitzer I, Stough C, Scholey A. Eur Neuropsychopharmacol. 2011 Dec;21(12):841-60.
A  wide-ranging review of the literature to ascertain mechanisms of action of various  herbal remedies, with a systematic review of controlled clinical trials for the herbal treatment of mood, anxiety and sleep disorders.
Link to Abstract

Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review.
Lakhan SE, Vieira KF. Nutr J. 2010 Oct 7;9:42.
Based on the available evidence, it appears that nutritional and herbal supplementation is an effective method for treating anxiety and anxiety-related conditions without the risk of serious side effects. Strong evidence exists for the use of herbal supplements containing extracts of passionflower or kava and combinations of L-lysine and L-arginine as treatments for anxiety symptoms and disorders. Magnesium-containing supplements and other herbal combinations may hold promise, but more research is needed before these products can be recommended to patients.
Link to Abstract