Therapeutic Herbs Are a Valid Treatment Option in the Case of Anxiety Disorders
The use of herbal medicines is a topic that has been documented from the past several thousands of years, and the popularity of herbal medicines as preferred treatment options has been steadily growing in the last decade. The Global Herbal Medicine Market Size and Forecast industry report put out by Hexa Research found that in 2016 the global herbal medicine market was valued at $71.19 billion dollars (USD). This was due to consumers having a preference of fewer side effects and no overdose toxicity from traditional medicines such as Ayurveda, Unani, and Traditional Chinese Medicine (Herb Research Foundation, 2018). Although many people think negatively about herbalism and other complementary alternative medicine modalities, therapeutic herbs can be a valid treatment option in the case of anxiety disorders because they reduce the symptoms of anxiety, have been shown to exhibit fewer side effects, and are supported by government and non-government organizations.
Unfortunately, modern western (or allopathic/orthodox) medical doctors have been known to publicly deny the benefits of using herbal medicines or even other complementary alternative medicine (CAM) modalities. The New England Journal of Medicine stated in 1998, “It is time for the scientific community to stop giving alternative medicine a free ride” (Yamey, 2000). Due to the way that orthodox medicine is validated, such as using double-blind placebo-controlled studies, the pressure has been on for practitioners and herbalists alike in providing such evidence to please the masses, showing how therapeutic herbs directly affect the human body systems.
Pertinent research evidence showing the benefits of herbal preparations in the treatment of anxiety disorders may not be as abundant when compared to allopathic medicinal research, but, it is available, and research is still currently happening. In August of 2009, the Psychopharmacology journal published their research results from The Kava Anxiety Depression Spectrum Study, also referred to as KADSS. The KADSS trial was performed directly at the request of the World Health Organization recommending that research is conducted on kava due to their concerns of hepatotoxicity, also known as liver damage (UNM Comprehensive Cancer Center, n.d.). In this randomized, placebo-controlled crossover trial, the researchers dispensed 250mg of kavalactones in tablet form to 60 adult participants for three weeks. Methods of testing for these results involved the use of the Hamilton Anxiety Scale, Beck Anxiety Inventory, and Montgomery-Asberg Depression Rating Scale scores. The results from this human clinical trial showed that anxiety levels reduced because the kavalactones provided significant anxiolytic and antidepressant activity. For the dosage and the duration of this study, there were no serious adverse effects from the kavalactones tablets that used. They also found that there was no clinical hepatotoxicity, which was the initial concern of the World Health Organization (Sarris et al., 2009). Conventional allopathic treatments for anxiety disorders heavily depend on anti-anxiety pharmaceutical drugs such as benzodiazepines, which have been used for over the last four decades (Argyropoulos, Sandford, & Nutt, 2000).
Using benzodiazepines to treat anxiety disorders may be effective at masking the symptoms, but using these drugs comes with a suitcase of risks. Some of these risks include not being able to stop taking the medications when wanting to, or need to because they come with the risk of going through withdrawals which can be dangerous in itself. Another complication of taking these types of pharmaceutical drugs is the matter of concern over the potential side effects that come along with them. According to the National Institute of Mental Health, possible side effects from anti-anxiety medications can include (but are not limited to) nausea, blurred vision, headaches, confusion, tiredness, nightmares, dizziness, unsteadiness, problems with coordination, difficulty thinking or remembering, an increase in salivation, muscle or joint pain, frequent urination, changes in sex drive or ability to perform, rash, hives, swelling of the facial features, difficulty breathing or swallowing, seizures, yellowing of the eyes, depression, and thoughts of suicide (National Institute of Mental Health, 2016). The number of risks involved in taking pharmaceutical anxiolytics is more numerous than the ones associated with an herbal preparation. Why would healthcare professionals choose a pharmaceutical with abundant risks to the patient, when there is a safer option available which would not put the patient at as much risk? The more innocuous options should be evaluated first to see if they are an appropriate option for the treatment of anxiety disorders for patients and that patients should be made aware that these options are available.
An intriguing 2016 clinical trial study published in 2017 Anesthesiology and Pain Medicine, the effects of the herb Passiflora incarnata (passionflower) was compared to the effects of melatonin in adult patients who underwent elective surgical procedures. This study is fascinating because many people do experience anxiety symptoms before having a surgical procedure because they are nervous. Having a safer option to help reduce these anxious feelings can be an excellent choice for patients. In this study, fifty-two patients were chosen to either take 1,000mg of passionflower, or 6mg of melatonin as their pre-operative medication one hour in advance of their surgery. The Ramsey scale was used for sedation and the scores is as follows:
1= Patient anxious
2= Patient cooperativeness
3= Patient responding to verbal commands
4= Patient with brisk response to light glabella tap
5= Patient sluggish response to light glabella tap
6= Patient with no response
This Ramsey scale was utilized to score the patient’s anxiety levels at various intervals. This scoring included when they arrived at the operating room before they were dispensed either the passionflower or melatonin, one hour after receiving the passionflower or melatonin, before induction, and before being discharged from the postanesthesia care unit. Psychomotor conditions were evaluated using a DSST, which stands for Digital Symbol Substitution Test. This test was performed upon the entrance of the operating room, before induction, and before discharge from the post-anesthesia care unit. Based on the Ramsey test scores, both groups of passionflower and melatonin showed reduced anxiety. Although, the passionflower group dominated when it came to the DSST test. These results represent that the passionflower group had more of a cognitive effect when it came to psychomotor conditions. This study inferred that both passionflower and melatonin were successful in relieving anxiety levels in the patients, but melatonin had less cognitive effects which reflect in the Digital Symbol Substitution Test. Side effects of using passionflower in doses of 500–1000mg three times per day are rare but can include hypersensitivity, asthma, rhinitis, uterine contractions (in pregnant women), nausea, vomiting, and arrhythmia (Rokhtabnak et al., 2016).
Let us compare the side effects of using passionflower to the side effects of a pharmaceutical drug called Oxazepam, a conventional medication prescribed in the treatment of anxiety disorders. Side effects of taking Oxazepam as prescribed are numerous and can include drowsiness, dizziness, tiredness, weakness, dry mouth, diarrhea, upset stomach, changes in appetite, restlessness or excitement, constipation, difficulty urinating, frequent urination, blurred vision, changes in sex drive or ability, a shuffling walk, persistent fine tremors, inability to sit still, fevers, difficulty breathing or swallowing, severe skin rash, yellowing of the skin or eyes, and irregular heartbeat (Medline Plus, 2017b). The side effects of taking this pharmaceutical drug seem to be riskier and more precarious than the amount of side effects of using passionflower for the treatment of anxiety. Oxazepam is also a pharmaceutical drug that falls into the category of benzodiazepines and has been found to rapidly produce tolerance and dependence to the drug (Hashmi et al., 2018, p.1). Pharmaceutical drugs, such as Oxazepam, are contributing to the opioid epidemic that is currently happening within the United States of America, as well as around the globe. Addictive pharmaceutical drugs are the reason why we currently have this opioid epidemic in the United States. In 2018, the Centers for Disease Control and Prevention published an article regarding overdoses from opioids, and they found that in the year 2017, over 70,000 people died due to a drug overdose. Out of that number, the number of deaths due to opioids specifically was 47,600 people, which equates to 67.8% of the drug overdose deaths overall (Centers for Disease Control and Prevention, 2018). These numbers are staggering and continue to increase by the year significantly.
Is the risk of loss of lives due to pharmaceutical overdoses outweigh the minimal risks associated with safely taking an herbal preparation? If we should be thinking negatively about anything, it should be our lack of concern over these unreasonable risks that come with using allopathic treatments for anxiety disorders. There are safer options available that medical professionals have access to that do not come with the risks of addiction and overdose. There are plenty of qualified master herbalists who can work in tandem with other healthcare professionals to ensure the safety of the patient. Physicians and other healthcare professionals can access the American Herbalists Guild Directory via the American Herbalists Guild website to find master herbalists to work with and add to their client’s healthcare team.
Amongst the variety of therapeutic herbs available to help ease the symptoms experienced from suffering from anxiety disorders is a longtime favorite, valerian root. Also referred to as the “dirty gym socks herb,” valerian root has proven itself useful due to its anxiolytic properties. It may not taste, nor smell, rather pleasant, but it gets the job done safely with little to no side effects. Valerian root products are one of the more commonly used herbs that are used to aid in sleep disorders as well as for nervous tension or stress. A study published in the January 2008 copy of Phytomedicine titled “Extracts of Valeriana officinalis L. s.l. show anxiolytic and antidepressant effects but neither sedative nor myorelaxant properties” found that methanolic and ethanolic extracts of the herb Valeriana officinalis (valerian root) had pronounced anxiolytic effects in mice and rats when they were put through an elevated plus maze. The dosage of this study was 100–500 mg/kg of body weight. The researchers found that it was not a sedative effect coming from this herb, but an anxiolytic effect (Hattesohl et al., 2008, p. 2). According to the National Institutes of Health, a sector of the U.S. Department of Health & Human Services, side effects of valerian root consumption from individuals who have participated in a clinical study included headaches, dizziness, pruritus, gastrointestinal disturbances, and the possibility of an increase in sleepiness the following morning. They also state that valerian should not be taken by women who are pregnant or nursing, children who are younger than three years old, and individuals taking medications or consuming alcohol because valerian could have additive sedative effects. This warning includes medications such as benzodiazepines, barbiturates, CNS depressants, and dietary supplements; such as St. John’s wort, kava, and melatonin (National Institutes of Health, 2013). For the sake of comparison, let us take a look at what Medline Plus has to say regarding the commonly prescribed antianxiety drug Lorazepam (branded name Ativan). The very first thing that is brought to the reader’s attention on the drug fact page is a notable warning box outlined in red bringing awareness that Lorazepam “…may increase the risk of serious or life-threatening breathing problems, sedation, or coma if used along with certain medications.” These medications they are referring to include the use of codeine, hydrocodone, fentanyl, hydromorphone, meperidine, methadone, morphine, oxycodone, and tramadol. The branded names of these medications also fall under this warning umbrella. Side effects of taking this antianxiety drug may include drowsiness, dizziness, tiredness, weakness, dry mouth, diarrhea, nausea, changes in appetite, restlessness or excitement, constipation, difficulty urinating, frequent urination, blurred vision, changes in sex drive or ability, shuffling walk, a persistent fine tremor or the inability to sit still, fever, difficulty breathing or swallowing, severe skin rash, yellowing of the skin or eyes, irregular heartbeat, and other side effects which are not listed, but Medline Plus states that you should still call your doctor immediately (Medline Plus, 2017, May 15). The side effects of drowsiness, dizziness, tiredness, and weakness causes concern to me as a parent. It is rather hard to be a functioning parent and tending to young children’s needs when a medication causes you not to be able to stay awake, nor be awoken by your children when they need you. This side effect can lead to a dangerous situation for a parent prescribed this medication to treat their anxiety, so why expect people to lead a relatively healthy life when they can hardly keep their eyes open to handle their everyday duties? It is bad enough that many people lack in quality of sleep, but to throw in a medication that can make it even harder seems counter-productive for an adequate treatment plan. These side effects can be a factor in an individual’s choice of choosing not to seek out treatment that is needed.
With the orthodox/allopathic medical community showing restraint against using herbal preparations in the treatment of not just anxiety disorders, but other disorders also, researchers and the herbalism community have worked assiduously to show evidence of validity that herbal preparations can be a safe option. Research into herbalism and natural products is supported by multiple different organizations which are recognized both nationally and internationally. This support also includes the National Center for Complementary and Integrative Health (NCCIH), which according to their website, is the “…Federal Government’s lead agency for scientific research on the diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine” (National Center for Complementary and Integrative Health, 2017). An additional organization in the United States is The Phytochemical Society of North America. This organization’s mission includes stimulating research regarding the chemistry and biochemistry of the constituents that are in plants and how they affect plant and animal physiology and pathology (Phytochemical Society of North America, 2019). One of the older societies, formed in 1959, is The American Society of Pharmacognosy, which is also an extension of the much older Plant Science Seminar which was established in 1923. The mission of the ASP is to be “…dedicated to the promotion, growth, and development of pharmacognosy and all aspects of natural products sciences” (American Society of Pharmacognosy, 2017). Pharmacognosists have a great understanding and training in chemistry, but also can have specializations such as biochemistry, botany, ethnobotany, ethnomedicine, immunology, medicinal chemistry, microbiology, molecular biology, organic chemistry, pharmaceutical sciences, pharmacology, toxicology, as well as many other areas of interest. (American Society of Pharmacognosy, 2016). These are most definitely not average workers. To require this amount of education takes a lot of time, dedication, and discipline. These are individuals who went to college and majored in sciences, not just people who have read a few books from their local bookstore and read a few blogs online. These workers are highly educated individuals. These organizations are just the tip of the iceberg of ones that work endlessly in supporting the research in herbal medicines and complementary alternative medicine modalities. The research accomplished is readily available to the general public to read and analyze for themselves using resources such as NCCIH, PubMed, and Research Gate. Even studies where the full-text might not be available, readers are still able to contact the authors and request the full-text version to view. Most times, free of charge also.
As the evidence shows, herbal preparations of anxiolytic herbs can be a valid treatment option in the case of anxiety disorders. These options include herbs such as kava, passionflower, and valerian root which have been shown in studies to have fewer side effects than the anti-anxiety pharmaceutical drugs that are commonly prescribed by medical doctors, as well as not contributing to the current opioid epidemic the people of this world are facing today. The research of these treatment options is supported by a multitude of organizations throughout the world, including our Federal Government with their lead agency; the National Center for Complementary and Integrative Health. This research and data are also readily available to whoever wants to read it and investigate into it further so that they can make their own educated choices regarding their options for anxiety disorder treatment. With the evidence there, and continuing to grow, there should not be so much pushback from the allopathic and orthodox medicine community.
References
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