If you've been curious about taking herbs for anxiety and felt overwhelmed with what formulation and what type of herb to choose, know that you are not alone. The market is full of all sorts of herbal teas, capsules, and foods with promises of improved wellbeing. And you're in good company - about 4% of Americans are seeking herbal remedies to improve their mental wellbeing.
We often recommend herbal options in conjunction with other treatment approaches and not just solely relying on herbs - just as in the same way we don't recommend relying solely on pharmaceutical medications. A multi-layered approach seems to work best. Along with other options such as nutrition, mind-body approaches, sleep hygiene, herbs are considered a natural remedy for anxiety.
Why does shopping for herbal options feel a little like the Wild West?
Fortunately, there are several herb treatments for anxiety that really seem to shine when it comes to helping people feel more calm and relaxed. We have thousands of years of ancient wisdom with many herbs but we have to remember that formulations now are different than in the past. Since the supplement industry is not regulated by the FDA, it is important to take into consideration:
The brand of the herbal product and if the product/brand participates in third party (independent) testing
Formulation of the herbal product
It's important to know what formulation and doses are being used in scientific studies. There are lots of different compounds that make up a plant and much work has been done to determine what the active ingredient (the compound that provides the health benefit) is. Be wary of new products on the market that tout anxiolytic benefits.
What are the best herbal treatments for anxiety?
Our top picks, based on research, clinical experience, safety profile - and taking into consideration the sustainability of harvesting the herb:
Passionflower
Passionflower has long been used as a folk remedy to calm nerves. One study found that passionflower was as effective as benzodiazepines in treating generalized anxiety disorder, but did not work as quickly as benzodiazepines. It also may be helpful for sleep, at least when taken as a tea. For anxiety, look for Passiflora incarnata L as the active ingredient, at 200-300 mg twice daily. Most studies utilize a liquid tincture formulation.
Chamomile
Chamomile is a safe herbal treatment option to help with sleep and relaxation. There are not many human clinical trials to explore the effect of oral, pharmaceutical grade chamomile on anxiety, but one randomized, double-blinded, placebo-controlled study found that chamomile can be an effective option for mild to moderate generalized anxiety. The study used pharmaceutical grade German chamomile (Matricaria Recutita) extract standardized to a content of 1.2% apigenin.
Look for a chamomile product with a "standardized extract", in either capsule or tincture form. The capsule dose used in one of the longer-term studies for anxiety was 500 mg three times daily, however the tincture form seems much more broadly available. There is also likely a relaxation benefit found from drinking a strong cup of chamomile tea, using 2 tea bags per mug of tea.
Lemon balm
Lemon balm is a safe option and has been used in traditional cultures to treat anxiety, stress, anxiety-related palpitations, and insomnia. In a review of the studies, the active and most important compound to look for is rosmarinic acid, which can cross the blood-brain-barrier. A meta-analysis of the impact of lemon balm on anxiety in randomized controlled trials found that lemon balm had been significantly successful in improving anxiety symptoms in comparison with the control groups in all of the trials.
Lemon balm seems more effective for acute anxiety rather than chronic anxiety, using it for 5-7 days at a time. The doses found to be most effective for improving anxiety was 300 mg - 600 mg daily. Formulations that were effective include capsules (most frequently used in the studies), tea (2.5 grams twice daily for 20 days), or essential oil inhalation (3 drops, twice a day for 30 minutes, on a cotton patch).
What herbal treatments are effective for anxiety but might be harmful?
There are other herbs known to have potential positive benefit on anxiety symptoms, like lavender and kava kava but safety concerns are enough to keep from fully recommending.
Lavender
While the capsule form of the oral standardized lavender preparation (known as Silexan), shows efficacy for anxiety, the long-term health effects with ingesting lavender are unknown. Some studies have found that lavender may potentially be a hormone disruptor so caution is warranted. Drinking tea with lavender or smelling lavender essential oil is likely beneficial for anxiety and since these are much less concentrated ways of "taking in" lavender, less likely to be hormone-disrupting.
Kava kava
Also known as kava, kava kava is an herb that carries some controversy with it. It has been withdrawn from various consumer markets in most of Europe due to concern about kava causing liver toxicity. In terms of efficacy, there have been many studies that have shown that kava reduces anxiety.
It isn't quite clear what aspect of kava is contributing to the rare cases of liver toxicity. It's been difficult for researchers and public health to study and determine what exactly is contributing to the liver toxicity. since there are so many formulations, sources, and varieties of kava on the market. Strict quality control, including making sure that the kava is sourced from controlled areas and is in the form of aqueous extracts of the peeled rhizome only, are needed. It is still legal to purchase in the United States but not recommended until more research is done.
The information and any products mentioned in this article are not intended to diagnose, treat, cure, or prevent any disease. The information provided is for educational purposes only and not intended to replace the relationships with your physician(s). Before initiating any conventional or integrative treatments, please first consult with a licensed medical provider. Please review references provided at the end of article for scientific support of any claims made.
References:
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;26:363–367. doi: 10.1046/j.1365-2710.2001.00367.x
Amsterdam, J. D., Li, Y., Soeller, I., Rockwell, K., Mao, J. J., & Shults, J. (2009). A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. Journal of clinical psychopharmacology, 29(4), 378–382. https://doi.org/10.1097/JCP.0b013e3181ac935c
Ghazizadeh, J., et al. (2021). The effect of lemon balm on depression and anxiety in clinical trials: A systematic review and meta-analysis. Phytotherapy Research, 35(12), 6690-6705. https://doi.org/10.1002/ptr.7252
Kim, M., Lim, H., Lee, H., Kim, T. (2017). Role identification of passiflora incarnata linnaeus: a mini review. Journal of Menopausal Medicine, 23(3), 156-159. https://doi.org/10.6118/jmm.2017.23.3.156
Lakhan, S. E., & Vieira, K. F. (2010). Nutritional and herbal supplements for anxiety and anxiety-related disorders: systematic review. Nutrition journal, 9, 42. https://doi.org/10.1186/1475-2891-9-42.
Malcolm, B.J., Tallian, K. (2017). Essential oil of lavender in anxiety disorders: ready for prime time? Mental Health Clinician, 7(4), 147-155. https://doi.org/10.9740/mhc.2017.07.147
Mao JJ, Xie SX, Keefe JR, Soeller I, Li QS, Amsterdam JD. Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. Phytomedicine. 2016 Dec 15;23(14):1735-1742. doi: 10.1016/j.phymed.2016.10.012. Epub 2016 Oct 24. PMID: 27912875; PMCID: PMC5646235.
Miroddi M, Calapai G, Navarra M, Minciullo PL, Gangemi S. Passiflora incarnata L.: ethnopharmacology, clinical application, safety and evaluation of clinical trials. J Ethnopharmacol. 2013 Dec 12;150(3):791-804. doi: 10.1016/j.jep.2013.09.047. Epub 2013 Oct 17. PMID: 24140586.
Scholey, A. (2011). Re-introduction of kava (piper methysticum) to the EU: is there a way forward? Planta Medica. doi:10.1055/s-0030-1250290.