Introduction
Anxiety is a common mental health condition affecting millions of people worldwide. While traditional treatments like therapy and medication are effective, many individuals also turn to natural supplements to help manage their anxiety symptoms. With so many options available, it can be challenging to determine which supplements are truly the best for anxiety relief.
This comprehensive article reviews the current scientific evidence behind the most promising supplements for anxiety. We’ll explore the efficacy, safety, and optimal dosing of supplements like passionflower, kava, St. John’s wort, lysine, arginine, magnesium, and others. By the end, you’ll have a clearer understanding of which natural remedies may be worth trying to support your mental well-being.
It’s important to note that while some supplements show potential in reducing anxiety, they should not be viewed as a replacement for conventional therapies. Supplements are best used under the guidance of a qualified healthcare provider as part of a holistic approach to managing anxiety. Let’s dive into the evidence to uncover the best supplements for anxiety.
Passionflower (Passiflora incarnata)
Passionflower, a climbing vine native to the southeastern United States, has been used traditionally to treat anxiety and insomnia (Miroddi et al., 2013). Several human trials have investigated the efficacy of passionflower for anxiety disorders.
A double-blind, placebo-controlled study by Akhondzadeh et al. (2001) found that passionflower extract was as effective as the benzodiazepine drug oxazepam for treating generalised anxiety disorder (GAD). The study involved 36 patients with GAD who received either passionflower extract (45 drops/day) or oxazepam (30 mg/day) for 4 weeks. Both treatments significantly reduced anxiety symptoms, with no significant difference between the two groups.
Movafegh et al. (2008) conducted a randomised, double-blind, placebo-controlled trial examining the effects of passionflower on preoperative anxiety. Sixty patients undergoing inguinal herniorrhaphy surgery received either oral passionflower (500 mg) or placebo 90 minutes before surgery. The passionflower group experienced a significantly greater reduction in anxiety compared to placebo, as measured by the numerical rating scale (NRS).
A combination herbal product containing passionflower, valerian, and St. John’s wort was found to be effective for reducing anxiety in individuals with adjustment disorder (Bourin et al., 1997). In this double-blind, placebo-controlled study, 182 outpatients received either the herbal combination or placebo for 28 days. The herbal group showed significant improvements in anxiety symptoms compared to placebo.
While these studies suggest passionflower may be helpful for anxiety, more research is needed to establish optimal dosing and long-term safety. Mild side effects like dizziness and confusion have been reported in some trials (Akhondzadeh et al., 2001). Passionflower should be used cautiously in combination with sedative medications due to potential interactions (Miroddi et al., 2013).
Kava (Piper methysticum)
Kava, a plant native to the South Pacific islands, is one of the most well-studied herbal remedies for anxiety. The roots of the kava plant contain active compounds called kavalactones, which are believed to be responsible for its anxiolytic effects (Sarris et al., 2013).
A meta-analysis by Pittler & Ernst (2003) reviewed 7 randomised, double-blind, placebo-controlled trials of kava for anxiety. The analysis found that kava was significantly superior to placebo in reducing anxiety symptoms, with an effect size considered to be medium to large. The reviewers concluded that kava appears to be an effective symptomatic treatment for anxiety.
A 3-week randomised, double-blind trial by Boerner et al. (2003) compared kava to two conventional anti-anxiety medications (buspirone and opipramol) in 129 outpatients with generalised anxiety disorder (GAD). Kava was found to be as effective as the two prescription drugs in reducing anxiety symptoms, with 75% of patients in the kava group classified as treatment responders.
Sarris et al. (2009) conducted a 3-week crossover trial involving 60 adults with 1 month or more of elevated generalised anxiety. Participants received kava (250 mg kavalactones/day) or placebo for 1 week, then switched treatments after a 1-week washout period. Kava was shown to significantly reduce anxiety compared to placebo, with no serious adverse effects reported.
While kava appears to be an effective and well-tolerated treatment for anxiety, concerns have been raised about its potential for causing liver toxicity. A review by Teschke et al. (2011) analysed 85 published case reports of kava-associated liver toxicity and found most cases involved the use of kava extracts that did not comply with standard quality requirements. When taken at recommended doses and from reputable sources, kava is considered to be a safe and effective treatment for anxiety (Sarris et al., 2013).
St. John’s Wort (Hypericum perforatum)
St. John’s wort (SJW) is a flowering plant that has been used for centuries to treat a variety of conditions, including depression and anxiety. The exact mechanism of action is not fully understood, but SJW is believed to work by inhibiting the reuptake of serotonin, dopamine, and norepinephrine in the brain (Butterweck, 2003).
While SJW is primarily used as a natural antidepressant, some studies have investigated its efficacy for anxiety disorders. A double-blind, randomised, placebo-controlled trial by Kobak et al. (2005) examined the effects of SJW on social phobia. Forty patients received either SJW (600 mg/day) or placebo for 12 weeks. Although SJW was well-tolerated, it was not found to be significantly superior to placebo in reducing social anxiety symptoms.
Another randomised, double-blind, placebo-controlled study by Kobak et al. (2005) investigated SJW for obsessive-compulsive disorder (OCD). Sixty patients with OCD received either SJW (900 mg/day) or placebo for 12 weeks. Again, SJW was not found to be more effective than placebo in reducing OCD symptoms.
A combination product containing SJW and valerian was studied for the treatment of anxiety with comorbid depression (Müller et al., 2003). In this open-label, uncontrolled study, 2,231 patients received the herbal combination for an average of 2 months. Significant improvements were observed in both anxiety and depressive symptoms, with good tolerability reported.
While SJW shows promise as a natural treatment for depression, the evidence for its efficacy in anxiety disorders is mixed. More high-quality, controlled trials are needed to determine whether SJW is an effective standalone or adjunctive treatment for anxiety. SJW should be used cautiously as it can interact with many medications, including antidepressants, birth control pills, and blood thinners (Hammerness et al., 2003).
Lysine and Arginine
L-lysine and L-arginine are two amino acids that have been studied for their potential anxiolytic effects. Lysine is a precursor to the neurotransmitter gamma-aminobutyric acid (GABA), which is involved in regulating anxiety and stress responses (Smriga & Torii, 2003). Arginine is a precursor to nitric oxide, a signalling molecule that plays a role in various physiological processes, including neurotransmission (Srinongkote et al., 2003).
A double-blind, placebo-controlled study by Smriga et al. (2007) investigated the effects of a lysine and arginine combination on anxiety in healthy adults. One hundred and eight participants received either oral L-lysine (2.64 g/day) and L-arginine (2.64 g/day) or placebo for 1 week. The lysine/arginine group experienced significant reductions in state anxiety and salivary cortisol levels compared to placebo.
Jezova et al. (2005) conducted a randomised, double-blind, placebo-controlled trial examining the effects of lysine and arginine on stress response in high-trait anxiety individuals. Twenty-nine healthy men with high trait anxiety received either lysine (3 g/day) and arginine (3 g/day) or placebo for 10 days. The amino acid combination was found to significantly blunt the stress-induced rise in cortisol and subjective measures of anxiety.
While these initial studies suggest a potential anxiolytic effect of lysine and arginine supplementation, more research is needed to replicate these findings and determine optimal dosing and long-term safety. No adverse effects were reported in the above trials, but high doses of arginine may be contraindicated in individuals with herpes infections (Gaby, 2006).
Magnesium
Magnesium is an essential mineral involved in over 300 enzymatic reactions in the body, including the regulation of neurotransmitters involved in mood and anxiety (Kirkland et al., 2018). Magnesium deficiency has been associated with increased anxiety and stress vulnerability in observational studies (Sartori et al., 2012).
Several randomised, double-blind, placebo-controlled trials have investigated the effects of magnesium supplementation on anxiety. Hanus et al. (2004) studied the efficacy of a magnesium-containing herbal supplement in 264 patients with generalised anxiety disorder (GAD). After 3 months, the supplement group experienced significant reductions in anxiety symptoms compared to placebo.
A study by Tarleton et al. (2017) examined the effects of magnesium bisglycinate supplementation in 112 adults with mild to moderate subjective anxiety. Participants received either magnesium (300 mg/day) or placebo for 6 weeks. The magnesium group showed a significantly greater reduction in anxiety symptoms compared to placebo, as measured by the State-Trait Anxiety Inventory.
Boyle et al. (2017) conducted a systematic review and meta-analysis of 18 randomised controlled trials investigating the effects of magnesium on subjective anxiety. The analysis found that magnesium supplementation was associated with a significant reduction in anxiety compared to placebo, with an effect size considered to be moderate.
While these findings suggest magnesium may be a promising natural treatment for anxiety, it’s important to note that not all studies have found significant anxiolytic effects. A randomised, double-blind, placebo-controlled trial by Walker et al. (2002) found no significant difference between magnesium oxide (400 mg/day) and placebo in reducing premenstrual anxiety symptoms.
Magnesium is generally well-tolerated when taken at recommended doses, but high doses can cause gastrointestinal side effects like diarrhea (Kirkland et al., 2018). Magnesium supplements may also interact with certain medications, such as antibiotics and diuretics, so it’s important to consult with a healthcare provider before starting supplementation.
Other Promising Supplements
Several other natural supplements have shown promise in reducing anxiety symptoms, although the evidence is more limited compared to the aforementioned remedies. These include:
- Ashwagandha (Withania somnifera): An Ayurvedic herb that has been shown to reduce anxiety and stress in several small randomised controlled trials (Chandrasekhar et al., 2012; Pratte et al., 2014).
- L-theanine: An amino acid found in green tea that has been shown to promote relaxation and reduce stress without causing drowsiness (Juneja et al., 1999). A randomised, double-blind, placebo-controlled study by Kimura et al. (2007) found that L-theanine (200 mg/day) significantly reduced subjective stress and salivary alpha-amylase (a marker of sympathetic nervous system activity) in healthy adults.
- Omega-3 fatty acids: Essential fats found in fish oil that have anti-inflammatory and neuroprotective properties. A meta-analysis by Su et al. (2018) found that omega-3 supplementation was associated with significant reductions in anxiety symptoms, particularly in individuals with clinical anxiety disorders.
- Chamomile (Matricaria chamomilla): An herb traditionally used for its calming and relaxing effects. A randomised, double-blind, placebo-controlled trial by Amsterdam et al. (2009) found that chamomile extract (220 mg/day) significantly reduced anxiety symptoms in patients with mild to moderate generalised anxiety disorder (GAD).
- Lavender (Lavandula angustifolia): An aromatic herb commonly used in aromatherapy for its relaxing and anxiolytic effects. A systematic review by Donelli et al. (2019) found that lavender essential oil inhalation was associated with significant reductions in anxiety symptoms across several randomised controlled trials.
While these supplements show potential for reducing anxiety, more high-quality, large-scale trials are needed to fully establish their efficacy and safety. As with any supplement, it’s important to consult with a qualified healthcare provider before starting use, particularly if you have any pre-existing health conditions or are taking medications.
Conclusion
In conclusion, several natural supplements have shown promise in reducing anxiety symptoms based on the available scientific evidence. Kava and passionflower have the strongest research support, with multiple randomised controlled trials demonstrating their efficacy in various anxiety disorders. Magnesium, lysine, arginine, and other herbs and nutrients like ashwagandha, L-theanine, omega-3s, chamomile, and lavender also show potential anxiolytic effects, but require further study to confirm their benefits.
It’s important to emphasize that while these supplements may be helpful for managing anxiety, they should not be viewed as a substitute for conventional therapies like psychotherapy and medication. Supplements are best used under the guidance of a qualified healthcare provider as part of a comprehensive treatment plan tailored to your individual needs.
When considering supplements for anxiety, it’s crucial to choose high-quality products from reputable sources and to be aware of potential side effects and interactions with medications. Start with the lowest effective dose and monitor your symptoms closely. If you experience any adverse reactions or your anxiety worsens, discontinue use and consult with your healthcare provider.
Remember that anxiety is a complex condition with multiple contributing factors, including genetics, environment, lifestyle, and personal history. A holistic approach that addresses both the physical and psychological aspects of anxiety is often the most effective. This may include a combination of supplements, therapy, medication, relaxation techniques, exercise, and dietary and lifestyle modifications.
If you’re struggling with anxiety, know that you’re not alone and that there are many evidence-based treatment options available. Work with your healthcare provider to develop a personalized plan that supports your mental well-being and helps you achieve greater peace of mind.
Key Highlights and Actionable Tips
- Passionflower, kava, and combinations of L-lysine and L-arginine show strong evidence as effective treatments for anxiety symptoms and disorders, with mild to moderate side effects.
- Magnesium-containing supplements and other herbal combinations may be promising for anxiety, but more research is needed to confirm their efficacy.
- St. John’s wort monotherapy has insufficient evidence as an effective anxiolytic treatment.
- Consult with a healthcare professional before starting any nutritional or herbal supplements for anxiety to ensure safety and appropriateness for your individual needs.
- Look for standardised, quality-controlled herbal supplements to ensure potency and minimise risk of contamination or unwanted side effects.
What are some of the most promising nutritional and herbal supplements for anxiety based on current research?
According to the systematic review, passionflower, kava, and supplements combining L-lysine and L-arginine have shown the most promising results in human clinical trials for treating anxiety symptoms and disorders. Magnesium-containing supplements and some herbal combinations have also shown potential anxiolytic effects, but more research is needed to confirm their efficacy.
Are there any potential risks or side effects associated with using nutritional and herbal supplements for anxiety?
While most of the reviewed studies reported only mild to moderate side effects, it’s important to be aware that herbal supplements can interact with medications and may cause adverse reactions in some individuals. Kava, in particular, has been associated with rare cases of liver toxicity. It’s crucial to consult with a healthcare professional before starting any supplement regimen to ensure safety and rule out potential contraindications.
How do nutritional and herbal supplements compare to conventional treatments for anxiety, such as therapy and medication?
The evidence suggests that certain nutritional and herbal supplements, like passionflower and kava, may be as effective as some conventional anxiety medications, such as benzodiazepines, with potentially fewer side effects. However, more head-to-head comparison studies are needed. Supplements should not be considered a replacement for therapy or medication without consulting a healthcare provider, as an integrative approach may be most beneficial.
Can nutritional and herbal supplements be used safely in combination with prescription anxiety medications?
Some nutritional and herbal supplements can interact with prescription medications, including anxiety drugs. For example, St. John’s wort is known to interact with many medications. It’s essential to inform your healthcare provider about all supplements you are taking or considering and to discuss potential interactions before combining supplements with prescription anxiety medications.
How long does it typically take to see results when using nutritional and herbal supplements for anxiety?
The onset of action and duration of treatment needed to see results may vary depending on the specific supplement and individual factors. Some studies showed symptom improvement in as little as a few weeks, while others assessed efficacy over several months. It’s generally recommended to give a supplement an adequate trial period, as determined by a healthcare professional, before assessing its effectiveness and making changes to your treatment plan.
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