Calming Anxiety, Depression & Insomnia: An Integrative Medicine Approach

Updated: Jun 16, 2020

On a daily basis in my medical practice I have patients approach me with terrible stomach issues, sleeping problems, heart palpitations, headaches, attention difficulty, and other issues frequently linked to the effects of stress hormones. In chronic stress and anxiety, the hormone cortisol drips through the body like a leaky fight-or-flight faucet. We need cortisol to survive, but too much for too long has toxic ramifications—the body and mind can compensate for a time, but, eventually, other health issues will manifest from cortisol’s unmitigated release, such as thyroid problems, chronic pain, eating disorders, adrenal fatigue, irritable bowel syndrome, hair loss, weight issues, hormonal imbalance, insomnia, immunosuppression, ulcers, heartburn, and much, much more.

Below, I list several herbs, foods, vitamins, amino acids, and more that have shown benefit in lowering anxiety, aiding sleep, and relieving depression.

For those who don't know me well, I am a family nurse practitioner (FNP). I am trained in conventional family medicine and urgent care. Prior to my FNP degree I worked as an RN in emergency medicine, ICU, maternal child health, and mental health. Alongside my partner, I own and operate Hearthside Medicine Family Care, an integrative medicine primary care practice. I love and value Eastern medicine, and I have studied—for over a decade and alongside traditional family-practice techniques—mind-body medicine and plant-based medicine. As such, I will frequently blend alternative and holistic medicines into my primary care practice, enhancing a given patient’s prescription treatment plan with herbs, supplements, and even new foods.

My mission is helping patients live a fuller life by getting to the root cause of their symptoms. Because I have personally dealt—off and on, and for much of my adult life—with anxiety, depression, and insomnia, I understand and empathize with my patients on their plane of struggle. First and foremost, I am adamant about destigmatizing mental health discussions. I have, intermittently, needed medication for the aforementioned health issues, and it is vital to remember that there is no shame in acknowledging that, sometimes, the hormones in our brains require reinforcements in the same manner we might support the hormones that impact our thyroid and blood sugar levels. Thus, I've also written a brief blog on which prescription medications may be useful to incorporate here:

While I will search rigorously for any and all underlying origins for a patient's symptoms, I can often trace ailments back to the toll of low serotonin (the "happy hormone") brought on by chronic anxiety. Depleted serotonin in the brain creates its own vicious cycle, one of increased nervousness and decreased sleep. Sometimes what’s needed to increase serotonin is a conventional pharmaceutical, just as sometimes synthetic panic-reducing medications and temporary prescriptive sleep aids are needed. But—and very often—nature's apothecary of herbs and supplements can do the trick, and even do it more effectively (then again, often a combination of herbs and supplements and pharmaceuticals, along with lifestyle changes and therapy, is the best course of action).

Below, I list several non-prescription options for treating anxiety and insomnia, and many of these will also aid with chronic fatigue, IBS, headaches, chronic pain, hormone imbalance, and depression. Please be aware that there are books and books containing volumes of warnings regarding possible drug-herb interactions and unpleasant side-effects and adverse reactions; I strongly advise discussing your personal health profile with me or another knowledgeable provider before beginning any of these options, as some may have dangerous consequences when combined with certain prescription meds or in the context of one's unique health picture. I list a few cautions, but certainly not all of them, so, again, it is vitally important that you seek professional guidance for any new regimen.

1. Lavender and Lavender Oil:

Taken on a regular basis about an hour before sleep, the European lavender extract product Lavela has demonstrated efficacy favorable to that of benzodiazapines in reducing anxiety, with none of the side effects or addictive potential.

Findings of two studies suggest that standardized extracts of lavender may have anti-anxiety effects similar to paroxetine (Paxil™) and lorazepam (Ativan™) (Kasper et al 2014; Woelk & Schlafke 2010).

Lavender oil can also be used as aromatherapy in a diffuser. On your pillow before sleep, in a bath, or a few drops applied topically to reduce acute anxiety symptoms.

The dose of lavender oil, as you find in the above product, is 80 mg/day.

Lavender relaxation tea: here is a nice recipe from Aviva Romm, MD:

½ tsp of each of the following: lavender blossoms, chamomile blossoms, and lemon balm leaf, and steep in a tea-pot or herbal tea infuser for 20 minutes in 1 cup of boiling water. The dose is 1 cup. Tincture dose is 1-2 mL in ¼ cup of water, up to 4 times/day.

Who should NOT use Lavender:

Lavender has been found to have mildly estrogenic actions (increasing estrogen),so if you have a history of estrogen receptor positive cancer, stick with gentle teas now and then, or skip this herb and choose from the other options below.

Oral lavender can cause constipation and headaches. It can also increase appetite, increase the sedative effect of other medications and supplements, and cause low blood pressure.

2. Curcumin

One of the principal active ingredients derived from the spice turmeric, has particularly powerful anti-inflammatory effects and these have been found to be helpful in reducing anxiety specifically associated with a chronically activated stress response.

For anti-anxiety effects, take curcumin extract. The key ingrediant that helps with both anxiety and inflammation is called "curcuminoids".

Curcumin has decent evidence for indications for anxiety, chronic pain, depression, IBS, lowering cholesterol and possibly aiding in weight loss. However, it has poor bioavailability alone, necessitating special formulations to be efficiently absorbed.

Dose: Studies typically use doses of 500–2,000 mg of turmeric per day, often in the form of an extract with a curcumin concentration that is much higher than the amounts naturally occurring in foods. Some brands include Meriva or Theracumin, which have been properly enhanced for best absorption--Turmeric can be safely used as a seasoning spice while pregnant; both turmeric and curcumin can be used safely in breastfeeding.

Side effects: High doses of curcumin may result in nausea and gastrointestinal problems. Use of curcumin with piperine may cause adverse drug reactions, as piperine greatly increases intenstinal permeability--but piperine is needed to make curcumin more bioavailable (better absorbed). Side effects of curcumin included sore throat, gastrointestinal bloating, swelling around the eyes and itching.  These side effects were more frequent at doses higher than 1,200 milligrams

Important note before you buy: Often, cheaper supplements contain just turmeric root powder, which contains about 2-4% curcuminoids. The key amount of curcuminoids you need for an effective turmeric supplement is around 1000 mg of 95% curcuminoids. Therefore, look on the label for the words "tumeric root extract" not just "tumeric root" or "tumeric root powder", generally speaking. Avoid supplments that list a "proprietary blend" in their ingrediant list--this often means there is no guarantee of how many curcuminoids you are actually getting because they don't have to disclose it.

Who should use caution/avoid use: Due to scant safety data in pregnancy, I advise to not use during pregnancy. Avoid if you have iron deficiency anemia. Caution if you have autoimmune disease—some people will find curcumin to help their condition, and others have found it to exacerbate symptoms. And finally, like many supplements, there are some reports that some brands may have lead contamination or contamination with other substances, so be sure to by a reputable brand that is USP verified and/or has a certificate of analysis (see more on this below).

3. Adaptogens

Adaptogens are a class of herbs that safely, gently, and effectively regulate the body’s stress response via their tonic actions on the adrenal glands. They are best used for chronic anxiety rather than for panic attacks (acute anxiety) and work well for adrenal fatigue.

Adrenal fatigue is a disorder that is associated with a variety of symptoms, including fatigue, lightheadedness, body aches, and low blood pressure. When your adrenal glands can’t work properly, mostly due to chronic physical and mental stress, you start experiencing the mentioned symptoms.