WHAT IS ANXIETY?
Although the cause of anxiety disorders, like many other mental health disorders, is really not fully understood, anxiety appears to be caused by an interaction of biophysical and psychosocial factors. Anxiety can be caused by medications, trauma, childhood experiences, or as a secondary to another condition such as depression or eating disorders. It can also occur due to other conditions such as thyroid problems, or menopause for example.
The significant mediators of anxiety in the central nervous system are thought to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA). The autonomic nervous system, especially the sympathetic nervous system, mediates most of the symptoms.
Anxiety disorders are one the most common of all mental health problems. It is estimated that one in ten Canadians is affected by it. Though the true prevalence is unknown because many people do not seek help or clinicians fail to make the diagnosis.
Types of Anxiety: Panic disorder, Phobias, Generalized Anxiety Disorder, PTSD, OCD, separation anxiety
ANXIETY AND THE PANDEMIC
Of course, due to current events in the world, we cannot ignore the elephant in the room and is important to also look at the impact the pandemic has had on mental health and in this case anxiety levels.
Since COVID-19, only about 55% of Canadians report having good mental health (July 2020), that's down from 68% the previous year. Youth aged 15-24 report the greatest decline with a 20-percentage point reduction going from 60% (pre-COVID) to 40% (July 2020).
Seniors aged 65 and older are the only group to date who have not experienced declines in mental health since the pandemic began. One could speculate this may be because for many of them, life was not disrupted in a significant way. But again, that is just speculation.
Unfortunately, women continue to report lower levels of mental health compared with men: 52% vs 58%.
NOTE: This blog post are notes from a presentation I did last spring. Hence, the statistical information should have changed now. However, I did look for the updated report from the gov of Canada and it didn't have this information on mental health again. I am unaware if they have continued recording this information.
STRESS VS ANXIETY
When you are suddenly faced with an unexpected situation or you are requested to speak in front of a large audience, your palms may start to get sweaty, your thoughts might feel like they are going a hundred miles per hour as your heart. This is anxiety, and we have all had it. When faced with a threatening event such as a physical attack or a natural disaster, most people feel anxiety or fear. Our bodies give us a surge of adrenaline and our instincts take over. This gives us the strength we need to get out of the situation and survive (as it is a perceived danger).
And this “transient anxiety” or stress response, from time to time is normal and healthy. It can help motivate us - like all of those nights when I had a paper or case study due the next morning! - and it can help us get out of tough situations. But when anxiety lasts beyond that moment of climax and goes on for hours and days, maybe weeks or months, it becomes a constant sense of dread or begins to affect your everyday life, then in this case the person may have an anxiety disorder. People who suffer from anxiety disorders have long periods of intense feelings of worry or distress about a perceived threat, even if they don’t know what it is.
Also, as previously mentioned, anxiety is not always a disorder on its own, it can be secondary to depression, or it can occur due to other conditions. While the herbal approaches I will share with you can help with anxiety regardless of its cause, is important to work with a practitioner in order to also address what the cause may be for a better outcome and to consult with your health provider for a proper diagnosis.
Many of the physiological and pharmacological effects of herbs in the body are still not fully understood. Some of the mechanisms of action for herbal medicines used in the support of psychiatric disorders are thought to primarily involve modulation of neural communication, via specific plant metabolites binding to neurotransmitter receptors. And/or through alteration of neurotransmitter synthesis and general function. Other actions may involve stimulating or sedating central nervous system activity, as well as regulating or supporting the healthy function of the endocrine system.
Herbal medicines have a range of therapeutic actions which may include antidepressant, anxiolytic, nootropic, sedative, analgesic, adaptogenic, and/or trophoresotrative. While there is nothing wrong with an informed consumer deciding what plants to use, for better results a lot of times is best to consult with a clinical herbalist that can help you select the proper herbs and formulations for your situation.
The following is just a small list with some examples of common plants/herbs that may have a safer range of safety for most people and that are also easily accessible. These are not by any means comprehensive monographs either, they are just a snippet of information relevant to this post.
Lemon balm (Melissa officinalis)
Lemon balm is a member of the mint family and one of my most favorite plants.
Part used: Leaf
Properties: Carminative, nervine, anxiolytic
Preparations: Tea, tincture
Dosage: 3-5g dried plant infusion per day
Safety considerations: Generally considered safe
A 2015 study evaluated the use of a water-based lemon balm treatment to reduce heart palpitations with anxiety as one of the secondary outcomes measured. This study found that regular use of lemon balm reduced the frequency of both palpitation and anxious episodes in the treatment group when compared to the control group.
Insomnia is a common problem during hormonal changes like menopause for example, but it is also a problem when you are anxious, and your mind is constantly worrying and thinking… unfortunately many of the available treatments for insomnia come with serious side effects. A 2013 study looked at the use of lemon balm with valerian added to treat sleep-related symptoms in menopause, with 81% of the women enrolled experiencing improvements in sleep as compared to the placebo.
We cannot underestimate the importance of good sleep, in both physical and mental health. When you have poor sleep your stress response may be heightened, you may have difficulty with decision-making processes, you may make poor food choices and it just basically becomes a vicious cycle. Personally, when I am working with a client, sleep is one of the very first things we look at, even if that was not one of their reasons for meeting me.
You can use lemon balm as an infusion or tincture, on its own or combined. One of my favorite combinations includes lemon balm (3 parts), lavender (3p), and rose petals (1p).
Lavender (Lavandula angustifolia)
Part used: Flowers
Properties: Anxiolytic, neuroprotective, antispasmodic
Preparations: Tea, tincture, volatile oil
Dosage: 3-6g dried plant infusion per day
Safety considerations: None known
We all know that lavender is very good for calming skin irritations and that lavender baths can be deeply relaxing for the mind and body through its effects from the volatile oil content. Though, sedative and relaxing properties are also enjoyed in teas and drinks made from dried flower buds. It is often added to formulas to bring a calming effect to regular pregnancy teas or childhood bedtime routines.
Now, much of the research that is done on lavender has been done with the distilled volatile oil (aka essential oil). But there is no reason to conclude the flowers wouldn’t have the same calming effects.
Applications and clinical indications:
• Useful in anxiety and insomnia; useful in anxiety associated with premenstrual
• Overall nervous tension; any symptoms associated with anxiety e.g., headaches
• Carminative action useful in indigestion, bloating, gas, IBS
There are other Nervines such as Valerian or Skullcap that do not suit everyone whereas Lavender is well-tolerated and most times amazingly effective.
Chamomile (Matricaria chamomilla)
Part used: Flowering tops
Properties: Anti-inflammatory, carminative, mild sedative
Preparations: Tea, tincture
Dosage: 6 - 12g dried plant infusion per day
Safety considerations: Avoid if known sensitivity or allergy.
A gentle herb that is kid friendly and very safe to use with most people, unless of course you have an allergy to the ragweed family. But as Jim Mcdonald has said “gentle does not mean weak.” Chamomile is not only gentle and powerful, but it also seemingly does a hundred different things, from soothing the nervous system, and helping to relieve some cold and flu symptoms, to promoting digestion. A soothing chamomile tea at night, or even as a bath - especially for little ones - can help with a good night's sleep.
Researchers have taken an interest in chamomile and have conducted several human clinical trials to evaluate its ability to address both depression and anxiety. In an exploratory study, researchers found that chamomile, even at a relatively small dose of 220 mg, was more effective than a placebo in relieving both depression and anxiety symptoms. A randomized, double-blind, placebo-controlled trial of oral chamomile extract for generalized anxiety disorder (GAD) found a significantly greater reduction in mean anxiety symptom ratings for chamomile versus placebo, and a non-significant reduction in depression ratings with chamomile versus placebo.
Holy basil (Ocimum sanctum)
Part used: Leaf
Properties: Adaptogen, aromatic digestive, relaxing nervine, cardiovascular tonic, neuroprotective
Preparations: Tea, tincture, capsules
Dose: 3 - 4g / dried or fresh plant per day
Safety considerations: Do not take during pregnancy or if trying to conceive.
Holy basil or Tulsi is an Ayurvedic herb that has now become widely used in western herbal medicine. Daily consumption of Tulsi is said to prevent disease, promote general health, well-being and longevity, and assist in dealing with the stresses of daily life. In addition to these health-promoting properties, Tulsi is recommended as a supportive treatment for a range of conditions including anxiety.
Animal studies further reveal that Tulsi may enhance memory and cognitive function and protects against aging-induced memory deficits. Similarly, in human studies, Tulsi has been observed to reduce stress, anxiety and depression. With a 6-week, randomized, double-blind, placebo-controlled study reporting that Tulsi could improve general stress scores, sexual and sleep problems and symptoms such as forgetfulness and exhaustion.
Holy basil may have an anti-fertility effect on both men and women and thus should not be taken by couples wishing to conceive or by pregnant women.
Ashwagandha (Withania somnifera)
Part used: Root
Properties: Adaptogen, mild sedative, tonic
Preparations: Decoction, tincture, powder
Dosage: 3 - 6g dried root as decoction per day. 1 - 3g of powdered root.
Safety considerations: Generally safe. May potentiate the sedative effects of barbiturates.
And then we have ashwagandha, another ayurvedic herb that has become really popular in the last few years. It’s commonly called “Indian ginseng” because it’s used in ayurveda in much of the same way as Ginseng in TCM to improve vitality. In western herbal medicine, it’s considered an adaptogen.
Adaptogenic herbs, by definition, are herbs that are non-toxic and used to generally support the health of a person under stress in non-specific ways. In a way it helps the body build resilience. It doesn’t mean you won't get stressed or that you will deal with a stressful situation cool as beans, just that your physiological response may become more appropriate and help reduce any of the negative effects that prolonged stress can have.
When it comes to ashwagandha Several studies have shown it helps reduce anxiety and tension. For example, in a study from 2009 ashwagandha combined with dietary advice, was found to be more effective in decreasing anxiety than a placebo and psychotherapy. Those taking the ashwagandha also reported improved concentration and less fatigue. Now, I am not suggesting here that it could replace therapy, au contraire, I think it would be a great addition! If it works well without it, imagine how much more beneficial it could be to include in your diet while talking to someone in a psychotherapy setting. And personally, am a big advocate for psychotherapy.
Ginger (Zingiber officinale)
Parts used: Rhizome
Properties: anti-inflammatory, stimulating diaphoretic, stimulating expectorant, carminative
Preparations: Food, decoction, tincture, capsules
Dosage: 1- 2g dried per day
Safety considerations: Should be avoided in large doses by those with peptic ulcers and gallstones. May interact with blood thinning medication.
You are probably wondering, why is ginger here? Isn’t that used for nausea?
Ginger has been evaluated in multiple clinical trials for nausea from a wide variety of sources ranging from chemotherapy to pregnancy. It is effective on an as-needed basis with a daily dose of 1 to 3g total. In the literature, studies evaluating ginger’s efficacy at treating nausea have found it to be effective for nausea caused by morning sickness, motion sickness, chemotherapy, medication side effects, and surgical procedures.
But ginger is also known for its ability to support gut health, and recent research has evaluated its ability to alleviate anxiety as a result. When taken regularly, it appears to help prevent and treat moderate anxiety. In a 2021 study, a water-based ginger extract was found to reduce anxious behavior (in rats), which the authors hypothesized may be caused by increased production of serotonin and the metabolism and of tryptophan (a serotonin precursor).
Ginger has many beneficial effects on digestion and gut flora, and although we still have not completely understood the full effect gut health has on our mental health, we do know there is a connection and thus you may have heard of the Gut-Brain Connection.
As I mentioned before, in its volatile or essential oil form, is very well known to promote relaxation. It can be used by inhalation, in baths, or topically. And a less conventional and more "controversial" form is by ingestion. Ingested lavender volatile oil has been shown to be effective against anxiety. A standardized lavender essential oil named Silexan has been the subject of many clinical studies and is currently an over-the-counter supplement in the US under the name CalmAid; and a pharmaceutical drug in Germany under the name Lasea.
After several studies demonstrated the effectiveness of his lavender oil against placebo for anxiety, a 2010 study compared it to pharmaceutical benzodiazepines in a randomized, double-blind study. In this study, 77 total patients were randomized with 40 entering the Silexan test group. They were evaluated for a total of 6 weeks. At the conclusion of the study, patients were assessed for improvement from the baselines collected prior to the start. The lorazepam (benzodiazepine) group showed a 40% reduction in the anxiety scale, whereas the lavender oil group showed a 52.5% reduction in the anxiety scale. The only common side effect recorded for lavender was “lavender burps”.
I am not suggesting that if you take benzos you can go off them and start taking silexan. You need to talk to your doctor if you want to make the switch so that you can properly tamper off the benzos and monitored. Also, if you are not currently on any medication and want to try silexan, do keep in mind that just like conventional drugs it may take a couple of weeks for you to notice a significant change. Products like silexan have standardized dosages of lavender and may not be replicated by home-made products.
Orange volatile oil, which comes from the rim of the fruit is a relaxing and anxiolytic oil that can be used to blend or mask the smell of lavender, because as great as lavender is, a lot of people cannot handle the smell. It can also be used on its own without lavender. In one randomized clinical trial that investigated the effects of sweet orange oil on the induction and recovery of 120 children experiencing dental extraction while under anesthesia, the researchers determined that orange oil caused the children to be more relaxed and cooperative during induction. A personal inhaler that you can carry in your purse would be a good choice for this oil, as are body wash products that you can use at nighttime to help you relax before bedtime.
Numerous studies exist to document the positive effects of bergamot inhalation on anxiety. Most find beneficial results after 10-15 minutes of total (direct) inhalation. For example, a 2013 study evaluated the effects of bergamot inhalation on pre-surgical anxiety among 109 patients. Those who inhaled bergamot for 30 minutes during preparation experienced a reduction in total anxiety scores, heart rate, and total blood pressure, reflecting what is believed to be an overall reduction in the corticosterone response to stress.
You can also use bergamot topically, but please keep in my mind that like other citrus oils, it is phototoxic, and when you apply them to skin and then come into contact with sunlight or tanning beds your skin will burn. So, it’s recommended you avoid direct sunlight for 12 hours after application, which may be doable in winter but not summer. Using a personal inhaler, essential oil jewelry, or cotton ball in a jar may be a better option.
Diet – you don’t need to have a perfect diet (whatever your idea is of that), just include a variety of nutritious foods. Making sure you are eating healthy fats, lots of colour, and adequate protein.
Lifestyle choices – smoking, drinking caffeine, and alcohol consumption all can negatively impact mental health, and more specifically anxiety.
Movement – are you moving your body daily? Have any exercise routines? Are you stiff and in pain?
Employing other techniques, such as breathing exercises, mindfulness, and spending time in nature.
Self-care practices - taking the necessary time to tackle some to-dos, to relax, do something you enjoy, sleep, eat, etc.
Psychotherapy/counseling - I have and will always advocate for talk therapy. Though I understand sometimes it may be cost-prohibitive for some, there are many affordable and even free resources available. Also, check with your insurance provider to see if they cover the expenses for this service.
Remember this post does not constitute medical advice. If you are experiencing severe anxiety and depression, seek help. Especially if is affecting your daily life, or you have thoughts of self-harm. Herbs can help, but they are not a one-stop answer, having a team of practitioners working with you can be the most beneficial. If you take any medication, is best to talk to your doctor or consult with a Clinical or Medical Herbalist before adding herbs to your daily routine to avoid any potential interactions.
References consulted (According to the order mentioned in the article).
The Social and Economic Impacts of COVID-19: A Six-Month Update. Impacts on Mental Health. Statistics Canada. Oct. 2020.
Alijaniha F, Naseri M, Afsharypuor S, Fallahi F, Noorbala A, Mosaddegh M, Faghihzadeh S, Sadrai S. Heart palpitation relief with Melissa officinalis leaf extract: double blind, randomized, placebo controlled trial of efficacy and safety. J Ethnopharmacol. 2015 Apr 22;164:378-84. doi: 10.1016/j.jep.2015.02.007. Epub 2015 Feb 11. PMID: 25680840.
Taavoni S, Nazem Ekbatani N, Haghani H. Valerian/lemon balm use for sleep disorders during menopause. Complement Ther Clin Pract. 2013 Nov;19(4):193-6. doi: 10.1016/j.ctcp.2013.07.002. Epub 2013 Sep 10. PMID: 24199972.
Amsterdam JD, Shults J, Soeller I, Mao JJ, Rockwell K, Newberg AB. Chamomile (Matricaria recutita) may provide antidepressant activity in anxious, depressed humans: an exploratory study. Altern Ther Health Med. 2012 Sep-Oct;18(5):44-9. PMID: 22894890; PMCID: PMC3600408.
Bano, S., Sharif, H., & Badawy, A. A.-B. (2021). Effects of oral administration of an aqueous ginger extract on anxiety behavior and tryptophan and serotonin metabolism in the rat. Asian Journal of Medical Sciences, 12(6), 38–43. https://doi.org/10.3126/ajms.v12i6.34480
Woelk H, Schläfke S. A multi-center, double-blind, randomised study of the Lavender oil preparation Silexan in comparison to Lorazepam for generalized anxiety disorder. Phytomedicine. 2010 Feb;17(2):94-9. doi: 10.1016/j.phymed.2009.10.006. Epub 2009 Dec 3. PMID: 19962288.
Mehta, S., Stone, D.N. and Whitehead, H.F. (1998), Use of essential oil to promote induction of anaesthesia in children. Anaesthesia, 53: 720-721. https://doi.org/10.1046/j.1365-2044.1998.537q-az0584q.x
Cheng-Hua Ni, Wen-Hsuan Hou, Ching-Chiu Kao, Ming-Li Chang, Lee-Fen Yu, Chia-Che Wu, Chiehfeng Chen, "The Anxiolytic Effect of Aromatherapy on Patients Awaiting Ambulatory Surgery: A Randomized Controlled Trial", Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 927419, 5 pages, 2013. https://doi.org/10.1155/2013/927419