Friday, September 18, 2009

Herbal remedies for anxiety

A number of herbal products are advertised as remedies for anxiety, including anxiety related to public speaking. The real remedy for anxiety just is preparation and enough practice or rehearsal.

A tablet called Bravina “The Speech Pill” was advertised on page 23 of the February 2009 issue of Toastmaster magazine. Two angry letters to the editor appeared in the April issue. There also were blog posts from Darren Baker and Ian Whitworth. Some claims for Bravina were withdrawn after a review by the National Advertising Division (NAD) of the Council of Better Business Bureaus.

I Googled and quickly found another four products. (Of course there actually are more, but these five are a reasonable sample). All employ combinations of herbal ingredients. Their mixtures are much like the “secret herbs and spices” used in the coating that makes commercial fried chicken tasty. Some products also add vitamins and minerals.

For example, Bravina contains: St. John’s Wort, Motherwort, Passiflora, Ashwagandha, Valerian Root, Eleuthero Root, Panax, Ginko Biloba, and Octacosanol.

Clarocet NRI contains: St. John’s Wort, Passiflora, Winter Cherry, Rhodiola Rosea, and 5-HTP.

Confidrex contains: Niacinamide (Vitamin B3), Panax Ginseng, Potassium, Magnolia Bark, Pyridoxine (Vitamin B6), Magnesium, Blue Scullcap, Methylcobalamin (Vitamin B12), Fennel Seed, Passion Flower (Passiflora), L-Theanine, and 5-Hydroxytryptophan.

PureCalm contains: Passiflora, Lavender, and Lemon Balm. It comes from the same folks who brought you the homeopathic remedy called SocialFear ReliefTM, that I discussed last month.

Serydyn contains: Passiflora, Valerian Root, L-Theanine, Niacinamide (Vitamin B3), and Magnesium Taurinate.

Are these combinations of ingredients effective? Are they safe? If you look at the bottom of their web pages for the small, light print (or click on their disclaimers) they are careful to say that their claims have not been evaluated by the Food and Drug Administration (FDA), and caution that you should consult your physician.

Has the common ingredient in these five remedies, passiflora, been shown to be effective in random, placebo controlled clinical trials (as are used to test modern pharmaceuticals)? Clinical trials compare a drug with an inert substance (a placebo), and neither the doctors nor the patients know who got which remedy. I looked up passiflora and some other ingredients out in the PubMed medical journal abstracts database. For the full texts of articles you may have to visit either your public library, or your friendly local state university library.

In 2006 Ernst discussed Herbal Remedies for Anxiety – A Systematic Review of Controlled Clinical Trials. He evaluated evidence for: blue skullcap, gotu kola, guarana, kava, keenmind, lemon grass, passion flower (passiflora), and valerian. His conclusion was that:
“Apart from kava, none has been shown beyond reasonable doubt to be efficacious (effective).”
Unfortunately there also are doubts about whether kava is completely safe, which is why it does not appear in the five products previously mentioned.

I also looked at the most recent review article I could find (2009) on Natural Remedies for Anxiety Disorders: Potential Use and Clinical Applications by Kinrys et al. You can read the abstract here. They found that:
“…although there is currently no evidence supporting the use of natural remedies as first-line treatments of anxiety, the limited data available suggest an overall safe side effect profile for such agents and their potential and future clinical use for the treatment of anxiety symptoms.”
In other words, they may be safe, but have not yet been proven to be effective.

Both passiflora and valerian also have been evaluated in Cochrane reviews. You can read their full texts online for free. The 2007 review on Passiflora for Anxiety Disorder concluded that:
“RCTs [random clinical trials] examining the effectiveness of passiflora for anxiety are too few in number to permit any conclusions to be drawn.”

The 2006 review on Valerian for Anxiety Disorders also concluded that:
“…there is insufficient evidence to draw any conclusions about the efficacy or safety of valerian compared with placebo or diazepam for anxiety disorders.”

In a ten-minute YouTube video rant, the Irish comedian Dara O’Briain, whose wife reportedly is a physician, comments (at about 2:55 in the video) that:

“I’m sorry, herbal medicine? Herbal medicine has been around for thousands of years. Indeed it has. And then we tested it all, and the stuff that worked became MEDICINE. And the rest of it is just a nice bowl of soup and some potpourri. So, knock yourself out.”

Proceed with caution before you take herbal medicines. As TV commercials say, ask your doctor if it is right for you. Visit the reference section of your public library. Look up the effects (and side effects) of all the ingredients in a product before you just buy it and try it.

I would rather ingest some of the brightly covered, placebo pills shown above. A whole box is just a dollar. They have pleasant tropical fruit (candy) flavors. Their brand is the nicknames for Michael and Isaac.


Intangible said...

@Richard - Thanks for writing this post! It's great to see the voice of the blogosphere increase awareness :) As you said in your second to last paragraph, "Proceed with caution" and that caution should be rooted in education... We can learn more about ourselves and what's marketed so that we can determine what's necessary and what's not... and we can determine what we should wash down with water versus what we should wash down with discipline.

Richard I. Garber said...

Another thing a consumer can look for is if and when a product was trademarked. Names for pharmaceuticals like Lipitor, Zocor, and Pravachor are registered trademarks. A superscripted uppercase R in a circle after a name means that the trademark was registered.

If there instead just is a superscripted TM, then the trademark is being claimed, but was not actually registered yet with the US Patent and Trademark Office, You can look up a trademark in their Trademark Electronic Search System (TESS).

For example, Seredyn was registered as a US trademark back on December 13, 2005. Clarocet was registered on August 8, 2006. Bravina only was registered on July 14, 2009, and Confidrex only was registered on July 21, 2009. PureCalm has not been registered.

A DiClementi said...

To cure anxiety attacks, herbs are the best medicine. No side effects, no giddiness, etc. Deep breathing exercises are excellent for anxiety and many people report positive results from meditation. Some other natural anxiety remedies to look into are St.John's Wort, SAMe, L-Theanine, and Tryptophan.

Anonymous said...

I have not tried the other products you mentioned, but I have been utilizing bravina for about the last three years. I have been terrified of public speaking since I can remember. I tried a prescription beta-blocker for a while until a co-worker asked me if "everything was OK" after I presented.

I was a sceptic of bravina, but felt like I had nothing to lose. I have been pleased with the results: my anxiety during presentations has gone down and I don't look or feel drugged like I did with beta blockers.