Supplements for Anxiety
What you need to know - because social media trends aren't reliable health resources
Anxiety is one of the most common mental health issues worldwide, affecting millions of people daily. The latest Surgeon General Advisory highlights how many parents struggle with overwhelming stress, but they’re not the only ones struggling. I spoke to a parent group about this recently and I see teens regularly who are struggling with stress and anxiety.
Some teens are taking matters into their own hands -- more than one parent has learned that their teen is self-medicating with a supplement when they sat in on office visit discussions with me and their teen.
With the growing demand for natural remedies, store-bought anxiety supplements have surged in popularity. They seem safe simply because they are sold in reputable stores and pharmacies, but there are few regulations to ensure their consistency and often limited data showing safety and efficacy.
From herbal extracts to vitamins and amino acids, these products claim to fix anxiety and improve mental well-being. Anyone can make a claim. They can even be pretty convincing, but it’s crucial to evaluate the science behind the claims, as well as potential benefits, risks, and the dangers of delaying proven treatments.
Parents need to talk with their teens, who are often getting advice from their favorite online resource. Ashwagandha is TikTok’s latest health trend to depression, anxiety, stress, and other health issues. I even talked with one teen who admitted to taking it as part of their work out plan because they “heard it could help build muscle.” Tik Tok trends are not my recommended resource, but I’m not a teen, just a pediatrician. What do I know? [sarcasm here, in case you couldn’t tell]
Let’s first cover general pros and cons of supplement use, then specific details of popular supplements for anxiety.
Benefits of Anxiety Supplements
Natural Appeal: Many people prefer supplements over prescription medications due to their perception as being 'natural' and having fewer side effects. (Note: I am not saying that natural is better. This can be a fallacy, so this isn’t necessarily a true benefit. Dr. Andrea Love covered this very well here.)
Accessibility: Most anxiety supplements are available over the counter, making them easy to obtain without the need for a prescription.
Potential Effectiveness: Supplements have shown some benefits in reducing mild anxiety, particularly in those with stress-related symptoms.
Risks and Considerations
Lack of Regulation: Supplements are not regulated as strictly as medications. This means the quality, potency, and purity of products can vary widely between brands, increasing the risk of contamination or incorrect dosing.
Inconsistent Evidence: While some supplements may show potential in certain studies, the scientific backing is often limited, inconclusive, or based on animal models. Long term safety is often unknown. This makes it difficult to predict their safety or effectiveness.
Interaction with Medications: Some anxiety supplements can interact with prescription medications, particularly those used to treat anxiety and depression, like SSRIs. This can lead to dangerous side effects or reduced efficacy of proven treatments.
Delayed Treatment with Proven Therapies: Relying on supplements may lead to a delay in seeking evidence-based treatments such as cognitive-behavioral therapy (CBT) or prescription medications with proven benefits and known risks. These proven interventions can significantly improve outcomes for people with moderate to severe anxiety. CBT is also all natural - and learning tools taught in therapy can change your brain and be used life-long! Delaying proper treatment can exacerbate symptoms and reduce the chances of recovery.
Excess Sugar: Many supplements come in liquid, chewable, or gummy forms, even when sold for adults, but especially when sold for kids. The bad taste is masked by a lot of sugar. Too much sugar increases our risk of obesity, diabetes, heart disease, and dental problems. The sugar-free varieties often have artificial sweeteners that can increase gas, bloating, and diarrhea.
Expense: The costs of supplements are not insignificant. Since supplements are not covered by most insurance plans, individuals may spend significant amounts of money on products that may or may not provide relief. Here are a few key points regarding cost as a risk:
High Price Tags: Many popular supplements can be expensive, especially if high-quality, third-party tested products are chosen. CBD products, for instance, can range from $30 to $100 per month depending on the dosage and brand. Regular use of multiple supplements can quickly add up.
Unproven Efficacy: Because scientific evidence supporting these supplements is often limited or mixed, there is a risk that consumers may spend money on products that don't deliver the desired results. This could lead to financial strain, particularly if the individual continues purchasing them without seeing significant improvements in symptoms.
Recurring Expenses: Unlike prescription medications, which are often taken for a set period, supplements may require ongoing use to maintain any perceived benefits. This can lead to prolonged and recurrent costs without long-term data confirming the necessity of such sustained use.
Unregulated Market: Since supplements are not regulated as rigorously as prescription medications, there’s no guarantee of potency, purity, or effectiveness. Consumers may end up spending money on low-quality or ineffective products.
Test Results Can Mislead: There is an unregulated market for laboratory testing that involves the use of non-standardized or unproven methods, such as blood, hair, or saliva tests, to recommend supplements. These tests often lack scientific validation and are not regulated by health authorities, leading to potentially inaccurate or misleading results. Practitioners may use these tests to justify supplement recommendations, which are frequently based on anecdotal evidence rather than reliable data, increasing the risk of unnecessary or harmful interventions. This can lead to consumers relying on supplements without proper medical oversight or evidence of their effectiveness.
Limited Knowledge: There is often limited information available about supplements, and even after consulting your doctor or pharmacist, they may not fully understand the risks and benefits. Potential drug interactions or risks with certain health conditions might be unrecognized. It's important to discuss supplements with your healthcare providers, but keep in mind they may not have complete knowledge due to the lack of available data. Be cautious of individuals who claim expertise, as their advice is often based on personal bias or marketability rather than scientific evidence.
Common Supplements Used for Anxiety Management
Ashwagandha (Withania somnifera)
Ashwagandha is an herb used in Ayurvedic medicine for centuries. It’s believed to help the body adapt to stress, promote relaxation and reduce anxiety symptoms.
Science: Research has shown that Ashwagandha may reduce cortisol levels (a stress hormone) and improve resistance to stress in both animal and human studies. Studies show Ashwagandha may have many health benefits.
Benefits: May help with mild to moderate anxiety, stress, and fatigue.
Risks: Generally well-tolerated, but potential side effects include upset stomach, drowsiness, and allergic reactions. There is concern of liver damage in rare instances. More research is needed to fully understand its long-term safety.
L-Theanine
L-Theanine is an amino acid found in tea leaves, particularly green tea, and mushrooms. It is believed to promote relaxation without causing drowsiness. It is often found with caffeine and this combination is used to improve focus and attention.
Science: There are many potential mechanisms of action of L-Theanine to help with anxiety and attention. Several studies suggest that L-Theanine increases alpha brain wave activity, which is linked to relaxation and attention. It is a glutamate reuptake inhibitor. It also acts on the gamma aminobutyric acid (GABA)-A receptors. GABA is a neurotransmitter that promotes a feeling of calm.
Benefits: May provide calming effects without sedation and can enhance focus.
Risks: Typically well-tolerated, though overconsumption can cause dizziness or gastrointestinal discomfort. Limited long-term studies are available.
Valerian Root (Valeriana officinalis)
Valerian root is often marketed as a natural remedy for anxiety and insomnia, but there is limited evidence of benefit.
Science: While some studies suggest Valerian may reduce anxiety by increasing levels of GABA (the neurotransmitter that promotes calmness), findings are inconsistent.
Benefits: Potential aid for anxiety-related insomnia but there are inconsistent study results.
Risks: Side effects include headaches, dizziness, and stomach discomfort. Long-term use may lead to dependency. Combining Valerian with alcohol or sedatives can increase the risk of side effects.
Magnesium
Magnesium plays an essential role in neurological function and mood regulation, with some evidence suggesting that magnesium deficiency is linked to anxiety and depression, fatigue, headaches, and more. Magnesium is found in seeds, nuts, dairy, grains, fruits, vegetables, and even some water, but there is concern that many of us don’t get enough in our diet alone.
Science: Magnesium supplementation may be beneficial for people with mild anxiety (as well as headaches, sleep problems, heart health, immunity, and more).
Benefits: May improve anxiety in individuals with low magnesium levels.
Risks: Excessive intake can lead to diarrhea, nausea, and irregular heartbeat. Supplementation may be less effective for those who already have adequate magnesium levels.
5-HTP (5-Hydroxytryptophan)
5-HTP is a precursor to serotonin, a neurotransmitter that influences mood, appetite, and sleep. Tryptophan can also be converted to serotonin. Tryptophan is found naturally in plant and animal proteins, whereas 5-HTP is only found in supplement form. 5-HTP may synthesize serotonin faster and more effectively than tryptophan, but tryptophan offers a broader array of health benefits.
Science: Some studies suggest that 5-HTP supplementation may help increase serotonin levels and reduce anxiety and depressive symptoms. As with many of these supplements, the research findings are mixed. More studies are needed.
Benefits: May improve mood and anxiety for some individuals.
Risks: Side effects include gastrointestinal issues and serotonin syndrome if taken with other serotonin-boosting medications (such as SSRIs). Safety over the long term remains unclear.
CBD (Cannabidiol)
CBD, a compound found in cannabis plants, has gained significant attention for its potential to reduce anxiety without causing a "high" (unlike THC). It is now legal in many states but has varying availability. For example, CBD is legal in my state of Kansas if there is no THC, which limits product availability.
Science: Preliminary research suggests that CBD plays a role in regulating mood, stress, and anxiety. As with all of these, more long-term studies are necessary to confirm its effectiveness and safety.
Benefits: May help alleviate anxiety, especially in individuals with generalized anxiety disorder (GAD) or social anxiety.
Risks: Side effects include drowsiness, dry mouth, and interactions with other medications. The quality and concentration of CBD can vary widely between products due to lack of regulation.
Balancing Supplements with Proven Therapies
While some store-bought anxiety supplements may offer mild relief for stress and anxiety, they are not a substitute for proven therapies.
It's essential to use supplements with caution, understanding the limited scientific evidence and potential risks. Talk with your physician and pharmacist to help find the best treatments for you.
For those experiencing mild anxiety, certain supplements may offer some benefit, but those with moderate to severe anxiety should not delay seeking professional help.
Consulting with a physician before starting any supplement is recommended, especially if you are taking other medications or have an existing medical condition.