About anxiety disorder

Anxiety disorder is a generic term that covers several different disorders, characterized by excessive rumination, worrying, uneasiness, apprehension and fear about the future. It can affect both physical and psychological health. There are some medical syndromes that may mimic the symptoms of an anxiety disorder such as hyperthyroidism that may be misdiagnosed as anxiety. Recent surveys have shown that anxiety disorders may affect up to 18% of Americans.

The term anxiety covers four types of experiences: mental apprehension, worry, physical tension, and physical symptoms. Anxiety disorder is divided into generalized anxiety disorder, phobic disorder, and panic disorder; each has its own characteristics and symptoms and they require different treatment. Anxiety disorders range from simple nervousness to episodes of stark terror.

doctor patient 3

DrCannell2
When I was an emergency room physician, I was amazed that the patients in the most distress were not the gunshot wounds or car accident victims, but rather those suffering from a panic attack. People suffering a panic attack often thought they were dying.

Low levels of GABA, a neurotransmitter that reduces activity in the central nervous system, contribute to anxiety. A number of medications we use to treat anxiety achieve their effect by modulating the GABA receptors. An area of the brain called the amygdala is central to the processing of fear and anxiety, and its function is disrupted in anxiety disorders.

Severe anxiety and depression can be induced by sustained alcohol abuse, which in most cases abates with prolonged abstinence. Even moderate, sustained alcohol use may increase anxiety and depression levels in some individuals. Caffeine, alcohol and benzodiazepine dependence can worsen or cause anxiety and panic attacks. Anxiety commonly occurs during the acute withdrawal phase of alcohol and can persist for up to 2 years as part of a post-acute withdrawal syndrome, in about a quarter of people recovering from alcoholism.

When medication is indicated, SSRIs like Prozac, Paxil or Zoloft are generally recommended as first line agents, SNRIs like Effexor are also effective.  Benzodiazepines like Valium, Xanax and Ativan are also sometimes indicated for short-term or as needed use but may also be needed for the long term. They are usually considered as a second-line treatment due to disadvantages such as cognitive impairment and due to their risks of dependence and withdrawal problems. There is evidence that certain antiepileptic medications like Neurontin and Lyrica may help. The novel antidepressant Remeron can also be effective. Medications like atypical antipsychotics such as Seroquel are sometimes needed but should be reserved for severe cases.

— John Cannell, MD

Supplements

Passionflower has a long history of use as an anti-anxiety agent in folklore and has been used by people all over the world to treat anxiety. However, one of the problems with herbal supplements is that plant material contains thousands of phytochemicals, making it challenging to pinpoint the specific biochemicals responsible for the anti-anxiety properties. In other words, although herbal remedies often produce positive results, identifying the active ingredients can be difficult. Therefore, users of herbal remedies may be consuming ineffective or possibly toxic substances in addition to the active, anxiolytic ingredients. One double-blind, placebo-controlled study analyzed the difference in efficacy between oxazepam, a prescription benzodiazepine used to treat chronic anxiety symptoms, and passionflower in patients who met the criteria for generalized anxiety disorder (GAD).1 The results showed no difference between the two anxiolytics with regard to the treatment of GAD, suggesting that passionflower is as effective as benzodiazepines in eliminating anxiety symptoms.

Kava is a drink that is prepared from the plant Piper methysticum. It has been consumed in many cultures because it is known to relieve anxiety, restlessness and insomnia for centuries. There as six randomized controlled trials (RCT) showing kava’s therapeutic potential both as a single agent for patients with anxiety disorder, GAD, elevated generalized anxiety, and those being tapered off of benzodiazepines.2 All of these trials also revealed that taking kava doses less than 400 mg/day does not cause serious side effects. Of the 435 clinical trial participants taking kava supplements, some at high doses, no liver issues were reported. Therefore, the current review supports the conclusion that liver toxicity is indeed a rare side effect.

Hypericum perforatum, or St John’s wort (SJW), is derived from the flowering tops of a perennial shrub. It has been used in traditional medicine for centuries to treat a wide range of disorders and is licensed in Germany to treat anxiety, depression and sleep disorders. A RCT of 149 patients with depression with co-morbid anxiety demonstrated that six weeks of treatment with SJW significantly reduced anxiety.3

Certain amino acids help anxiety. Two RCTs showed that L-lysine + L-arginine combination effectively reduces anxiety scores with no reported side effects.4 Amino acid supplements may also help in balancing cortisol levels triggered by stress in both healthy individuals and those with high trait anxiety.

A combination of magnesium, vitamin B6, zinc and calcium dramatically decreased psychological distress compared to placebo, which worsened symptoms.5 Results showed a decrease in anxiety for the treatment group. The effects became more pronounced as the multivitamin treatment progressed but could not be linked solely to magnesium supplementation. That is why we recommend Life Extension mix as it has magnesium and so much more.

Anxiety usually comes with depression so all the supplements used for depression may help anxiety. Please see our depression page.

References

  1. Akhondzadeh S, Naghavi HR, Vazirian M, Shayeganpour A, Rashidi H, Khani M: Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. J Clin Pharm Ther 2001, 26:363-367.
  2. Lakhan SE, Vieira KF.  Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutr J. 2010 Oct 7;9:42.
  3. Volz HP, Murck H, Kasper S, Moller HJ: St John’s wort extract (LI 160) in 
somatoform disorders: results of a placebo-controlled trial. 
Psychopharmacology 2002, 164:294-300.
  4. Lakhan SE, Vieira KF.  Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutr J. 2010 Oct 7;9:42.
  5. Carroll D, Ring C, Suter M, Willemsen G: The effects of an oral 
multivitamin combination with calcium, magnesium, and zinc on psychological well-being in healthy young male volunteers: a double- blind placebo-controlled trial. Psychopharmacology (Berl) 2000, 150:220-225.