Out of Anxiety - Supplements: Alternatives to Medications

Medications for anxiety and depression are fraught with issues. Everyday we are learning more about the hazards of SSRIs, MAOIs, TCAs and benzo drugs. All of these drugs, as helpful as they can be for a small percentage of the population, are designed to interrupt the natural processes of the body which is why they have so many side effects. None of them promotes the increased or balanced functioning of your body’s systems. In fact they can and often do disturb those systems in such a way so as to create dependencies/addictions. They do not cure. In many cases, when you stop taking the medication, you will have the same symptoms you had when you started. Even SSRIs, the safest of these drugs, have been shown to decrease the natural production of serotonin once the user has been weaned, thus possibly compounding the initial problem. Those of us with long term depression or anxiety know that it is not an option worth considering. In addition, these drugs can cause severe high blood pressure, low libido, a feeling of emotional numbness, an increased risk of osteoporosis, dry mouth, memory problems, constipation, mental fogginess, vision problems, weight gain, and increased risk of worsening depression and suicidal thoughts. Some practitioners are reconsidering the use of these drugs in all but the most severely affected individual for these reasons.

Thankfully there are other choices. Even though they are not publicized or often prescribed by physicians in the U.S., doctors in Europe have been using various supplements and herbs to treat chronic depression and anxiety for years. These supplements, which essentially boost the natural content and chemistry of your body, have few if any side effects and are used safely in children and adults. For our purposes, I will highlight the more popular supplements with a long, proven record of safety. Herbs are another category worth exploring, but do so with a naturopathic doctor since they sometimes have more side effects and drug interactions that should be considered before taking them. All dosages listed are for adults.

A few basic chemicals in the body are responsible for the presence or absence of anxiety. Serotonin, the lack of which is implicated in depression, is a hormone and neurotransmitter that essentially gauges abundance or scarcity, factors which determine your sense of wellbeing. Low serotonin levels have been established in approximately 80% of people with depression. Other serious conditions associated with low serotonin are bulimia, obsessive compulsive disorder, heart problems, insomnia, SIDS, migraines and obesity. In the case of bulimia and obesity, low serotonin short circuits the feeling of satiety. In SIDS, infants who are left alone or to “cry it out” have low levels of serotonin and high levels of cortisol which upset breathing and heart rhythms. Serotonin is required for the production of melatonin and too little of it will result in sleep disorders. And for those of us with depression and/or anxiety, low serotonin means we feel a terrible emptiness and/or dread about life and the world around us. It also explains why a higher percentage of depressed and anxious persons are overweight and have difficulty sleeping. (If any of this sounds like you, keep reading for ways to change that!)

Epinephrine, also called Adrenaline, is a chemical produced in the adrenal glands in response to real or perceived physical threats (fear). The production and release of epinephrine increases with constant noise, bright lights, and high temperatures as well. When you have an adrenaline rush your heart rate increases, and at the same time sets off ACTH production which tells the adrenals to produce another chemical called cortisol.

Cortisol is produced and secreted by the adrenals in response to all kinds of stress. It can be triggered by an adrenaline rush, a prolonged illness or an emotional trauma. Prolonged high blood levels of cortisol shut down reproduction (causing issues with menstrual cycle), reduces the amount of tryptophan available for the production of serotonin, and can suppress the immune system. In short, this chemical is good for a short term response to stress, but terrible if secreted over long periods of time.

Cortisol levels are increased during commuting to work, in persons who are overweight, do exercise they are not conditioned for, do not get regular amounts of sleep and who drink caffeine. In studies, cortisol levels are reduced by being touched or massaged, listening to relaxing music, being in a quiet environment or sitting in low light. The expression of cortisol in high amounts over long periods can cause adrenal fatigue and failure, basically working the adrenals to death. When the adrenals are fatigued or have failed, the resulting lack of adrenal hormones increases the risk of osteoporosis, impairs learning, causes infertility, and may be the root cause of chronic fatigue syndrome.

Norepinephrine/noradrenaline, like epinephrine/adrenaline, is a hormone that supports the fight or flight response. Its job is to promote blood flow to large muscle groups and improve attention. Depression where there is no anxiety and ADHD will often have a low norepinephrine component. But for anxiety, high levels of norepinephrine are often found, indicating that the individual is experiencing unhealthy levels of stress. When anxiety is coupled with panic attacks, this is most certainly a norepinephrine issue. Panic attacks, while short-lived (usually 10 min.) are debilitating. The type of stress implicated in panic attacks is usually the result of a threat to your ability to care for yourself or to survive either physically or emotionally, e.g. fear of losing your job, limited access to food, warmth, etc., fear of being publicly shamed, and so on.

DHEA is a steroid produced by the adrenals. The adequate presence of DHEA is protective against cardiovascular disease, mitigates high cortisol thereby increasing serotonin, helps to regulate and balance pituitary and thyroid function, and increases production of sex hormones. Though DHEA naturally decreases after the age of 25, prolonged stress can cause levels to drop further.

Because DHEA is a precursor to the formation of the major sex hormones estrogen and testosterone, for women in the menopausal years, low levels of DHEA are of particular concern since they lower the levels of protective estrogen and increase anxiety and moodiness from a lack of testosterone. For the same reason, a high incidence of hot flashes can also alert you to low adrenal function and consequently a DHEA deficiency.

For men, low levels of DHEA mean low levels of testosterone. Low testosterone in turn is known to cause anxiety in men (and women) as well as poor body image, social anxiety, and erectile dysfunction.

Our last chemicals are closely related. GABA is metabolized from Glutamate, but they have very different functions in the body. Whereas glutamate amplifies messages to the brain in an attempt to excite a response, GABA turns down the volume so that low value stimuli can be ignored or turned off. When not enough GABA is synthesized from glutamate, a person will experience anxiety, low libido, headaches, sleep disruption, and in severe cases, seizures. The causes of GABA deficiency are not well understood, but there is some evidence that it may be a genetic condition.

So now what? Thankfully there are ample treatments for imbalances in the above hormones. They carry with them little to no side effects and have few drug interactions. Like most medications, these remedies can take a little time to show their benefits. Usually you will notice improvement in 2-14 days. But in some cases it can take 3 months to see the full effects.

If your anxiety is accompanied by depression, if you have a difficult time controlling what you eat and/or don’t ever quite feel full, if you have trouble sleeping, have migraines, or some degree of obsessive compulsive disorder, then you might need a boost to your serotonin levels. 5-HTP is a safe and effective treatment made from a plant. 5-HTP is the precursor for serotonin and, unlike tryptophan, easily leaves the intestines and crosses the blood-brain barrier where it is turned into serotonin. The recommended dosage is 50 mg 3x/day. Some people experience temporary nausea so take it with food. The nausea is usually not a problem after a week or two and only occurs after dosage (not constant.) After two to four weeks if you experience benefit, but still feel depressed, increase the dosage to 100 mg 3x/day. For anything higher I would recommend consulting a naturopath. It is safe to take 5-HTP with the other remedies listed here.

If you suspect that adrenal issues are at the root of your anxiety, you will likely also be experiencing additional symptoms like daily fatigue particularly in the afternoon hours, disruptions to your menstrual cycle, periodic erectile dysfunction, fertility issues, difficulty sleeping through the night, increased urination, or difficulty learning new information aka fogginess. Adrenal health can be regained, usually within the period of a year, with supplements like Drenotrophin PMG and DHEA. Drenotrophin PMG is available online or from a naturopath, while DHEA is available in most health food stores. Drenotrophin is taken 3x/day with meals. Before you start taking DHEA you might consider having your doctor test your levels for a baseline. Women take 10-25 mg/day, while men should take 50-100 mg/day. I would recommend starting with the lowest dosage and moving it up as needed. If you are perimenopausal or menopausal and have mood swings, moderate to mild depression and/or anxiety as well as hot flashes, this could be just what you’re looking for.

The supplemental form of GABA is available in most natural food stores and is a priceless addition to the anxious person’s pharmacy. GABA is an excellent treatment for people with anxieties of all kinds, but especially for those with high levels of norepinephrine and panic attacks. For those suffering from pervasive anxiety and trouble sleeping take 500 mg once in the morning and once an hour before bed. Because this is fast acting, you will notice the benefits within an hour or two. If after time you need to increase your dose, see an ND for guidance. At no point should you take more than 1000 mg of GABA in a single dose. Some recommendations say the upper limit is 750 mg at one time. So get the advice of an ND if you want to up the dose. You can also use this as needed for anxiety inducing situations such as flying on planes, going to a party, before an important presentation or a trip to the doctor. Take 500 mg one to two hours before the event for optimum benefit. If you have trouble sleeping, GABA can be used in place of habit forming sleep medications. Simply take the 500 mg one hour prior to bedtime. DO NOT TAKE GABA IF you are on medications for ADHD, Prader-Willi syndrome, Angleman syndrome, or for brain diseases that are the result of liver disease.

Instead of increasing the dose of GABA, some doctors recommend adding Theanine. Theanine promotes the natural production of GABA in your body and has very effectively been used as a replacement for Ritalin in children and adults in the treatment of ADD/ADHD. There are no known side effects or drug interactions. Take 100-200 mg 1-4x/day. Start small and increase as needed.

Other important supplements: The overwhelming majority of people with depression and anxiety show deficiencies in B-vitamins. For this reason B-100 complex is recommended. Take 1-2 each day. Vitamin D is also implicated in anxiety especially for those whose condition worsens in the winter months. Start with 2000 IU in the summer and 4000 IU in the winter. Vitamin C isn’t just for immunity. It is a powerful anti-oxidant that turns off a feedback loop that tells your body it is stressed out even when it isn’t any more. Take 2000-4000 mg of Vitamin C each day when well. Add 2000 mg when you are ill. Essential fatty acids seem to be all the rage these days for a variety of issues. Persons with anxiety and depression show low levels of omega fatty acids in their blood. When supplemented, these same people show improvement in symptoms and lowered cortisol levels. I don’t have a recommended dosage so I would just pick one made from fish oil and take it according to the directions. 650 mg has been suggested as a minimum daily intake of EFAs, so if you don’t regularly eat fish or flaxseed you might want to shoot for that. 1000 mg would be the high end. This is not a comprehensive list, but I think I covered the biggies.

Though supplements are a great bridge to emotional wellbeing, they should not be used in place of a good diet, talk therapy, basic self-care and other stress reducing lifestyle changes. Recovery from anxiety is a multi-layered process that must address the underlying cause, which is an overly stressful lifestyle. No supplement will change that. You must engage in a paradigm shift and allow your body the chance to recuperate from the trauma of being “used up”. There is nothing so perfect as a daily, leisurely walk to use up excess adrenaline/epinephrine. Low lights, periods of quiet, and massages work miracles. The point of supplements is to carry you through until you have made your changes. After that only a small percentage of anxiety sufferers will need to continue supplementation because of genetic, digestive or metabolic factors that prevent them from making enough of their body’s own chemicals.

Honor Thy Mother and Thy Father

I am continually asking myself the question what the commandment to honor your parents really means. Does it mean we have to do whatever they say or does it mean that we have to simply hear them out? What if what your parents say is generally abusive or rails against your values? What if they use their words to try to control, manipulate or harrass you?

Does it mean they are free to show up at your front door unannounced and permitted to stay for as long as they like? Or does it mean that we cloth and shelter them in their old age or infirmity? Does it mean you can't get angry, or if you do get angry, you're not allowed to say? What does this mean?

I am hoping it means--and I say this rather boldly--that you have to treat them like human beings, not like your nation's dictator. I believe in working toward forgiveness, especially when it is asked for. I believe in actively trying to understand another person's perspective and where they came from. I believe in recognizing the imperfect nature of humanity and letting the little stuff slide. I believe in honoring the wisdom that sometimes comes with age.

I don't think honoring involves "sucking it up" for the sake of harmony, or overlooking serious offensives, or accepting or allowing habitually hurtful behavior to go unchecked. The brownie points parents get for making a life quickly get used up. Parents who want respect should treat their children with respect. Parents who want forgiveness should practice forgiveness, not save "evidence" of "wrong doing" for later use. And for that matter, parents who want forgiveness should change their hurtful behavior and entitled attitudes.

Since I became a mother, I have desperately tried to earn the trust and respect of my children. I show that I can be trusted and I act respectably and with respect for them, then they know to trust me and to respect me. When I messed up, even when they were babies and toddlers, I said I was sorry and made every effort not to repeat my mistake. Just because I put a roof over their head and feed them my job isn't done. And it certainly doesn't buy me the right to say and do whatever I like without taking responsibility for my actions. I've tried to teach them that every action has a consequence, good or bad. That applies to parents too.