Alternative Medicines for Anxiety: A Psychiatrist's Review of Non-Prescription Options

Dr. Tracey Marks, a psychiatrist, discusses five non-prescription alternative medicines for anxiety, acknowledging the common biases against pharmaceutical interventions. She highlights that many individuals prefer over-the-counter options for mild to moderate symptoms. The episode systematically reviews chamomile, kava, L-theanine, valerian, and oral GABA, detailing their purported mechanisms, recommended dosages, potential side effects, and drug interactions, while critically evaluating the scientific evidence supporting their efficacy.

Chamomile, derived from the daisy family, is presented as a sedative and antispasmodic, with some limited scientific support for mild to moderate generalized anxiety. Dr. Marks emphasizes its potential for allergic reactions in sensitive individuals and its coumarin content, which necessitates caution for those on blood thinners. Kava, historically used for anxiety and insomnia, is largely discouraged due to rare but serious liver toxicity concerns, leading to bans in several countries. L-theanine, an amino acid found in green tea, is noted for its relaxation properties, though its efficacy for clinical anxiety disorders is not robustly supported by research.

Valerian root, which theoretically increases GABA, is critiqued for its "extremely limited and poor" research, showing no significant benefit over placebo. Dr. Marks also touches upon the practical challenges of its dosing schedule and its unpleasant smell in essential oil form. Finally, she explains the theoretical appeal of GABA as an inhibitory neurotransmitter, but clarifies the significant hurdle of the blood-brain barrier, which prevents oral GABA from directly impacting brain activity in the same way as prescription benzodiazepines like Xanax or Klonopin.

Based on available research, Dr. Marks suggests chamomile and L-theanine as the "best bet" for those seeking alternative options, while acknowledging that anecdotal reports often favor GABA and chamomile, particularly in tea form, for general relaxation and evening use. The discussion underscores the importance of understanding both the potential benefits and significant risks or limitations of these alternative remedies, urging caution and physician consultation, especially for individuals with pre-existing conditions or those taking other medications.

"Even though there's a lot of medication options to treat anxiety, there are a lot of biases against taking a medication for it. Ain't nobody here crazy."

"There haven't been a lot of randomized trials for this and randomized trial is just code for a rigorous scientific study that scientists take seriously."

"Another issue with chamomile is it contains coumarin, a naturally occurring blood thinning agent found in plants."

"Here's the ugly of kava. There's been some case reports of liver toxicity attributed to using kava and it's mostly been outside of the United States."

"The research shows that it may help with relaxation but it's not really robust enough to take care of an anxiety disorder."

"Unfortunately the studies for valerian are extremely limited and poor and they really haven't shown benefit over placebo."

"GABA stands for gamma-aminobutyric acid and it's an inhibitory neurotransmitter which means that it's a chemical in the brain that's made by the nerve cells and it works to inhibit or slow down cell activity."

"Not everything we take by mouth crosses the blood-brain barrier. So here's some serious science here. The blood-brain barrier is a special boundary that separates your brain from the rest of your body and the brain is very picky about what it's going to let through that barrier."

"Out of this list what would I say is probably your best bet based on research? I'd say probably chamomile number one, L-theanine number two."