Supplements for anxiety

A while back, we posted a review of holistic M.D. Hyla Cass’ recommendations for avoiding the dependence-inducing benzodiazepines for anxiety. Her prescription was to use supplements instead, and she had some specific recommendations:

In her 2007 book, Supplement Your Prescription: What Your Doctor Doesn’t Know About Nutrition, Dr. Hyla Cass has an interesting section (pp. 139-140) dealing with supplement alternatives to benzodiazepines and other drugs such as Ambien. (These drugs are generally prescribed as anti-anxiety agents and as sleep aids.)

Of benzodiazepines (the best-known tradenames in this category are Valium, Xanax, Ativan, Klonopin, Librium, Halcion), Dr. Cass writes that a principal problem is that these drugs develop dependence, and so can require steadily increasing dosages as time goes on. (Ideally, she says, they are intended as short-term therapies, but in fact many patients end up being prescribed them for a much longer time.) Withdrawal from these drugs can be quite hazardous, and should be done only under medical surpervision. Moreover, the effect of this class of medications is often a dulling of response, so their use can be associated with accidents.
[…]
She states that in her own practice she has often successfully substituted supplements for these prescription drugs. Among the calming supplements that she has used:

5-HTP: 100-200mg at bedtime
Melatonin: 0.5-3.0mg at bedtime
L-theanine: 200mg, one to three times daily, as needed

In Dr. Cass’s view, supplements such as these, sometimes used in combinations, can provide a good alternative to the addictive benzodiazepines and their side effects.

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See the following NYBC entries for additional information on the supplements mentioned above:

Melatonin 1mg and Melatonin 3mg

Theanine Serene (includes L-theanine)

NYBC also stocks 5-HTP and the closely related Tryptophan.

If you do decide to take one of the prescription benzodiazepines, Dr. Cass further notes, it is advisable to supplement to offset the key nutrients that these drugs tend to deplete in the body. We note that the Jarrow supplement Bone Up very closely matches the set of depleted supplements listed by Dr. Cass (Calcium, Magnesium, Folic acid, Vitamin D, Vitamin K).

One last note: rather small doses of melatonin may do the trick in terms of helping you to sleep. A 1mg dose may be all that’s necessary.

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Drugs versus supplements as sleep aids

One of the reasons people turn to supplements is that drugs often have side-effects which make their use, especially over the long term, more damaging than helpful. That may be the case with long-term use of some common over-the-counter drugs to aid sleep.

A 2010 study published in the journal Neurology, for example, looked at drugs called anticholinergics, which block acetylcholine, a nervous system neurotransmitter. They include such common over-the-counter brands as Benadryl, Dramamine, Excedrin PM, Nytol, Sominex, Tylenol PM, and Unisom. They are taken for a variety of common medical conditions including insomnia or allergies. Unfortunately, according to this Indiana University study, over the long term these drugs also produce cognitive impairment. According to the study authors, taking “one anticholinergic significantly increased an individual’s risk of developing mild cognitive impairment and taking two of these drugs doubled this risk.”

Given these risks, it makes sense to consider such alternatives as Melatonin or 5-HTP. While these supplements, like many others, should be taken carefully and according to recommendations, we don’t know of any research suggesting that they produce cognitive impairment over the long run!

Chinese herbal combination as sleep aid: HerbSom

NYBC is now stocking HerbSom Capsules (Zhang) a proprietary extract of corydalis root, jujube seeds and schisandra fruit.

Corydalis, known also as jin bu huan, grows in China and has some evidence suggesting it can help people suffering from insomnia to fall asleep.

Jujube seeds, from Zizyphus jujube, has a long use in Chinese medicine for managing insomnia associated with weakness (as defined in that tradition). Subhuti Dharmanand notes “Zizyphus Combination treats weakness fatigue, and distress due to weakness, which causes insomnia.” Zizyphus is the main ingredient of the formula both in terms of the quantity used and its central action for the treatment of deficiency and insomnia, which are the formula’s main indications.

For more information on these herbal components, as well as recommended dosage, see the NYBC entry at

HerbSom

Tryptophan as a sleep aid, antidepressant, and for chronic pain relief

Clinical research has tended to confirm tryptophan’s effectiveness both as a sleep aid and for other conditions typically associated with low levels of the neurotransmitter serotonin. It has shown value as an antidepressant, and as an “enhancer” or “augmenter” of antidepressant drugs. Other promising indications include relief of chronic pain.

For dosing recommendations, see NYBC product entry for Tryptophan

As a sleep aid, Melatonin also has good evidence to support its use. Note that 5-HTP, which is closely related to Tryptophan, has also been studied as an antidepressant.

Citation: Shaw K, Turner J, Del Mar C (2002). “Tryptophan and 5-hydroxytryptophan for depression”. Cochrane database of systematic reviews (Online) (1): CD003198.

Tryptophan for chronic pain: Seltzer S, Dewart D, Pollack RL, Jackson E. The effects of dietary tryptophan on chronic maxillofacial pain and experimental pain tolerance. J Psychiatr Res 1982-83;17(2):185-6.