Taming Anxiety without Addictive Substances
Imagine a gazelle, peacefully grazing in a field of grass. Suddenly the animal notices something moving out of the corner of its eye. Its hair stands up and its body suddenly goes on high alert as it sees a lion coming towards it. Everything in the animal’s body suddenly shifts to survival mode. The heart races, the blood is diverted to the muscles and away from digestion, and the brain’s decision-making circuits are turned off in favor of more primitive channels. Stress hormones flood the body and allow the gazelle to run for its life. These mechanisms allow the gazelle to out run the lion. Once the threat is over, the gazelle eventually returns to grazing and its hormones and nerves recalibrate.
But what happens to humans in our modern lifestyles when we can’t ever seem to out-run the lion? Our lives now force us to see and deal with one crisis after the other. Work, family, traffic, finances, horrible things on the news, traumatic events, death and illness…our brains are constantly exposed to a metaphorical, relentless, lion.
Unlike the gazelle, our bodies cannot return to normal. Our hormones are constantly flooding our bodies which diverts attention away from reparative systems and towards ones that can result in illness. Headaches, irritable bowel syndrome, weird skin rashes, insomnia, post-traumatic stress disorder, and a myriad of other syndromes are related to the fact that we cannot turn off these systems in our bodies. What is even more concerning is that we are finding that the chronic effects of stress can actually change the structure of our brains, which leads to further dysfunction and this can ultimately change our genes. Our anxiety and trauma then becomes hereditary, and can be passed on to our children. (McEwen, 2012).
Anxiety and substance abuse are the leading cause of years lost to disability worldwide. Whiteford, 2013. In my opinion, substance abuse often starts when people are desperately trying to medicate a crippling anxiety problem. We need treatments that work differently and can help us get our lives back.
Alcohol seems to be the most widely available and socially acceptable way to self-medicate anxiety. In our culture we are often frowned upon if we don’t partake in using alcohol as a social lubricant. However, while we may feel better in the short-term, alcohol ultimately makes anxiety worse.
Booze can initially cause a dampening of anxiety as it hits the receptors in our brain responsible for down-regulating our experiences of hyper-vigilance and over-thinking. This results in disinhibition and that feeling that we don’t have a care in the world. However, our brains are working overtime in the background producing chemicals that will override this effect in order to keep us alive. As soon as the alcohol wears off we are flooded with glutamate and we are suddenly more anxious than when we started. This is why people often wake up at 3 am and can’t go back to sleep after an evening of drinking.
If patients present to their physician with complaints of anxiety, the more severe and acute forms are often treated with a class of medications that I think are some of the most addictive chemicals on earth: the benzodiazepines. While these can be helpful in the short-term, they are incredibly difficult if not impossible at times to stop taking. I find that heroin addicts can recover from their addictions easier than a soccer mom can stop her nightly benzo.
Some of the selective-serotonin reuptake inhibitors can also treat anxiety, and are helpful in many people. However, for those who would prefer a more natural approach, I would like to discuss some of my favorite herbs for anxiety:
Kava is a root that is native to polynesia and micronesia. The people native to these areas knew of its mind-altering potential and would make a drink by sitting around chewing the root and then spitting it into a communal bowl. They would then mix it with coconut juice and pass it around. While this may sound like a disgusting way to have a party, it actually helped them resolve their differences. When warring leaders could not come to an agreement, everyone would sit around drinking kava kava and after a while everyone was laughing together and feeling great.
Given the anxiolytic effects, Kava was actually tested against the benzodiazepenes bromazepam and oxazepam (Woelk et al, 1993). After six weeks of treatment, there was no difference in anxiety scores between Kava and the prescription drugs! This is especially amazing to me, because Kava does not seem to have an addictive potential. It can calm anxiety to the same degree as these powerful prescription medications, without the addictive potential.
There have been some case reports of liver failure with the use of Kava, resulting in the FDA labeling as possibly dangerous. However, these cases are somewhat questionable as to whether it was actually kava or a contaminant in the herbal mix.
To avoid possible complications, it should not be taken if alcohol is also involved, and should not be taken in people prone to liver complications. I actually like to get the ground root and mix it with juice to make “kava cocktails” as an alternative to alcohol at a party. While this goes over well with my friends, my in-laws looked at me suspiciously and were concerned that I was trying to give them a mysterious substance that might completely disinhibit them or show up on their drug tests. While Kava has many of the same effects on the mind as marijuana, you can rest assured your employer will not fire you if you partake!
My next favorite supplement addresses anxiety as it relates to insomnia:
This naturally occurring supplement increases serotonin in your brain, much like the prescription selective serotonin inhibitor drugs. It has actually been found to treat depression as well as Prozac! (Jangid, 2013). According to the Natural Medicines Database, it can be used as a treatment in alcohol detoxification, assisting the brain to return to a normal state and fighting off anxiety. Like some of the SSRI’s, it can be used to treat chronic pain in Fibromyalgia. Interestingly, it can also be used to help people lose weight, possibly by reducing cravings in the brain.
5-HTP turns tryptophan into serotonin, and can actually be a little sedating. When taken in the evening, it can help you get a better night’s sleep. This is a good medication for people who wake up at 3 AM with their mind racing about something.
Since this supplement increases serotonin, it should not be used with other herbs or drugs that increase serotonin because theoretically it could increase the risk of serotonin syndrome.
My third favorite herb is what I like best for children:
This herb is related to the mint plant, and can be easily grown at home. It’s leaves are quite fragrant and pleasant. It can be used as a tea in the evening to help little ones settle down and go to bed! This herb has also been used safely in infants, to help with colic.
Lemon balm has been used to assist with conditions such as alcohol withdrawal, insomnia, and may even improve the symptoms of Alzheimer’s dementia.
It can be mixed with other herbs such as Chamomile, Lavender, Orange Blossoms, or Valerian for a synergistic effect.
I use lemon balm in a tea for my own child, who has problems settling down at night. The ritual of making tea with him also often serves as an indicator that it is time to shut off his brain and play for the day, and calms his night-time fears.
Anxiety is a crippling illness that rises to epidemic proportions in our hectic lifestyles. What is most concerning, is that repeated traumatic events can actually change the physical structure of our brains leaving us disabled when it comes to dealing with problems for the rest of our lives. We desperately need new treatments that will not create an addiction, worsening our ability to function further. Although prescription drugs can be helpful, many plants and supplements can effectively treat our brains without the potential for abuse. Integrative Medicine physicians can help use these medications combined with prescriptions or without. This post does not constitute medical advice and please seek out a medical professional for more help.
Dr. Erin Fenstermacher is a Board-Certified Internal Medicine Physician and Fellowship-Trained Integrative Medicine Physician with a practice in Albuquerque New Mexico as well as a Telemedicine practice available in other states.