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Herbal Medicine For Anxiety

ANXIETY DISORDERS can be painful, exhausting and frustrating. But there's plenty of hope for healing--and not just from a bottle of pills.

I thought I was handling the breakup just fine. I cried a lot, talked to friends, saw my therapist and prepared to move on. But I couldn't sleep very well. One, two sleepless nights--that's to be expected after a five-year relationship ends. But soon it was a week, then two weeks of insomnia. I'd drift off for an hour or two, then awake with a start and find it difficult to relax again. I also started feeling anxious during the day. My mind raced with troubling thoughts, and I never seemed to feel calm.

We all experience fear. If we didn't, we wouldn't be human and wouldn't be prepared for actual threats, physical or emotional. We all feel the tingle of anxiety too, especially before a daunting experience like public speaking or starting a new job.

But when anxiety becomes a constant state of mind and is no longer a reaction to a specific stressful event, then it's termed a disorder. And what was once characterized by stomach butterflies or a pounding heart can feel like a raging storm.

"Anxiety represents an alarm going off that something is threatening," says John D. Buksbazen, a psychoanalyst in Santa Monica, Calif. "If it's doing its job, then it's not a symptom but a natural function of the mind. When it gets stuck or goes off inappropriately, then we need to pay attention to the alarm system itself."

The question of whether overactive anxiety is caused by our psychology or our biology is hotly debated by the experts. Current research suggests that anxiety is rooted in a complex combination of life events, psychological traits and genetic factors. No anxiety gene per se has been identified, but some anxiety disorders--especially panic disorder--do appear to be hereditary.

Although its symptoms are rarely dangerous, anxiety disorder can nevertheless debilitate sufferers. People begin to fear their symptoms and are even more unnerved by their unpredictable onset. It can become a vicious cycle, in acute cases leaving those it affects paralyzed with fear. "Anxiety disorder is debilitating to the exact extent that it interferes with your ability to be in a relationship, to carry on at work or to engage in social or other activities," Buksbazen says.

Common around the globe, anxiety disorder is also the most frequently occurring mental health problem in the United States, according to the U.S. Surgeon General. About 19 million Americans between the ages of 18 and 54 will suffer from an anxiety disorder each year, according to a recent analysis by the National Institute of Mental Health (NIMH). Although the number of sufferers seems to have held steady in the past decade, awareness of the disorder has increased, especially since the NIMH has been focusing on the issue for the past

10 years, an agency spokesman said. "It's hard to say if we're seeing more anxiety than we used to," says Kenneth Mazey, Ph.D., a psychologist in private practice in Westwood, Calif. "But our way of life is so accelerated, and the technologically oriented world is very demanding. It's taking us away from the more natural rhythms of our existence."

Four million Americans suffer from a form of anxiety called generalized anxiety disorder, which is diagnosed by a persistent and excessive worry continuing more than six months and accompanied by symptoms like muscle tension, poor concentration, insomnia, irritability and panic attacks. Although panic disorder affects just 2.4 million Americans yearly, it is the best known and researched form of anxiety. It is diagnosed after a person has experienced at least two panic attacks and then begins to practice avoidance behavior. It's this fear of fear that distinguishes panic disorder, although people with other anxiety disorders can also experience panic attacks. Other anxiety disorders include social anxiety, specific phobias and obsessive-compulsive and post-traumatic stress disorders.

Recovering natural equilibrium is the goal, but many stricken by anxiety start the healing process by taking tranquilizers and antidepressants. Those drugs have a stabilizing effect, but they're only part of the healing process that can include therapy and complementary alternative treatments. "It's clear that medication masks symptoms and gives you the illusion that you don't have a problem when you do," says Mazey, also a staff psychologist and guest lecturer on dental phobias at UCLA's School of Dentistry. "Medications can take the edge off and be useful, but to master anxiety you need to confront the edge and realize you're not going to disintegrate."

The standard Western approach to anxiety combines medication with psychotherapy. Some patients, in fact, may go to a psychologist, who guides them through therapy, and a psychiatrist, who prescribes medication. This can be an effective way to treat anxiety disorder. And alternative practitioners like homeopaths, acupuncturists and yoga teachers try to get to the heart of the matter by patiently and deliberately guiding their patients to the root of their anxiety.

Diagnosis: Anxiety

It's not surprising that people afflicted with anxiety disorders become fearful of their symptoms when they run the gamut from dry mouth, sweaty palms, rapid pulse, heart palpitations, a feeling of chest tightness, abdominal pain and diarrhea to insomnia, loss of appetite, fatigue, general weakness, headache and panic attacks. Panic attacks--sudden and concentrated bouts of intense anxiety lasting from a few minutes to half an hour--are probably the most severe and frightening occurrence.

Although they're in the same extended family, anxiety differs from fear and depression. You may fear a growling dog, but that legitimate reaction subsides when the threat is gone. "Fear is a sense of being in danger and needing to escape from it," Buksbazen says. Anxiety--a hyperstimulation of the fear response--is unprovoked and sustained. Anxiety may also be a component of clinical depression, which is characterized more by feelings of sadness and hopelessness. Depressed people are frequently anxious and anxious people may frequently find themselves depressed, Buksbazen says. "The two are not the same but they often occur together."

Anxiety disorders also can be spurred by physiological problems like thyroid imbalances or gastrointestinal problems. If you experience prolonged anxiety, first schedule a checkup with your health practitioner. If the cause isn't physical, your next step should be to visit a psychiatrist or psychological therapist. In this case, don't rely on self-diagnosis. You need professional guidance to evaluate your condition and avoid unnecessarily prolonging suffering.

From diagnosis to treatment, anxiety is a complicated disorder with roots in brain functions that still aren't fully understood. Medical researchers don't know exactly why some people's inherent fear response becomes overactive. Psychologists, however, have several theories. One connects anxiety with unresolved conflicts in relationships. Another suggests that the way people react to stressful events, especially if they feel out of control or helpless, predisposes them to anxiety. Because women tend to have higher rates of anxiety and depression than men, some researchers have suggested that the male and female hormones play a role in triggering anxiety. It is known that at least five different neurotransmitters are disturbed in various anxiety disorders, and all of them have been targeted by anti-anxiety and antidepressant medications.

Little Yellow Pills

I started taking the tranquilizer Xanax to help me relax and fall asleep at night. The drug provided some relief, but it also made me feel groggy in the morning. Then, out of the blue, I started having panic attacks. They'd come on with a wave of fear, and my heart pounded as I waited anxiously for the feeling to subside. When I took an ill-advised plane trip that Christmas, the attacks increased in frequency and severity--striking every couple of hours nearly around the clock. After I got home, exhausted and depressed, I saw a psychiatrist who suggested that I take small doses of Xanax throughout the day. The panic attacks stopped, but the drug made me feel stoned, and the anxious feelings continued. After a couple of weeks on this medication schedule, my general anxiety worsened, especially when my nighttime dose of Xanax wore off at about 5 a.m.

It's not surprising that those who are diagnosed, as well as their medical professionals, turn first to pharmaceuticals for relief. The widely prescribed tranquilizers in the class known as benzodiazepines--which go by popular trade names like Xanax, Valium and Activan--can be highly effective in masking anxiety or quelling panic on a short-term basis. They are also addictive, and withdrawal can be tricky, unpleasant and even dangerous, Buksbazen says. He believes that patients who need drugs to overcome acute anxiety would be better treated with certain antidepressants, especially the selective serotonin re-uptake inhibitors (SSRIs), such as Prozac, Zoloft, Paxil and the newer Celexa, which can help short-circuit obsessional thinking and lessen panic and anxiety. Buksbazen says his patients on SSRIs show enormous improvements when their treatment includes psychotherapy.

Alternative practitioners, however, view anxiety disorders from a different perspective. And patients who seek out non-pharmaceutical treatment should be prepared to approach healing with introspection and patience. Integral yoga practitioners, for example, look at anxiety "from the inside out, rather than the outside in," explains Susan Bouthillier, an Integral instructor in Montreal. "We try to find out what the stress is, how it is perceived and managed, and then teach various yogic practices to release tension, revitalize all the systems in the body and calm the mind. The goal is to return to a state of balance and strength in which the person can respond creatively to each situation rather than with behavior conditioned by past experiences."

Acupuncturists look for one of six classic anxiety patterns, characterized by a patient's symptoms as well as her appearance (including her tongue) and pulse. "One of the main patterns in anxiety is a stagnation or blockage of energy in the liver, but it could also be caused by a shortage of energy," says Lauren Jacob, Lc.A., a Beverly Hills acupuncturist. Acupuncture, often given along with Chinese herbs, can be effective for treating anxiety, but don't expect a quick fix. "These therapies have a cumulative effect and work slowly," Jacob points out. "If you want to treat a psychological problem with acupuncture, you have to go every week for a while to heal. You have to be dedicated and willing."

Mind Over Matter

I soon weaned myself off the Xanax (not an easy task) by gradually cutting back on the dosage. Eventually I was able to stabilize the worst of my anxiety and panic symptoms with the antidepressant Zoloft. Then I discovered cognitive-behavioral therapy (CBT), which taught me how to think about anxiety symptoms in a less catastrophic way, and my life began to change for the better. Research has shown CBT to be the most useful treatment for a majority of anxiety patients because it teaches them to cope directly with their symptoms. Unlike traditional interpersonal therapy, which can take years for patients to resolve childhood conflicts and reach a catharsis, CBT provides much faster relief by emphasizing the here and now.

The behavioral aspect of CBT is based on the belief that fears are learned and thus can be unlearned. For certain phobias, therapists gradually expose patients to the frightening situation, intending to desensitize them to it. The cognitive aspect recognizes that we can think our way through fears. "You build confidence in your ability to work effectively with your anxiety," Mazey says.

I learned how to talk myself through my anxiety by diminishing the importance of certain symptoms while focusing on my goals. It became a holistic process involving the body, mind and spirit. A myriad of positive experiences helped me heal, including acupuncture, massage, exercise and a healthy diet.

If you're dealing with an anxiety disorder, all the medicine and therapy in the world may not help if your lifestyle contributes to the problem. Diet, for example, is a critical factor in either promoting anxiety or keeping it at bay. "The first thing I would look at is eliminating or reducing caffeine and alcohol," says Nan Fuchs, Ph.D., a nutritionist in Sebastopol, Calif., and author of Overcoming the Legacy of Overeating (Lowell House, 1999). Both substances can be prime anxiety promoters. And alcohol, except in moderate amounts, acts as a depressant. "While it may dull the immediate pain, it's at a cost," says Buksbazen, a practicing Zen Buddhist priest.

In an attempt to quell their anxiety, some people overeat, while others lose their appetites. In the latter case, Fuchs suggests high-protein shakes, which are easy to get down and help maintain energy levels. They also help displace high amounts of refined carbohydrates, which quickly turn into anxiety-boosting sugars. For those who use food as a way to calm anxiety, she suggests monitoring eating habits. "Sit down when you're eating and chew your food well so you can digest it better," Fuchs says. For more dietary guidance, check out the Anxiety Self-Help web site, (www.anxietyhelp.virtualave.net). Other helpful web sites include www.anxietypanic.com and www.algy.com/anxiety.

Supplements can tone down anxiety as well, Fuchs says. Start with a multivitamin that has a B-complex, she suggests, because anxiety can deplete vitamin [B.sub.6]. In addition, she recommends taking 200 to 500 milligrams (mg.) of muscle-relaxing magnesium daily, since anxiety also negatively affects those levels. Begin by adding a 100 mg. dose to your multivitamin and gradually increase it by as much as your bowels will tolerate. She also suggests taking 500 to 800 mg. of supplemental calcium daily.

Intense anxiety and panic initially may be best treated with pharmaceuticals, but herbal remedies also have been found to be effective. Their usage, however, must be supervised by a knowledgeable practitioner. Antidepressant herbs like St. John's wort and the hot new supplement Sam-e should not be taken with SSRIs because of possible serotonin overload. "Even these natural substances are not without their side effects," Buksbazen says.

Beyond that, Carol Howard, O.M.D., a naturopath and acupuncturist in Sherman Oaks, Calif., is concerned about herbs being "prescribed" without an investigation into the cause of anxiety. "To tell someone to just take St. John's wort is bogus," she says. "And Sam-e is not appropriate for everyone. If you don't have certain physiological problems, it could actually increase your anxiety."

Fuchs recommends kava kava for anxiety sufferers, at a standardized dose of 45 to 70 mg. kavalactones, the active ingredient in the herb, three times a day. This herb should not be taken with prescription anti-anxiety or antidepressant drugs, either. When exploring possible herbal anxiety remedies, Buksbazen advises seeking information from neutral authorities who aren't marketing particular herbs or products.

Through trial and error, and in conjunction with my therapist, I have developed a repertoire of coping behaviors I can fall back on when anxiety bubbles up. Besides my cognitive strategies, I took brisk walks, gardened, attended 12-step meetings and listened to meditation tapes. My motto became "Whatever works!" Here are some specific suggestions to strengthen your mind and body in an ongoing process to ward off anxiety.

MIND

* Breath work is useful because it induces relaxation and can refocus thinking patterns. "The simple things are often the most powerful ones," Buksbazen says. "Regulating breathing does seem to move the mind away from repetitive thought processes that are distressing."

* Meditation can calm and quiet the mind. Focusing on the breath is a good starting point, but aspiring meditators should seek out more formal instruction.

* Biofeedback is a valuable way to learn self-regulation, Buksbazen says. It trains you to alter bodily systems that usually aren't considered voluntary, such as brain activity, blood pressure, muscle tension and heart rate--offering a sense of bodily control when faced with the physiological symptoms of anxiety.

BODY

* A 30-minute brisk walk three times weekly can prove as effective as strenuous exercise. Exercise alone won't cure severe anxiety, but it creates a "favorable condition for healing," Buksbazen says. Bodywork, including massage, chiropractic adjustments or postural work, relieves the physical tension created by anxiety, which can help the psychological tension as well.

SPIRIT

* Whether a personal practice or a traditional ritual, prayer can be a powerful antidote to anxiety--substituting hope and faith for fear and despair.

* 12-step programs offer a place to share experiences without judgment, learn coping skills and "turn over" fears to a higher power.

It's been more than 10 years since I first started experiencing anxiety and panic problems. I haven't had a full-blown attack for five years now, and I rarely experience anything worse than mild anxiety. Long-distance travel is still a challenge for me--I get that old tingle when I think about being far away from the safety of home. It wasn't easy writing this article because it evoked some of those old feelings. But if I don't share my experience--and my triumphs--I could be depriving others who could use a dose of hope. No one with anxiety disorder needs to stay trapped in fear. There are too many ways out.

easy to swallow

Wouldn't it be nice if you could pick up something at the natural food store to relieve your anxiety-something that was safe, inexpensive and didn't come with a laundry list of warnings? Well, there is such a thing-thousands of them, in fact. Properly prescribed by an experienced practitioner, homeopathic remedies can treat or cure almost any physical or psychological disorder. Homeopathy is based on the law of similars, which holds that trace amounts of a substance (usually, though not always, a plant) that can cause a condition can also cure it. These remedies come in 6, 12 or 30X or C doses and can be found in natural food stores. The catch: Self-diagnosis is not particularly effective. We asked George Vithoulkas, M.D., founding director of the International Academy of Classical Homeopathy in Alonissos, Greece, to discuss the homeopathic perspective on anxiety.

"To treat a person suffering from anxiety in homeopathy, we have to examine her from a holistic perspective, meaning mentally, emotionally and physically-and assess to what degree she is suffering. I work in a clinic in Athens with 30 medical doctors who treat anxiety every day, and the success rate is quite high. Homeopathy is one of the few therapeutic modalities that can tackle such cases, the thinking being that anxiety isn't just something that should be quelled with drugs. It's a deep, energetic disturbance of the organism on a chemical level, which must be corrected before the person can really feel better.

"Besides a long, initial verbal consultation, with anxiety patients we have to re-examine traumatic or frightening events from their past. That will help determine the beginning of the problem and thus the remedy that is needed to counteract this trauma-even one that happened 15 or 20 years ago. Then we look at `co-symptoms,' which are always present. Typically, with anxiety disorders, people also experience excessive perspiration, dryness of the mouth, palpitation, a sense of losing consciousness or a fear of dying, sleep or sexual dysfunction, irritability, anger, tearfulness, anxiety for others and excessive concerns about their business or worries about the household. We need about 12 to 20 symptoms to get a picture of the correct remedy to prescribe. When the level of disturbance is not very deep, it can be cured quite easily. But other cases may need two or three years of treatment." --S.G.

MICHELE KORT, a freelance writer and editor based in Venice, Calif., specializes in women's health, fitness and sports.

Michele Kort ("The Inner Storm," p. 70) waged successful battle against anxiety disorder by following her own program of medication, therapy, acupuncture and diet. A health and fitness writer, Kort has also authored a biography of singer/ songwriter Laura Nyro, to be published by St. Martin's Press next year.

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