Antianxiety medications, sleeping pills! What if you don't want to take medications to treat your anxiety? CBT, biofeedback and natural anxiety treatments can work.
I don't remember how I first ended up talking with a doctor about my little "worry problem." I do remember that I was 16 and my mother had brought me in for some ordinary health concern, but that we quickly got onto the subject of my insomnia. And I can still picture the doctor's look of fretful outrage when I said I was sleeping only six hours a night. "That's not enough! You're still growing!" he insisted. "You must go to bed earlier."
It wasn't that simple, I told him— sleep just wouldn't come. Instead I'd lie rigidly in the dark, trying to push away the thoughts spiraling around my mind, feeling like my brain was a motor that couldn't be turned off.
He didn't have much to offer—he suggested I cut down on coffee and dismissed my mother's questions about biofeedback. But one suggestion he made stuck with me. "Keep a notebook next to your bed," he said. "Write down everything that's worrying you so you can let go of it and fall asleep." That simple prescription, it turned out, was only the first of many remedies I've tried in what has become a lifelong struggle to cope with anxiety.
While I've often felt isolated and ashamed of my near-constant inner turmoil, the truth is, I'm in good company. More than 19 million Americans—13 percent of the population—suffer from a diagnosable anxiety disorder, 4 million of them meeting the criteria for generalized anxiety disorder, the chronic low-level anxiety that plagues me. And of course today the multiple threats of war, terrorism, and economic instability have made anxiety the malady of our age; millions of people who don't meet the criteria for a full-blown disorder struggle with excessive worry nonetheless. The number of prescriptions written for antianxiety medications and sleeping pills jumped in the weeks following September 11 and has continued rising steadily ever since.
At several points in my life, I too have considered medication. But in the end I've always pursued natural remedies instead. Chalk it up to my stubborn refusal to believe my problems are great enough to warrant full-on drugs, or to my preference for all things natural. Either way, my strategies have served me well. What I've learned about using them, though, is that no single approach works in every situation; I've needed to keep experimenting to see what works for me at a particular time and place in my life. Here's my tale of "recovery"—complete with all the messy detours along the way. Everything's okay—so why am I so tense?
During my college years and early 20s, no one would have described me as calm. I'm sure many of my former roommates still remember my bitten fingernails and late-night prowling around the house.
It was during these years that I began building a foundation for coping with my anxiety, experimenting with various relaxation techniques in addition to filling the "worry pad" I kept beside my bed. I took up running, and immediately found that 40 minutes of pounding up and down neighborhood hills left me feeling calmer and more confident, and able to sleep better at night. I also tried meditation and yoga, which relaxed me physically and refreshed my mind. Since my worries back then tended to be both concrete and relatively common—from whether I'd finish a term paper on time to whether the cute guy in Shakespeare 101 would ask me to coffee—the exercise and mind-body practices were enough to keep me feeling like a normally functioning member of society. It wasn't until later that I found I needed more—much more.
I'm a working mom—and it's more than I can handle
Fast-forward to my mid-30s, when I'd married, had two children, and was working full-time at a job I loved. I seemed to have it all, but my stress level was through the roof. I felt incredibly guilty about leaving my kids to go off to work and was convinced the world thought I was a poor mother for doing so. I set out to prove everyone wrong by holding myself to exhaustingly high standards.
I wouldn't let myself crawl into bed at night until the house was clean—even if that meant I was doing dishes and sweeping the kitchen well past midnight—because I was so fearful of dismaying our baby-sitter with a mess in the morning. I'd spend hours at work secretly researching college savings plans, and then come home and inundate my husband with charts and graphs, convinced that we'd hopelessly missed our chance to provide our daughters with a college education. My previous coping strategies—exercise, meditation, and yoga—fell victim to my impossibly tight schedule.
The out-of-control anxiety put a huge strain on my marriage; I simply couldn't sit down and enjoy a relaxed hour with my husband. "Come here and check this out," he'd call from the living room, where he was laughing over an episode of Seinfeld. "In a minute," I'd call back, hands deep in dishwater, and by the time I was hovering tensely in the doorway, the credits would be rolling.
It was around this time that I saw a news item about kava, an herb from Polynesia that was said to relieve anxiety with few or no side effects. What really appealed to me was the writer's promise that kava wasn't sedating and could bolster mental clarity. I headed straight for the health food store. The first time I tried kava, I was sold. A capsule in the morning just before I ran for the bus made the day flow better, without the usual edge of hysteria that had tinged my every decision. Soon I found that a combination of kava and valerian just before bed slowed the spinning in my mind and left my limbs rubbery with relaxation.
My happy solution didn't last long, however. Just months after I started taking kava, headlines proclaimed that the herb had been found to cause liver damage. Friends started warning me against kava, and it began disappearing from my local health food store. At first, I was too enamored of my new ally to stop taking it, and tried to get away with cutting down my usage to about once a week. But I found myself getting increasingly nervous about the very thing that was supposed to calm me down, and after a while I stopped taking it.
That's when I began prowling the health food store shelves looking for substitutes. In some stores, a whole shelf of supplements, bearing soothing names like "True Calm" and "Calm Mood," promised to soothe ruffled temperaments. Some seemed to be made up largely of amino acids that claimed to regulate brain chemistry and soothe overstimulated nerve cells.
I first tried GABA (gamma-aminobutyric acid), an amino acid that tends to be low in people with panic disorders and other anxiety-related conditions. I found the idea of replacing a natural brain chemical very appealing; however, I have to say that I didn't notice much long-term effect.
I also tried various herbs, including valerian, hops, chamomile, passionflower, and lemon balm, many of which have a long history of use in Europe. My experience echoed the research, which has shown passionflower and lemon balm to be the most effective of the bunch, with the least tendency to cause lethargy or drowsiness. On days when I felt pulled in ten different directions, I got the most notable stress relief from supplements that blended amino acids and herbs. A homeopathic remedy called "Calm Forté," made up of minute amounts of many of these herbs, seemed to do the trick for a while, though I could never be sure it wasn't just the soothing effect of waiting for the tablets to dissolve on my tongue. Still, between the amino acids, the herbs, and the homeopathy, I was holding things together most of the time.
My life is falling apart—what now?
Then, about a year-and-a-half ago, I separated from my husband of 11 years. Just two months later, my father was diagnosed with terminal cancer, and he died after a heartbreakingly short battle with the disease.
It was all too much, and my anxiety level soared. But like the proverbial frog in the pot who doesn't notice that the water's getting warmer, I was too preoccupied with day-to-day survival to notice. Work deadlines slipped, papers piled up unsorted. In my head there was a constant white noise of worry. I'd drift from room to room, starting and stopping tasks without finishing any of them. I finally found the courage to ask a therapist for help after I locked my keys in the car not once but twice, left my wallet on a plane, and forgot to pick up the kids after school—all in the same week.
Right about that time, my three sisters and I were spending a weekend together when, after we'd finished a bottle of wine, one of us asked tentatively, "Hey, are any of you guys having a problem with anxiety?" It was as if someone had pulled the cornerstone out of a retaining wall; the stories came tumbling out. Two of my sisters had had panic attacks while driving or in meetings; the third was having crying fits several times a day. The sister whose home we were in was studying to be a therapist, so she happened to have the Diagnostic and Statistical Manual of Mental Disorders on her dining room table. We looked up anxiety; sure enough, right there in the terse and formal write-up, it said anxiety disorders were sometimes triggered by the death of a parent.
The discovery that we shared a secret war with worry made me wonder: Could there be a genetic underpinning to our anxiety? The experts seem to think so. Mood disorders do run in families, says James Gordon, director of the Center for Mind-Body Medicine in Washington, D.C. My sisters' and my common tendency to be overstressed "suggests a biological basis," he says.
If that was the case, I thought, perhaps I should take a serious look at medication. After reading up a bit I broached the subject—somewhat shamefacedly—with my therapist, asking if she thought it was time to try what she called "the big guns." My desperation had overtaken my reluctance; I felt I had run out of options.
She suggested I hold off just a bit longer—and I'll always be thankful for the insight she offered. "What we look for is whether your anxiety is out of proportion to your situation," she said with a sympathetic smile. "But I think we'd both agree that your life really is stressful right now and you really do have a lot to worry about." She had me tick off the things that were keeping me up nights, and sure enough, it read like a laundry list of life crises. At least it helped me see that I wasn't just feeling overwhelmed—I truly was overwhelmed. Paradoxically, having a compassionate observer confirm that my life really was a mess somehow made me feel I could cope with it all.
The first target we took aim at was sleep. She suggested I try an over-the-counter preparation as a short-term solution: Get a few good nights of rest, she said, then check back in and see if things look more reasonable. I did as she suggested, finding that a combination of valerian and lemon balm was usually enough to settle me into bed. On particularly restless nights, taking melatonin half an hour before bedtime was the perfect way to reset my internal clock.
Sure enough, once I replenished the sleep deficit, my sense of urgency subsided and I was ready to look at the big picture. I got to thinking about what was missing in my life, and resolved to reinstate it. I started running again, found a yoga class, and began spending an evening a week at a meditation center. I also started making time for my "personal therapies": gardening and jewelry-making. Finally, I turned my attention to diet, the part of the picture I'd completely neglected in the past. "Food can have a profound effect," says Susan Lord, director of nutrition at the Center for Mind-Body Medicine.
At least one of the culprits in my case, I decided after a consult with Lord, was an overreliance on refined carbohydrates (candy, crackers, chips) for quick bursts of energy. My body processed those carbs like sugar, Lord explained, causing an insulin imbalance that might well contribute to my roller-coaster moods. Another weak spot, Lord pointed out, was my habit of not eating for long periods when I got busy. "Some people who suffer from anxiety are actually mildly hypoglycemic but don't know it," she said, advising me to keep high-protein snacks on hand to keep my blood sugar from plummeting.
I went even further along the dietary route after I discovered Julia Ross's book, The Mood Cure. Ross, who pioneered the use of nutritional therapy in treating eating disorders and addictions, makes a compelling case that the epidemic of mood disorders in America today is tied to our poor diet.
"The typical American diet starves the brain sites that make us feel good," Ross says, adding that stress depletes the same sites. Ross recommends foods high in protein, like meat and poultry, which are packed with the tryptophan our bodies need to produce serotonin; she also suggests what she calls "good mood fats" like olive oil to help the brain turn the tryptophan into serotonin.
I'm not one to jump enthusiastically onto a dietary bandwagon, but since Ross's approach seemed sensible, I gave it a try, first cutting out caffeine and greatly reducing my sugar intake, then taking magnesium and B vitamins, eating lots of tuna and eggs, and cutting out the cookies and corn chips. The results have been dramatic: The supplement bottles on my shelf are getting dusty, I haven't taken a sleep aid in months, and I've lost five pounds, which doesn't hurt my outlook, either.
I will also confess that I continue to take kava from time to time, mostly on the days when an extended "worry list" is making my brain buzz like a nest of angry yellow jackets. I'd like to say I started taking kava again because I researched it thoroughly and discovered it was perfectly safe. The truth is, I did it based on the questionable rationale that I didn't seem to have sustained any damage from my previous use—and I sure did miss it. It turns out I got lucky: Several studies in the past year have convincingly questioned the liver damage attributed to kava.
I'm probably down to a capsule or two once or twice a month, on the dark nights when my fears can't be calmed by any other means. I think of kava as the big brother you call in when you just can't handle the neighborhood bully by yourself. But as a general rule I prefer to build up my own strength to face the enemy.
These days, my greatest weapon against worry can be summed up in the wonderful, simple little phrase, "This too shall pass." It's true I have to monitor my anxiety levels and take steps to restore balance—but that's not so different from someone else's need to lower their cholesterol or coddle a bad back, is it? My tendency to fret too much will probably always be with me. But just as with other problems that come around from time to time, like relationship trauma and taxes, it's something I've learned to cope with. All the tactics I've built into my life have taught me that one thing I don't have to worry about is my tendency to worry.
Top Ten Alternative Remedies For Anxiety
When you're feeling utterly stress-crazed, no one can blame you for heading straight for the supplement aisle. But that shouldn't be the first thing you do, experts say. A better way to begin is to step back and take a critical look at your lifestyle. "I'd start with a comprehensive self-help approach focusing on diet, exercise, and relaxation techniques such as meditation," says physician Jonathan Davidson, director of the anxiety and traumatic stress program at Duke University Medical Center and author of The Anxiety Book: Developing Strength in the Face of Fear. "Then if symptoms persist three to four months later, you might need to do more."
If you fall into this category, here are the top ten herbs and supplements for anxiety. We selected them based on the recommendations of several experts, who pointed out that while most of these treatments have not yet been subjected to rigorous study, many have long histories of use in Europe or in the ancient medical traditions of countries like India and China.
Herbs
1. Chamomile
What it is: A mild sedative, sleep aid
How to use it: As a tea: Steep 1 to 2 teaspoons in a cup of hot water (or buy prepared tea bags). As a tincture: Take 1 to 4 milliliters three times a day.
Safety considerations: none
2. Kava kava
What it is: A sedative that doesn't cause drowsiness
How to use it: Commercial supplements have varying levels of kavalactones, the active ingredient, so read the label: Most studies used 40 to 70 mg of kavalactones three times daily.
Safety considerations: Some experts consider it safe; others advise avoiding it. (See "Is Kava Safe?" on page 112.) If you decide to try it, don't take more than 300 mg a day, and be alert for warning signs of liver damage, like dark urine. Don't mix with alcohol or drugs or take daily for more than four weeks without medical advice.
3. Lemon Balm
What it is: A mild sedative
How to use it: As an ingredient in calming teas, along with hops, valerian, and passionflower. Studies used dosages from 300 to 900 mg. Many find it effective to take during the day.
Safety considerations: It may cause drowsiness, though less so than other herbal sedatives.
4. PassionFlower
What it is: A sedative
How to use it: As a supplement: Take 200 to 500 mg up to three times a day. As a tea: Drink up to three cups daily (steep 1 teaspoon per cup of water).
Safety considerations: May boost other sedatives' effects.
5. Saint-John's-Wort
What it is: An herb that's thought to boost brain levels of several mood-lifting chemicals, including serotonin, dopamine, and norepinephrine
How to use it: Take one 300-mg capsule once a day.
Safety considerations: Saint-John's-wort may disrupt the effectiveness of certain drugs, including digoxin, theophylline, warfarin, and cyclosporin. It can even interfere with the action of birth control pills. This herb shouldn't be combined with other antidepressants unless indicated by your doctor. In some people, it may increase sun sensitivity.
6. Valerian
What it is: Tranquilizer and muscle relaxant
How to use it: Studies have used a wide variety of dosages. A common
recommendation is 150 to 300 mg during the day or, as a sleeping aid, 300 to 500 mg an hour before bedtime. Start with the lower dosage and work up.
Safety considerations: Should not be combined with alcohol. High doses may result in stomach upset, nausea, or drowsiness, and may interfere with driving.
Other Supplements
7. 5HTP
What it is: An amino acid that enhances serotonin synthesis
How to use it: As a supplement: Take 50 mg up to three times a day. For insomnia, take 50 mg 30 minutes before bedtime. Foods with high levels of tryptophan, which promotes the synthesis of 5HTP, include meat, poultry, fish, and avocados.
Safety considerations: Do not take 5HTP with antidepressants, prescription or otherwise. Use it for no more than two months, since longer use hasn't been studied. If necessary, you can resume after a several-month break. (For more information on 5HTP and another amino acid, GABA, see "Do Amino Acids Really Stack Up?" on page 76.)
8. Melatonin
What it is: A sleep-promoting hormone, produced by the pituitary gland, that decreases with age
How to use it: Take .3 milligrams half an hour before bedtime; increase to 1.5 mg if necessary. (This is less than in many supplements, so you may have to split pills.)
Safety considerations: Higher doses can bring on a "hangover" effect and leave you tired during the day. Possible dangers from high doses taken for a long period include infertility, reduced sex drive in males, hypothermia, retinal damage, and interference with hormone replacement therapy.
9. B vitamins (B3, B6, and B12)
What they are: Vitamins that lessen your body's tendency to be overstimulated by adrenaline
How to use them: Look for a supplement with at least 50 micrograms of B12 and at least 50 mg of other B vitamins.
Safety considerations: More than 2,000 mg of B6 can damage nerves; more than 200 mg of B3 can lower blood pressure and cause the skin to flush.
10. Omega-3 fatty acids
What they are: Substances that improve communication between brain cells. Most fish oil supplements are 18 percent EPA and 12 percent DHA. Flax oil capsules provide alpha linolenic acid, which the body converts to EPA and DHA.
How to take it: Check dosage instructions on the label.
Safety considerations: Watch out for fish breath and an upset stomach.
Is Kava Safe?
It's been hard to stay calm about kava since reports linking it to liver damage surfaced in 1998. Though it was used for centuries in Polynesia without problems, the herb has lately been implicated in 28 cases of severe liver problems, four of them requiring transplants. Kava has since been banned in several countries, including England, Germany, Canada, and Singapore. While it remains available here, the Food and Drug Administration has warned of potential liver damage.
Some studies, however, have questioned whether the troubling findings were overstated. One concluded that of the cases originally cited, only two were actually related to kava. And some experts think the problems stemmed from contamination during processing, or the use of kava in combination with other liver stressors like alcohol or drugs.
In January, the Cochrane Review, a respected publication that analyzes the best of recent medical research, weighed in, concluding that 11 studies had shown kava to be both effective and safe, with minimal side effects.
But even that might not be the last word. Last May, researchers at the University of Hawaii at Manoa, led by C.S. Tang, found that a substance in kava stem peelings and leaves—but not the roots used traditionally—was harmful to liver cells. (Tang also interviewed growers who reported that they'd been selling stem shavings to keep up with climbing demand.) If the findings hold up, getting back to using the root might make kava safer.
If you're using any of the products on the market today, it's worth taking precautions. "If you're a healthy young adult who ends up needing a liver transplant, you'd have to ask if kava was worth the risk," says Duke University physician Jonathan Davidson, author of The Anxiety Book.
To protect yourself, here's what the experts at the Austin, Texas-based American Botanical Council recommend:
- Avoid kava if you have liver problems, are taking a drug known to harm the liver, or drink alcohol regularly.
- Don't take it daily for over a month without medical advice.
- Stop taking it if you notice any symptoms of jaundice, such as yellowing of the eyes. For more information, check the Council's website at http://www.herbalgram.org/.
Where To Seek Help
If your worries are so intense they're interfering with your ability to work, socialize, or sleep, you should consult a psychiatrist, or a psychologist who can refer you to someone licensed to prescribe medication.
If your symptoms are less severe, you may prefer an alternative approach. A good place to start is with a naturopathic physician or a holistically minded M.D. To find a naturopath, go to www.naturopathic.org/, the website of the American Association of Naturopathic Physicians. For a holistic physician, check http://www.ahha.org/, the website of the American Holistic Health Association, or our listing at http://www.alternativemedicine.com/. Be sure the person you choose has experience treating anxiety.
Source: Alternative Medicine
next: Restorative Yoga For True Relaxation
I have discovered that anxiety is my friend. It calls attention to the options I have open; to the new choices that are available to me.
