It can be difficult to catch a breath these days. Between our always-on work and media culture, an accelerated pace of life, and timeless challenges like raising kids and providing eldercare, life in the 21st century can be anxiety provoking. To say the least.
“We live in unacceptably stressful times,” says integrative psychiatrist Henry Emmons, MD, author of The Chemistry of Calm. “People are so uniformly stressed that they are looking for quick relief, often in the form of alcohol or prescription drugs. We need better options.”
Fortunately, we have them — and have had them for some time. “Plants have been used to relieve anxiety for thousands of years, because anxiety has always existed,” he explains.
Anxiety originates in the brain’s amygdalae, two almond-size structures (one in each hemisphere) that modulate the body’s response to stress. Functional-medicine physician and herbalist Aviva Romm, MD, likens their function to a surveillance system: When we perceive danger, the body’s stress response sounds the alarm and releases a torrent of hormones, including adrenaline and cortisol. This prepares the body to fight, flee, or freeze.
The hypervigilance that accompanies this response is key to survival, Romm says. “But when the alarm gets stuck in the on position, hypervigilance turns into anxiety.”
This can take many forms. For some, it feels like a racing heart or a queasy stomach. In others, it creeps in as a fog of overwhelming emotions or a persistent sense of dread.
An estimated 40 million Americans experience these sensations often enough to be diagnosed with an anxiety disorder, such as social anxiety disorder, panic disorder, and generalized anxiety disorder, or GAD, which is the most common.
Benzodiazepines — such as Valium, Xanax, and Klonopin — are some of the most commonly prescribed drugs for acute anxiety, but their use often produces some unpleasant side effects. This is why many functional-medicine physicians and healthcare providers recommend plant-based remedies.
Using plants this way is less mystical than it may sound. Herbs and benzodiazepines both enhance the calming influence of the neurotransmitter gamma-aminobutyric acid (GABA), a naturally occurring amino acid that helps regulate the fear response. Yet some herbalists argue that herbs boost GABA more effectively than drugs.
“Most herbals are pluripotent, meaning they hit multiple molecular targets,” says clinical herbalist Lily Mazzarella, MS, CNS. And, compared with benzodiazepines, she explains, “plant-based remedies have a much lower risk of dependence and a better safety record.”
Not only are benzodiazepines addictive and habituating (meaning increased doses are needed to achieve the same result over time), recent studies link their use to cognitive dysfunction and decline. The reasons to avoid these drugs keep accumulating, says Romm.
“They have a place in emergency-rescue situations, such as panic attacks, but otherwise I tell people to steer clear.” She favors the safety profile and efficacy of herbal remedies.
Sensible precautions are necessary when using any treatment, including herbs. Always follow the directions on the packaging. If you take prescription medications, especially antianxiety drugs, check with your healthcare provider before adding herbs to the mix. They may intensify a drug’s effect, explains Mazzarella, making you feel loopy or sedated. Some herbs also interact poorly with other medications — another reason to do your homework first.
Finally, like people, antianxiety herbs don’t all act the same. This means that finding the correct herb to treat your anxiety can require a bit of persistence. This guide will help direct you to those most likely to relieve your specific symptoms.
Best Herb for Acute Anxiety Relief
Kava (Piper methysticum)
The root of a plant native to the South Pacific, kava is perhaps the best-researched herb for anxiety relief. Randomized, double-blind, placebo-controlled studies show that kava significantly reduces anxiety. Most participants found relief when taking between 120 and 240 mg of the herb daily over a period of weeks, but it also works well as an on-the-spot remedy.
“Kava is the best example of an herb that matches the effectiveness of an antianxiety medication but without the side effects,” says Emmons. The herb acts fast, often in just 15 to 20 minutes. This makes it especially useful in acute situations — after a near accident, a heated conversation, or anytime the stress response kicks in.
Best of all, kava relaxes the muscles without sedating the brain. “Muscle tension can exacerbate, enhance, and amplify feelings of anxiety,” says Mazzarella. “But with kava you literally feel the sensation of coming down.”
How to Use: When anxiety strikes, take a dropperful of kava tincture in a small glass of water. Your lips may tingle a bit.
Safety Note: Kava is a potent herb and has been linked to liver damage. Romm recommends using it primarily as an “emergency remedy” for panic or acute anxiety, like stage fright or a fear of flying.
“It is overwhelmingly safe for occasional use — a few times a month — and even daily use at very low doses,” she says. “For higher doses, taken regularly, I recommend working with a licensed practitioner. There is a remote risk of it affecting the liver.”
Best Herb for Insomnia
Passionflower (Passiflora incarnata)
Passionflower can relieve anxiety-induced insomnia. The herb’s flavonoids and alkaloids interact with GABA to gently muffle the body’s alarm bells. Emmons calls it “a potent and underutilized herb for sleep.” It’s Mazzarella’s favorite remedy for quieting circular thinking: “Most people find it both mentally and physically relaxing.”
In addition to relaxing the mind for sleep, passionflower can help calm anticipatory fear. In a recent study, researchers gave 40 dental-surgery patients 260 mg of passionflower 30 minutes before their procedures. The herb lowered signs of anxiety (measured by blood pressure and heart rate) as effectively as the pharmaceutical sedative midazolam but with fewer side effects.
How to Use: Nighttime waking is the most common sleep complaint that Mazzarella addresses in her clinic. She suggests placing a small cup of water with passionflower tincture on your nightstand. “That way, if you find yourself awake and lost in a worry loop, you’re prepared.”
Best Herb for Chronic Stress
Ashwagandha (Withania somnifera)
This adaptogenic herb helps the body rein in a runaway stress response by addressing chronically high cortisol and adrenaline. Romm calls ashwagandha “a nerve tonic that builds resilience and coping.”
In a review of five randomized controlled clinical trials, researchers noted significant anxiety relief among 400 participants who took daily doses of ashwagandha ranging from 120 to 1,200 mg for six to 16 weeks.
Over time, ashwagandha helps return the body’s stress response to baseline, says Mazzarella. It may especially benefit anxiety sufferers with a history of trauma, who often experience anxious hypervigilance. (For more on ashwagandha and other adaptogenic herbs, see “Ancient Healers: Adaptogens”.)
How to Use: Mazzarella recommends taking ashwagandha for at least three months. “People taking ashwagandha report an almost imperceptible upturn in mood and overall energy,” she says. “They’ll say, ‘I can handle things more easily’ or ‘Life is just better.’”
Best Herb for Restoring Mental Focus
Rhodiola (Rhodiola rosea)
Rhodiola has a history of use in supporting memory and mental focus, especially in northern locales, such as Siberia, where it grows wild. It’s also used to treat immune depletion resulting from overwork, chemotherapy, radiation, and other stressors.
Mazzarella likes rhodiola for its fast-acting assistance with focus, especially for stressful tasks like studying for an exam or rushing to meet a deadline. It’s ideal for “a big push of cognitive labor,” she says.
Despite rhodiola’s obvious appeal for people working long hours, research is scarce. But a small 2008 clinical trial at the University of California, Los Angeles, found that people with generalized anxiety disorder who took 340 mg of rhodiola extract daily for 10 weeks felt significant improvements — and experienced few side effects.
“Rhodiola is good for supporting and restoring a strained-adrenal system,” says Emmons, “especially if chronic stress has left you with brain fog.”
How to Use: Rhodiola can be mildly stimulating, so it’s best taken in the morning or early afternoon. Tinctures and capsules are both effective.
Best Herb for Mild to Moderate Anxiety
Chamomile (Matricaria recutita)
Chamomile is one of the oldest and most widely studied herbs. An estimated 1 million cups of chamomile tea are consumed worldwide every day. It can also be taken as a tincture.
“Chamomile is one of the safest calming herbs you can try,” says functional-medicine practitioner Mark Menolascino, MD.
Chamomile has many calming constituents, but one of the most potent is apigenin, a flavonoid that influences GABA.
Although chamomile is typically used for mild anxiety, new research hints that it can tackle moderate to severe symptoms too. In a 2016 study published in Phytomedicine, people with generalized anxiety disorder took 500 mg of chamomile three times daily for up to eight weeks. More than half-reported a “clinically meaningful” reduction in symptoms.
How to Use: Chamomile comes in many forms, but herbal tea is the most traditional form used to ease anxiety. Pour hot-water over 2 to 3 heaping teaspoons of dried chamomile, steep for five to 10 minutes, then strain. Drink as needed throughout the day.
Using Herbs for Anxiety
Most herbs can be taken in one of three forms:
- Tinctures are ideal for acute — meaning “in the moment” — stress because the active ingredients are quickly absorbed through tissues in the mouth and upper GI tract.
- Tea, made by steeping herbs in hot water, is a good choice. Wrapping your hands around a hot mug and sipping slowly can provide additional calming effects.
- Extracts are common for adaptogenic herbs, like ashwagandha. Freeze-dried extracts have a guaranteed potency, providing a consistent dose easily ingested in capsule form.
Tips for Buying Herbal Remedies
Not all herbal formulations are created equal.
“It’s the wild, wild West out there as far as what’s being sold and who is recommending what,” says functional-medicine practitioner Mark Menolascino, MD. The safe use of herbal remedies requires doing some homework and keeping a buyer-beware attitude. With that in mind, follow these basic guidelines:
- Avoid buying herbs online unless you know and trust the company. When possible, go to a natural-food store or co-op and ask staff for help selecting a reputable product. If you do buy online, herbalist Lily Mazzarella, MS, CNS, suggests choosing manufacturers with solid reputations, such as Herb Pharm and Gaia Herbs.
- Pass on the cheapest option. High-quality herbal formulas are expensive to produce, so avoid the temptation of the lowest cost.
- Notice certifications. A seal on the package may show the product is endorsed by a trustworthy third-party certification organization, such as the U.S. Pharmacopeial Convention (USP). But the absence of a seal doesn’t mean a product isn’t good, says Mark Blumenthal, founder and executive director of the American Botanical Council, a nonprofit herbal-research organization. “Some of the best products don’t have certification, which leaves consumers in a tough spot.”
- Start by trying single herbals in lieu of antianxiety mixtures. “With individual formulas, it’s easier to pinpoint what works for you,” says Menolascino.
- Pay attention to shelf life. When looking for freshness and potency, know that teas are the first to fade. Tinctures last quite a bit longer, because most are preserved in alcohol; Blumenthal believes these can last up to five years, and some maintain their potency even longer. For freeze-dried extracts, he suggests discarding them if you haven’t finished them before their expiration date. Still, there is little danger if you do take an expired capsule.
- Consider seeing an herbalist, a naturopath, or an acupuncturist for guidance, says Mazzarella. “A professional will help to identify if your anxiety is an indicator of a systemic imbalance that needs attention.”
Nutritional Support for Anxiety Relief
Herbal remedies can help manage acute stressors, but sustained anxiety relief usually requires a multitiered approach. Integrative psychiatrist Henry Emmons, MD, author of The Chemistry of Calm, advises including nutritional support in any anxiety-relief plan. He recommends these four supplements:
1. Magnesium: This nutrient is essential for the production of serotonin and the support of GABA. But most important, Emmons says, nerve-cell membranes use magnesium to relax after they’ve fired.
This relaxation is crucial because it calms brain activity. “I use a lot of magnesium for people suffering from anxiety and sleep issues,” he says. Studies show roughly half of all Americans aren’t getting enough magnesium from food alone. Emmons recommends a daily dose of 400 to 600 mg in the form of magnesium citrate, threonate, succinate, or glycinate.
2. 5-HTP: Made from the amino acid tryptophan, 5-HTP (short for 5-Hydroxytryptophan) is a precursor of serotonin, which also helps with depression, anxiety’s co-conspirator. 5-HTP also boosts melatonin, which is essential for good sleep. “If you were making a serotonin pie crust, 5-HTP would be analogous to the flour,” says Emmons. “5-HTP is crucial for getting the soothing brain chemical serotonin to be more available.” He recommends 50 to 100 mg up to three times a day.
3. B-complex: Vitamins B6, B12, and B9 (folate) support methylation, a process that tamps down cortisol production. “Plus, vitamin B6 aids in the production of GABA and serotonin, the two brain chemicals most likely to calm the fires of anxiety,” Emmons says.
He recommends 25 to 100 mg daily of B6; 50 to 200 mcg (micrograms) of B12; and 400 to 800 mg of folate.
Some people’s bodies don’t convert folate easily because of a variant in the MTHFR gene. If tests reveal this is the case for you, choose “activated” B vitamins.
4. L-theanine: A naturally occurring amino acid found in green tea, L-theanine balances the glutamine–GABA equation, explains Emmons. Glutamine is a naturally occurring substance that accelerates brain activity, while GABA works in the opposite way, slowing brain action.
“For safety and efficacy, L-theanine is one of the best antianxieties out there,” he says. He recommends taking 100 to 200 mg twice a day.
Lemon balm (Melissa officinalis)
A member of the mint family, lemon balm relaxes the body without sacrificing clarity of thinking. Lemon balm is great for quickly cooling off the sympathetic nervous system, says functional-medicine practitioner Mark Menolascino, MD. “It’s also extremely safe.” In a 2011 study, 300 mg of lemon-balm extract taken twice a day (morning and evening) lowered anxiety by 15 to 18 percent and reduced anxiety-related insomnia by 42 percent.
Although lemon balm is often combined with other calming and sedating herbs, such as valerian, lavender, and hops, Menolascino recommends trying it on its own first. “In general, I like to try one thing and see if it works before adding a second or a third herb. Otherwise, if it works you’re not sure why, and if it doesn’t work, same thing, you’re not sure why.”
How to Use: As a rule, start out by giving kids and elders half the dose recommended for adults and see how it goes. And, of course, if your child or elder is on prescription drugs, check with their healthcare provider before layering on an herbal antianxiety.
This originally appeared as “Herbs for Anxiety” in the March 2020 print issue of Experience Life.