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: https://www.hearthsidemedicine.com/post/anxiety-to-medicate-or-not-medicate-and-which-ones-if-so
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.
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).
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.
Adaptogens are meant to be taken daily, over a period of 3 months to a year for optimal results. They are safe for pretty much all adults (not for pregnant women, and if you are on medications for an autoimmune disease talk with your medical provider first) and 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, may increase risk of bleeding if taken in large amounts, which can be significant for those on blood-thinners or with clotting disorders. Also check with your provider before starting a supplement. Just because it is “natural” does not mean it does not have potential serious side effects, especially if it interacts with other medications you may be taking.
One of my own favorite blends is Vital Adapt by Natura Natural Products. It contains these adaptogens as well as additional supporting herbs. Stress Response by Gaia Herbs is also excellent, and contains Holy Basil, another reliable adaptogen.
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, (adaptogen), 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 as well as helping to induce relaxation and aid sleep. A number of studies support the effectiveness of the herb as a natural anxiety 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.
You can add a teaspoon or two 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. It can be taken before bed to help with sleep. 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 ashwagandah. 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).
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.
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.
Limited data shows that short-term use of chamomile is generally considered safe and can be effective in reducing symptoms of anxiety.
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 also take it as a supplement, typically standardized to contain 1.2% apigenin (an active ingredient), along with dried chamomile flowers. 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.
Lemon balm may also be helpful in treating digestive issues and headaches.
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.
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 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. The dose of Vitex in capsules is 180 mg twice daily, or in tincture, 3-5 mL daily.
8. Essential Fatty Acids:
Our nervous system requires essential fatty acids for healthy 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 symptoms. There are many excellent brands. I recommend Nordic Naturals most often.
9. Magnesium and Vitamin D:
Dose: (150 – 600 mg/day of Magnesium citrate or glycinate)--generally, if you start having stools that are too loose, you'll know you need to cut back a bit on the dose of magnesium (but this is a perfect antidote for constipation!)
Magnesium deficiency is quite common and not only contributes to anxiety, but to heart palpitations associated with anxiety attacks. Magnesium also reduces insomnia. It's my most commonly recommended supplement for anxiety. I personally enjoy a cup of "CALM" magnesium powder with warm water on nights I'm having difficulty sleeping or feel edgy.
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 1,000-2,000 IU daily. 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 and with calcium and magnesium. 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 take B-complex with active folate and B-12 daily. "B-complex" is simply a vitamin composed of multiple types of B vitamins. B vitamins play a role in metabolism, act as antioxidants, are involved in hormone and cholesterol production, cell growth and division, and much more. B vitamins affect mood as well, including anxiety and depression. If you’re low in certain B vitamins, 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
L-theanine is an amino acid derived from green tea. Able to cross the blood-brain barrier, at recommended doses it safetly 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.
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)some side effects such as headaches, dizziness and drowsiness. Be advised, it smells and tastes terrible, so pill form is preferred over tincture.
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. 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. Originally native to Peru, Passionflower has spread throughout the world. Some studies suggest the flower may help relieve anxiety and aid sleep, but more research is required to properly assess all the potential uses of passionflower, according to the National Centre for Complementary and Integrative Health (NCCIH). 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.
There is ongoing investigation and debate about how GABA supplements work in the body, and how their mechanisms of action may differ from the body’s internally-produced GABA. Specifically, scientists have not reached consensus about whether, or how effectively, supplemental GABA crosses what’s known as the blood-brain barrier — meaning, how well it moves from the bloodstream directly into the brain.
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 physician before taking GABA.
Interactions with other
Because GABA may lower your blood pressure, if you take GABA along with other herbs or supplements that also may lower blood pressure, the combination may lead to your blood pressure dropping too low
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.
Depression. Some clinical research shows that taking 5-HTP by mouth improves symptoms of depression. Several studies have found that doses of 150-3000 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.
Evidence on the effects of 5-HTP for anxiety is unclear. Early research shows that taking 25-150 mg of 5-HTP by mouth daily along with carbidopa seems to reduce anxiety symptoms in people with anxiety disorders. However, other early research shows that taking higher doses of 5-HTP, 225 mg daily or more, seems to make anxiety worse.