Anxiety describes any feeling of worry or dread, usually about events that might potentially happen. Some anxiety about stressful events is normal. However, in some people, anxiety interferes with the ability to function.

Some people who think they are anxious may actually be depressed. Because of all these factors, it is important for people who are anxious to seek expert medical care. Natural therapies can be one part of the approach to helping relieve mild to moderate anxiety.

What are the symptoms of anxiety?

Physical symptoms of anxiety include fatigue, insomnia, stomach problems, sweating, racing heart, rapid breathing, shortness of breath, and irritability.

Medical treatments for anxiety

Prescription drug treatment includes anti-anxiety agents such as lorazepam (Ativan®), alprazolam (Xanax®), and buspirone (Buspar®). Antidepressants, such as fluoxetine (Prozac®), paroxetine (Paxil®), and venlafaxine (Effexor®), are often prescribed to treat generalized anxiety and panic attacks.

Underlying medical conditions, such as excess hormone secretion from the thyroid or adrenal glands, should be treated when present. Psychological counseling often accompanies drug therapy.

Dietary changes that may be helpful for anxiety

All sources of caffeine should be avoided, including coffee, tea, chocolate, caffeinated sodas, and caffeine-containing medications. People with high levels of anxiety appear to be more susceptible to the actions of caffeine.

Nutritional supplements that may be helpful for anxiety

Inositol has been used to help people with anxiety who have panic attacks. Up to 4 grams three times per day was reported to control such attacks in a double-blind trial. Inositol (18 grams per day) has also been shown in a double-blind trial to be effective at relieving the symptoms of obsessive-compulsive disorder.

An isolated double-blind trial found that supplementation with a multivitamin-mineral supplement for four weeks led to significant reductions in anxiety and perceived stress compared to placebo.

Many years ago, magnesium was reported to be relaxing for people with mild anxiety. Typically, 200 to 300 mg of magnesium are taken two to three times per day. Some doctors recommend soaking in a hot tub containing 1–2 cups of magnesium sulfate crystals (Epsom salts) for 15 to 20 minutes, though support for this approach remains anecdotal.

Niacinamide (a form of Vitamin B3) has been shown in animals to work in the brain in ways similar to drugs such as benzodiazepines (Valium®-type drugs), which are used to treat anxiety. One study found that niacinamide (not niacin) helped people get through withdrawal from benzodiazepines - a common problem. A reasonable amount of niacinamide to take for anxiety, according to some doctors, is up to 500 mg four times per day.

Herbs that may be helpful for anxiety

Several plants, known as “nervines” (nerve tonics), are used in traditional herbal medicine for people with anxiety, with few reports of toxicity. Most nervines have not been rigorously investigated by scientific means to confirm their efficacy. However, one study found that a combination of the nervines valerian and passion flower reduced symptoms in people suffering from anxiety. In a double-blind study, 45 drops per day of an extract of passion flower taken for four weeks was as effective as 30 mg per day of oxazepam (Serax®), a medication used for anxiety.

Other nervines include oats (oat straw), hops, passion flower, American scullcap, wood betony, motherwort, pennyroyal, and linden.

St. John’s wort has been reported in one double-blind study to reduce anxiety.

An old folk remedy for anxiety, particularly when it causes insomnia, is chamomile tea. There is evidence from test tube studies that chamomile contains compounds with a calming action. There are also animal studies that suggest a benefit from chamomile for anxiety, but no human studies support this belief. Often one cup of tea is taken three or more times per day.

Warning: Kava should only be taken with medical supervision. Kava is not for sale in certain parts of the world.

Until recently, the preeminent botanical remedy for anxiety was kava, an herb from the South Pacific. It has been extensively studied for this purpose. One 100 mg capsule standardized to 70% kava-lactones is given three times per day in many studies. Preliminary and double-blind trials have validated the effectiveness of kava for people with anxiety, including menopausal women. A previous study found kava to be just as effective as benzodiazepines over the course of six weeks. The latest research shows that use of kava for up to six months is safe and effective compared with placebo. Although kava rarely causes side effects at the given amount, it may cause problems for some people if combined for more than a few days with benzodiazepines.

Holistic approaches that may be helpful for anxiety

Reducing exposure to stressful situations can help decrease anxiety. In some cases, meditation, counseling, or group therapy can greatly facilitate this process.

Acupuncture has been the subject of limited research as a therapy for anxiety. In an uncontrolled study, eight patients suffering from anxiety were treated with acupuncture three times per week for eight sessions. Six of the eight patients achieved good to moderate improvement. However, a trial of acupuncture treatment for anxiety associated with quitting smoking did not provide any evidence of benefit. A double-blind study of acupuncture for the treatment of anxiety associated with dental procedures reported that acupuncture and placebo were equally effective. Acupuncture remains unproven in the treatment of people with anxiety.

A form of counseling known as Cognitive-Behavioral Therapy (CBT) has been shown to be superior to placebo for managing the symptoms of panic disorder. In a controlled trial, six months of CBT produced a response rate of 39.5%, compared to only 13% in the placebo group. When combined with the tricyclic antidepressant drug imipramine (Tofranil®), response rates were even higher (57.1%). For long-term management of panic disorder, imipramine produced a superior quality of response, but CBT had more durability and was better tolerated.