Why Herbs Should Be the First Choice of Treatment for Acute Anxiety

Anxiety can manifest in a wide range of ways. Apart from the internal emotional fearfulness, symptoms can include irritability, agitation, muscle tension, palpitations, sweating, insomnia, breathlessness, poor concentration, reduced socialisation and ability to undertake everyday activities. It is the most prevalent mental health disorder affecting children and adults, but many more people are dealing with problematic anxiety symptoms without any diagnosis.

In our increasingly changing world, where our daily exposure to stressful stimuli and life challenges can produce a rising barometer of worries, anxiety is often a major impediment to leading a fulfilling and happy life. Like most other health woes, humans have long pursued various practices to help overcome anxiety, the most popular of which is alcohol. Then there are drug medications, which have long been used to relieve anxiety, and remain widely prescribed.

Barbiturates were the first of these, sedative and anticonvulsant drugs which became popular particularly with sleep-deprived young mothers in the middle of last century, but which lead to the overdose deaths of thousands of people, including Elvis Presley and Marilyn Monroe. The next day ‘hangover effect’ from barbiturates was also always a problem, and development of a new chemical group of anxiolytic (anti-anxiety) and sedative drugs known as the benzodiazepines, lead to these superceding the barbiturates for the treatment of anxiety and insomnia. Benzodiazepines seem to act predominantly through stimulating GABA (gamma amino butyric acid) receptors in the central nervous system, and the commercialisation of Valium® (diazepam) by Roche in 1963 marked the start of a period during which this and other benzodiazepine drugs such as lorazepam, alprazolam and clonazepam began to be widely prescribed by GP’s and psychiatrists for anxiety and sleep difficulties. Between 1969 and 1982 Valium® was the most prescribed drug in the U.S., during which time Roche’s share price soared.

While safer than barbiturates, and effective as a ‘quick fix’ for anxious feelings or insomnia, safety concerns for benzodiazepines soon emerged. Feelings of fatigue, or a hangover the following day when taken as sleeping tablets, and a wide range of other side effects are all too common experiences. Most significant of these is the development of tolerance when they are used for more than a short period of time. As anyone who has been through it will testify, withdrawing from long term benzodiazepine use is a hugely stressful, unpleasant and often very protracted experience.

Feelings of depression can both contribute to or arise from excessive anxiety, and it is not uncommon for feelings of low mood and a low tolerance to stress, to be experienced together with anxiety. Apart from GABA, neurotransmitters such as serotonin, adrenaline and dopamine are intrinsically involved in influencing our emotions and mood, interacting together in complex ways that scientists still have little understanding of. It is therefore not surprising that many SSRI’s (selective serotonin reuptake inhibitor) drugs, used primarily as antidepressants, can have an anxiolytic effect in some people, and in many countries, these are often prescribed instead of or together with benzodiazepines, for anxiety conditions.

While sometimes effective as anxiolytics and less likely to produce adverse effects than most older generation tricyclic antidepressants, some find that SSRI’s can cause or increase anxiety feelings, or experience any one or more of a wide range of unpleasant side effects including insomnia, weight gain, emotional numbing or sexual dysfunction.

Another class of non-benzodiazepine sleeping tablets, the so-called  ‘Z-drugs’ such as zopiclone and zolpidem, have become popular in recent years, and while initially thought to be less habit-forming than benzodiazepines, they can also be very difficult to withdraw from after more than short-term use.

A large number of herbs have been traditionally used for nervous conditions and their anxiolytic effects, several of which have been shown in clinical trials to be beneficial as anxiety treatments. These include Chamomile, Skullcap, Passionflower, Valerian, Kava, Lemon balm and Withania.  Despite the number of well-designed trials undertaken to date being relatively low, and results sometimes variable depending on the particular herbal product(s) and dosages used, results are encouraging and in all cases show a better safety profile than for comparable anxiolytic drugs.

Of these, Kava (Piper methysticum), is the most studied, and is a non-addictive anxiolytic with great potential to treat anxiety. Its effectiveness in treating anxiety has been affirmed through several clinical trials and meta-analysis(1-3). While case reports of liver toxicity associated with kava usage lead to its restriction in some countries at the end of last century, use of the wrong plant part as raw material, or use in combination with alcohol or various drugs, were likely contributory factors. Also the frequency of such adverse events reports was substantially less than that for paracetamol, a commonly used analgesic.

Aerial parts of the herb Passionflower (Passiflora incarnata), have also been taken for anxiety for many centuries, and in a trial involving 36 outpatients with generalized anxiety disorder, it was as effective as the benzodiazepine drug oxazepam, but unlike oxazepam caused no impairment of job performance(4).

Roots of the herb Withania (Withania somnifera, Ashwagandha), have a subtle but powerful nervous system and adrenal tonic action, which insulates the nervous system from stress, and enables the adrenal glands to be better prepared to respond appropriately to stressful stimuli. A large number of scientific papers now support its applications for stress-associated anxiety conditions, including several recent human clinical trials(5,6).

While further studies involving greater participant numbers and longer term treatment are needed to identify optimal dosages and phytochemical makeup of the treatments involved, the fact that most herbal anxiolytic agents are safe and have the same or only a slightly higher incidence of adverse effects to placebo, is clear. It is therefore logical that before reverting to drug medications, more likely to produce unwanted adverse effects and in some cases long term dependency, herbal anxiolytics should be tried, in anxiety conditions.


  1. Sarris J, Aust NZ J Psychiatry 2011; 45(1):27-35.
  2. Sarris J, J Clin Psychopharmacol 2013; 33(5):643-648.
  3. Savage K et al, Trials 2015; 16:493.
  4. Akhondzadeh S et al, J Clin Pharm Ther 2001; 26(5):363-367.
  5. Chandrasekhar K et al, Indian J Psychol Med 2012; 34(3):255-262.
  6. Pratte MA et al, J Altern Complement Med 2014; 20(12):901-908

How Quickly should Herbs Work?

One of the most common questions I have from my new patients when recommending or prescribing them herbal medicines for the first time, is ‘how long will it take to work’? This is totally understandable, particularly when they are often grappling with a serious health complaint, or have pushed their budget to afford to pay for an unsubsidised consultation and herbal treatment.


When my answer is invariably that that they should notice an improvement either straight away or within a short space of time, the reaction is usually one of surprise. This is because there seems to be a fairly common misconception among consumers and many health practitioners that herbal medicine and the ‘natural approach’ to treating a health ailment usually takes a long time to manifest results.

There is no question that certain drugs such as the steroid prednisone, can invoke a dramatic and sudden amelioration in inflammation or related symptoms, or that use of nitrolingual spray has a virtually instantaneous effect in angina.  However, for most everyday human health conditions, herbs work as quickly as drugs in resolving the problems concerned.

Diarrhoea and dysentery, are situations where a rapid rather than protracted response is called upon when taking a remedial treatment. Until a couple of hundred years ago when refrigeration was invented and human public health measures improved, such lurgies were also extremely common. Back then and still today in many countries, most communities relied heavily on the use of local tannin-rich herbs with astringent properties, to help manage such problems. These ranged from Agrimony (Agrimonia eupatoria) and Oak bark (Quercus robur) in European herbal medicine, to Koromiko (Hebe salicifolia) and Tanekaha (Phyllocladus trichomanoides), in traditional Mâori medicine. Tannin-rich plants were also applied as poultices and other topical preparations to help stop bleeding from battle wounds or accidents, where again rapid haemostatic actions which halted such bleeding and promoted healing as quickly as possible, were very important. Such use included well known plants such as Tormentil (Potentilla tormentilla), Harakeke (Phormium tenax) and Pohutakawa (Metrosideros excelsa). It is also reflected in the Latin names of other well-known plants such as Yarrow (Achillea millefolium), used by the Greek warrior Achilles on his soldiers spear and sword wounds.

One of the best treatments for bruises, strains and sprains, Comfrey (Symphytum officinale), starts providing pain relief and an anti-inflammatory effect within 30 minutes of application, according to clinical trials on an ointment preparation. This is just as rapid as mainstream gel treatments containing non-steroidal anti-inflammatory drugs (NSAID’s).

Despite drug companies throwing billions of dollars at research aiming to develop a superior analgesic, the Opium poppy derived alkaloid morphine remains the most highly regarded and used analgesic for major pain. This status has been maintained not only because of its ability to overcome intense pain, but also the speed of its onset of action. Similarly, the rapidity of onset of mood changes following marijuana smoking, is another testament to how quickly herbs can produce their many pharmacological effects.

Insomnia can be a highly debilitating condition which requires effective and fast acting remedies. The use and reputation of well-known herbs such as Valerian, Kava, Passionflower and Skullcap as aids to sleep, is based upon acute or single dose ingestion shortly before retiring, in the same manner as sleeping tablets such as zopiclone. Their effectiveness varies from person to person, and is of course dependent on adequate doses of sufficiently good quality product, but they should either work straight away, or there’s little point in persisting. Use of these and other herbs as part of an approach to managing anxiety disorders, should also invoke some degree of relaxation within an hour or so of ingestion, in a similar manner to benzodiazepine drugs such as diazepam (Valium®). Both drugs and herbs seem to work on the same sites of action (GABA, gamma-aminobutyric acid receptors) within the body, to produce these anxiolytic actions.


However, just as with drugs, not all herbs produce resolution of symptoms straight away, and the improvement in feelings of depression following appropriate treatment, is an example of where a longer timeframe is involved. Like antidepressant drugs, the herb St Johns Wort (Hypericum perforatum),  only manifests its antidepressant action after 3-5 weeks of daily administration in most cases. This is probably related to the time required for its active phytochemicals to modulate serotonin and other involved neurotransmitter systems, in order to produce an antidepressant response.

To summarise, we are often mislead into thinking that ‘herbs take longer to work than drugs’. While the timeframe between starting herbal treatment and a response being achieved is highly variable depending on the condition and person being treated, effective herbal medicine treatment should in most cases take no longer than that of drug treatments.