Updated: Jan 20
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. I also provide links to my favorite brands-our readers can access these suggestions and any other supplement they may want for 10-15% off suggested retail price by creating an account on our Fullscript dispensary: https://us.fullscript.com/welcome/hearthsidemedicine/signup
For those who don't know me well, I am a family nurse practitioner (FNP) trained in conventional family medicine and integrative + functional medicine. 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 will frequently blend herbs and nutrients into my primary care practice, sometimes as a stand-alone treatment or as an adjunct to a prescription. For nutrient levels, including all vitamins, minerals, antioxidants and omega-3 fatty acids, I often order a comprehensive nutrient panel on patients to check their baseline nutrient levels to determine which supplements are needed most and in what dose.
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 and insomnia, I understand and empathize with my patients. First and foremost, I am adamant about destigmatizing mental health discussions. Thus, I've also written a brief blog on which prescription medications may be useful to incorporate here: https://www.hearthsidemedicine.com/post/anxiety-to-medicate-or-not-medicate-and-which-ones-if-so
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. High Potency Lavender Extract:
Taken on a regular basis about an hour before sleep, the European lavender extract product Lavela has demonstrated efficacy favorable to that of benzodiazepines 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.
One of the principal active ingredients derived from the spice turmeric, has particularly powerful anti-inflammatory effects, found to be helpful in reducing anxiety specifically associated with a chronically activated stress response. *Side Note: Curcumin is one of my go-to nutrients for gut health issues, high cholesterol and/or chronic pain and inflammation as well!
For best absorption, take curcumin extract. The key ingredient that helps with both anxiety and inflammation is called "curcuminoids". Curcumin has decent evidence for indications for anxiety, chronic pain, inflammation, depression, IBS, lowering cholesterol and possibly aiding in weight loss.
Dose: Studies typically use doses of 500–2,000 mg of curcumin/ 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 Theracurmin, which have been properly enhanced for best absorption; curcumin can be used safely in breastfeeding.
Side effects: High doses may result in nausea and gastrointestinal problems. 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. I suggest patients start with a dose of 500 mg /day x 1 week and increase as tolerating.
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 500- 1200 mg of 95% curcuminoids. Look on the label for the words "turmeric root extract" not just "turmeric root" or "turmeric root powder", generally speaking. Avoid supplements that list a "proprietary blend" in their ingredient 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. 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).
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 and depression rather than for panic attacks (acute anxiety) and work well for adrenal fatigue or insomnia as well. They start working their best after 30 days of use, much like anti-depressant prescription drugs.
I have had multiple patients with depression and/or anxiety start Ashwagandah instead of an SSRI (prozac, lexapro, zoloft, etc) and report a major shift in their mood. It is safe to take with an SSRI as well. It can also help with ADHD and 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.
Adaptogens are meant to be taken daily, over a period of 3 months to a year for optimal results. They are safe for most adults (not for pregnant folks, and if you are on medications for an autoimmune disease talk with your medical provider first). Some can be used with children, too (check with your child’s provider).
Examples include Ashwagandha (Withania somnifera), Rhodiola (Rhodiola rosea), Eleutherococcus (Eleutherococcus senticosus) , Reishi mushroom, Ginseng (Panax ginseng) , and Schisandra (Schisandra chinensis) and Holy Basil (Tulsi). Please note that some herbs, including some of these (like ginseng, may increase risk of bleeding if taken in large amounts, which can be significant for those on blood-thinners or with clotting disorders.
One of my own favorite blends is Vital Adapt by Natura Natural Products. It contains these adaptogens as well as additional supporting herbs. There are many adaptogen blend products I love, and I generally choose the calming adaptogens like holy basil and rhodiola for anxiety and the energizing adaptogens like eleuthero, ashwagandha and ginseng for depression.
Reishi (adaptogen). This is safe to use while breastfeeding. The dose is 3 to 9 g dried mushroom in capsules or tablets daily or 2 to 4 mL tincture in water 2 to 3x/day
Ashwagandha can significantly reduce the symptoms of anxiety, and has been shown to improve cortisol levels by resetting adrenal-associated stress, overall reducing your predisposition to anxiety. Adaptogens do not work overnight. They are best taken daily, not “as needed”, to reach full effectiveness.
Ashwagandha helps balance hormones that contribute to anxiety and depression as well as helping induce relaxation . A number of studies support the effectiveness of the herb as a natural anxiety & depression remedy. In 2012, a study found that patients diagnosed with anxiety disorder showed significantly lower anxiety and 28% lower levels of serum cortisol when taking Ashwagandha as opposed to a placebo. I advise taking it in the morning, starting with 500 mg/day x 1 week, then slowly increase up to 1800 mg /day if needed/tolerated.
You can add 1-2 tsp of the powder to smoothies or other foods, it can be taken in capsules, 500-1000 mg twice daily, or in tincture form, 2-4 mL, twice daily. I don't care for the grassy taste so stick to the pills. Most patients tolerate this relatively well, but caution should be advised if there are underlying thyroid concerns, and some studies suggest that intermittent thyroid levels be checked. I have had a couple patients report increased anxiety taking it, so as with anything, “start low, go slow” with the dose to see how your body responds to it.
Also know as tulsi, holy basil is another adaptogen often used together with ashwagandha and/or rhodiola. This combination is often helpful for those with anxiety-induced sleep disorders as well. There is some evidence that holy basil may help lower cholesterol as well as high blood sugar levels (such as in pre-diabetes or frank diabetes). Holy basil is one of my favorites to calm an over-stimulated brain and nervous system.
Contraindications: Holy Basil (Tulsi) and Ashwagandah are contraindicated if you have hypoglycemia, are pregnant or breastfeeding.
Rhodiola. The bright yellow-green plant is also known as golden root or roseroot. Rhodiola is an adaptogen herb and is the second-most-consumed in traditional medicine. As an adaptogen herb, it can have a direct effect on your stress levels and ability to control and manage stress. The herb has been shown to have beneficial qualities in the relief of anxiety symptoms. Rhodiola encourages calmness and relaxation as well as being a natural stress reducer. I find this adaptogen to be incredibly helpful for high anxiety and stress.
For a calming blend of adaptogens, I like Gaia's Daytime HPA.
Chamomile is a gentle, effective and natural way to treat anxiety. If you’re not a fan of tea, it’s also available in pill form. It’s also been known to ease digestion issues and encourage sleep, helping many insomnia sufferers. Chamomile tea is safe during pregnancy and while breastfeeding. It is a good option for children as well.
Limited data shows that short-term use of chamomile is generally considered safe and can be effective in reducing symptoms of anxiety. It also works well for stomach cramps and indigestion. It can be taken as a stand-alone or in combination with other calming ingredients for sleep such as 5-HTP, L-theanine, hops, passionflower and GABA. An example of some combo supplements I like are Botanicalm, Sleep and Neurosera.
Caution: chamomile can increase the risk of bleeding when used with blood-thinning drugs (or with other blood-thinning foods and supplements such as gingko, ginger, and garlic).
Use of chamomile can cause allergic reactions in some people who are sensitive to the family of plants that includes chamomile. Other members of this family are ragweed, marigolds, daisies and chrysanthemums. Don't take it for more than a few weeks at a time, unless your medical provider approves. It can cause some side effects such as headaches, dizziness and drowsiness. Some compounds in chamomile (Matricaria recutita) bind to the same brain receptors as drugs like Valium.
You can take chamomile extract as a supplement, typically standardized to contain 1.2% apigenin (an active ingredient). In one study at the University of Pennsylvania Medical Center, in Philadelphia, patients with generalized anxiety disorder (GAD) who took chamomile supplements for eight weeks had a significant decrease in anxiety symptoms compared to patients taking placebo.
5. Lemon balm
Lemon balm is used classically to promote relaxation and improve outlook; motherwort, a bitter tasting herb, is also gentle go-to for anxious moments and often combined with lemon balm. Lemon balm may also be helpful in treating digestive issues and headaches. Motherwort is generally considered safe while breastfeeding only (not pregnancy). The full dose is 300 milligrams up to four times a day.
In one study of healthy volunteers, those who took standardized lemon balm extracts (600 mg) were more calm and alert than those who took a placebo. Lemon balm is sold as a tea, capsule, and tincture. It's often combined with other calming herbs such as hops, chamomile, and valerian. Capsules: Take 300 to 500 mg dried lemon balm, 3 times daily or as needed
A calming combo product that can be taken during the day for those with high anxiety, or at night for those with sleep concerns, is "Sleep Aide" by Vital Nutrients: lemon balm, ashwagandha, L-theanine, magnolia, cordyceps and phosphatidylserine:
Caution: Lemon balm is generally well-tolerated and considered safe for short-term use, but can cause nausea and abdominal pain.While it's generally safe, be aware that some studies have found that taking too much can actually make you more anxious. So follow directions and start with the smallest dose.
6. Kava kava (Piper methysticum)
Extracts of kava mediate anti-anxiety effects by binding to neurotransmitter receptors for GABA, dopamine, and the opioid receptors. Research findings support that an effective dose of kava for reducing symptoms of generalized anxiety is between 120 and 300mg of a standardized extract.
Caution: Kava inhibits certain liver enzymes involved in the metabolism of different medications, resulting in potential herb-drug interactions in individuals who take antidepressants, benzodiazepines and beta-blockers.
Kava is an excellent “emergency remedy” for a panic attack, and is great for use when there is stage fright, test anxiety, or fear of flying. 3-5 drops is often a sufficient dose of kava, though you can go up to even 30 drops at a time-- give it 30 minutes before you take more at any given time because it doesn’t always ‘hit’ right away.
Caution: While it is overwhelmingly safe for occasional use (a few times a month, for example) and even daily use at very low doses, for higher doses, taken regularly, I recommend working with a licensed practitioner, because there is a remote risk of it affecting the liver (do not use if you have liver disease!)
Its side effects may include stomach complaints, restlessness, headache and fatigue. Of more concern are interactions between kava and other medications. Kava can intensify sleepiness if taken with sedatives, sleeping pills, antipsychotics or alcohol, raising the risk of injury during activities such as driving and using heavy machinery. It may also enhance the sedating effects of anticonvulsants and worsen the side effects associated with antipsychotic medication
7. Vitex (also called Chasteberry or Chaste tree)
Vitex is often used for hormonally-related mood swing support caused from low progesterone. Vitex works by decreasing levels of the hormone prolactin. This helps rebalance other hormones, including estrogen and progesterone — thus reducing PMS/PMDD symptoms.
Dose: Vitex is best taken in one dose, first thing in the morning with water. If you’re taking capsules, you need to be taking about a 900-1000 mg a day. Vitex is also available as a liquid extract. If you choose this option, take 2-3 dropperfuls (or follow the suggested use of the manufacturer of the product you purchase). You can start to see results in about 10 days. Vitex, however, takes some time to be effective. The amount of time it takes to see results in part depends on the severity of hormonal imbalance, sometimes up to 2-3 cycles.
Vitex is well-known for hormonal mood support, often easing depression and anxiety that may occur during PMS and can reduce PMS symptoms in general. Motherwort is another herb often combined with vitex for hormonal support.
Because chasteberry affects hormones, it may worsen some diseases, including breast, uterine and ovarian cancer. Avoid chasteberry if you have any of these or another condition that’s negatively impacted by hormonal changes. Don’t take chasteberry if you’re pregnant or breast or chestfeeding.
8. Essential Fatty Acids:
Our nervous system requires essential fatty acids for healthy brain functioning. They can be obtained from foods that contain them, for example, cold water fish, walnuts, and flax seed oil all contain different types. They can also be obtained by supplementation – which I recommend as an addition to a healthy diet if you have anxiety, depression, ADHD, OCD, or Bipolar disorder.
Dose: 2000-3500mg/day taken with food and Vit D/K/Mag
There are many excellent brands. I recommend Nordic Naturals most often because they test for mercury contamination, something to consider. For vegans, there is a non-animal derived variety:
9. Magnesium and Vitamin D:
Magnesium Dose: 400 – 600 mg/day of Magnesium glycinate. Taking magnesium can reduce insomnia--in fact, tt's my most commonly recommended supplement for anxiety and insomnia. I personally enjoy a cup of magnesium powder with warm water on nights I'm having difficulty sleeping or feel edgy or having restless legs.
Magnesium deficiency is quite common and not only contributes to anxiety, but to heart palpitations associated with anxiety attacks, muscle tremors, cramps, headaches, stomach aches, and restless legs and constipation.
Low vitamin D is also associated with higher anxiety and mental health issues in general. For Vitamin D, I generally like to check a patient's baseline blood (serum) levels before suggesting a starting dose. Here in Central Oregon, I find that many folks are low, especially in the winter, so a typical starting dose is 2,000-4,000 IU daily. Vit D needs Vit K2 and Magnesium to be properly absorbed safely.
That being said, there is such a thing as vitamin D toxicity, so I periodically check my patient's serum levels when advising them to take D. Further, D is best absorbed when taken with a healthy fatty meal. Getting plenty of sunshine can also help with increasing Vit D levels. Foods rich in D include salmon, mushrooms, cod liver oil, herring, sardines, canned tuna, egg yolks, fortified milk and juice.
B vitamins are necessary for the production and breakdown of neurotransmitters involved in modulating anxiety. I recommend my patients to taking a methylated B-complex with active folate and B-12 daily, but I like to check their baseline levels first. Sometimes we also check for a genetic variant called MTHFR which can predispose them to low B vitamin levels and necessitates a special type of folate and B12 ( "methylated").
B-complex" is simply a vitamin composed of multiple types of B vitamins. B vitamins affect mood as well, including anxiety and depression. I often order a comprehensive nutrient panel on patients to check their baseline nutrient levels to determine which supplements are needed most.
If you’re low in certain B vitamins (more likely in vegans and vegetarians), you may feel extreme fatigue, or have cognitive difficulties, including foggy thinking and short term memory loss. Each B complex vitamin works a little differently, and impacts different aspects of health. Some people have health conditions that cause them not to absorb B12, which can cause serious medical problems. B vitamins are found in dark, green leafy (preferably organic) veggies, avocados, eggs, salmon, beans, or via a high-quality vitamin.
11. Amino Acids
Amino acids such as tryptophan, tyrosine, histidine and arginine are used by the brain for the synthesis of various neurotransmitters and neuromodulators. Free form amino acids are one of the most consistent and powerful tools available for supporting depression and other aspects of mental health. In patients struggling with mental health, you often find an underlying protein deficiency, even in patients eating a good quality diet. With amino acid testing, you can verify deficiencies. When deficient, free-form amino acids can rapidly replete the missing nutrients. Amino acid deficiency is common in those with gut problems.
Amino Replete by Pure Encapsulations is one of the few amino acid products on the market that contains a broad spectrum of amino acids in proper ratios, including L-tryptophan. I also really like putting a scoop of amino acid peptides into my smoothie or coffee. Vital proteins makes plain powder or creamer powder in coconut, vanilla, or chocolate flavors:
In response to supplementation, patients rapidly improve. Mood is elevated and energy levels increase. The effects are often dramatic, with patients describing a night and day difference when supplementing with free-form amino acids as compared to without.
L-theanine is an amino acid derived from green tea. Able to cross the blood-brain barrier, at recommended doses it safely imparts a sense of calm and well-being, reduced mental stress and anxiety, and improves memory and cognitive function. It may interact with GABA and dopamine receptors in the brain, explaining its actions. While it is found in tea and coffee, the supplement allows you to get the benefits without the caffeine – which worsens anxiety for many.
Research shows that L-theanine helps curb a rising heart rate and blood pressure, and a few small human studies have found that it reduces anxiety. In one study, anxiety-prone subjects were calmer and more focused during a test if they took 200 milligrams of L-theanine beforehand. You can get that much L-theanine from green tea, but you'll have to drink many cups—as few as five, as many as 20.
A small trial in Japan showed that a combination of two amino acids -- 2.64 grams each of L-lysine and L-arginine daily -- helped to reduce stress and anxiety. Both amino acids are available in tablets and capsules. Amino acids are generally considered safe in pregnancy. L-lysine is encouraged in pregnancy, in fact, at a higher dose.
Taurine is an amino acid that helps quiet down excitatory signals in the brain. A typical dose is 250 mg- 1000 mg/day.
Better known for a safe and effective cold sore treatment, L-lysine is a quiet unsung hero for immunity and anxiety. As an amino acid, not only is it safe in pregnancy, but encouraged, even at higher doses in pregnancy. There is no simple dose, but 1000-1500mg of the pill or tincture form daily is safe for anxiety (and bonus points: might prevent or reduce cold sore duration and other viral illness)
Best for acute panic attacks rather than chronic anxiety, glycine is another amino acid. I find men to be especially responsive to it. The best way to administer glycine is sublingually so that the gastrointestinal route is bypassed. This allows for quicker absorption, a faster onset of action, and swift entry to the CNS. At least 2-10 grams are required in order to stop a panic attack. It is very palatable and sweet tasting, making it easy to administer sublingually. Place 2 grams under tongue at the onset of an acute panic attack. Take another 2 grams every few minutes until the panic attack subsides. It usually works within a matter of a few minutes. Side effects are very rare with high doses of glycine.
14. Valerian (Valeriana officinalis)
Commonly used to treat insomnia, Valerian works well for anxiety-induced insomnia.
In some studies, people who used valerian reported less anxiety and stress. In other studies, people reported no benefit.
Valerian is generally considered safe at recommended doses, but since long-term safety trials are lacking, caution is always advised (as with most plant-medicines).
Be advised, it smells and tastes terrible, so pill form is preferred over tincture.
Side effects: Side effects of valerian include headache, stomach upset, mental dullness, excitability, uneasiness, heart disturbances, and even insomnia in some people. A few people feel drowsy in the morning after taking valerian, especially at higher doses. Some people experience dry mouth or vivid dreams.
15. Ginkgo, (Ginkgo biloba) may have significant anxiety lowering effects.
A standardized extract derived from the leaves of Ginkgo biloba is widely used to treat symptoms of memory loss and dementia. It may also help with focus and attention, so best to take in morning.
Some studies on Ginkgo as a treatment of dementia report improvements in anxiety and depressed mood, frequent components of dementia.
16. Passionflower has calming effects on those feeling restless and anxious. It’s known to cause sleepiness for some, so it’s best to take before bed after a busy day. Some studies suggest the flower may help relieve anxiety and aid sleep, and some species of the flower may even help with treating stomach problems.
A placebo-controlled study comparing passionflower extract to a benzodiazepine (oxazepam--a prescription anxiety medication) found equivalent anti-anxiety effects in response to both treatments in individuals with generalized anxiety disorder.
Some individuals who take passion flower report transient dizziness and drowsiness.
Gamma-Aminobutyric acid is an amino acid produced naturally in the brain. GABA functions as a neurotransmitter, facilitating communication among brain cells. Many medications interact with GABA and GABA receptors in the brain, altering their function to achieve certain effects, typically relaxation, pain relief, stress and anxiety reduction, lower blood pressure, and improved sleep. Barbiturates, anesthetics, benzodiazepines, antidepressants, and anti-seizure medications are some of the medications that target GABA.
A number of natural supplements also affect GABA activity.
GABA supplements are often used to treat high blood pressure, stress and anxiety, and sleep, as well as to stimulate the body’s natural growth hormone, often by athletes.
GABA plays a role in the healthy functioning of the body’s immune and endocrine systems, as well as in the regulation of appetite and metabolism. There’s also interesting emerging research about GABA’s role in gut health and gastrointestinal function, where it may work to support motility, control inflammation and support immune system function, and help regulate hormone activity.
The following doses are based on amounts that have been investigated in scientific studies. In general, it is recommended that users begin with the lowest suggested dose, and gradually increase as needed. For sleep, stress and anxiety: 100-200 mg and higher doses, in scientific studies. Individual dosing and length of use will vary. For high blood pressure: 10-20 mg, in scientific studies.
Caution: GABA oral supplements are generally well tolerated by healthy adults. Some people may experience negative side effects, including:
Drowsiness and fatigue.
Shortness of breath, at very high doses
Caution: If you are taking high blood pressure medications, GABA can lower blood pressure. If you take GABA in addition to taking blood pressure medication, your blood pressure may drop too low.
Antidepressant medications. People taking antidepressants should consult with their physician before taking GABA.
People taking medications that affect brain activity (for example, seizure medication) should consult their provider before taking GABA.
5-HTP works in the brain and central nervous system by increasing the production of the chemical serotonin. Serotonin can affect sleep, appetite, temperature, sexual behavior, and pain sensation. Since 5-HTP increases the synthesis of serotonin, it is used for several diseases where serotonin is believed to play an important role including depression, insomnia, obesity, and many other conditions. It may also be helpful for digestion and gut motility.
Depression. Some clinical research shows that taking 5-HTP by mouth improves symptoms of depression. Several studies have found that doses of 150-400 mg daily for 2-4 weeks can improve symptoms of depression. Some early research shows that 5-HTP might be as beneficial as conventional antidepressant therapy for some people. New research shows that up to 95% of serotonin is made in the gut, so it is common for folks with gut health issues to have low levels and higher rates of depression. We suggest a gut health healing protocol if this is the case.
L-tryptophan and 5-HTP are widely used alternative treatments of generalized anxiety. Both amino acids are essential for the manufacturing of serotonin in the brain. Serotonin is a neurotransmitter that plays a central role in the regulation of mood and anxiety. B6 is needed to make serotonin, so I advise getting levels checked--too much B6 can cause negative side effects such as tremors. The risk of serotonin syndrome and other adverse effects is minimized when 5-HTP is started at low doses, such as 25 milligrams per day, and gradually increased over several weeks to a daily regimen that is well tolerated and produces beneficial anti-anxiety effects.
Caution: Some people who have taken 5-HTP have developed a condition called eosinophilia-myalgia syndrome (EMS). EMS is a serious condition involving extreme muscle tenderness (myalgia) and blood abnormalities (eosinophilia). Other potential side effects of 5-HTP include heartburn, stomach pain, nausea, vomiting, diarrhea, drowsiness, sexual problems, and muscle problems.5-HTP is POSSIBLY UNSAFE when taken by mouth in large doses. Doses from 6-10 grams daily have been linked to severe stomach problems and muscle spasms.
Pregnancy and breast-feeding: There isn't enough reliable information to know if 5-HTP is safe to use when pregnant or breast-feeding. Stay on the safe side and avoid use.
**Taking 5-HTP along with medications for depression might increase serotonin too much and cause serious side effects including heart problems, shivering, and anxiety. Do not take 5-HTP if you are taking medications for depression. Some of these medications for depression include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), amitriptyline (Elavil), citalopram (Celexa). Taking 5-HTP along with dextromethorphan (Robitussin DM, others) might cause too much serotonin in the brain and serious side effects including heart problems, shivering, and anxiety.
Tramadol (Ultram) can affect a chemical in the brain called serotonin. 5-HTP can also affect serotonin. Taking 5-HTP along with tramadol (Ultram) might cause too much serotonin in the brain and side effects including confusion, shivering, stiff muscles, and others.
5-HTP—50 milligrams to 100 milligrams taken three times a day—is a safe and effective approach for chronic generalized anxiety that is well tolerated without excessive daytime sedation. 5-HTP may be taken alone or in combination with anti-anxiety medications.
Gradually increasing a bedtime dose of 5-HTP from 50 milligrams to 200 to 300 milligrams over a period of two to three weeks often improves the quality of sleep in chronically anxious patients who complain of insomnia while also reducing the severity of daytime anxiety. It has been used safely in doses up to 400 mg daily for up to one year.
Magnolia bark (also known as Houpo, Hou Po, magnolol, honokiol) has been used for centuries in traditional Chinese medicine to treat a wide array of conditions including depression, anxiety, and sleep issues like insomnia. One study showed that magnolia bark extract combined with phellodendron reduced cortisol levels in the body.
People who took the supplement felt less stressed when compared to people who didn’t. Research has shown that magnolol and honokiol interact with brain chemistry in a way that promotes relaxation and sleep. Specifically, these compounds – especially honokiol – interact with a brain chemical called GABA in a way that is similar to sedative drugs like benzodiazepines. Dosages of extracts range from 200 to 800 milligrams a day. Magnolia Bark is used primarily to lower stress and and help with sleep.
Experts recommend against using magnolia bark extract if you currently take:
Drugs to thin your blood
Medication for diabetes
Phosphatidylserine is a phospholipid, a fatty substance produced in the body that helps transmit messages between nerve cells in the brain and is thought to play a role in helping to regulate mood. In a 2015 study published in Mental Illness, for instance, people over the age of 65 with major depression took a supplement containing phosphatidylserine and the omega-3 fatty acids DHA and EPA three times daily for 12 weeks. At the study's end, scores on a depression scale had improved. Using phosphatidylserine in combination with omega-3 fatty acids may also aid in the treatment of ADHD symptoms in children and adults. You can find phosphatidylserine in some foods — such as soybeans, egg yolks, and liver
Phosphatidylserine may have a blood-thinning effect. If you take blood-thinning medication such as Coumadin (warfarin), take anti-inflammatory medication, or have blood-clotting problems, speak with your doctor before taking phosphatidylserine. Do not take it within two weeks of scheduled surgery. Possible phosphatidylserine side effects, especially at doses over 300 milligrams, include insomnia and upset stomach. You should also use caution when combining it with natural blood-thinning supplements like ginkgo biloba.
Phosphatidylserine supplements may also interact with medications used to treat glaucoma, Alzheimer's disease, antihistamines, and antidepressants.
Possible side effects: intestinal gas, stomach upset, or insomnia
20. St John's Wort
According to the Mayo Clinic "There is good evidence that St. John's wort may reduce symptoms in people with mild-to-moderate, but not severe (or major) depression. In many studies it seems to work as well as selective serotonin reuptake inhibitors (SSRIs), a popular type of antidepressant often prescribed to treat depression. SSRIs include fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft). In addition, St. John's wort doesn't seem to cause loss of sex drive, one of the most common side effects of antidepressants."
Also from the Mayo Clinic: "St. John's wort has also shown promise in treating the following conditions, a few of which are related to depression."
Premenstrual syndrome (PMS). Research suggests that St. John's wort may help relieve physical and emotional symptoms of PMS in some women, including cramps, irritability, food cravings, and breast tenderness. One study reported a 50% reduction in symptom severity.
Menopause. There's some evidence to suggest that St. John's wort, combined with black cohosh, helps improve mood and anxiety during menopause.
Seasonal affective disorder (SAD). Used alone, St. John's wort has improved mood in people with SAD, a type of depression that occurs during the winter months because of lack of sunlight. SAD is usually treated with light therapy. Research shows that using St. John's wort together with phototherapy works even better.
Obsessive compulsive disorder (OCD), social phobia. One early open-label study found that taking St. John's wort 450 mg, 2 times a day for 12 weeks improved OCD symptoms. However, other studies show that St. John's wort doesn't improve OCD.
St. John's wort can be effective for treating mild to moderate depression. However, the supplement interacts with many medications and can cause serious side effects. Consult with your doctor before taking St. John's wort if you take any other medications.
Dose: The usual dose for mild depression and mood disorders in adults is 300 mg (standardized to 0.3% hypericin extract), 3 times per day, with meals. St. John's wort is available in time-release capsules.It may take 3 to 6 weeks to feel any effects from St. John's wort. DO NOT stop taking St. John's wort all at once because that may cause unpleasant side effects. Gradually lower the dose before stopping.
Safety and side effects:
When taken orally for up to 12 weeks in appropriate doses, St. John's wort is generally considered safe. However, it may cause:
Agitation and anxiety
Diarrhea, constipation and stomach discomfort
Fatigue and insomnia
Increased sensitivity to sunlight (photosensitivity)
There isn't enough information about the safety of using St. John's wort topically.
Don't use St. John's wort during pregnancy or while breastfeeding.
Saffron extract may improve depressive symptoms & contribute to increased resilience against stress-related disorders. Similar to antidepressants, saffron may exert its antidepressant effect by modulating the levels of certain chemicals in the brain, including serotonin (a mood-elevating neurotransmitter).In clinical trials conducted, evaluating the efficacy of saffron in mild-to-moderate depression, saffron was more effective than placebo and at least equivalent to the therapeutic doses of prescription antidepressants imipramine and fluoxetine.
Dose for Depression: 20 to 30 mg/day of saffron extract (stigma or petal) for mild to moderate depression
Saffron may trigger mood swings in people with bipolar disorder. Those who are pregnant or breastfeeding should not use saffron. Interactions. When used as a supplement, saffron may cause problems for people on blood pressure medicine or blood thinners
Tinctures you can make at home:
‘Herbal Stress Rescue’ is one I found from Aviva Rhom, MD (Thank you, Aviva!)
To prepare it, purchase one of each of the following extracts from a reputable company. You can mix these herbs for anxiety together in a larger glass bottle with a dropper and take 20-60 drops of the blend (the kava kava is diluted in the blend, that’s why you can take a higher dose)
If you’re not comfortable including the kava kava because it’s too strong for you — that’s okay — swap it out for Motherwort tincture.
Another calming tincture you can make at home:
Passion Flower (Passiflora incarnata)
Lemon balm (Melissa officinalis)
Chamomile (Matricaria recutita)
St. John's wort (Hypericum perforatum)
Typically these herbs are combined in a liquid extract and taken together, about 2-5 mL one to several times/day depending on the severity of the anxiety and at the higher end to promote sleep.
Address other, contributing or underlying causes of anxiety:
In my medical practice, I typically assess thyroid function, fasting blood sugar levels, sleep disorders, adrenal disorders, hormone imbalance and much more to rule out any underlying contributors to disrupted mental health. Learn more in my separate blog Here.
Ensure The Safety & Quality of Your Supplement
Supplements aren't required to be tested for things like safety, purity, heavy metals like lead or other contaminants--- since this is not required, many supplement manufacturers simply don't do it! Look for something called a "COA" which stands for a "Certificate of Analysis" and/or "USP Verified" on the label. Learn more about what these mean and why they're important in my separate blog.
Buying your supplement:
Our readers and patients can access these suggestions and any other supplement they may want for 10-15% off suggested retail price by creating an account on our Fullscript dispensary: https://us.fullscript.com/welcome/hearthsidemedicine/signup
About the author:
Havilah Brodhead, RN, MSN, FNP is a board-certified family nurse practitioner with training in integrative/functional medicine and primary care. She is mother to two girls, loves mountain biking, snowboarding, climbing and yoga, and owns Hearthside Medicine Family Care in Bend, Oregon.
Havilah has been working in the medical field for nearly 20 years. Her background as an RN gave her experience working in ER, ICU, mental health, and maternal-child health. As a family nurse practitioner, she provides holistically-minded, evidenced-based care to children and adults. She completed her initial master's degree as a clinical nurse leader with an emphasis on incorporating complementary and alternative medicine into conventional medicine--a field known as integrative medicine.
To learn more about Hearthside Medicine click here.
To schedule an appointment you can call the clinic or schedule from our website.
We are located in Bend, Oregon.
Havilah is accepting new patients in Oregon (in-person or virtually), from Washington (virtually) and accepts most insurance plans. For those interested in simply more info or help with supplements, Havilah is available for health coaching. Please specify "health coaching" if this is what desired when scheduling an appointment virtually.
(https://www.psychologytoday.com/us/blog/integrative-mental-health-care/201911/herbal-treatments-anxiety and https://www.ncbi.nlm.nih.gov/pubmed/?term=Schweitzer+I.(2010)+Kava%3A+a+comprehensive+review+of+efficacy%2C+safety%2C+and+psychopharmacology.+Aust+N+Z+J+Psychiatry
Glycine for acute panic attacksProusky, J. E. Orthomolecular treatment of anxiety disorders. Townsend Letter for Doctorsand Patients. February-March 2005.