More and more, I have clients coming into see me who are taking over-the-counter “natural” or “alternative” products. Sometimes these are recommended by a specialist, sometimes by a friend. I was curious about these alternative products and did a little research about what they are—and whether there’s any evidence of their effectiveness. I came across a helpful 2010 review by Zoberi and Pollard, two researchers at the Saint Louis University School of Medicine, and supplemented their paper with some of my own investigations.
St John’s Wort
St John’s Wort (Hypericum perforatum) is derived from a plant species and more commonly known as an alternative treatment for depression. It’s available in natural food stores in capsule form, tinctures, and even tea. There’s some evidence that St. John’s Wort may be helpful for mild depression, but there’s no research to suggest it helps with anxiety.
I first heard about Valerian (Valeriana officinalis) years ago when it was touted as a sleep aid and even tried it once for sleep (seemed okay). Valerian is a perennial flowering plant that blooms in the summer. It’s been used as a sedative, historically, which is probably why it’s being marketed as a possible supplement for anxiety. Like St John’s Wort, it can be found as capsules, teas, and tinctures.
A review by the Cochrane Collaboration, a non-profit organization aimed at providing the public with summaries of the best scientific medical research, examined available studies on Valerian. Only one study was considered of a high enough quality for the Cochrane authors to seriously consider it.
The Cochrane Review concluded that Valerian had no more of an impact on anxiety than a non-active placebo. Consequently, there’s no reason to believe at this time that Valerian is useful for treating anxiety.
Kava (Piper Methysticum) is a plant found among islands in the Pacific Ocean that many Polynesian cultures traditionally turned into a drink and used as a sedative or relaxant. People still make Kava into a drink, but pharmaceutical companies have also converted it into pill form.
The Cochrane Review also looked at the impact of Kava on anxiety. Their results were a little more promising than Valerian: the Cochrane Review concluded that there is some evidence that Kava may have a small impact on reducing anxiety.
The Cochrane Review didn’t feel the side effects of Kava were anything to worry about, but I have elsewhere read that Kava may cause liver damage. Not everyone has problems with Kava, but some people have required liver transplants because of it. The FDA issued a warning about these dangers in 2002, and my understanding is that government funding for studies of Kava were suspended (Zoberi & Pollard, 2010).
Consequently, it appears the potential benefits from Kava are a little iffy and don’t necessarily outweigh the potential dangers. (At the very least, I’m not comfortable recommending something that may cause liver damage.)
Some conclusions and reflections
It’s hard to sort through information on alternative products, as enthusiasm for them often outstrips the research. Perhaps some of you know people who swear by these products. An important point to consider is placebo.
We often think of placebo as something that doesn’t work, but this is only partially true. Many people respond to being given a pill or treatment—more so than they would have if they were not given the pill—even if there’s nothing active in the pill (i.e., sugar). This is a crucial point: believing that a pill or supplement will work can often result in short-term benefits, even if the product has no actual benefits. (If you’re interested, here’s a great short video on the power of the placebo effect.) Consequently, if you read the Cochrane Reviews that I linked to, you’ll notice that they focused on studies where people were blind to whether they were being given the alternative treatment or something inactive.
Another point is that, as Kava illustrates, a substance can be natural and still toxic. Too often I see people equate “natural” with “harmless.” Much of the time this is true, but it’s important to be careful.
At this point, I couldn’t recommend any alternative supplements for anxiety based on the research I’ve seen.