The research is in. We have comparable mood-regulating herbal options to select from that may also be suitable and beneficial alongside commonly prescribed pharmaceutical mood stabilising medications and offer additional benefits.
The prevalence of Generalised Anxiety Disorder (GAD) continues to rise with up to 15% of the global population affected.1 Typical first-line treatments for anxiety include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs) and benzodiazepines. These medications may offer varying success and can be associated with serious side effects, including cognitive impairment, sedation, dependence, tolerance, rebound anxiety and discontinuation-syndrome.2
A PET and MRI-based randomised, controlled trial showed how a herbal remedy taken for a minimum of 8 weeks can induce a reduction of 5-HT1A receptor binding in healthy subjects compared to placebo. Findings are in line with a general mechanism of action shared by anxiolytic and antidepressant medications.3
Recent reviews and meta-analyses bring together the research strongly demonstrating the beneficial effects of certain herbal preparations for anxiety and depressive symptoms across a range of population groups with over 2000 participants.2 Herbs were also superior to placebo in trials of patients with generalised restlessness, agitation and disturbed sleep, significantly reducing the total Hamilton Anxiety Scale (HAMA) score.4
Linalool (at least 36.8%) and linalyl acetate (at least 34.2%) are primarily responsible for the pharmacological calming and sedative effects.2 They exert anxiolytic properties by acting as antagonists of the NMDA-receptor which inhibits SERT.2
In a 2014 clinical trial of more than 530 participants concluded that a specific preparation was at least as effective as paroxetine for the treatment of GAD. In addition, the intervention showed a pronounced antidepressant effect and improved general mental health and health-related quality of life.4
When comparing the anxiolytic effects of certain herbs and introductory doses of lorazepam in patients with GAD, both were found to be as effective as measured by HAMA total score reduction over 6 weeks.4
Although GAD is an independent disorder, in some research more than 90% of patients fulfill the criteria for at least one other psychiatric disorder including depression.4
Herbal remedies may regulate neurotransmitters and the immune system, reduce oxidative stress and modulate the HPA axis by reducing plasma corticosterone concentrations. In animal studies herbs can dose-dependently increase brain concentrations of dopamine with some research demonstrating positive effects on brain-derived neurotrophic factor (BDNF). Crocin has also been found to modulate serotonergic activity in subjects exposed to nonselective serotonin receptor agonists, lowering obsessive-like behaviours.5
In a 2019 systematic review and meta-analysis saffron had a positive effect on depressive and anxiety symptoms compared to placebo; there was no significant difference between the herb used and the medications tested. Herbs taken at the correct dose also demonstrated positive outcomes when used as an adjunct to antidepressant medications for depressive symptoms.5
One study looking at the effect of saffron for anxiety symptoms compared with citalopram found no significant difference between treatment groups.5
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1. Baxter, A. J., Scott, K. M., Vos, T. & Whiteford, H. A. Global prevalence of anxiety disorders: A systematic review and meta-regression. Psychol. Med. 43, 897–910 (2013).
2. Donelli, D., Antonelli, M., Bellinazzi, C., Gensini, G. F. & Firenzuoli, F. Effects of lavender on anxiety: A systematic review and meta-analysis. Phytomedicine 65, 153099 (2019).
3. Baldinger, P. et al. Effects of silexan on the serotonin-1A receptor and microstructure of the human brain: A randomized, placebo-controlled, double-blind, cross-over study with molecular and structural neuroimaging. Int. J. Neuropsychopharmacol. 18, 1–9 (2014).
4. Kasper, S. et al. Lavender oil preparation Silexan is effective in generalized anxiety disorder – A randomized, double-blind comparison to placebo and paroxetine. Int. J. Neuropsychopharmacol. 17, 859–869 (2014).
5. Marx, W. et al. Effect of saffron supplementation on symptoms of depression and anxiety: A systematic review and meta-analysis. Nutr. Rev. 77, 557–571 (2019).