Is there an effective herbal treatment for anxiety?
Answer From Brent A. Bauer, M.D.
Several herbal remedies have been studied as a treatment for anxiety, but more research is needed to understand the risks and benefits. Here’s what we know — and don’t know:
- Kava. Kava appeared to be a promising treatment for anxiety, but reports of serious liver damage — even with short-term use — caused the Food and Drug Administration to issue warnings about the use of dietary supplements containing kava. While these initial reports of liver toxicity have been questioned, use extra caution and involve your doctor in the decision if you’re considering using products containing kava.
- Passion flower. A few small clinical trials suggest that passion flower might help with anxiety. In many commercial products, passion flower is combined with other herbs, making it difficult to distinguish the unique qualities of each herb. Passion flower is generally considered safe when taken as directed, but some studies found it can cause drowsiness, dizziness and confusion.
- Valerian. 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, don’t take it for more than a few weeks at a time, unless your doctor approves. It can cause some side effects such as headaches, dizziness and drowsiness.
- Chamomile. Limited data shows that short-term use of chamomile is generally considered safe and can be effective in reducing symptoms of anxiety. But chamomile can increase the risk of bleeding when used with blood-thinning drugs. 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.
- Lavender. Some evidence suggests that oral lavender or aromatherapy with lavender can reduce anxiety; however, evidence is preliminary and limited. 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.
- Lemon balm. Preliminary research shows lemon balm can reduce some symptoms of anxiety, such as nervousness and excitability. Lemon balm is generally well-tolerated and considered safe for short-term use, but can cause nausea and abdominal pain.
Herbal supplements aren’t monitored by the FDA the same way medications are. Despite enhanced quality control regulations in place since 2010, the quality of some supplements may still be an issue. Remember, natural doesn’t always mean safe.
If you’re considering taking any herbal supplement as a treatment for anxiety, talk to your doctor first, especially if you take other medications. The interaction of some herbal supplements and certain medications can cause serious side effects.
Some herbal supplements taken for anxiety can cause you to feel sleepy, so they may not be safe to take when driving or doing dangerous tasks. Your doctor can help you understand possible risks and benefits if you choose to try an herbal supplement.
If your anxiety is interfering with daily activities, talk with your doctor. More-serious forms of anxiety generally need medical treatment or psychological counseling (psychotherapy) for symptoms to improve.
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- Natural medicines in the clinical management of anxiety. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Feb. 13, 2018.
- Kava. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Feb. 13, 2018.
- Passion flower. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Feb. 13, 2018.
- Valerian. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Feb. 13, 2018.
- German chamomile. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Feb. 13, 2018.
- Lavender. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Feb. 13, 2018.
- Lemon balm. Natural Medicines. https://naturalmedicines.therapeuticresearch.com. Accessed Feb. 13, 2018.
- FDA issues consumer advisory for dietary supplements containing kava. National Institutes of Health Office of Dietary Supplements. https://ods.od.nih.gov/Health_Information/kava.aspx. Accessed Feb. 13, 2018.
- Bystritsky A. Complementary and alternative treatments for anxiety symptoms and disorders: Herbs and medications. https://www.uptodate.com/contents/search. Accessed Feb. 13, 2018.
- Mixing medications and dietary supplements can endanger your health. U.S. Food and Drug Administration. https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm420349.htm. Accessed Feb. 13, 2018.
- Dietary supplements: What you need to know. U.S. Food and Drug Administration. https://www.fda.gov/Food/DietarySupplements/UsingDietarySupplements/ucm109760.htm. Accessed Feb. 13, 2018.
- Using dietary supplements wisely. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/supplements/wiseuse.htm. Accessed Feb. 13, 2018.
- Bauer BA (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 16, 2018.
See more Expert Answers
People with anxiety sometime consider herbal remedies as an alternative to prescription drugs. This may be because some medications, for example, beta-blockers or benzodiazepines, can have unwanted side effects.
It is important to talk to a doctor before reducing or stopping prescription medication or starting an herbal supplement. Some herbs can cause side effects or interact with other medications.
Here, we describe 9 herbs and supplements that could help to alleviate anxiety.
1. Ashwagandha
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Ashwagandha may help reduce stress levels.
Ashwagandha or Withania somnifera is among a group of herbs called ‘adaptogens’.
Adaptogens affect systems and hormones in the body that regulate a person’s stress response.
Ashwagandha has a long history of use in traditional Indian, or Ayurvedic, medicine.
A small 2019 clinical trial investigated the efficacy of ashwagandha for stress and anxiety.
The 8-week study involved 58 participants with perceived stress. Each participant randomly received one of three treatments: Ashwagandha extract at doses of either 250 milligrams (mg) per day or 600 mg per day, or a placebo.
The participants who took ashwagandha showed less of the stress hormone cortisol than those in the placebo group. They also experienced improved sleep quality.
Participants who took 600 mg of ashwagandha reported significantly reduced stress levels. However, participants who took the lower dose of ashwagandha did not report a reduction in stress.
In another 2019 study, 60 participants with mild anxiety received 250 mg of ashwagandha or placebo for 60 days. Those taking the herb showed a significant reduction in some measures of anxiety but not others.
People can take ashwagandha as a tablet or in liquid tincture form.
2. Chamomile
Chamomile is a flowering herb similar in appearance to a daisy. There are two types of chamomile that people can use medicinally: Roman chamomile and German chamomile.
Some people use chamomile in the following forms to help relieve stress and anxiety:
- tea
- extract
- tablet
- skin cream
A 2016 clinical trial investigated the efficacy and safety of chamomile as a long-term treatment for generalized anxiety disorder (GAD).
All 93 participants received 1,500 mg of chamomile daily for 12 weeks. Some then continued taking chamomile for the next 26 weeks, while the remainder switched to a placebo.
Researchers observed that those participants who continued taking chamomile were no less likely to experience a relapse of GAD symptoms than those switching to placebo. However, when relapse did occur, the symptoms were less severe.
Some people may experience allergic reactions to chamomile, particularly if they experience reactions to the following plants:
- ragweed
- chrysanthemums
- marigolds
- daisies
Chamomile may interact with certain drugs, including the blood thinner warfarin, and the antirejection drug cyclosporine.
Anyone taking any type of medication should check with their doctor before consuming chamomile teas or supplements.
3. Valerian
Valerian or Valeriana officinalis is a plant native to Europe and Asia. For many centuries, people have used the root to help treat sleep problems, anxiety, and depression.
Valerian root is available in the following forms:
- tea
- tablet
- tincture
To date, there have only been a few high quality studies on the effects of valerian. The National Center for Complementary and Integrative Health (NCCIH) state that there is insufficient evidence to determine whether valerian can alleviate anxiety or depression.
Studies suggest that valerian is generally safe. However, the NCCIH note that there is no information on the long-term use or safety of valerian in the following groups:
- pregnant women
- nursing mothers
- children under 3 years of age
People should also be aware that valerian may have a sleep inducing effect. Taking the herb with alcohol or sedatives will add to this effect and could be dangerous.
4. Lavender
Lavender is a flowering plant belonging to the mint family. Many people use lavender to help calm the nerves and alleviate anxiety.
People may use lavender in the following ways:
- making tea from the leaves
- using the oil in aromatherapy
- mixing the essential oil into a base oil for massage
- adding the oil or flowers to baths
Lavender essential oil (LEO) contains chemicals called terpenes. A 2017 review article suggests that two of these terpenes called linalool and linalyl acetate may have a calming effect on chemical receptors in the brain.
The review suggests LEO may be an effective short-term treatment for anxiety disorders. However, studies of the long-term effects of LEO are lacking.
5. Galphimia glauca
Galphimia glauca is a plant species native to Mexico. People traditionally used it as a tranquilizer to reduce anxiety.
A 2012 clinical trial investigated the efficacy of G. glauca as a treatment for GAD. Participants received either G. glauca or the prescription antianxiety medication lorazepam for 12 weeks. Researchers continued to monitor the participants for a further 3 weeks to test for withdrawal symptoms.
Results showed that participants who received a daily dose of 0.175 mg of G. glauca showed a greater reduction in GAD symptoms compared with those who took lorazepam. Both treatments were safe.
According to a 2018 review, the evidence for G. glauca as a treatment for anxiety is promising. However, medical companies have not exploited its potential due to a lack of available plant material.
6. Passionflower
Passionflower or Passiflora is a family of plants with around 550 different species. Some studies show that a particular species, P. incarnata, may be effective in treating restlessness, nervousness, and anxiety.
According to an older 2010 review of complementary treatments, some evidence suggests that the antianxiety effects of P. incarnata are comparable to those of benzodiazepines. Benzodiazepines are a class of drug that doctors may prescribe to treat anxiety.
People can take P. incarnata in tablet form or as a liquid tincture.
7. Kava kava
Kava kava, or simply kava, is a shrub that is native to the islands of the Pacific Ocean. Its scientific name is Piper methysticum.
In the Pacific Islands, people use kava in a ceremonial beverage intended to relieve stress and alter mood.
A 2013 placebo-controlled trial investigated the efficacy of kava as a treatment for GAD. The 6-week study involved 75 participants. Each person received one of three treatments: Kava extract at doses of either 120 mg or 240 mg per day, or a placebo.
Participants taking kava showed a significant reduction in anxiety compared with those who received the placebo, suggesting kava may be a moderately effective short-term treatment for GAD.
The study also found kava to be safe.
In 2002, the Food and Drug Administration (FDA) advised that taking supplements containing kava could result in severe liver injury. However, the World Health Organization (WHO) have since indicated that the link between kava and liver toxicity is unclear, saying that scientists need to re-evaluate the data.
People can buy kava as a supplement online or in health food stores.
8. Cannabidiol
Cannabidiol (CBD) is one of the active ingredients of the cannabis plant.
Research from 2019 suggests that CBD may have a calming effect on the central nervous system.
Although the FDA do not currently approve the use of CBD, this natural chemical is widely available in the following forms:
- tablet
- liquid extract
- vape liquid
- topical cream
The study above investigated whether CBD could help to treat anxiety and sleep disorders. Researchers retrospectively analyzed data from 103 adults taking CBD as an additional therapy for anxiety and sleep disorders.
Of the 72 adults they included in the final sample, 57 experienced a decrease in their anxiety scores within the first month of taking CBD. These scores remained low for the 3-month study period.
The researchers concluded that CBD may be beneficial for people with anxiety-related disorders. However, clinical trials are necessary to confirm these results.
Safety considerations
Many herbs can interact with over-the-counter (OTC) and prescription medications. Some can increase or reduce the effects of certain drugs, potentially causing serious health effects.
People taking any kind of medication should consult their doctor or pharmacist before beginning herbal supplements.
They should also be aware that herbal remedies can take longer to start working than prescription medications.
If a person needs more advice about an herbal product, they should consult a qualified herbalist about brand, strength, and quantity.
The FDA does not monitor herbal remedies, so there are potential safety concerns for herbs that have mislabeling or contamination with heavy metals.
Summary
People have been using herbs for thousands of years to treat many health conditions. Scientific studies indicate that certain herbs may help to alleviate the symptoms of anxiety.
As with prescription medications, some herbal products can cause side effects. Herbal products may also take longer to begin working. People must consider these factors when weighing up the pros and cons of a particular treatment.
There can be serious interactions between certain herbs and medications. A person who is taking any kind of medication should consult their doctor before they begin taking herbal products.
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