Anxiety: Complementary & Alternative Medicine

Many people use “natural” medicine to manage anxiety symptoms. Be sure to ask about all over-the-counter medications, herbs, supplements, and other treatments that have been previously tried or are being tried; many herbal remedies and supplements can have significant drug-drug interactions. Using large doses of anything can lead to side effects and toxicity, and product quality varies among manufacturers. Herbs and Dietary Supplements Program (OSU) is an on-line training program for clinicians that categorizes various natural approaches to treating anxiety based on evidence and risks. For anxiety, the program advises clinicians to:
  • Recommend - lavender aromatherapy, melatonin (for pre-operative anxiety or sleep)
  • Tolerate use of - chamomile, lemon balm, passion flower, rhodiola, St. John’s wort, valerian, probiotics, theanine, L-tryptophan
  • Monitor more closely for side effects and interactions - kava (hepatotoxicity)
  • Advise avoiding - coffee and other caffeinated products such as energy drinks
  • Assess and encourage healthy lifestyle habits, including healthy diet, sleep, and regular exercise
Dr. Kathi Kemper, MD, MPH, Director of the Center for Integrative Health and Wellness at Ohio State University, discusses her nutritional recommendations for managing anxiety in her AAP published book: Mental Health, Naturally by Kathi Kemper:
  • Multivitamins/minerals - usually well tolerated and can help reduce anxiety and stress in some people
  • B vitamins - can help with stress; however, may have side effects. Inositol supplements (B8) are generally safe and can be helpful for anxiety and stress.
  • Vitamin C - reduces feelings of stress
  • Vitamin D - suboptimal levels linked to anxiety in some patients with fibromyalgia
  • Calcium with magnesium and zinc - can reduce anxiety
  • Magnesium - low levels linked to anxiety. Watch for diarrhea when supplementing magnesium.
  • Iodine - deficiencies can result in hypothyroidism, which can be associated with anxiety
  • Iron - deficiencies can result in increased feelings of stress and fatigue
  • Selenium - deficiencies can result in abnormal thyroid function, and correcting deficiencies can improve anxiety in some people
  • Omega-3 fatty acids - can be helpful for patients with anxiety
  • Gamma-aminobutyric acid (GABA), an amino acid - unclear evidence on use in anxiety
  • D-cycloserine (DCS), an amino acid - unclear evidence
  • Theanine, an amino acid in green tea - decaffeinated green tea could be helpful in reducing stress and promoting calm sensations
  • Tryptophan and 5-hydroxytryptophan (5-HTP), an amino acid - thought to help with panic and anxiety, but can interfere with SSRIs and cause a variety of side effects
  • Lysine, an amino acid - deficiencies associated with increased anxiety
  • Arginine, an amino acid - can reduce anxiety and stress; however, has potential for significant side effects
Refer to Mental Health, Naturally by Kathi Kemper or the online databases (below) for supplement use and dosing recommendations.


Information & Support

For Professionals

Herbs and Dietary Supplements Program (OSU)
The Introduction to Herbs and Dietary Supplements Across the Lifespan program is an on-line training program for professionals that categorizes various natural approaches to treating anxiety based on evidence and risks; Ohio State University (available for a fee).

FDA-Approved Drugs by Condition (CenterWatch)
Scroll to bottom of page for a list of approved drugs for pediatric ADHD.

Drugs, Herbs, & Supplements (MedlinePlus)
Searchable database with information about side effects, dosages, and precautions for prescription and over-the-counter medications; from the U.S. National Library of Medicine.

Dietary Supplements (NIH)
Fact sheets for health professional and consumer that give a current overview of dietary supplements: National Institutes of Health.

Office of Cancer Complementary and Alternative Medicine (OCCAM)
Contains scientific information about many CAM therapies, a workbook about "Talking about CAM" with info for families and clinicians (free for download), info about integrative medicine programs, video of lectures, and trial information; by National Institutes of Health.

Use of Complementary and Alternative Medicine (CAM) in the United States (NCCIH/NIH)
Report based on the 2007 National Health Interview Survey (NHIS) detailing use of alternative medicine by adults and children; from the National Center for Complementary and Integrative Health, National Institutes of Health.

National Center for Complementary and Integrative Health (NIH)
A wealth of information, research, and training for patients and clinicians on the use and safety of complementary and alternative medicines; National Institutes of Health.

Supplement Samplers for Clinicians (University of Wisconsin)
Information about best indications, mechanism of action, cost, dosages for adults, and best studies; Integrative Medicine, Department of Family Medicine.

Mental Health, Naturally by Kathi Kemper
Holistic health expert and pediatrician Dr. Kathi J. Kemper presents natural treatments used for mental health issues such as ADHD, depression, anxiety, stress, and substance abuse; available for purchase on American Academy of Pediatrics website.

For Parents and Patients

Complementary and Alternative Medicine Guide (University of Maryland)
Patient and provider information about common medical conditions, herbal remedies and supplements (including possible interactions and side effects), and other alternative treatments including aromatherapy, acupressure, massage, relaxation techniques, and more.

What to Do When You Worry Too Much
An interactive self-help book designed to guide 6–12 year olds and their parents through the cognitive-behavioral techniques most often used in the treatment of generalized anxiety. Metaphors and humorous illustrations make difficult concepts easy to understand, while prompts to draw and write help children to master new skills related to reducing anxiety; written by Dawn Huebner, PhD.

Complementary and Integrative Medicine: Facts for Families (AACAP)
Brief information about what to consider when choosing complementary and alternative medication treatments, and discussion points to bring up with health care providers; American Academy of Child and Adolescent Psychiatry.

Drugs & Supplements Related to Anxiety: Patient Information (MayoClinic)
Describes for families precautions, proper use (includes pediatric use), and side effects of drugs and supplements used for anxiety. Can also search by first letter of drug/supplement name.

Acupressure for Stress and Anxiety (Memorial Sloan Kettering Cancer Center)
Patient information about acupressure and integrative medicine.

Helpful Articles

Kemper KJ, Vohra S, Walls R.
American Academy of Pediatrics. The use of complementary and alternative medicine in pediatrics.
Pediatrics. 2008;122(6):1374-86. PubMed abstract

Authors & Reviewers

Current Authors and Reviewers:
Author: Jennifer Goldman-Luthy, MD, MRP, FAAP
Reviewer: Mary Steinmann, MD