Anxiety

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As a permanent fixture in many people's lives, anxiety affects not only the mind, but the body and daily functioning. Anxiety can be defined in two ways: the first as an apprehensive, uneasy state of mind, often as the result of anticipated events (i.e., life stress); and the second, more clinical definition characterizes anxiety as an abnormal, overwhelming feeling of apprehension or fear that is punctuated by physiologic reactions, such as rapid pulse, tension, and sweating. Anxiety affects both the mind and the body to varying degrees, and people experience these feelings in their lives regardless of the definition.

The current prevalence of anxiety in the population (particularly Americans) is undoubtedly caused by people working longer hours while attempting to balance their relationships with family and home responsibilities. It is not surprising that today more people experience stress and anxiety than ever before, and many more are seeking treatment to relieve their suffering. It is estimated that 19 million adults in the United States suffer from anxiety disorders, with a cost estimated to be nearly $42 billion per year. Nearly $23 billion has been spent for repeated medical visits by patients seeking relief from symptoms that appear to be physical illnesses caused by anxiety. People with anxiety are three to five times more likely to see a doctor and are six times more likely to be hospitalized for these disorders than those without such problems.1 Because these conditions can be chronic and often disabling, the economic and individual burdens of anxiety disorders are quite high. People with anxiety disorders tend to use primary health care providers more than psychiatric medical personnel, creating a strain on the health care system. These patients seek medical care more often, in part because of increased concerns about their health and the manifestations of a racing heart, insomnia, shortness of breath, and other physical presentations. Only 30% of individuals afflicted with anxiety disorders seek treatment for their conditions, and 30 million people will experience some type of anxiety disorder at some point in their lives.2

Niacin

Niacinamide (also known as nicotinamide) is a form of the B vitamin niacin (vitamin B3). Niacinamide has effects similar to benzodiazepines on the brain.3 Nicotinamide stimulates the gamma aminobutyric acid (GABA)-benzodiazepine receptor complex, which is an inhibitory neuron grouping, and by modulating these specific neurons, exerts a calming effect.4 Experiments designed to test the efficacy of nicotinamide and brain function demonstrate that GABA nerve receptors were less stimulated when nicotinamide was lacking in individuals, and that reintroduction of nicotinamide led to a calming effect on the GABA receptors.5 Based on this research, it is reasonable to assume that supplementation with nicotinamide may contribute to fewer or less-severe anxiety symptoms.

Pyridoxine

Pyridoxine (vitamin B6) is an important coenzyme in the biosynthesis of several important neurotransmitters, including GABA, dopamine, and serotonin, all of which may be affected in anxiety. Pyridoxine deficiency causes an increased sympathetic discharge and hypertension in animals that have been suggested to reflect a decrease in production of GABA, dopamine, and serotonin. In addition, supplementing pyridoxine in these animals lowered their blood pressure.6 In another study, the use of magnesium and pyridoxine on anxiety-related premenstrual syndrome (PMS) symptoms was investigated. Researchers showed that women who were supplemented 200 mg of magnesium with 50mg of pyridoxine daily experienced significant reductions in anxiety-related PMS symptoms, including irritability, nervous tension, and generalized anxiety.7

Magnesium

Supplementation with magnesium has a reputation for producing a calming effect on patients with anxiety symptoms and=or elevated stress levels. In one study, nervousness and insomnia levels decreased in patients who were given 200 mg of magnesium combined with 400 mg of calcium.8 Another researcher found an association between magnesium deficiency and anxiety symptoms.9 In a study investigating the use of magnesium to alleviate pain in postsurgical patients, the patients were infused with magnesium both during and following surgery and were evaluated for anxiety levels. Patients who received the magnesium infusion required significantly less pain medication compared to the subjects in the control group who did not receive magnesium. In addition, the magnesium-treated group reported less anxiety symptoms.10 Magnesium deficiency is common in the typical American diet. One large survey determined that adequate magnesium was lacking in nearly 72% of diets, and that 50% consume less than 75% of the recommended daily allowance (RDA) of magnesium; 30% of these people ate less than 50% of the RDA of magnesium.11 Also, individuals who take oral contraceptives or diuretics and who overuse laxatives may be at increased risk of magnesium deficiency as well.

Kava (Piper methysticum)

Numerous studies have shown the efficacy of kava standardized to 70% kavalactones for anxiolytic activity. In a 25-week multicenter, randomized, placebo-controlled, double-blind trial, kava supplementation showed significant superiority over a placebo, both objectively and subjectively, beginning in week 8 of treatment.12 In another randomized, placebo-controlled, double-blind study, two groups containing 29 patients each with anxiety syndrome not caused by psychotic disorders were treated for a period of four weeks with kava extract. The Hamilton-Anxiety-Scale overall score of anxiety symptomatology showed a significant reduction in the kava group after one week of treatment.13 Research suggests that one mechanism in which kava induces sedation is via the constituents kava pyrones, which modulate GABA(A) receptor binding.14 Standardized kava is, however, difficult to find as many companies have stopped selling it.

L-theanine

Theanine is an amino acid found in high concentrations in green tea. Theanine can pass through the brain-blood barrier and may act as an agonist or an antagonist of some receptors. Research has shown that L-theanine supplementation does provide some relaxing effects, possibly by increasing levels of GABA and serotonin.15 A small study showed that administration of 200 mg of L-theanine increased alpha brain wave activity and induced a sense of relaxation.16 L-theanine is also known to block the binding of L-glutamic acid to glutamate receptors in the brain. A double-blind, placebo-controlled study showed that L-theanine intake resulted in a reduction in heart rate and salivary immunoglobulin A responses to an acute stress task, compared to the placebo group, likely attributable to an attenuation of sympathetic nervous activation suggesting antistress activity of theanine.17 Using animal models, L-theanine has been shown to cause dopamine release from dopaminergic neurons, and may inhibit excitatory neurotransmission and cause inhibitory neurotransmission via glycine receptors, suggesting a possible mechanism for its anxiolytic activity.18

Valerian (Valeriana officinalis)

A study examined the effects of either valerian or kava supplementation for seven days and physiological and subjective response to stress tasks. The results showed a significant decrease in systolic blood pressure responsivity in both the kava and valerian groups relative to the first stress task. Between the first and second stress tasks, the heart rate reaction to mental stress was found to decline in the valerian group but not in the kava group. Individuals taking either kava or valerian reported less pressure during the second stress task after seven days of supplementation.19 Valeriana wallichii was used in another study in which 33 subjects were supplemented with 500 mg capsules, twice daily for 60 days. Valerian not only significantly attenuated stress and anxiety, but also significantly improved depression and also enhanced the "willingness to adjustment'' in this study.20 In one study, a valerian=lemon balm combination was supplemented in 918 children under 12 years old suffering from restlessness and dys-somnia. The results showed that 80.9% of the patients who suffered from dyssomnia experienced an improvement for this symptom and 70.4% of the patients with restlessness also improved.21 Research has demonstrated that the pharmacological effects of valerian extract and the constituent valerenic acid are mediated through modulation of GABA(A) receptor function.22

Other antianxiety botanicals and supplements include passionflower (Passiflora incarnata), skullcap (Scutellaria lateriflora), cowhage (Mucuna pruriens), and GABA.

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