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Anxiety and Panic Attacks

Feeling anxious can be normal, especially before events like taking a test or having surgery. However, some feel anxious or tense nearly all the time. If these feelings interfere with daily life then they may be diagnosed as an anxiety disorder.

In addition to feeling distressed, regular anxiety can lead to physical symptoms like headaches, stomach pain, or sleeping problems. Panic attacks are a type of anxiety disorder that cause sudden, strong physical symptoms, such as a racing heartbeat or a deep feeling of dread. Panic attacks can occur randomly or with stressful triggers.

Standard treatment for anxiety disorders include medications and counseling. Medications can have side effects that make it hard to continue with treatment. Alternative therapies may have similar benefits, but without the side effects. Some alternative therapies may be helpful on their own, but most are best when combined with standard treatment. It is always important to check with your doctor to make sure new therapy does not interfere with your current treatment.

Natural Therapies

Researchers have investigated the benefits of natural therapies for many different types of anxiety. Currently more evidence supports benefits of the therapies for anxiety because of stressful situations rather than anxiety disorders.

Likely Effective

  • Meditation —A relaxation therapy that helps manage the stress response. Mindfulness is a popular type of meditation. Meditation is likely to be effective for easing anxiety during stressful events. It appears less effective as a treatment for anxiety disorders.A1
  • Kava —An herb that is as likely as effective as standard medications in people with generalized anxiety disorder.B1-B5
    • Note : Kava has been linked to severe liver toxicity. However, this seems to be a rare problem. The risk of liver toxicity increase with higher doses, poor quality supplements, and long term use.

Possibly Effective

Herbs or supplements that may be as effective as standard medications for anxiety disorders:

  • Lavender oil gel capsC1
  • Galphimia J1-J3

Herbs or supplements that are possibly effective:

  • Valerian —Note: Valerian can actually cause anxiety and confusion when used in high doses.D1-D5
  • Passionflower E1-E5
  • Lemon Balm F1-F4
  • Ashwagandha G1-G5
  • Lysine and Arginine H1-H3
  • Brahmii I4
  • Gotu Kola K1-K3
  • Chamomile L1,L2
  • Ginkgo biloba M1,M2
  • Melatonin S1-S6

Therapies that may be effective:

  • Exercise N1,N2
  • Acupuncture O1-O4
  • Yoga —mindfulness is a part of yoga trainingP1-P7
  • Aromatherapy (in combination with other relaxation therapies, like massage)Q1,Q2
  • Music therapy R1,R2

Editorial process and description of evidence categories can be found at EBSCO NAT Editorial Process.

Herbs and Supplements to Be Used With Caution

Talk to your doctor about all herbs or pills you are taking. Some may get in the way of your treatment or other health problems you may have. The following have known safety issues that you should be aware of:

  • Kava has been associated with liver toxicity. There is conflicting information about how dosing affects the liver. However, studies suggest that kava is generally safe when taken as directed. However, it should be avoided in those with liver conditions of any kind.B1,B3-B5
  • Valerian is generally considered safe. Taking higher doses than recommended has been associated with anxiety and confusion.D1
 

References

Meditation

A1. Chen KW, Berger CC, Manheimer E, et al. Meditative therapies for reducing anxiety: a systematic review and meta-analysis of randomized controlled trials. Depress Anxiety. 2012;29(7):545-562.

Kava

B1. Pittler MH, Ernst E. Kava extract for treating anxiety. Cochrane Database Syst Rev. 2003;(1):CD003383.

B2. Sarris J, Kavanagh DJ, Byrne G, Bone KM, Adams J, Deed G. The Kava Anxiety Depression Spectrum Study (KADSS): a randomized, placebo-controlled crossover trial using an aqueous extract of Piper methysticum. Psycopharmocology (Berl). 2009;205(3):399-407.

B3. Lakahan SE, Vieira KF. Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutr J. 2010;9:42.

B4. Sarris J, McIntyre E, Camfield A. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27(4):301-319.

B5. Pantano F, Tittarelli R, Mannocchi G, et al. Hepatotoxicity induced by "the 3Ks": kava, kratom, and khat. Int J Mol Sci. 2016;17(4):580.

Lavender Oil

C1. Kasper S, Gastpar M, Muller WE, Volz HP, Moller HJ, Schafke S, Dienel A. Lavender oil preparation Silexan is effective in generalized anxiety disorder—a randomized, double-blind, comparison to placebo and paroxetine. Int J Neuropsychopharmacol. 2014;17(6):859-869.

Valerian

D1. Kohnen R, Oswald WD. The effects of valerian, propranolol, and their combination on activation, performance and mood of healthy volunteers under social stress conditions. Pharmacopsychiatry. 1988;21:447-448.

D2. Andreatini R, Sartori VA, Seabra ML, et al. Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study. Phytother Res. 2002;16:650-654.

D3. Miyasaka LS, Atallah AN, Soares BG. Valerian for anxiety disorders. Cochrane Database Syst Rev. 2006;(4):CD004515.

D4. Bhattacharyya D, Jana U, Debnath PK, Sur TK. Initial exploratory observational pharmacology of Valeriana wallichii on stress management: a clinical report. Nepal Med Coll J. 2007;9(1):36-39.

D5. Sarris J, McIntyre E, Camfield A. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27(4):301-319.

Passionflower

E1. Akhondzadeh S, Naghavi HR, Vazirian M, et al. Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther. 2001;26:363-367.

E2. Miyasaka LS, Atallah AN, Soares BG. Passiflora for anxiety disorder. Cochrane Database Syst Rev. 2007;(1):CD004518.

E3. Movafegh A, Alizadeh R, Hajimohamadi F, et al. Preoperative oral Passiflora incarnata reduces anxiety in ambulatory surgery patients: a double-blind, placebo-controlled study. Anesth Analg. 2008;106:1728-1732.

E4. Lakahan SE, Vieira KF. Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutr J. 2010;9:42.

E5. Sarris J, McIntyre E, Camfield A. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27(4):301-319.

Lemon Balm

F1. Kennedy DO, Wake G, Savelev S, et al. Modulation of mood and cognitive performance following acute administration of single doses of Melissa officinalis (lemon balm) with human CNS nicotinic and muscarinic receptor-binding properties.Neuropsychopharmacology. 2003. [Epub ahead of print]

F2. Kennedy DO, Little W, Scholey AB. Attenuation of laboratory-induced stress in humans after acute administration ofMelissa officinalis (lemon balm). Psychosom Med. 2004;66:607-613.

F3. Kennedy DO, Little W, Haskell CF, Scholey AB. Anxiolytic effects of a combination of Melissa oficinalis and Valeriana oficinalis during laboratory induced stress. Phytother Res. 2006;20(2):96-102.

F4. Cooley K, Szczurko O, Perri D, Mills EJ, Bernhardt B, Zhou Q, Seely D. Naturopathic care for anxiety: a randomized controlled trial ISRCTN78958974. PLoS One. 2009;4(8):e6628.

Ashwagandha

G1. Andrade C, Aswath A, Chaturvedi SK, Srinivasa M, Raguram R. A double-blind, placebo-controlled evaluation of the anxiolytic efficacy ff an ethanolic extract of withania somnifera. Indian J Psychiatry. 2000;42(3):295-301.

G2. Cooley K, Szczurko O, Perri D, Mills EJ, Bernhardt B, Zhou Q, Seely D. Naturopathic care for anxiety: a randomized controlled trial ISRCTN78958974. PLoS One. 2009;4(8):e6628.

G3. Sarris J, McIntyre E, Camfield A. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27(4):301-319.

G4. Pratte MA, Nanavati KB, Young V, Morley CP. An alternative treatment for anxiety: a systematic review of human trial results reported for the Ayurvedic herb ashwagandha (Withania somnifera). J Altern Complement Med. 2014;20(12):901-908.

G5. Pantano F, Tittarelli R, Mannocchi G, et al. Hepatotoxicity induced by "the 3Ks": kava, kratom, and khat. Int J Mol Sci. 2016;17(4):580.

Lysine and arginine

H1. Smriga M, Ando T, Akutsu M, et al. Oral treatment with L-lysine and L-arginine reduces anxiety and basal cortisol levels in healthy humans. Biomed Res. 2007;28:85-90.

H2. Lakahan SE, Vieira KF. Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutr J. 2010;9:42.

H3. Pantano F, Tittarelli R, Mannocchi G, et al. Hepatotoxicity induced by "the 3Ks": kava, kratom, and khat. Int J Mol Sci. 2016;17(4):580.

Brahmi

I1. Stough C, Lloyd, J, Clarke J. The chronic effects of an extract of Bacopa monniera (Brahmi) on cognitive function in healthy human subjects. Psychopharmacology (Berl). 2001;156(4):481-484.

I2. Calabrese C, Gregory WL, Leo M, Kraemer D, Bone K, Oken B. Effects of a standardized Bacopa monnieri extract on cognitive performance, anxiety, and depression in the elderly: a randomized, double-blind, placebo-controlled trial. J Altern Complement Med. 2008’14(6):707-713.

I3. Pase MP, Kean J, Sarris J, Neale C, Scholey AB, Stough C. The cognitive-enhancing effects of Bacopa monnieri: a systematic review of randomized, controlled human clinical trials. J Altern Complement Med. 2012;18(7):647-652.iI4.

I4. Sarris J, McIntyre E, Camfield A. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27(4):301-319.

Galphimia

J1. Herrera-Arellano A, Jiménez-Ferrer E, Zamilpa A, Morales-Valdéz M, García-Valencia CE, Tortoriello J. Efficacy and tolerability of a standardized herbal product from Galphimia glauca on generalized anxiety disorder. A randomized, double-blind clinical trial controlled with lorazepam. Planta Med. 2007;73(8):713-717.

J2. Herrera-Arellano A, Jiménez-Ferrer JE, Zamilpa A, García-Alonso G, Herrera-Alvarez S, Tortoriello J. Therapeutic effectiveness of Galphimia glauca vs. lorazepam in generalized anxiety disorder. A controlled 15-week clinical trial. Planta Med. 2012;78(14):1529-1535.

J3. Sarris J, McIntyre E, Camfield A. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27(4):301-319.

Gotu Kola

K1. Bradwejn J, Zhou Y, Koszycki D, Shlik J. A double-blind, placebo-controlled study on the effects of Gotu Kola (Centella asiatica) on acoustic startle response in healthy subjects. J Clin Psychopharmacol. 2000;20(6):680-684.

K2. Jana U, Sur TK, Maity LN, Debnath PK, Bhattacharyya D. A clinical study on the management of generalized anxiety disorder with Centella asiatica. Nepal Med. Coll J. 2010;12(1):8-11

K3. Sarris J, McIntyre E, Camfield A. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27(4):301-319.

Chamomile

L1. Amsterdam JD, Li Y, Soeller I, Rockwell K, Mao JJ, Shults J. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. 2009;29(4):378-382.

L2. Sarris J, McIntyre E, Camfield A. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27(4):301-319.

Gingko Biloba

M1. Woelk H, Arnoldt KH, Kieser M, Hoerr R. Ginkgo biloba special extract EGb 761 in generalized anxiety disorder and adjustment disorder with anxious mood: a randomized, double-blind, placebo-controlled trial. J Psychiatr Res. 2007;41(6):472-480.

M2. Sarris J, McIntyre E, Camfield A. Plant-based medicines for anxiety disorders, part 2: a review of clinical studies with supporting preclinical evidence. CNS Drugs. 2013;27(4):301-319.

Exercise

N1. Bartley CA, Hay M, Bloch MH. Meta-analysis: aerobic exercise for the treatment of anxiety disorders. Prog Neuropsychopharmacol Biol Psychiatry. 2013;45:34-39.

N2. Pelletier L, Shanmugasegaram S, Patten SB, Demers A. Self-management of mood and/or anxiety disorders through physical activity/exercise. Health Promot Chronic Dis Prev Can. 2017;37(5):149-159.

Acupuncture

O1. Eich H, Agelink MW, Lehmann E, et al. Acupuncture in patients with minor depressive episodes and generalized anxiety. Results of an experimental study [in German; English abstract]. Fortschr Neurol Psychiatr. 2000;68:137-144.

O2. Wang SM, Kain ZN. Auricular acupuncture: a potential treatment for anxiety. Anesth Analg. 2001;92:548-553.

O3. Au DW, Tsang HW, Ling PP, Leung CH, Ip PK, Cheung WM. Effects of acupressure on anxiety: a systematic review and meta-analysis. Acupunct Med. 2015;33(5):353-359.

O4. Goyatá SL, Avelino CC, Santos SV, Souza Junior DI, Gurgel MD, Terra Fde S. Effects from acupuncture in treating anxiety: integrative review. Rev Bras Enferm. 2016;69(3):602-609.

Yoga

P1. Javnbakht M, Hejazi Kenari R, Ghasemi M. Effects of yoga on depression and anxiety of women. Complement Ther Clin Pract. 2009;15:102-4.

P2. Vadiraja HS, Raghavendra RM, Nagarathna R, et al. Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: a randomized controlled trial. Integr Cancer Ther. 2009;8:37-46.

P3. Satyapriya M, Nagendra HR, Nagarathna R, Padmalatha V. Effect of integrated yoga on stress and heart rate variability in pregnant women. Int J Gynaecol Obstet. 2009;104:218-22.

P4. Kovačič T, Kovačič M. Impact of relaxation training according to Yoga In Daily Life system on perceived stress after breast cancer surgery. Integr Cancer Ther. 2011;10(1):16-26.

P5. Li AW, Goldsmith CA. The effects of yoga on anxiety and stress. Altern Med Rev. 2012;17(1):21-3576. Li AW, Goldsmith CA. The effects of yoga on anxiety and stress. Altern Med Rev. 2012;17(1):21-35.

P6. Falsafi N. A randomized controlled trial of mindfulness versus yoga: effects on depression and/or anxiety in college students. J Am Psychiatr Nurses Assoc. 2016;22(6):483-497 A10. Rao M, Metri KG, Raghuram N, Hongasandra NR. Effects of mind sound resonance technique (yogic relaxation) on psychological states, sleep quality, and cognitive functions in female teachers: a randomized, controlled trial. Adv Mind Body Med. 2017;31(1):4-9.

P7. Danielly Y, Silverthorne C. Psychological benefits of yoga for female inmates. Int J Yoga Therap. 2017 Apr 24 [Epub ahead of print].

Aromatherapy

Q1. Morris N, Birtwistle S, Toms M. Anxiety reduction by aromatherapy: anxiolytic effects of inhalation of geranium and rosemary. Int J Aromatherapy. 1995;7:33-39.

Q2. Cooke B, Ernst E. Aromatherapy: a systematic review. Br J Gen Pract. 2000;50:493-496.

Music Therapy

R1. Horne-Thompson A, Grocke D. The effect of music therapy on anxiety in patients who are terminally ill. J Palliat Med.2008;11:582-590.

R2. Erkkilä J, Punkanen M, Fachner J, et al. Individual music therapy for depression: randomised controlled trial. Br J Psychiatry. 2011;199(2):132-139.

Melatonin

S1. Naguib M, Samarkandi AH. Premedication with melatonin: a double-blind, placebo-controlled comparison with midazolam.Br J Anaesth. 1999;82:875-880.

S2. Naguib M, Samarkandi AH. The comparative dose-response effects of melatonin and midazolam for premedication of adult patients: a double-blinded, placebo-controlled study. Anesth Analg. 2000;91:473-479.

S3. Samarkandi A, Naguib M, Riad W, et al. Melatonin vs. midazolam premedication in children: a double-blind, placebo-controlled study. Eur J Anaesthesiol. 2005;22:189-96

S4. Capuzzo M, Zanardi B, Schiffino E, et al. Melatonin does not reduce anxiety more than placebo in the elderly undergoing surgery. Anesth Analg. 2006;103:121-123

S5. Turkistani A, Abdullah KM, Al-Shaer AA, et al. Melatonin premedication and the induction dose of propofol. Eur J Anaesthesiol. 2007;24(5):399-402.

S6. Kurdi MS, Muthukalai SP. A comparison of the effect of two doses of oral melatonin with oral midazolam and placebo on pre-operative anxiety, cognition and psychomotor function in children: A randomised double-blind study. Indian J Anaesth. 2016;60(10):744-750.

Last reviewed March 2019 by EBSCO NAT Review Board Richard Glickman-Simon, MD  Last Updated: 3/2/2019