How Anxiolytics Work and Should I Take Them? Any Natural Options?

by Brian P. Ramos

If you are someone who struggles with anxiety, whether you regularly find yourself having panic attacks or you simply find yourself feeling stressed from time to time, then you may have been recommended anxiolytics by your doctor. These are medications designed expressly for treating anxiety and they work in a number of ways to help combat both the psychological and physiological symptoms associated with it.

But how do they work? And should you take them?

What is Anxiety?

Anxiety is a mood of fear, worry, and uneasiness resulting from the apprehension of something bad happening and has widespread deleterious social consequences. While anxiety can be a normal beneficial response to events that truly threaten one’s security, chronic and irrational anxiety in response to normal life events in the absence of genuine threats can be debilitating and is considered to be an anxiety disorder.

In developed countries, anxiety disorder rates range from 13.6% to 28.8% of the population. In the United States, anxiety disorders effect 40 million people above the age of 18.

Anxiety can be the consequence of a variety of causes and arise in individuals through various different chemistries. For example, anxiety can be the consequence of dietary deficiency, hormonal changes, illness, traumatic experiences, bad habits, life stressors, aging, and genetics.

In specific vitamin, mineral, and amino acid deficiencies in the diet are associated with increased risk for anxiety disorder. Changes in hormonal balances, particularly associated with women during menstruation, pregnancy, post-partum periods, and menopause are all associated with increased frequencies of anxiety disorder.

Furthermore, a traumatic violent experience may lead to post-traumatic stress disorder in which a person will feel anxiety when the environment reminds them of the original violent experience. Lastly, the stress and discomfort associated with the treatments that go along with these illnesses increase the risk of anxiety.

Anxiety is also closely associated with other mental health conditions, especially depression. This relationship can work both ways causally. For example, anxiety can lead to depression and depression can lead to anxiety. In the National Comorbidity Survey, the co-occurrence of anxiety and depression is in 58% of the cases. In part, due to the overlapping chemistry and treatment between anxiety and depression, the use of diet, herbs and lifestyle changes is a valuable means both treat anxiety and depression and dissect the causes of anxiety from the causes of depression.

Anxiety disorders are stress-related and constitute, as a group, the most common of all psychiatric and medical disorders. This group of disorders includes acute stress disorder, generalized anxiety disorder, panic disorder, phobias (most common type), obsessive-compulsive disorder, and posttraumatic stress disorder. All of these disorders can range in severity from persistent and excessive anxiety to sheer acute terror or panic.

Neuroscience of Anxiety

The neurochemistry of anxiety disorders can be distilled into two main categories. First, is an imbalance in neurotransmitter (GABA, serotonin, and dopamine) function in the amygdala, an area of the brain involved with the perception and assessment of threats. Second is the hypothalamic-pituitary-adrenal axis (HPA-axis) which I describe in my book “The Art of Stress-Free Living” and involves brain stimulation of the adrenal gland to release cortisol, DHEA, adrenaline, and noradrenaline. Cortisol is the stress hormone and adrenaline and noradrenaline increase heart rate and breathing in what is known as the “fight or flight” response.

All anxiolytics work by changing the release of neurotransmitters and hormones that are associated with stress or anxiety. Stress is essentially caused by the ‘fight or flight’ response, which is our body’s chemical response to danger. When we think we’re under some kind of threat, we release adrenaline, norepinephrine, dopamine, cortisol and more and this leads to an increase in our heart rate, dilation of the pupils, dilation of the blood vessels and even increased blood viscosity. The muscles become stronger and we become more alert but the immune system and digestion are suppressed until we become safer.

Most anxiolytics work by increasing the amount of a substance called ‘GABA’ or gamma-aminobutyric acid. This is an ‘inhibitory’ neurotransmitter, meaning that its purpose is to suppress activity in the brain and communication between brain cells. When it does this, it leaves us feeling less alert and less anxious which in turn causes those anxiety-related neurotransmitters to subside. Essentially it works by sedating us slightly.

Other anti-anxiety medication works by increasing serotonin. Serotonin is the ‘feel good’ neurotransmitter and when there are lots of it in the brain, we feel happy and cheerful. Increasing this can, therefore, reduce feelings of anxiety and dread.

Anxiety disorders are treated with anxiolytic medicines that fall into four categories:

1) Benzodiazepams, like Xanax, that augment GABA signaling to balance brain activity and relieve anxiety symptoms. However, these drugs can become habit forming, and also, patients can develop a tolerance to them, which results in an increasing required dosage during treatment. After the use of benzodiazepines, some individuals experience a variety of withdrawal symptoms.

2) Anti-depressant drugs, like Prozac, which increase serotonin and dopamine. These drugs can also be effective in treating anxiety, especially when anxiety occurs in conjunction with depression.

3) Tranquilizers that also elevate serotonin and dopamine. Some of these drugs, like azapirones, are anxiolytic but do not have the same tolerance and dependency issues as the benzodiazepines.

4) Beta-blockers, which act on the HPA-axis and are used primarily to treat heart conditions. However, these drugs reduce heart palpitations and other physical HPA-related symptoms of anxiety. By controlling these feedback signals, the beta blockers offer a relatively new approach to treating some forms of anxiety. Despite this, they still come with various potential side effects.

The Problems

The problem with these traditional approaches is that it can lead to unwanted side effects as well as addiction. When you increase or decrease specific neurotransmitters, the brain responds by reducing its natural production of those chemicals, or by reducing its ability to respond to them (by removing ‘receptors’).

Thus, you can get to the point where you need stronger doses of the medication to get the same results. Likewise, you can find yourself feeling even worse when you’re not using the medication. This is called ‘tolerance and dependence’.

Furthermore, using medication like this does not address the root cause of the problems — the thought processes that lead to that chemical change. While anxiolytics might be useful in the short term for preventing the onset of an attack, it is important to use other methods in the long term to solve the problem.

Natural and Safer Alternatives

Even though medicines offer a great temporary alternative to treating anxiety, there are a number of nutrients and herbs that have been identified to reduce anxiety. A functional medicine approach, which focuses on prevention and nutrition is crucial as well.

You should work to re-establish and sustain a healthy diet mainly of whole plant-based foods rich micronutrients and essential molecules that feed your brain the right way and promote the activation of healthy genetic programs. Moreover, you should consider altering both neurotransmitter levels and the HPA axis in a way that avoids some of the potentially severe side effects associated with conventional drug therapies.

For example, vitamins C, D, and E, omega-3 fatty acids, and the green tea amino acid L-theanine are dietary supplements known to increase the production of dopamine or GABA in some cases. Further, supplementation with the amino acid L-tryptophan and its precursor, 5-HTP, and the B vitamins, vitamin D, selenium, and omega-3 fats increases serotonin production.

These amino acid supplements are neurotransmitter building blocks and the vitamins act as cofactors in neurotransmitter biosynthesis pathways. This dietary approach can correct the underlying neurochemistry, unlike many of the drugs mentioned above which simply mask the problem.

Nutritional Approach

Amino Acids

The amino acid glutamate is the principal excitatory neurotransmitter and also used to make the neurotransmitter gamma-aminobutyric (GABA). L-tryptophan and L-tyrosine are precursors for the neurotransmitters, serotonin, dopamine, and norepinephrine. The ability of the body to produce these neurotransmitters is directly linked to the levels of these amino acids consumed in the diet.

Magnesium

I have discussed previously the importance of magnesium in your diet both here on Medium and also in “The Art of Stress-Free Living”. Briefly, numerous studies support boosting your magnesium levels, which many of us are deficient in, to reduce anxiety. Deficiency in magnesium leads to anxiety behaviors and increased stress. Interestingly, magnesium supplementation reverses anxiety similar to benzodiazepams.

Omega fatty acids

Again, I have previously discussed omega fatty acids and their importance to the brain and mental health. Dietary omega-3 fatty acids have been shown to both improve mood and reduced the risk of anxiety.

Vitamins

Vitamin C is a cofactor for enzymes involved in biosynthesis and supplementation with this vitamin reduces anxiety by limiting the oxidative stress from metabolites and reducing cortisol levels. Furthermore, one clinical study showed that high dose vitamin C improves moodVitamin Ealso reduces anxiety in humans.

In addition to the nutrients mentioned above, dietary supplementation with herbs and plant products have also been shown to be effective in treating anxiety. These herbs, unlike traditional anxiolytic medications, have little to no side effects and yet have been shown to be effective at treating anxiety.

Botanical Approach

Ginkgo biloba

Animals given nutritional supplements of Ginkgo biloba demonstrated reduced anxiety. Furthermore, in controlled clinical studies using MRI, Ginkgo biloba extracts activated GABA pathways, acted like a benzodiazepine, and reduced anxiety in patients with a generalized anxiety disorder.

Holy Basil

Tulsi is an herb used for thousands of years not only for cooking, but also as an adjunct treatment for coughs, colds, and the flu, as it helps to cleanse the respiratory tract of toxins. This holistic healing tonic has many uses, but the one most relevant to this book is its ability to act as an adaptogen.

Holy basil increases endurance and enhances metabolism in animals. It is also able, though it is unknown how to reduce the stress response in stressful environments in both animals and humans. Holy basil has antidepressant and anti-anxiety effects, similar to drugs commonly prescribed to patients.

Maca Root

Maca is another of the great manmade cruciferous vegetables that are so valuable to our health and wellbeing. This is an adaptogenic root that helps combat stress and fatigue, in addition to being very nutritious (high in protein, iron, vitamin C, etc.). Furthermore, it contains many powerful bioactive compounds, such as flavonoids. Maca has numerous benefits, including enhanced energy and sports enduranceincreased libidodecreased cognitive decline, and improved mood by reducing symptoms anxiety and depression.

Ashwagandha

This is another herb I discuss at length in “The Art of Stress-Free Living”, and therefore I suggest that you read more about it there. Briefly, this herb has anti-inflammatory and rejuvenating qualities. Animals treated with ashwagandha showed reduced anxiety behavior that is comparable to reductions seen with several benzodiazepine drugs. Similar results have been seen in human studies where patients treated with ashwagandha demonstrated anxiety reductions greater than with psychotherapy.

Kava

Of all of the anxiolytic herbs, Kava is the most studied and also demonstrates the best results against mild anxiety and anxiety disorders in humans. Patients with anxiety given a kava extract for 25 weeks had significantly reduced anxiety. Subsequent clinical studies confirm that dietary kava is an effective treatment for anxiety and benzodiazepam replacement.

Valerian Root

Valerian root components have been shown to both increase GABA synthesis and decrease synaptic GABA reuptake. Moreover, it activates glutamic acid decarboxylase, an enzyme involved in the synthesis of GABA. Valerian root extracts have anxiolytic properties in rodents and in people when taken at doses of 400–900 mg daily valerian root was as effective as diazepam in reducing anxiety.

Green Tea

Theanine is an amino acid found in green tea that produces a calming effect on the brain. Theanine crosses the blood-brain barrier and increases the production of both GABA and dopamine. In a clinical study, healthy volunteers were given theanine and a benzodiazepine and subjected to experimentally induced anxiety. The people who received theanine had lower baseline anxiety throughout the trial.

GABA

GABA is a neurotransmitter and is found occurring naturally in herbs and plants. GABA is the main inhibitory neurotransmitter and works by reducing the excitability of a neural network thereby functioning as a brake on the neural circuitry during stress. Indeed, low GABA levels are associated with, restlessness, agitation, anxiety, and mood disordersDietary GABA supplement in clinical studies relieves anxiety and increases alpha brain waves, which are associated with relaxation. These are the same alpha brain waves the meditation can enhance, thereby suggesting a possible link between meditation and enhanced GABA signaling in the brain.

In in my book “The Art of Stress-Free Living” I discuss at length other ways in which you can use nutrition to reduce not only body or oxidative stress but also mental stress and anxiety. You will want to check that out as this phenomenal handbook of life includes additional holistic strategies to conquer anxiety and stress once-and-for-all.

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