If you are faced with the prospect of taking drugs to treat a health problem, you will want to know if there are any natural agents you may use instead.
—ANDREW WEIL, M.D.
Each year Americans take billions of doses of benzodiazepines for anxiety and insomnia. Common benzodiazepine tranquilizers include Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam), Tranxene (clorazepate), and Klonopin (clonazepam). Common benzodiazepine sleeping pills include Dalmane (flurazepam), Restoril (temazepam), Halcion (triazolam), and Serax (oxazepam). These are addictive and can produce drowsiness, impaired coordination, poor concentration, memory impairment, and amnesia. Narcotics, birth control pills, Inderal (propranolol), and other sedatives can make such side effects even worse. Regular benzodiazepine use can also exacerbate depression.
Synthetic tranquilizers should only be prescribed for moderate to severe anxiety or panic disorder. But because they are addictive, they should never be used for longer than two to three weeks. Use for a longer period of time can cause physical and psychological dependence. People susceptible to abusing alcohol or drugs can become addicted to benzodiazepines after a single dose. Alcohol should not be consumed when taking benzodiazepines, because their interaction can depress both breathing and blood pressure, possibly causing a coma or death. Abrupt discontinuation of benzodiazepines taken for more than three weeks can also cause significant withdrawal symptoms. Among these are anxiety, insomnia, and panic attacks, symptoms that may have led the person to take these drugs in the first place! Benzodiazepine treatment therefore has a high relapse rate.
If used to treat insomnia, benzodiazepines can cause abnormal sleeping patterns and a morning hangover. Synthetic drugs do not produce natural sleep; they chemically knock you out. Despite regulatory and professional cautions, about 20 percent of chronic insomniacs take these addictive agents nightly for years. As with benzodiazepine tranquilizers, abrupt discontinuation of these sedatives often causes rebound insomnia, the condition these pills are meant to alleviate.
ANTIDEPRESSANTS TO ALLEVIATE ANXIETY
When anxiety is moderate to severe or herbal medicines are ineffective, synthetic antidepressants may be necessary. Antidepressants can be effective for 60 to 80 percent of those with panic attacks or other anxiety disorders. The drugs proven to be most effective in treating obsessive-compulsive disorder (OCD) are four antidepressants—Anafranil (clomipramine), Luvox (fluvox), Prozac (fluoxetine), and Zoloft (sertraline). There has been no research on herbal treatment for OCD. There are roughly a dozen antidepressants from which to choose if synthetic antidepressants are prescribed. None are addictive or habit-forming.
Antidepressant medications are usually taken for two to three weeks before benefits are derived. During this time, patience and perseverance are essential. Some patients decide the medication doesn’t work after a few days or weeks and discontinue it. Others experience side effects and stop without telling their doctor. Either response is a mistake.
Communicate any side effects to your doctor. If the problem is especially troublesome, call at once; don’t wait until your next appointment. Your doctor may wish to prescribe a different antidepressant, but if your doctor suggests continuing with the medication as prescribed, please consider doing so. Most side effects disappear within two to three weeks.
Because of the length of time it takes to see the results from taking antidepressants, it may take a while for you and your doctor to arrive at the proper medication and dosage. Be patient with the process. During the initial phase of treatment, you may require more frequent consultations with your doctor. Do not change your medication or dosage on your own. If selective serotonin reuptake inhibitors (SSRIs) are discontinued too abruptly, the result can be serotonin withdrawal syndrome, with flulike symptoms. A gradual dose reduction of SSRIs is necessary.
SSRIs, such as Prozac (fluoxetine) and Effexor (venlafaxine), can sometimes cause nervousness, agitation, insomnia, palpitations, sweating, and sexual dysfunction. These side effects can easily be mistaken for symptoms of anxiety, the disorder these medicines are attempting to treat. If the side effects are severe, you and your doctor may decide to lower the dosage or discontinue the drug and try a different medication.
Do not take any additional drugs—OTC, prescription, or recreational—without first consulting your health care provider. Drugs that when taken alone are relatively harmless can become dangerous, even deadly, when taken with some antidepressants.
HERBS AS A FIRST-LINE TREATMENT FOR ANXIETY
The first rule of medicine is Primum non nocere, which means “Above all, do no harm.” Asclepios of Thessaly, a great physician of antiquity, gave the following advice for the use of medicines: “First the word, then the plant.” Three thousand years later R. F. Weiss, M.D., updated this principle as follows: “First the word, then the plant drug, next the major synthetic chemotherapeutic agent.”1
If patients persist in complaints to their doctors about stress and anxiety, they can walk out of the office with a prescription for the Valium-like tranquilizers or sleeping pills. Overprescription of benzodiazepine tranquilizers and sleeping pills has reached epidemic proportions. These drugs are often abused because, until now, most doctors and patients were unaware of herbal alternatives. Mild anxiety, stress, and insomnia may require neither herbs nor synthetic drugs. Natural self-healing techniques alone can suffice (see Part 3). When a medicinal agent is needed, however, herbal remedies deserve to be considered before synthetic drugs because of their relative safety and fewer side effects, as well as their effectiveness.
HEALING ANXIETY NATURALLY CHECKLIST
After you and your doctor have ruled out an anxiety disorder or any other medical or psychiatric illness, the herbal medicines discussed in Part 2 can be used to heal the following signs and symptoms of anxiety and stress and anxiety (mentioned here for those who may have skipped Part 1), provided they are mild to moderate:
A commitment to the natural self-healing program (Part3), without the use of medicinal herbs or synthetic drugs, may suffice if symptoms of anxiety are few and mild. If you have a number of moderate symptoms, medicinal herbs along with the tools and techniques of the natural self-healing program will probably be necessary. Again, if your symptoms are moderate to severe at this time, don’t despair. Pharmaceutical medicines or psychotherapy can be very effective in consultation with a supportive health professional to launch you on your way to natural self-healing. You and your doctor can periodically reevaluate when a switch to herbal medicines would be appropriate.
Herbal remedies can be a first-line treatment for many millions of people suffering from mild to moderate anxiety. Kava should be considered for anxiety (see chapter 12) and valerian as a sleep aid (see pages 91–94) before prescribing tranquilizers or sleeping pills. Hypericum, an antidepressant, can also help to reduce anxiety (see chapter 13).
You and your physician should discuss fully whether herbal medicines or synthetic drugs are appropriate for your condition and also what the potential benefits, side effects, risks, and length of treatment might be. If your doctor is not familiar with prescribing herbs for anxiety and refuses to become informed, ask for a referral to a naturopathic or osteopathic physician, herbalist, or chiropractor who has this knowledge (see Appendix C). It is time for health professionals to wake up and smell the herbs!
Sometimes the herbal remedy initially chosen does not produce the desired result. Don’t give up. Often the second or third alternative will produce the desired benefit. This may be due to subtle differences in individual needs. Some herbs work right away; others may take three to four weeks to exert their benefits. Although the herbal medicines used to treat anxiety and insomnia are not addicting, you should be under a doctor’s care.
Many patients who have been taking pharmaceutical tranquilizers and sleeping pills have difficulty discontinuing these drugs. Rapid withdrawal from benzodiazepines can cause severe or even dangerous symptoms. While herbs can support this process, tapering off and discontinuing these drugs can be challenging, and should be done under careful medical supervision.