Anxiety and Panic Attacks
As W.H. Auden pointed out, we live in the age of anxiety. Most of us suffer from a certain level of chronic anxiety because modern life is jagged, fast-paced, and divorced from the natural rhythms that tend to create a harmonious inner life. For some, this existential unease goes further and becomes a psychological disorder.
Typical symptoms of anxiety disorder include feelings of tension, irritability, worry, frustration, turmoil, and hopelessness, along with insomnia, restless sleep, grinding of teeth, jaw pain, an inability to sit still, and an incapacity to cope. Physical sensations frequently arise as well, including a characteristic feeling of being unable to take a full, satisfying breath; dry mouth; rapid heartbeat; heart palpitations; a lump in the throat; tightness in the chest; and cramping in the bowels. Anxiety can also give rise to panic attacks. These may be so severe that they are mistaken for heart attacks. The heart pounds and palpitates, the chest feels tight and painful, and the whole body tenses with unreasonable fear. Such attacks can be triggered by anxiety-provoking situations, but they may also come out of nowhere, perhaps even awakening you from sleep. When a person tends to suffer more from panic attacks than generalized anxiety, physicians call the illness panic disorder.
The medical treatment of anxiety involves anti-anxiety drugs in the benzodiazepine family, the unique drug BuSpar (buspirone), and antidepressants. Panic attacks are generally more difficult to treat than other forms of anxiety.
Proposed Natural Treatments
There are no natural treatments for anxiety that have been shown to be safe and effective. However, some treatments have shown promise for generalized anxiety disorder and related conditions. No natural treatment is likely to be effective for panic disorder.
Valerian: May Provide Calming Effects
The herb valerian is best known as a remedy for insomnia. However, because many drugs useful for insomnia also reduce anxiety, valerian has been proposed as an anxiety treatment as well.
In a double-blind, placebo-controlled study, 36 people with generalized anxiety disorder were given either valerian extract, valium, or placebo for a period of 4 weeks.8 The study failed to find statistically significant differences between the groups, presumably due to its small size. However, a careful analysis of the results hints, at least, that valerian was helpful.
In addition, a preliminary double-blind study found that valerian may produce calming effects in stressful situations.28 Again, though, this study was too small to provide definitive results. Another study evaluated the anxiety-relieving effects of a combination containing valerian and lemon balm taken in various doses; some benefits were seen with doses of 600 mg or 1200 mg three times daily, but the highest dose (1800 mg three times daily) actually appeared to increase anxiety symptoms during stressful situations. Furthermore, people taking the herbal treatment at any dose showed slightly decreased cognitive function as compared to those given placebo.
For more information, including dosage and safety issues, see the full Valerian article.
Up until 2002, the herb kava was widely used in Europe as a medical treatment for anxiety, based on the evidence of a substantial body of double-blind, placebo-controlled studies. However, because of recent concerns involving its potential effects on the liver, it has been withdrawn from the market in many countries, and we do not recommend its use. For more information, see the full Kava article.
Other Herbs and Supplements TOP
A large (264-participant) 3-month, double-blind, placebo-controlled study tested the possible anti-anxiety benefits of a combination therapy containing the mineral magnesium (150 mg twice daily), the herb hawthorn (150 mg twice daily of a standardized extract), and the seldom-studied herb Eschscholtzia californica (California poppy, 40 mg twice daily).44 Study participants all suffered from generalized anxiety disorder of mild-to-moderate intensity. The results indicated that the combination treatment was more effective than placebo. No significant side effects were seen. This particular combination therapy is currently used in France.
A double-blind, placebo-controlled trial of 80 healthy male volunteers found that 28 days of treatment with a multivitamin and mineral supplement (containing calcium, magnesium, and zinc) significantly reduced anxiety and the sensation of stress.30
The supplement 5-HTP is best known as a proposed treatment for depression. An 8-week, double-blind, placebo-controlled study compared 5-HTP and the drug clomipramine in 45 individuals suffering from anxiety disorders.31 The results indicated that 5-HTP was effective, but clomipramine was more effective.
Based on its apparent ability to promote sleep, melatonin has been tried as a treatment for reducing anxiety. However, while four studies performed by Saudi researchers reported benefits,32,3352. 55 independent researchers have been unable to confirm these results.53,54
A 4-week, double-blind study of 36 individuals with anxiety (specifically, generalized anxiety disorder) compared the herb passionflower to the standard drug oxazepam.35 Oxazepam worked more quickly, but by the end of the 4-week trial, both treatments proved equally effective. Furthermore, passionflower showed a comparative advantage in terms of side-effects: use of oxazepam was associated with more impairment of job performance. And, in a placebo-controlled trial involving 60 surgical patients, passionflower significantly reduced anxiety up to 90 minutes prior to surgery.64 The only other supporting evidence for passionflower comes from animal studies.45
Several small double-blind studies by a single research group have found preliminary evidence that oral use of lemon balm ( Melissa officinalis) may reduce anxiety levels.46,47 Like other anti-anxiety agents, it may also impair mental function to some degree. A combination of lemon balm and valerian has also been tested, with generally positive results.48
A double-blind, placebo-controlled trial of 40 individuals found that gotu kola reduced the "startle" response to sudden loud noises.34 This suggests, but doesn't prove, that gotu kola may be helpful for anxiety.
The herb Galphimia glauca is traditionally used as a “nerve tonic” by Mexican herbalists. One substantial double-blind study purportedly found that a standardized Galphimia extract is as effective as the standard medication lorazepam.58 However, because this study failed to use a placebo group, these results mean little.
Other herbs or supplements that are frequently recommended for anxiety attacks include Chinese skullcap, flaxseed oil, chamomile, gamma oryzanol, hops, selenium, and suma, as well as inositol for panic disorder. However, there is no reliable supporting evidence to indicate that they work.
The substance GABA (gamma-aminobutyric acid) is a naturally occurring neurotransmitter that is used within the brain to reduce the activity of certain nerve systems, including those related to anxiety. For this reason, GABA supplements are sometimes recommended for treatment of anxiety-related conditions. However, there are no studies whatsoever supporting the use of GABA supplements for anxiety. In fact, it appears that, when taken orally, GABA cannot pass the blood-brain barrier, and therefore does not even enter the brain.60
A 12-week, double-blind, placebo-controlled trial involving 68 healthy medical students without anxiety disorders found that taking fish oil supplements may reduce anxiety (ie, stress related to test taking).69
Alternative Therapies TOP
Various alternative therapies have shown some promise for the treatment of anxiety, including:
However, more research needs to be done on the effectiveness of these treatments.
There is a fair amount of evidence in support of relaxation therapies38,40,61,62,65 and massage (either alone or combined with aromatherapy),11,37 as means to treat the symptoms of anxiety, at least in the short-term. In a 2008 review of 27 studies, for example, researchers concluded that relaxation therapies (including Jacobson's progressive relaxation, autogenic training, applied relaxation, and meditation) were effective against anxiety. (Although, not all of the studies were randomized, controlled trials.)66 In a randomized trial involving 68 patients with generalized anxiety disorder, ten sessions of therapeutic massage, thermotherapy (application of heat), or relaxation were all found to be beneficial at reducing anxiety, though none was superior to the others.67
Meditation improved symptoms in a review of 40 randomized trials with 2,466 adults with anxiety. In the trials, meditation was compared to active controls (medication, exercise or alternative therapies), attention controls (education or non-directive therapy) or inactive control (waitlist) groups.78
References[ + ]
1. Meyer HJ, Kretzschmar R. Kawa Pyrones—a new kind of substance group of central muscle relaxants of the mephenesin type [translated from German]. Klin Wochenschr. 1966;44:902-903.
2. Klohs MW, Keller F, Williams RE, et al. A chemical and pharmacological investigation of Piper methysticum Forst. J Med Pharm Chem. 1959;1:95-103.
3. Bruggemann VF, Meyer HJ. Studies on the analgesic efficacy of the kava constituents dihydrokavain (DHK) and dihydromethysticin (DHM) [in German; English abstract]. Arzneimittelforschung. 1963;13:407-409.
4. Meyer HJ. Pharmacology of the active compounds of the Kava rhizome ( Piper methysticum Forst) [translated from German]. Arch Int Pharmacodyn Ther. 1962;138:505-535.
5. Meyer HJ, May HU. Local anaesthetic properties of natural Kava pyrones [translated from German]. Klin Wochenschr. 1964;42:407.
6. Meyer HJ, Kretzschmar R. Kawa Pyrones - a new kind of substance group of central muscle relaxants of the mephenesin type [translated from German]. Klin Wochenschr. 1966;44:902-903.
7. Singh YN. Effects of kava on neuromuscular transmission and muscle contractility. J Ethnopharmacol. 1983;7:267-276.
8. 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.
9. Wolfson P, Hoffmann DL. An investigation into the efficacy of Scutellaria lateriflora in healthy volunteers. Altern Ther Health Med. 2003;9:74-78.
10. Wang SM, Kain ZN. Auricular acupuncture: a potential treatment for anxiety. Anesth Analg. 2001;92:548-553.
11. Cooke B, Ernst E. Aromatherapy: a systematic review. Br J Gen Pract. 2000;50:493-496.
12. Malsch U, Klement S. Randomized placebo-controlled double-blind clinical trial of a special extract of kava roots (WS 1490) in patients with anxiety disorders of non-psychotic origin [abstract]. Eur Phytojournal [serial online]. 2000. The European Scientific Cooperative on Phytotherapy website. Available at: http://www.escop.com/issue_1. Accessed May 10, 2001.
13. Woelk H, Kapoula O, Lehrl S, et al. The treatment of patients with anxiety. A double blind study: kava extract WS 1490 versus benzodiazepine [translated from German]. Z Allg Med. 1993;69:271-277.
14. Jussofie A, Schmiz A, Hiemke C. Kavapyrone enriched extract from Piper methysticum as modulator of the GABA binding site in different regions of rat brain. Psychopharmacology. 1994;116:469-474.
28. 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.
29. 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.
30. Carroll D, Ring C, Suter M, et al. The effects of an oral multivitamin combination with calcium, magnesium, and zinc on psychological well-being in healthy young male volunteers: a double-blind placebo-controlled trial. Psychopharmacology (Berl). 2000;150:220-225.
31. Kahn RS, Westenberg HG, Verhoeven WM, et al. Effect of a serotonin precursor and uptake inhibitor in anxiety disorders; a double-blind comparison of 5-hydroxytryptophan, clomipramine and placebo. Int Clin Psychopharmacol. 1987;2:33-45.
32. Naguib M, Samarkandi AH. Premedication with melatonin: a double-blind, placebo-controlled comparison with midazolam. Br J Anaesth. 1999;82:875-880.
33. 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.
34. Bradwejn J, Zhou Y, Koszycki D, et al. 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;20:680-684.
35. 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.
36. Moore NC. A review of EEG biofeedback treatment of anxiety disorders. Clin Electroencephalogr. 2000;31:1-6.
37. Field T, Morrow C, Valdeon C, et al. Massage reduces anxiety in child and adolescent psychiatric patients. Am Acad Child Adolesc Psychiatry. 1992;31:125-131.
38. Wachelka D, Katz RC. Reducing test anxiety and improving academic self-esteem in high school and college students with learning disabilities. J Behav Ther Exp Psychiatry. 1999;30:191-198.
39. Thompson MB, Coppens NM. The effects of guided imagery on anxiety levels and movement of clients undergoing magnetic resonance imaging. Holist Nurs Pract. 1994;8:59-69.
40. Kabat-Zinn J, Massion AO, Kristeller J, et al. Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders. Am J Psychiatry. 1992;149:936-943.
41. Walach H, Rilling C, Engelke U. Efficacy of Bach-flower remedies in test anxiety: a double-blind, placebo-controlled, randomized trial with partial crossover. J Anxiety Disord. 2001;15:359-366.
42. Armstrong NC, Ernst E. A randomized, double-blind placebo-controlled trial of a Bach Flower Remedy. Complement Ther Nurs Midwifery. 2001;7:215-221.
43. 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.
44. Hanus M, Lafon J, Mathieu M. Double-blind, randomised, placebo-controlled study to evaluate the efficacy and safety of a fixed combination containing two plant extracts ( Crataegus oxyacantha and Eschscholtzia californica) and magnesium in mild-to-moderate anxiety disorders. Curr Med Res Opin. 2004;20:63-71.
45. Dhawan K, Kumar S, Sharma A. Comparative anxiolytic activity profile of various preparations of Passiflora incarnata Linneaus: a comment on medicinal plants’ standardization. J Altern Complement Med. 2002;8:283-291.
46. 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]
47. Kennedy DO, Little W, Scholey AB. Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (lemon balm). Psychosom Med. 2004;66:607-613.
48. Kennedy DO, Little W, Haskell CF, et al. Anxiolytic effects of a combination of Melissa oficinalis and Valeriana oficinalis during laboratory induced stress. Phytother Res. 2006 Jan 27. [Epub ahead of print].
49. Viola H, Wolfman C, Levi de Stein M, et al. Isolation of pharmacologically active benzodiazepine receptor ligands from Tilia tomentosa (Tiliaceae). J Ethnopharmacol. 1994;44:47-53.
50. Coleta M, Campos MG, Cotrim MD, et al. Comparative evaluation of Melissa officinalis L., Tilia europaea L., Passiflora edulis Sims. and Hypericum perforatum L. in the elevated plus maze anxiety test. Pharmacopsychiatry. 2001;34(suppl 1):S20-S21.
51. Kennedy DO, Pace S, Haskell C, et al. Effects of Cholinesterase Inhibiting Sage (Salvia officinalis) on Mood, Anxiety and Performance on a Psychological Stressor Battery. Neuropsychopharmacology. 2005 Oct 5. [Epub ahead of print].
52. 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
53. Sury MR, Fairweather K. The effect of melatonin on sedation of children undergoing magnetic resonance imaging. Br J Anaesth. 2006 Jun 17. [Epub ahead of print]
54. 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
55. Turkistani A, Abdullah KM, Al-Shaer AA, et al. Melatonin premedication and the induction dose of propofol. Eur J Anaesthesiol. 2006 Nov 10. [Epub ahead of print]
56. Karst M, Winterhalter M, Munte S, et al. Auricular acupuncture for dental anxiety: a randomized controlled trial. Anesth Analg. 2007;104:295-300.
57. 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.
58. Herrera-Arellano A, Jimenez-Ferrer E, Zamilpa A, et al. 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 Jun 11. [Epub ahead of print]
59. Halberstein R, DeSantis L, Sirkin A, et al. Healing with Bach® Flower Essences: testing a complementary therapy. Complement Health Pract Rev. 2007;12:3-14.
60. Inoue K, Shirai T, Ochiai H, et al. Blood-pressure-lowering effect of a novel fermented milk containing gamma-aminobutyric acid (GABA) in mild hypertensives. Eur J Clin Nutr. 2003;57:490-495.
61. Evans S, Ferrando S, Findler M, et al. Mindfulness-based cognitive therapy for generalized anxiety disorder. J Anxiety Disord. 2007 Jul 22. [Epub ahead of print]
62. Lahmann C, Schoen R, Henningsen P, et al. Brief relaxation versus music distraction in the treatment of dental anxiety: a randomized controlled clinical trial. J Am Dent Assoc. 2008;139:317-24.
63. 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.
64. 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.
65. Nyklicek I, Kuijpers KF. Effects of mindfulness-based stress reduction intervention on psychological well-being and quality oflife: is increased mindfulness indeed the mechanism? Ann Behav Med. 2008 Jun 6.
66. Manzoni GM, Pagnini F, Castelnuovo G, et al. Relaxation training for anxiety: a ten-years systematic review with meta-analysis. BMC Psychiatry. 2008 Jun 2.
67. Sherman KJ, Ludman EJ, Cook AJ, et al. Effectiveness of therapeutic massage for generalized anxiety disorder: a randomized controlled trial. Depress Anxiety. 2010;27(5):441.
68. Lande RG, Williams LB, Francis JL, Gragnani C, Morin ML. Efficacy of biofeedback for post-traumatic stress disorder. Complement Ther Med. 2010;18(6):256-259.
69. Kiecolt-Glaser JK, Belury MA, Andridge R, et al. Omega-3 supplementation lowers inflammation and anxiety in medical students: A randomized controlled trial. Brain Behav Immun. 2011 Jul 19. [Epub ahead of print]
70. Erkkilä J, Punkanen M, Fachner J, et al. Individual music therapy for depression: randomised controlled trial. Br J Psychiatry. 2011;199(2):132-139.
71. Li AW, Goldsmith CA. The effects of yoga on anxiety and stress. Altern Med Rev. 2012;17(1):21-35.
72. Javnbakht M, Hejazi Kenari R, Ghasemi M. Effects of yoga on depression and anxiety of women. Complement Ther Clin Pract. 2009;15:102-4.
73. 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.
74. 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.
75. 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.
76. Li AW, Goldsmith CA. The effects of yoga on anxiety and stress. Altern Med Rev. 2012;17(1):21-35.
78. 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.
Last reviewed December 2015 by EBSCO CAM Review Board
EBSCO Information Services is fully accredited by URAC. URAC is an independent, nonprofit health care accrediting organization dedicated to promoting health care quality through accreditation, certification and commendation.
This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.
To send comments or feedback to our Editorial Team regarding the content please email us at firstname.lastname@example.org. Our Health Library Support team will respond to your email request within 2 business days.