The feeling of unease, worry, foreboding and fear, commonly known as anxiety, is a normal and often useful reaction to a dangerous or stressful situation. When the brain senses a threat, it triggers the release of hormones that prepare the body to either defend itself or flee. In this "fight or flight" response, muscles become tense, heart and breathing rates quicken, pupils dilate, the mouth dries out, and the blood becomes more likely to clot in case an injury is sustained. While undoubtedly beneficial as a defense against temporary stress, anxiety becomes a health problem when it is triggered excessively or persistently; when it occurs for no obvious reason or begins to interfere with day-to-day activities; or when it causes emotional distress.
Anxiety disorders can lead to a variety of physical and psychological problems, including fatigue, headaches, stomach upsets, high blood pressure, poor concentration, sleep disturbances, a sense of detachment from reality and depression. Left untreated, anxiety disorders can also increase the risk of substance abuse and suicide.

There are two basic types of anxiety disorders, chronic and acute.

The chronic form, called generalized anxiety disorder (GAD), is characterized by a recurring sense of worry and foreboding, accompanied by restlessness, insomnia, low sex drive and other mild physical symptoms.

The acute form of anxiety disorder is the panic attack, a sudden and unexpected bout of intense fear and dread accompanied by rapid heartbeat and breathing, chills, excessive perspiration and other physical symptoms so severe that they are often mistaken for a physical illness, including a heart attack.

Anxiety disorders are very common, more so among women than among men. In fact, around 15% of Americans will experience at least one panic attack in their lifetime (and 3% have these attacks often). Fortunately, anxiety disorders are highly treatable, primarily through psychotherapy, often combined with drug therapy. Certain supplements may be as effective as prescription drugs in treating anxiety disorders without the side effects and risk of dependency of conventional medications.

Key Symptoms Acute anxiety (panic attack):

Intense fear and dread
Rapid heartbeat and rapid or shallow breathing
Profuse sweating, hot flashes or chills
Dry mouth or the feeling of having a lump in the throat
Dizziness
Dilated pupils
Chronic anxiety (generalized anxiety disorder):
Recurring worry and a sense of foreboding not associated with a specific activity or event
Muscle tension, headache and back pain
Restlessness, irritability and insomnia
Decreased sex drive
Depression
What Causes Anxiety and Panic?
The exact causes of anxiety disorders are usually unknown. Some cases may be triggered by a traumatic event, such as a death, accident, or divorce, while others have no identifiable root causes. Genetic and biochemical factors, however, are thought to play a major role in anxiety disorders. Some people's central nervous systems may be predisposed to overreact to stress and to take a longer time to calm down after a stressful event, or their brain and adrenal glands may produce an excessive amount of stress hormones.

People who experience panic attacks seem to have high blood levels of lactic acid, a chemical produced when muscles metabolize sugar without sufficient oxygen. Certain drugs and chemical substances, such as caffeine, over-the-counter decongestants and cold remedies; thyroid hormone; and inhaled asthma drugs can trigger anxiety. Other contributing factors include withdrawal from tobacco, alcohol, caffeine, sedatives, narcotics and other addictive substances.

Treatment and Prevention
Psychotherapy, combined with prescription anti-anxiety or antidepressant drugs, can be very successful in treating anxiety disorders.

Drugs can be used to treat both generalized anxiety and panic attacks. The principal class of anti-anxiety medications, benzodiazepines, produce a calming effect by depressing activity in areas of the brain that control emotions. Although such drugs--which include alprazolam (Xanax) and diazepam (Valium)--help ease anxiety symptoms in the majority of sufferers, they can cause drowsiness and lethargy, and their use for extended periods (usually longer than three months) can lead to psychological dependence.

More recently, antidepressant drugs--SSRIs (selective serotonin reuptake inhibitors) and tricyclics--have become the preferred treatment for many cases of anxiety. A drug such as sertraline (Zoloft), for example, is quite effective at reducing panic attacks. And another recently released SSRI, Effexor-XR, was shown to be clinically effective for treating generalized anxiety disorder (GAD). Antidepressants are not habit forming and can be effective at low doses (whereas doses of benzodiazepines must often be increased). And obviously antidepressants are useful when anxiety is accompanied by depression.

Other medication options include a relatively new anti-anxiety drug, busprione (Buspar), which has fewer side effects than benzodiazepines. Doctors also sometimes prescribe beta blockers--commonly prescribed for high blood pressure--to treat physical symptoms of anxiety, such as palpitations.

In some situations, anti-anxiety supplements, especially kava, can be as effective as prescription drugs. Similarly, mood-enhancing supplements such as St. John's wort and SAMe can be tried in cases where an antidepressant medication might be recommended for treating anxiety. Unlike conventional medications, the supplements have very few side effects and do not lead to dependence. Interestingly, the problem of drug tolerance, where increasingly large doses of a medicine are needed to maintain a therapeutic effect, does not occur when using supplements.

Eliminating caffeine, reducing your intake of sugar, sugary food products, refined carbohydrates and foods with additives and chemicals, exercising regularly, and practicing any of a variety of relaxation techniques (meditation, yoga, tai chi, progressive relaxation) can all help relieve anxiety disorders.

A note of caution: Never make any changes in either your prescription anti-anxiety medications or your antidepressant medications without talking to your doctor first. And never combine kava with conventional anti-anxiety medications, or St. John's wort with antidepressants. Also, if you have a medical or psychiatric condition, it's always wise talk to your doctor before beginning a supplement program.

How Supplements Can Help
The primary anti-anxiety supplement is kava, an herb long known for its calming effects. Kava is very effective at easing the nervousness, dizziness and heart palpitations of anxiety and may even prevent panic attacks.

In addition to kava, take calcium and magnesium, as well as a vitamin B complex. All of these nutrients promote the health and proper functioning of the nervous system and play an important role in the production of neurotransmitters, chemicals that help relay messages between nerve cells.

If kava doesn't work, try the herb valerian, a natural sleep aid that if taken in low doses throughout the day can also relieve anxiety symptoms. Even if you take kava during the day, try valerian at night if you're having difficulty falling asleep.

Also consider either St. John's wort or SAMe (S-adenosylmethionine) if you are experiencing the depression that sometimes accompanies anxiety. It takes at least a month before the full effects of St. John's wort are felt. The other recommended anti-anxiety supplements usually begin to take effect right away.

Self-Care Remedies
Avoid caffeine, alcohol and too much sugar, all of which can trigger anxiety. To minimize headaches and other withdrawal symptoms, reduce caffeine intake gradually. Instead of caffeinated beverages, try drinking tea made from chamomile (or passionflower, skullcap or lemon balm), which will relax you without causing drowsiness or addiction.

Engage in a regular program of aerobic exercises. This type of exercise burns lactic acid, produces mood-enhancing chemicals called endorphins, and causes the body to use oxygen more efficiently.

Controlled breathing techniques can help ease a panic attack. When an attack strikes, try this breathing exercise: Inhale slowly to a count of four, wait four counts, exhale slowly to a count of four, wait another four counts, then repeat the cycle until the attack passes.

Yoga, meditation, tai chi and other mind-body techniques can also help you relax and shed stress.

Consult a mental health counselor to help you control and overcome anxiety.

When to Call a Doctor

If anxiety symptoms or recurring panic attacks interfere with your daily activities and quality of life.
If you experience rapid heartbeat, chest pain, shortness of breath or other anxiety symptoms--these could also be signs of a serious physical illness or be caused by certain medications. (A doctor can determine the cause of your symptoms and suggest appropriate treatments.)

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