On The Shelf
Aina Abell
Stress and anxiety affect millions of people in the United States and have only worsened during the COVID-19 pandemic. While therapy, prescription medications, or a combination of both remain the standard treatment for anxiety and stress, some supplements are available to manage mild to moderate symptoms. As more and more patients turn to their local pharmacists for advice on managing mental health symptoms, what should they know about the supplements out there?
Background
The Anxiety and Depression Association of America reports that 40 million adults in the United States—18.1% of the population—experience anxiety disorders such as generalized anxiety disorder (GAD), panic disorder, and social anxiety disorder, making them the most common type of mental illness in the country.
In addition, more than 75% of U.S. adults reported physical or emotional symptoms of stress, including headache, fatigue, or changes in sleeping habits, according to the American Psychological Association’s 2019 Stress in America survey. Nearly one-half of participants reported having lain awake at night due to stress in the prior month, and nearly three out of five adults said they could have benefited from more emotional support in the last year.
Supplement options
Not many robust studies exist on the benefits of supplements on stress and anxiety, but some have shown certain supplements may help ease mild to moderate symptoms in patients.
For instance, studies have revealed that vitamin D may play an important role in mood regulation and brain health. Although further studies are needed, vitamin D deficiency has been linked to anxiety and depression. Supplements may help manage symptoms of stress and anxiety in those who are deficient.
Vitamin B complex supplements may also help lower stress and anxiety levels. In a 2017 study published in Journal of Biomedical and Clinical Research, Todorov and colleagues found a link between lower levels of vitamin B12 and depression or anxiety. Another study by Mikkelsen and colleagues, published in Journal of Functional Foods in 2018, found that people who consumed foods high in B vitamins had better anxiety and stress scores than those who did not.
Omega-3 fatty acids may also have anti-anxiety effects, according to a 2018 systematic review and meta-analysis of 19 clinical trials published by Su and colleagues in JAMA Network Open. And a 2017 systematic review published by Boyle and Colleagues in Nutrients suggests that magnesium may improve anxiety in vulnerable populations. However, “the quality of the existing evidence is poor,” wrote the authors.
L-theanine may also ease anxiety and stress. According to a 2016 study published in Nutrients by White and colleagues, participants taking the amino acid had lower stress response and cortisol levels after undertaking a multitasking challenge—which acted as a stressor—compared with placebo.
The National Center for Complementary and Integrative Health (NCCIH) reported that, based off two preliminary studies, chamomile extract might be helpful in managing GAD; however, the findings are inconclusive. The agency also said that lavender, including teas and essential oils, is safe and may help ease anxiety and stress, but existing research of its effectiveness have mixed results.
NCCIH noted that melatonin has been studied as “a possible alternative to conventional anxiety-reducing drugs for patients who are about to have surgery, and the results have been promising.” The agency also reported that some studies have shown kava to have a small effect on reducing anxiety, but pharmacists should warn patients that the supplements have been linked to a risk of severe liver injury.
Lemon balm, which can be consumed as a tea or in capsules, may also help with anxiety symptoms, according to a 2019 paper by Soltanpour and colleagues published in the European Journal of Integrative Medicine. According to NCCIH, passionflower or valerian are generally safe for short-term use, but there is currently insufficient evidence to conclude they are effective in managing stress and anxiety.
What to tell patients
Counsel patients to talk to their health care provider before taking any supplements for stress or anxiety. While supplements may help ease symptoms, evidence of their effectiveness is limited, and they should not be used as a substitute for care from a health professional.
Those experiencing stress and anxiety, especially severe symptoms, may benefit from prescription medications, therapy, or a combination of both.