Naturopathic medicine’s proverbial toolbox is full with herbs that can help treat anxiety and panic disorder. Plants with sedative or anxiolytic, (literally, “anxiety breaking”) properties can quickly dampen symptoms of anxiety. Some of these herbs may be familiar, frequently discussed in everyday culture; herbs like Passionflower, Oats, and Lemon Balm have wonderful calming qualities and many have used Valerian for its sedative properties in promoting sleep. I often give patients the example of Hops, which is used to make beer, and describe the use of Kava in the islands of the South Pacific to quell social anxiety. Another classic example of an herbal sedative is Chamomile, famous in households across the globe as a relaxing tea. It’s here that I usually differentiate between a tea and an herbal tincture so patients can better understand how a botanical extract is different from the tea they have at home.
Most of us are familiar with a tea or infusion, where the herb is steeped in water for several minutes. A botanical tincture is a liquid herbal mixture in which alcohol is used to extract the medicinal constituents, usually over a period of weeks. This process strengthens the liquid, rendering it much more potent than a household tea, which is why a Chamomile tincture is more effective in treating an anxiety than the common tea. When we’re treating children, adolescents, or adults wishing to avoid an alcohol base, we can use tinctures called glycerites, using vegetable glycerin rather than alcohol to extract the plant’s medicinal qualities. Of course, these herbs are also available in pills or capsules for those who prefer to avoid the liquid form.
With so many herbs to choose from, finding the right prescription sometimes involves taking into account an individual’s constitution, (such as whether the patient is a “warm” or “cold” person), as well as the other healing properties of the herbs. For instance, an herbalist might choose to avoid Lemon Balm for its effects on the thyroid gland or to include Kava in a patient suffering from muscle spasms. Choosing the right tincture for a patient and deciding its proportions is part of the “art” of botanical medicine, allowing for a much more personalized approach to the treatment of anxiety.
Beyond Herbs: Amino Acids & Neurotransmitters
Herbs can be very effective at calming anxiety and panic, but most times, we are looking to address potential imbalances in the brain chemistry that can be causing symptoms. I tell my patients to imagine two opposing factors in the brain, glutamate and GABA, neurotransmitters working opposite one another with very different effects on mood. We can imagine glutamate as excitatory and neuro-stimulatory, increasing symptoms of anxiety and alertness. Glutamate is opposed by GABA, which is instead inhibitory and exerts calming effects. The goal in the treatment of anxiety becomes to either decrease glutamate or increase GABA to restore balance in the brain. Many of the sedative herbs discussed earlier, such as Valerian, exert their calming effects by suppressing glutamate.
Neurotransmitters can be difficult to measure so it’s not always clear whether the anxious patient suffers from too much glutamate or too little GABA. In reality, it’s likely that the anxiety can be helped by restoring balance to both neurotransmitters. In the case of GABA, the simplest and most direct way to increase levels in the brain is to supplement with GABA itself, in pill form. In private practice, I have found GABA to be especially beneficial in some patients, but there is constant debate in the medical community on GABA’s ability to effectively cross what is known as the blood-brain-barrier (BBB). Fortunately, we can avoid this by supplementing instead with l-theanine, an amino acid that helps to produce GABA in the brain, avoiding any absorption issues.
L-theanine is a component of green tea, responsible for the so-called “zen” state of relaxation, affecting alpha waves in the brain which are created during states of mediation and mindfulness. Since theanine has a role in affecting mindfulness and awareness, it is unique in that it can improve mental clarity and focus. Theanine’s role in promoting mental performance separates it from the other natural agents and medications used to treat anxiety because it isn’t heavily sedating. Patients will complain of side-effects from anti-anxiety medications, including drowsiness, headache, decreased libido and poor memory. While anti-anxiety medications and calming herbs work by sedation, theanine stands apart in doing just the opposite, helping us to function better under stress and anxiety, whether at work or at school. Patients will often ask whether drinking green tea is a good substitute for theanine supplementation and it is here that we get into a discussion of therapeutic doses. A patient with more severe anxiety or panic will often start a dose comparable to the amount of theanine in 10 cups of green tea!
Back to the Basics: Vitamins & Minerals
You may have heard of B-Complex and its ability to reduce stress or have experienced the calming effects of an Epsom salt bath after a stressful day. The relaxing properties of each can be explained by looking again at the neurotransmitters discussed earlier. Vitamin B6 and magnesium are both co-factors in the conversion of glutamate to GABA; that is, both nutrients promote the conversion of glutamate into GABA, decreasing excess glutamate and increasing GABA. Epsom salt consists of magnesium sulfate so it makes sense that this commonly touted warm bath would promote a sense of calm. Ideally, a healthy, nutrient-dense diet should provide us with the necessary vitamins and minerals to keep this conversion running smoothly, but nutrient deficient soil and genetic factors sometimes mean supplementation is necessary.
Lavender: In a Class of its Own
When talking with patients about the treatment of anxiety and panic, I like to discuss lavender because of its rather unique effects on mood. Many of us are familiar with aromatherapy and the uplifting properties of lavender, helping to elevate mood and relieve sadness. While aromatherapy certainly has its therapeutic benefits, the use of lavender oil internally is especially beneficial in the treatment of anxiety. While much of our conversation has focused on normalizing levels of glutamate and GABA, lavender works instead on the modulation of calcium channels in the brain.
Calcium channels are responsible for the release of neurotransmitters and hyperactive nerve cells can result in anxiety. Since lavender works internally to restore balance to calcium channels in the brain, it provides us with yet another treatment for anxiety through an entirely different pathway. In fact, some of the research has shown lavender oil to be as effective as paroxetine and lorazepam, commonly used anxiolytic medications. Not only does lavender provide us with an alternative pathway in the treatment of anxiety, but its mood stabilizing effects bridge the gap between anxiety and depression. With constant anxiety and especially panic, it’s understandable that a person’s mood can also suffer and I often say anxiety and depression go “hand in hand.” Since lavender oil can improve mood while reducing anxiety, I sometimes use this in combination with herbal tinctures and neurotransmitters for a more well-rounded approach.
Therapy and Self-Awareness, an Integrative Approach
As with any condition, the goal is never to simply suppress symptoms, but to identify and address the cause. In some cases, panic attacks can occur suddenly and without reason. Other times, finding the cause can be difficult and the start of a long, but healthy and critical process to healing. Most naturopaths are comfortable counseling patients as part of a general office visit, but a referral to a licensed mental health professional is sometimes necessary. I like to refer my patients to therapists who specialize in cognitive behavioral therapy (CBT), which is remarkably effective for panic disorder. With CBT, patients take an active role in the healing process, reenacting scenarios that can elicit anxiety and provoke panic. The purpose is to learn to feel comfortable in situations where panic might arise, which is useful, given the often unpredictable nature of panic disorder.
This can be difficult for patients to accept, but I often explain that the goal of herbal medicine is to lessen anxiety while learning coping mechanisms that become life-long tools for success. Therapy, whether CBT or a more traditional approach, is an essential part of any anxiety treatment plan because it helps the patient develop a better understanding of his or her body and self-perception. Without it, we are simply replacing anti-anxiety medications with anti-anxiety herbs, albeit with less side-effects.
In the meantime, I counsel my patients on the benefits of yoga and breathing techniques that can help them while we work together on addressing imbalances in the brain chemistry and restoring mood through the use of herbs, vitamins, minerals, amino acids and neurotransmitters. With so many options, the treatment of anxiety can seem overwhelming, but it’s comforting to know there are many possibilities, each treatment as unique to every individual as anxiety itself.
Antonio Reale, ND, MS is a licensed naturopathic physician and nutritionist practicing in Wethersfield, CT. He specializes in personalized botanical medicine and is founder of The Herbal Room, a multidisciplinarywellness center with an in-house botanical dispensary. For insurance information and scheduling, visit: www.theherbal-room.com.