has generalized anxiety disorder and, although she's been taking medication
(paroxetine), she doesn't seem to be improving. Are there any alternative
methods that might be able to help?-M.K., via e-mail
A. Anxiety is something we all suffer from at times; it's a normal reaction
to stress. But when anxiety becomes excessive and irrational, and interferes
with everyday life, it's time to get help. Persistent anxiety-generalized
anxiety disorder (GAD)-is a genuine, recognized psychiatric condition with
physical symptoms that include palpitations, dry mouth, sweating and sleep
problems (Lancet, 2006; 368: 2156-66).
Fortunately, your friend has sought professional advice. However, the
medication she's been prescribed may be doing her more harm than good.
Paroxetine, like other selective serotonin reuptake inhibitors (SSRIs), is
linked to a host of unwanted side-effects, such as sedation, constipation,
weight gain, sexual dysfunction and withdrawal symptoms upon stopping the
drug (Expert Opin Drug Saf, 2008; 7: 783-94).
Even more worrying is that paroxetine has also been linked with an increased
risk of attempted suicide (BMC Psychiatry, 2006; 6: 55).
Considering that other drug treatments for anxiety are also fraught with
problems, it's no surprise that many patients are seeking alternative
- Herbs. A variety of herbal remedies can treat anxiety, the most
popular being the South Pacific plant kava-kava (Piper methysticum). Indeed,
a literature review of all randomized, double-blind, placebo-controlled
studies found it to be "an effective symptomatic treatment option for
anxiety" (Cochrane Database Syst Rev, 2003; 1: CD003383). However, there
have been concerns over its safety, leading some countries-including the
UK-to ban it. Although some experts believe the ban is unwarranted, until
the safety issues are cleared away, other herbs might be a better option.
v Chamomile (Matricaria recutita). In 57 patients with
mild-to-moderate GAD, a chamomile extract was significantly better than a
placebo at reducing symptoms (J Clin Psychopharmacol, 2009; 29: 378-82).
v Valerian (Valeriana officinalis). This may be useful
for the symptoms associated with GAD such as nervousness, sleep disturbances
and depression (Z Arztl Fortbild Qualit"atssich, 2001; 95: 33-4).
v Passionflower (Passiflora incarnata). In one study,
this proved to be just as effective as the benzodiazepine drug oxazepam for
GAD (J Clin Pharm Ther, 2001; 26: 363-7).
- Supplements. Anxiety appears to be one of the many problems that can
be exacerbated by vitamin deficiency. A UK study of 80 male volunteers found
that a daily multivitamin/mineral tablet (containing calcium, magnesium and
zinc) was more effective than a placebo for reducing anxiety and stress
(Psychopharmacology [Berl], 2000; 150: 220-5). Other supplements that may
also help are 5-hydroxytrypto-phan (5-HTP), and amino acids l-lysine and
l-arginine taken in combination (Int Clin Psychopharmacol, 1987; 2: 33-45;
Biomed Res, 2007; 28: 85-90).
- Massage. In one study, patients receiving massage therapy reported
less anxiety, greater self-confidence, and feeling relaxed in both body and
mind (Complement Ther Clin Pract, 2009; 15: 96-101). Massage combined with
aromatherapy has also worked, although the effects are mild and short-lived
(Br J Gen Pract, 2000; 50: 493-6).
- Relaxation therapy. There is consistent evidence supporting the use
of relaxation techniques to treat GAD. A review of 27 studies concluded that
relaxation therapy (Jacobson's progressive relaxation, autogenic training,
applied relaxation and meditation) can all significantly reduce anxiety (BMC
Psychiatry. 2008; 8: 41).
- Exercise. Physical activity appears to be a powerful antidote to
stress and anxiety, and is often recommended for anxiety disorders and
depression. According to one report, the best results are seen with
rhythmic, aerobic exercises of moderate-to-low intensity (such as jogging,
swimming, cycling and walking). This should be carried out in 15- to
30-minute bouts at a minimum of three times a week in programmes of 10 weeks
or longer (Psychiatr Pol, 2004; 38: 611-20).
- Cognitive behavioural therapy (CBT), a form of counselling, can help
a variety of anxiety disorders, including GAD. In a review of 13 trials
which studied the use of CBT in children and adolescents, the response rate
was 56 per cent with CBT compared with 28 per cent for the controls
(Cochrane Database Syst Rev, 2005; 4: CD004690).
- Transcranial magnetic stimulation (TMS). Preliminary evidence
suggests that this non-invasive technique that stimulates neurons in the
brain may be useful for controlling anxiety. Although, so far, the results
are mixed, TMS has been reported to reduce anxiety symptoms in
post-traumatic stress and panic disorders (Int Clin Psychopharmacol, 2009;
Vol. 20 06 September 2009