Accurate Education – Anxiety & Stress

Anxiety & Stress

 

Anxiety is a mood of fear, worry, and uneasiness resulting from the apprehension of something bad happening, the source of which may or may not be identified. While anxiety can be a normal, appropriate response to circumstances, chronic and irrational or excessive anxiety  in response to normal life events can be debilitating and is considered to be an anxiety disorder. In the United States, anxiety disorders effect 40 million adults, representing 15-25% of the population and affecting women 2-3x more often than men.

 

See also: 

Alternative Therapies:

• Animal-Assisted Therapy
• Cognitive Behavior Training (CBT)
• Hypnosis/Self-Hypnosis
• Meditation & Mindful Exercise
• Music Therapy
• Yoga & Tai Chi

 

Medications:

• Antidepressants (used for Anxiety)
• Benzodiazepines
• Gabapentin & Lyrica (Gabapentinoids)

 

Complementary and Alternative Medications (CAM):

Supplements:

 

Guided Meditations:

Terence Yallop:

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Stress

For the most part, while conventional medicine provides reasonably effective medications for short term managment of anxiety and stress, conventional medicine offers very limited options regarding the treatment of chronic anxiety and stress.

 

In an attempt to help patients with chronic anxiety and stress, conventional management has tended to “over-medicalize” anxiety and stress. By this it is meant that lifestyle and life circumstance problems are too often treated as medical problems and a medical solution is offered when, in fact, the more appropriate solution lies in lifestyle or cognitive and behavioral solutions rather than the use of medications. As a result of this “over-medicalization,” patients are too often started on medications that have adverse effects, long-term dependency and other problems while at the same time these medications never actually correct the underlying problem.

 

In truth, while the medical community bears responsibility for the problem of “over-medicalization,” so does western society which seeks a “pill for every ailment,” regardless of the nature of the ailment – medical or not.

 

The following reviews medical solutions for acute anxiety and stress along with the limited medical options for managing chronic anxiety and stress. At the same time, however, emphasis is placed on behavioral and mind-oriented solutions that have greater effectiveness with better chances of a “cure,” given that there really is no actual “cure,” but instead the cure lies in engaging effective methods for managing the inevitable anxiety and stress that present to all those who are alive.

 

Conventional Medical Management of Anxiety

 

Complementary and Alternative Medical (CAM) Management of Anxiety

Medical management of anxiety and stress also includes the use of Complementary and Alternative Medicine (CAM) treatment options, including herbal and natural supplements as adaptogens and anxiolytics.  Anxiety, depression, and insomnia are the most common reasons for people to use complementary (CAM) therapies. CAM approaches to the treatment of anxiety include use of nutritional, dietary and herbal supplements, acupuncture, aromatherapy, light therapy, meditation and hypnosis.

See:  Meditation and Hypnosis

 

For the purposes of this section, only dietary, nutritional and herbal supplements and aromatherapy will be reviewed. It should be noted that research evidence for the following CAM treatments are weak due to a lack of large, well-designed studies. While the evidence is encouraging, few agents have strong evidence to recommend their effectiveness. With certain caveats, however, for the most part most of these agents are considered safe with only mild side effects likely. As with all supplements, it is advised that you discuss their use with your physician prior to self-treatment to review safety and dosing precautions.

 

Diet

 

Nutritional Supplements

Amino Acids

Various amino acids are proposed to be effective in anxiety, largely related to their role as precursors to the biologic formation of different neurotransmitters including dopamine, serotonin, noradrenaline and GABA, all key players in the neurochemistry of anxiety. The amino acid glutamate is the principle excitatory neurotransmitter and is also used to make the neurotransmitter gamma-aminobutyric (GABA). L-tryptophan and L-tyrosine are precursors for the neurotransmitters, serotonin, dopamine, and norepinephrine. The ability of the body to produce these neurotransmitters is directly linked to the levels of these amino acids consumed in the diet.

 

 

L-tryptophan, L-tyrosine and L-phenylalanine

Deficiencies of L-tryptophan, L-tyrosine and L-phenylalanine lead to reduced serotonin production and are associated with anxiety. While the prevalence of these dietary deficiencies is not established in the U.S., supplementing with L-tryptophan is known to increase serotonin synthesis and is often recommended for anxiety and sleep. Supplementing with 5-hydroxytryptophan (5-HTP), the tryptophan precursor, and tryptophan have been shown to elevate brain serotonin levels and enhance a sense of well-being.

 

Supplementing with D,L-phe
nylalanin
e and L-tyrosine increases synthesis of dopamine and norepinephrine supporting their role in fighting anxiety. D,L-phenylalanine is also recommended in opioid withdrawal and may have a role in reducing chronic pain.

 

Minerals

Magnesium

In a placebo controlled clinical study, when magnesium was taken orally along with calcium supplements, anxiety was decreased compared to placebo. Similarly, supplementation with magnesium and vitamin B6 was shown to reduces premenstrual-related anxiety and GAD in women. Magnesium supplementation has also been found to be effective in many conditions often associated with anxiety including chronic muscle pain/spasm, migraine headaches and insomnia.

 

It should be noted that the absorption of magnesium may be superior when absorbed through the skin through the use of epsom salt baths as well as less side effect of diarrhea, commonly seen with oral use supplementation with magnesium. It has been reported that dietary insufficiency of magnesium is common in the U.S., with estimates as high as 80% prevalence in women and 70% in men. The argument for epsom baths 3-4x/week for patients with chronic pain and anxiety is particularly high when factoring in the benefit of 15-20 minutes of “off-time” with a quiet soak.

See:  Magnesium

 

Selenium

In clinical trials people given daily oral supplementations of 100 mg of selenium for 5 weeks reported less anxiety. Confirmatory research is lacking as to cause-effect and to prevalence of selenium deficiency as a contributor to anxiety.

 

Fatty acids

Omega-3 fatty acids

Dietary supplementation with omega-3 fatty acids has been shown to both improve mood and reduce the risk of anxiety. Again, studies are lacking to confirm these benefits for anxiety, but omega-3 fatty acids are also thought to have beneficial roles in cardiovascular health and oxidative stress. That being said, it is likely that the best approach here would be to include fish in one’s diet with at least 5 servings/week to maintain adequate nutritional quality and balance of the omega-3 fatty acids.

 

Vitamins

Because Vitamin C is a cofactor for enzymes involved in biosynthesis, and it is effective for oxidative stress and possibly reducing levels of stress-related cortisol, supplementation with Vitamin C to reduce anxiety has been advocated by some. One clinical study did show that high dose vitamin C improves mood, but substantial research for this anxiolytic benefit is lacking. Vitamin E also may reduce anxiety and vitamin D supplementation may reduce anxiety in patients with fibromyalgia-associated anxiety.

See: Vitamin D

 

Herbs and Botanicals for Anxiety

Ashwagandha

 

Cannabidiol (CBD)

Cannabidiol (CBD) is one of the major constituents found in marijuana, second in abundance in the plant only to THC. Unlike THC, which provides the euphoria and “high” associated with the use of marijuana,  CBD does not cause any euphoria or “high” and does not impair thought processing aside from its potential for sedation as a side effect in some people,  and with high doses. Since CBD has become legal in the U.S. and is now available as an affordable over-the-counter medication, it has been found to have proven benefits in the management of anxiety as well as insomnia.

 

CBD’s benefit for anxiety has been studied in humans since 1982 and has shown to be safe with few side effects, mostly limited to sedation. CBD is effective for general anxiety (GAD), panic disorder, post-traumatic stress disorder (PTSD) and social anxiety (SAD). In most early studies an oral dose of CBD between 300-600 mg/day was employed and was well-tolerated in doses up to 1,500 mg/day. Subsequently it has been shown to effective at doses as low as 25-100mg/day. As with most medications, dosing should be initiated at low doses and gradually increased as needed to achieve the desired response and avoid side effects. Recent research suggest CBD has a biphasic dosing response,  meaning that sometimes lower doses are more effective than higher doses. CBD is available in liquid form, powders and capsules.

See Cannabidiol (CBD) – Clinical Use and Dosing)

 

Kava Kava (Piper methysticum)

The best studied botanical with the most established benefit is kava kava (Piper methysticum). Unfortunately, recommendations for its use have been clouded by controversial concerns regarding its safety with respect to liver toxicity. The controversy is based on rare reports of liver toxicity, but apparently the only reported cases of this liver toxicity stemmed from the use of extracts from kava that included not just the kava root that is the traditional source for use, but also extracts from the stems and leaves. It is believed that the solvents and/or the extraction process is what lead to the few reported cases rather than traditional use of simple water extracts from the kava root. As a result of these insights, kava once banned in Canada and the United Kingdom is now again available. It has never been banned in the U.S.

 

There are six psychoactive agents in kava, kavalactones, and they bind to GABA receptors, dopamine receptors and opiate receptors and they also uncouple sodium potassium channels thereby reducing impulses to muscles causing muscle relaxation. The anxiolytic benefits of Kava have been compared to the use of benzodiazepines. It may also be effective for symptoms of premenstrual syndrome.

 

GABA 

GABA is an inhibitory neurotransmitter of the central nervous system that reduces nerve impulse transmission between neurons (through the hyperpolarization of postsynaptic membranes and the reduction of neurotransmitter release into the synapse through presynaptic G-protein coupled receptor inhibition of voltage-gated Ca++ mechanisms). GABA is also found occurring naturally in herbs and plants and it works by reducing the excitability of a neural network thereby functioning as a brake on the neural circuitry during stress. Low GABA levels are associated with restlessness, anxiety, insomnia and a poor mood state. Dietary GABA supplement has been shown in some clinical studies to relieve anxiety.

 

Honokiol reduces anxiety at low doses (100-400 mg). This benefit is believed to be partially attributed to its interaction with  GABA-A receptors, the same target as benzodiazepines (such as Valium (diazepam) and other anxiolytics. Honokiol may also alter the brain’s synthesis of GABA, an inhibitory neurotransmitter in the brain.

Honokiol is commercially available in combination with PEA, a neuropathic pain agent, in a product called ComfortMax.

 

 

Lemon balm (Melissa officinalis)

Valerian (Valeriana officinalis)

Valerian is a temperate plant root that has been used medicinally since the time of Hippocrates as a remedy for sleep and anxiety. It has been shown to be effective as a hypnotic (sleep agent), with particular effectiveness for benzodiazepine withdrawal-related insomnia, suggesting that it is likely to also be effective for benzodiazepine withdrawal-related anxiety.

 

Valerian root components have been shown to both increase GABA synthesis and decrease synaptic GABA reuptake. Valerian root activates glutamic acid decarboxylase, an enzyme involved in the synthesis of GABA. The active Valerian root extract known as valernic acid acts as a GABA agonist by binding to GABA receptors. Valerian root extracts have anxiolytic properties at doses of 400–900 mg daily. Valerian root has been shown in some research to be as effective as diazepam in reducing anxiety. More research is needed to confirm these findings but Valerian root has established safety profiles that would argue for an initial trial of Valerian root for anxiety before starting benzodiazepines.

 

Anxiety and Hormones

Anxiety disorders in general affect more women than men. Furthermore, pregnant, postpartum, premenstrual and menopausal women also experience symptoms of anxiety to a greater extent than at other times in life. This general observation has lead researchers to investigate a link between hormones and anxiety. By now, it is well known that most steroid sex hormones (e.g., pregnenolone, estrogen, progesterone, testosterone, and DHEA – a precuror to building the sex hormones) are neurologically active. In fact, the brain has large quantities of DHEA along with estrogen and progesterone receptors. These hormones have a number of effects within the brain, including regulation of mood.

 

A number of studies have linked abnormalities in hormone levels to various anxiety disorders. During the first week of menses when there are increased levels of estrogen, women produce more serotonin and have improved mood. Decreased estrogen and serotonin levels are associated with the premenstrual period when there is often impaired mood and increased anxiety. In addition, the drop in estrogen during menopause is associated with reduced serotonin production and more anxiety. It has been shown that the selective serotonin reuptake inhibitors (SSRIs) used to treat anxiety have also been shown to improve mood and cognitive function in menopausal women.

 

DHEA

During times of prolonged stress a greater proportion of cortisol (the stress hormone) is made compared to DHEA such that increased blood cortisol/DHEA ratios are believed to be a marker of stress and are associated with anxiety disorder. Women with insufficient progesterone levels are more susceptible to anxiety and studies indicate supplementing these women with proegesterone, or DHEA, can reduce anxiety.

 

Cordoncillo (Piper hispidum)

Recent research has looked at a Central American plant (Piper hispidum) that has been traditionally used by Q’eqchi Maya healers, midwives, and community members in Guatemala for female reproductive disorders. The leaves of Piper hispidum are used to prepare a tea for the treatment of amenorrhea (lack of menses), dysmenorrhea (abnormal menses), menopause and pain and are considered effective.

 

Researchers have found that that extracts of the leaves of Piper hispidum (butenolides) bind to both the estrogen receptor and serotonin receptors and act as serotonin and estrogen agonists, thus explaining the mechanism of benefit for these disorders and suggesting a possible use for anxiety related to menstrual complaints. No evidence was found for drug interactions related to inhibition of CYP450 liver enzymes. More research is needed.

 

Commercial Products for Anxiety

Without intending to specifically promote any individual commercial product, based on anecdotal reports from patients with positive results some products are presented here as offering potential benefit for anxiety and stress management. An effort has been made to confirm the safety and effectiveness of the product and/or its ingredients prior to listing the product here.

 

Opidone

Opidone is promoted as an effective supplement for anxiety and stress. While there is some evidence for the effectiveness of the individual substances making up Opidone’s formula which suggests the product may be helpful, no studies evaluating this specific product appears to be available.

See: Opidone

 

The individual substances making up the Opidone formula include:

(1) PharmaGaba

(2) Agmatine

(3) L-Theanine

(4) Magnolia Bark Extract (contains the active ingredients Honokiol and Magnolol)

(5) Ginger Root

 

 

RediCalm

RediCalm is also promoted as an effective supplement for anxiety and stress. While there is some evidence for the effectiveness of the individual substances making up RediCalm’s formula which suggests the product may be helpful, no studies evaluating this specific product appears to be available.

See: RediCalm

The individual substances making up the RediCalm formula include:

(1) Ashwaganda

(2) Passion Flower

(3) L-Theanine

(4) Lemon Balm

(5) 5-HTP

 

Behavioral Management of Anxiety

Bebavioral management of anxiety and stress includes Cognitive Behavioral Training (CBT), meditation, hypnosis, yoga and other “mindful exercises,” even listening to muic, that are actually very effective and easily learned and engaged into dail practice. All of these modalities are offered at Accurate Clinic to those interested in pursuing them. While they all require greater commitment than simply swallowing a pill, these options are very effective with their outcome and benefits proportional to the effort placed in engaging them.

See: CBT, Meditation and Music Therapy, Hypnosis and Yoga

  

 

This page remains unfinished: an overview and summary of the articles below is forthcoming. In the meantime, please review the articles below.

 

Resources:

Benzo.org.uk is the best resource for learning about discontinuing benzodiazepines:

www.Benzo.org.uk

 

 

References:

 

Anxiety & Stress – Overviews

Anxiety & Stress – Prescription Medications

Anxiety & Stress – Benzodiazepines

Anxiety & Stress – Buspirone: MedlinePlus Drug Information.pdf (Buspar)

Anxiety & Stress – Gabapentinoids: (Lrica (pregabalin) & Neurontin (gabapentin)

Anxiety – Lyrica

1. Pregabalin in acute treatment of anxious depression – 2013
2. Pregabalin in Generalized Anxiety Disorder – A Placebo-Controlled Trial – 2003
3. The treatment of generalized anxiety disorder with pregabalin, an atypical anxiolytic – 2007
4. Efficacy of pregabalin in the treatment of generalized anxiety disorder: double-blind, placebo-controlled comparison of BID versus TID dosing. – PubMed – NCBI no higlights
5. Pregabalin – A guide to its use in fibromyalgia, neuropathic pain and generalized anxiety disorder – 2014

 

Anxiety – Gabapentin

1.  Gabapentin – long-term a
   ntianxiety and hypnotic effects in psychiatric patients with comorbid anxiety-related disorders – 1998

 

   Anxiety & Stress – SNRIs (Selective Norepinephrine and Serotonin Reuptake Inhibitors)

   Anxiety & Stress – SSRIs (Selective Serotonin Reuptake Inhibitors)

 

Anxiety & Stress – Exercise

1. Exercise for Mood and Anxiety Disorders – The State-of-the Science (2015)

 

Anxiety & Stress – CAM Treatment

Anxiety & Stress, CAM Tx – Overviews

1. What Can CAM Do for Anxiety?
2. Complementary and alternative medicine in the treatment of anxiety and depression – 2008
3. Natural Medicine Treatment Considerations for Generalized Anxiety Disorder – 2014

 

Anxiety & Stress, CAM Tx – Natural, Herbal Options Overviews

1. Dietary_and_botanical_anxiolytics – 2012
2. Natural Nutritional Supplements for Anxiety and Depression Treatment
3. Herbal remedies for anxiety – a systematic review of controlled clinical trials. – PubMed – NCBI
4. [Medicinal plants for the treatment of generalized anxiety disorder: a review of controlled clinical studies]. – PubMed – NCBI
5. Plant-Based Medicines for Anxiety Disorders, Part 1 – A Review of Preclinical Studies – 2013
6. Plant-Based Medicines for Anxiety Disorders, Part 2 – A Review of Clinical Studies with Supporting Preclinical Evidence. – PubMed – NCBI
7. Complementary and alternative medicine in the treatment of anxiety and depression – 2008

 

Anxiety & Stress, CAM Tx – Ashwaganda (Withania somnifera)

1. An Alternative Treatment for Anxiety – A Systematic Review of Human Trial Results Reported for the Ayurvedic Herb Ashwagandha (Withania somnifera) – 2014
2. Naturopathic Care for Anxiety – A Randomized Controlled Trial – 2009

 

Anxiety & Stress, CAM Tx – Lavender, Overviews

1. An Orally Administered Lavandula Oil Preparation (Silexan) for Anxiety Disorder and Related Conditions- An Evidence Based Review – 2013
2. Lavender and the Nervous System – 2013
3. In-vitro inhibition of human erythrocyte acetylcholinesterase by salvia lavandulaefolia essential oil and constituent terpenes. – PubMed – NCBI – 2000
4. A question of scent – lavender aroma promotes interpersonal trust – 2015

 

Anxiety & Stress, CAM Tx – Lavender, Anxiety

1. Essential oil of lavender in anxiety disorders – Ready for prime time? – 2017
2. The Effect of Lavender Aroma on Anxiety of Patients Having Bone Marrow Biopsy- 2020

   

Anxiety & Stress, CAM Tx – Lavender, Anxiety – Silexan

1. A Multi-Center, Double-Blind, Randomised Study of the Lavender Oil Preparation Silexan in Comparison to Lorazepam for Generalized Anxiety Disorder – 2010
2. Is Lavender an Anxiolytic Drug? A Systematic Review of Randomised Clinical Trials – 2012
3.  An Orally Administered Lavandula Oil Preparation (Silexan) for Anxiety Disorder and Related Conditions- An Evidence Based Review – 2013
4. Lavender oil preparation Silexan is effective in generalized anxiety disorder – a randomized, double-blind comparison to placebo and paroxetine – 2014
5. Silexan in anxiety disorders – Clinical data and pharmacological background – 2017
6. Silexan in anxiety disorders Clinical data and pharmacological background – PubMed – 2018
7. Efficacy and safety of lavender essential oil (Silexan) capsules among patients suffering from anxiety disorders – A network meta-analysis – 2019
8. Efficacy of Silexan in subthreshold anxiety – meta-analysis of randomised, placebo-controlled trials – 2019
9. Therapeutic effects of Silexan on somatic symptoms and physical health in patients with anxiety disorders – A meta- analysis – 2020

 

Anxiety & Stress, CAM Tx – Lavender, Sleep

1. An olfactory stimulus modifies nighttime sleep in young men and women. – PubMed – NCBI
2. Lavender and sleep – A systematic review of the evidence – 2012
3. Effects of odorant administration on objective and subjective measures of sleep quality, post-sleep mood and alertness, and cognitive performance – 2003
4. Odors enhance slow-wave activity in non-rapid eye movement sleep – 2016
5. Effectiveness of Silexan Oral Lavender Essential Oil Compared to Inhaled Lavender Essential Oil Aromatherapy for Sleep in Adults- A Systematic Reviewv – 2018

 

Anxiety & Stress, CAM Tx – Lemon Balm (Melissa Officinalis)

1.  Anxiolytic properties of Melissa officinalis and associated mechanisms of action – A review of the literature – 2015
2. modulation-of-mood-and-cognitive-performance-following-acute-administration-of-single-doses-of-melissa-officinalis-lemon-balm-2002
3. melissa-officinalis-l-a-review-of-its-traditional-uses-phytochemistry-and-pharmacology-pubmed-ncbi
4. Lemon balm | University of Maryland Medical Center

Anxiety & Stress, CAM Tx – Passion Flower

1. Passiflora incarnata L. Improves Spatial Memory, Reduces Stress, and Affects Neurotransmission in Rats. – PubMed – NCBI
2. Passiflora incarnata L. (Passionflower) extracts elicit GABA currents in hippocampal neurons in vitro, and show anxiogenic and anticonvulsant effects – 2010

 

Anxiety & Stress, CAM Tx – Yoga

1. Yoga for the primary prevention of cardiovascular disease. – PubMed – NCBI
2. iRest Yoga-Nidra on the College Campus – Changes in Stress, Depression, Worry, and Mindfulness
3. Individualized yoga for reducing depression and anxiety, and improving well-being: A randomized controlled trial
4. Yoga Practice Associations with Mindfulness, Kundalini, and Mystical Experiences – 2015
5. Yoga as an Adjunctive Treatment for Posttraumatic Stress Disorder – A Randomized Controlled Trial – 2014
6. The Effects of a Hatha Yoga Intervention on Facets of Distress Tolerance – 2015
7. Recent Development in Yoga – A Scientific Perspective – 2016

   

Anxiety & Stress, CAM Tx – Music Therapy

1. Music listening as a means of stress reduction in daily life. – PubMed – NCBI
2. The impact of acute stress on hormones and cytokines and how their recovery is affected by music-evoked positive mood – 2016

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Emphasis on Edu
cation

 

Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.

 

For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.

 

Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.

 

For more information, please contact Accurate Clinic.

 

Supplements recommended by Dr. Ehlenberger may be purchased commercially online or at Accurate Clinic.

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