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It's a catch phrase, "I'm nervous." My seven-year-old is anxious his basketball team might lose against the orange team this weekend. Anxiety and the anxious lexicon have crept into our society over the past decades and we as a culture have turned into a bundle of nervous. So many people are placed on anxiolytics like Xanax or Ativan; which is like getting a brand new car. It looks good, but it doesn't go anywhere without gas. So what is the gas needed for someone who suffers from anxiety. Let's figure out how you can fill your car with a 90 minute check-up.
Even though we use the word anxiety easily, the truth is that Generalized Anxiety Disorder or GAD is an unnatural response to stressful stimuli and has links to abnormalities in brain chemistry. There have been studies suggesting a genetic component and there are medical causes like hyperthyroidism. Also, there is a multitude of drugs and medications that can cause or exacerbate anxiety (caffeine, phenteramine, methylphenidate). Once your physician has excluded any causes that are serious, medically difficult, or psychological there are many things you can try as an integrative and mind-body approach.
Exercise - Many with anxiety and the "racing heart" think aren't I already challenging my heart enough? If only that were the case. Most studies done introducing exercise in patients with anxiety show a decrease in symptoms; aerobic being better than anerobic. I would ask your physician if you are cleared for three 30-minute aerobic sessions per week gradually increasing as tolerated.
- Food - You are what you eat! You are also what you drink and caffeine and alcohol can increase anxiety. Organic or natural fruits and vegetables with limited or no processed carbohydrates is key.
- Supplements and Herbal Medicines
- S-Adenosyl Methionine (SAMe) - This molecule assists in the methylation of certain neurotransmitters and can be decreased in patients with anxiety. You should start with 200mg twice daily and increase to 400mg twice daily if no side effects occur (nausea and insomnia). The dose can eventually be increased to three times a day.
- Vitamins B6 and B12 are essential vitamins in the body's natural production of SAMe so taking up to 100 milligrams of B6 and 400 micrograms of B12 could be helpful.
- Valerian - Normally seen for sleep disturbances it has been used for centuries as a sedative. This herbal medicine has been seen in studies to have an effect similar to some antipsychotics - recommended 300-600 mg of liquid root extract.
- Passionflower - has been used for centuries as a calmative and was temporarily removed from US markets in the 1970s because safety could not be shown, but this was later removed.
- Kava - much fear and suspicion surround the use of Kava because of its potential for liver toxicity. A review of studies has shown Kava was better than placebo in treating GAD. One must be certain they are obtaining a product that has 50mg of kava lactones derived from the roots and not stems or leaves. If you obtain a respectable FDA inspected brand then you can be reassured the product contains roots.
- Psychotherapy - If we look back at the car analogy then psychotherapy is the high-octane gasoline for the new car. As a physician I would make this the basis for treatment and then add supplements and other treatments after this has been adequately established.
- Yoga - There is no doubt this practice calms the mind and improves mental health. The data may not conclusively prove yoga decrease anxiety, but anecdotally there participants will report definitive improvement. This may be the physical or spiritual aspect of yoga.
- Acupuncture - a few small studies have shown positive effects with individuals receiving acupuncture for anxiety. The mechanisms are not well understood by the scientific community, but it is relatively minimally invasive and there are reports showing mild to moderate benefit.
There is no substitute for sound medical and psychological care if your anxiety is causing you physical or emotional distress. An integrated approach would seem best and while a typical 10-minute physician visit may find you holding a prescription for anti-anxiety or anti-depressant medications, you now have other things you might consider adding to your regimen. As always, it is good to let your provider know what you are adding so you can be a team.
