Anxious About Anxiety?

You’re not anxious about going on vacation or performing a pleasant task. You’re enthusiastic (but not enthused). You could be anxious about going to the dentist or to defend your last income tax return. Here, you’re entertaining a feeling of dread or apprehension, probably lacking clear justification.  Anxiety results from a subjective way of looking at a situation in the absence of a clear and actual danger. Of course, the sweating, increased pulse, and tension coupled with self-doubt about being able to handle the matter tell a different story. Sometimes respirations increase, the mouth gets dry and the intestines gurgle. All this is part of a defense mechanism. Anxiety can be particular, such as a panic attack in a crowd of people, in which case the stimulus can be identified. Or it may be generalized, being a long-term experience with no explanation of its cause. Obsessive-compulsory disorder (OCD) is an anxious state characterized by quandaries of uncertainty and compulsions to act. If the act is frustrated, the uncertainty remains and anxiety is intensified. Anxiety is considered a normal, but transient, response to stress, encouraging a person to take action in order to deal with what is perceived to be a difficult situation.

What’s The Risk?

Women are twice as likely as men to become anxious, mostly because of hormones and the archaic expectations that women are supposed to take care of everybody else before themselves. Age plays a minor role, in that OCD, separation anxiety and social phobias that include panic disorder show up in childhood and the teenage years. Early identification and treatment can forestall later problems. Certain environmental factors, such as poverty, separation from family, overly strict parents, family conflicts, anxious family members and lack of support can induce anxiety disorders. That anxiety runs in families is accepted, but it’s not known if the onset is genetic or learned, or both.

Physiologically, anxiety may be prompted by faulty brain chemistry, where an imbalance of serotonin, for instance, may result in irregular moods and emotions. There may be a structural fault, too.  The amygdala is the part of the brain in charge of processing emotional reactions and memory consolidation, including the recollection of fear.  If it’s overactive, this structure will heighten the fear response and increase anxiety in social situations.   Non-structural physical concerns, such as health problems, can cause anxiety.  Diabetes, alcoholism, heart disease, odd sensations that have no apparent cause, and thyroid disease are a few.

How Do I Handle Anxiety?

Besides the traditional psychotherapy practices and anti-anxiety medications, there are a few things you can do to take charge. First, you need to know that withdrawal from a psychoactive drug can cause anxiety. So, weaning from benzodiazepines causes the thing for which you took the drug in the first place. But beta-blockers, typically used for blood pressure control, have no such effect. They’re used off label to control rapid heartbeat, nervousness, trembling voice and shaky hands that accompany anxiety attacks. Alcohol withdrawal causes anxiety in many people.

Alternative approaches to anxiety treatment include things you can do and things you can swallow. Some modalities that require active participation include music therapy, art therapy, aromatherapy and meditation. With these you have to turn the music on, wield a paintbrush, light a candle, or think about pleasant things. But many people are unwilling or unable to be so engaged because of time constraints, family and job obligations, or simple faineance. Deglutition is the answer.

Options to psychological interventions for anxiety were sought in order to overcome limitations on time and resources. Because of adverse side-effects, alternatives to anxiolytic drugs also were explored. There is a shrub from the South Pacific islands that’s been used for centuries to calm the nerves, Piper methysticum, commonly known as kava kava. In a meta-analysis performed by the Cochrane Database at England’s Exeter University, researchers found that anxious subjects who took kava extract as a sole constituent in their treatment experienced a substantial reduction in symptoms compared to those taking a placebo (Pittler, 2000, 2003). One of the differences between a natural substance and a synthetic one is the time it takes to demonstrate effectiveness.  With a natural substance—in this example, herbal—you get the active ingredient and all the supportive components of the plant. Many enjoy an unexplainable synergy.  With a synthetic one—a drug—you get an isolated chemical that is not toned down by collaborative elements. Although earlier study found kava to be effective at taming anxious moments, it took eight weeks for kava’s superiority to placebo to be displayed (Volz, 1997).

Benzodiazepines are the drugs commonly used to treat anxiety. Their side effects, besides excessive drowsiness and decreased alertness, include paradoxical consequences, such as aggression, impulsivity, and irritability. Cognitive impairment and tolerance can result, as well. Tapering off these medications requires deliberation and a watchful eye. Using kava kava during such an ordeal, patients who were weaned from the drugs while being introduced to the herbal showed good tolerance and improved symptoms over a period of two weeks in a five-week trial in Germany (Malsch, 2001).

Generalized anxiety disorder has responded well to another folk remedy, passion flower. In a study comprising three dozen individuals, half received passion flower plus placebo and half received a benzodiazepine plus placebo in a one-month trial. The outcome showed both the herb and the drug to be effective in controlling anxiety symptoms. The drug, with rapid onset of action, impaired job performance (Akhondzadeh, 2001). The herb did not. Pharmacologically, extracts of the upper parts of the passion flower plant are most dynamic (Dhawan, 2001).

If you’ve taken fish oil for heart and brain health, that’s good. It’s been discovered that low levels of omega-3 fatty acids play a significant role in a number of mental irregularities (Buydens-Branchley, 2008) and that mood disorders respond especially well to omega-3 supplementation, with EPA getting better press than its companion, DHA (Ross, 2007). With a ratio of 3 to I, EPA to DHA, a fish oil product called Kirunal appears more than adequate to satisfy the mono- or adjunctive therapy approach in treating mood anomalies. For decades it’s been given that omega-3 fats are effective in the treatment of major depressive disorders, so it is reasonable to submit that they be likewise in anxiety disorders (Ross, 2009). If the presence of a substance yields a specific result, then the absence of that substance should yield the opposite. A deficit of n-3 fats has been identified in the red cell membranes of anxious persons (Greena, 2006), specifically those with social anxieties. Overall, it’s been proposed that human foods be supplemented with omega-3 fats as a strategy to improve behaviors and cognitive functions (Vinot, 2011). This makes one wonder if the education community needs to sit up and take notice. If that’s an inflammatory statement, n-3 supplementation can ameliorate that while reducing self-induced anxiety (Kiecolt-Glaser, 2011).

A relative newcomer on the anti-anxiety supplement stage is curcumin, the active ingredient of the turmeric spice common to Southern Asian and Middle Eastern cuisine.  Known predominantly as an anti-inflammatory agent, curcumin was found to have antidepressant like activity similar to tricyclic antidepressants, such as fluoxetine and imipramine (Sanmukhani, 2011). Because it is a natural substance, doses of curcumin used in an Indian trial were extraordinarily high, at 100 mg per kilogram of body weight, which equates to about 6,800 mg (6.8 grams) for a 150-pound person. Lesser dosages, from 10 to 80 mg/kg, demonstrated a positive effect on serotonin and dopamine activity, acting similarly to commonly prescribed drugs (Kulkami, 2008).

If you maintain a healthy diet, making sure to get the full array of macro and micro minerals, especially magnesium and zinc, as well as sufficient B vitamins, focusing on B 12, you’ll be able to avoid at least one cause of anxiety. Cutting back on alcohol and caffeine, and getting ample sleep are others. A caveat: before embarking on a supplement regimen to address anxiety, check with a healthcare professional to look for interactions with medicines and foods.

Andreatini R, Sartori VA, Seabra ML, Leite JR. Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study. Phytother Res. 2002 Nov;16(7):650-4.

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 Oct;26(5):363-7.

Buydens-Branchey L, Branchey M. n-3 polyunsaturated fatty acids decrease anxiety feelings in a population of substance abusers. J Clin Psychopharmacol. 2006 Dec;26(6):661-5.

Buydens-Branchey L, Branchey M, Hibbeln JR. Associations between increases in plasma n-3 polyunsaturated fatty acids following supplementation and decreases in anger and anxiety in substance abusers. Prog Neuropsychopharmacol Biol Psychiatry. 2008 Feb 15;32(2):568-75. Epub 2007 Nov 1.

Dhawan K, Kumar S, Sharma A. Anxiolytic activity of aerial and underground parts of Passiflora incarnata. Fitoterapia. 2001 Dec;72(8):922-6.

Ernst E. The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava. Ann Intern Med. 2002 Jan 1;136(1):42-53.

Ernst E. Herbal remedies for anxiety - a systematic review of controlled clinical trials. Phytomedicine. 2006 Feb;13(3):205-8. Epub 2005 Aug 15.

G. Fontani, F. Corradeschi, A. Felici, F. Alfatti, S. Migliorini, L. Lodi Cognitive and physiological effects of Omega-3 polyunsaturated fatty acid supplementation in healthy subjects European Journal of Clinical Investigation. Vol 35, Iss 11, pages 691–699, Nov 2005

Pnina Greena, Haggai Hermeshb, Assaf Monselisec, Sofi Marom, Gadi Presburger, Abraham Weizman Red cell membrane omega-3 fatty acids are decreased in nondepressed patients with social anxiety disorder European Neuropsychopharmacology. Feb 2006; 16(2): 107-113

Harauma A, Moriguchi T. Dietary n-3 fatty acid deficiency in mice enhances anxiety induced by chronic mild stress. Lipids. 2011 May;46(5):409-16. Epub 2011 Feb 7.

Jadoon A, Chiu CC, McDermott L, Cunningham P, Frangou S, Chang CJ, Sun IW, Liu SI, Lu ML, Su KP, Huang SY, Stewart R. Associations of polyunsaturated fatty acids with residual depression or anxiety in older people with major depression. J Affect Disord. 2012 Feb;136(3):918-25. Epub 2011 Nov 21.

Kiecolt-Glaser JK, Belury MA, Andridge R, Malarkey WB, Glaser R. Omega-3 supplementation lowers inflammation and anxiety in medical students: a randomized controlled trial. Brain Behav Immun. 2011 Nov;25(8):1725-34. Epub 2011 Jul 19.

Kinrys G, Coleman E, Rothstein E Natural remedies for anxiety disorders: potential use and clinical applications. Depress Anxiety. 2009;26(3):259-65.

Kulkarni SK, Bhutani MK, Bishnoi M. Antidepressant activity of curcumin: involvement of serotonin and dopamine system. Psychopharmacology (Berl). 2008 Dec;201(3):435-42. Epub 2008 Sep 3.

Lakhan SE, Vieira KF. Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutr J. 2010 Oct 7;9:42.

Malsch U, Kieser M. Efficacy of kava-kava in the treatment of non-psychotic anxiety, following pretreatment with benzodiazepines. Psychopharmacology (Berl). 2001 Sep;157(3):277-83.

McBride S, Graydon J, Sidani S, Hall L. The therapeutic use of music for dyspnea and anxiety in patients with COPD who live at home. J Holist Nurs. 1999 Sep;17(3):229-50.

Pittler MH, Ernst E. Efficacy of kava extract for treating anxiety: systematic review and meta-analysis. J Clin Psychopharmacol. 2000 Feb;20(1):84-9.

Pittler MH, Ernst E. Kava extract for treating anxiety. Cochrane Database Syst Rev. 2003;(1):CD003383.

Ross BM, Seguin J, Sieswerda LE. Omega-3 fatty acids as treatments for mental illness: which disorder and which fatty acid? Lipids Health Dis. 2007 Sep 18;6:21.

Brian M. Ross Omega-3 polyunsaturated fatty acids and anxiety disorders Prostaglandins, Leukotrienes and Essential Fatty Acids. Nov 2009; 81(5): 309-312

Saeed SA, Bloch RM, Antonacci DJ. Herbal and dietary supplements for treatment of anxiety disorders. Am Fam Physician. 2007 Aug 15;76(4):549-56. Sanmukhani J, Anovadiya A, Tripathi CB. Evaluation of antidepressant like activity of curcumin and its combination with fluoxetine and imipramine: an acute and chronic study. Acta Pol Pharm. 2011 Sep-Oct;68(5):769-75.

Song C, Li X, Leonard BE, Horrobin DF Effects of dietary n-3 or n-6 fatty acids on interleukin-1beta-induced anxiety, stress, and inflammatory responses in rats. J Lipid Res. 2003 Oct;44(10):1984-91. Epub 2003 Jul 1.

Vinot N, Jouin M, Lhomme-Duchadeuil A, Guesnet P, Alessandri JM, Aujard F, Pifferi F. Omega-3 fatty acids from fish oil lower anxiety, improve cognitive functions and reduce spontaneous locomotor activity in a non-human primate. PLoS One. 2011;6(6):e20491. Epub 2011 Jun 7.

Volz HP, Kieser M. Kava-kava extract WS 1490 versus placebo in anxiety disorders--a randomized placebo-controlled 25-week outpatient trial. Pharmacopsychiatry. 1997 Jan;30(1):1-5.

tYehuda S, Rabinovitz S, Mostofsky DI. Mixture of essential fatty acids lowers test anxiety. Nutr Neurosci. 2005 Aug;8(4):265-7.