Anxiety and Panic Attacks

As W.H. Auden pointed out, we live in the age of anxiety. Most of us suffer from chronic anxiety to some extent because modern life is jagged, fast-paced, and divorced from the natural rhythms that tend to create a harmonious inner life. The calming cycles of farming, the instinctive satisfactions of hunting and gathering, and pure faith in religion gave our ancestors inner resources that few of us possess today.
People who suffer from the emotional illness called anxiety disorder, however, go a step beyond this common feeling. The quality of their lives is significantly diminished by the pervading presence of fear, which is often unrelated to any obvious cause. Even if a cause can be identified, the magnitude of anxiety they experience is greater than the actual degree of stress.
Typical symptoms of anxiety disorder include feelings of tension, irritability, worry, frustration, turmoil, and hopelessness, along with insomnia, restless sleep, grinding of teeth, jaw pain, an inability to sit still, and an incapacity to cope. Physical sensations frequently arise as well, including a characteristic feeling of being unable to take a full, satisfying breath; dry mouth; rapid heartbeat; heart palpitations; a lump in the throat; tightness in the chest; and cramping in the bowels. Anxiety can also give rise to panic attacks. These may be so severe that they are mistaken for heart attacks. The heart pounds and palpitates, the chest feels tight and painful, and the whole body tenses with unreasoning fear. Such attacks can be triggered by anxiety-provoking situations, but they may also come out of nowhere, perhaps even awakening you from sleep. When a person tends to suffer more from panic attacks than generalized anxiety, physicians call the illness panic disorder.
The medical treatment of anxiety involves mainly antianxiety drugs. Some, such as Xanax, are effective immediately; others, such as BuSpar, take a week or more to reach full effect. Antidepressant drugs may also be helpful. Panic attacks are generally more difficult to treat than other aspects of anxiety.
Medications are best used in the short term, and it is advisable to seek more permanent help through psychotherapy.

Principal Proposed Treatments for Anxiety and Panic Attacks:
The herb kava is widely used in Europe as a medical treatment for anxiety.
Kava: Widely Used in Europe for Anxiety
In Europe, the herb kava is widely prescribed for anxiety. Kava is a member of the pepper family that has long been cultivated by Pacific Islanders for use as a social and ceremonial drink. The first description of kava came to the West from Captain James Cook on his celebrated voyages through the South Seas. Cook reported that when village elders and chieftains occasionally gathered for significant meetings, they would hold an elaborate kava ceremony at the beginning to break the ice. Typically, each participant would drink two or three bowls of chewed-up kava mixed with coconut milk. They also drank kava in less formal social settings as a mild intoxicant.
When European scientists learned about kavas effects, they set to work trying to isolate its active principles. However, it was not until 1966 that substances named kavalactones were isolated and shown to be effective on their own. One of the most active of these is the chemical dihydrokavain, which has been found to produce a sedative, painkilling, and anticonvulsant action. Other named kavalactones include kavain, methysticin, and dihydromethysticin.
High doses of kava extracts cause muscular relaxation and, at very high doses, paralysis without loss of consciousness. Kava is also a local anesthetic, producing peculiar numbing sensations when held in the mouth.
Germanys Commission E, that countrys official herb-regulating body, has authorized the use of kava as a medical treatment for "states of nervous anxiety, tension, and agitation." It is also used for insomnia.
NOTE: Recent case reports of liver damage have raised significant safety concerns about the use of kava. See the full kava article for more information.
What Is the Scientific Evidence for Kava?
According to double-blind studies involving a total of about 400 participants, kava appears to be an effective treatment for symptoms of anxiety. The best study was a 6-month, double-blind trial that tested kavas effectiveness in 100 individuals with various forms of anxiety. Over the course of the trial, they were evaluated with a list of questions called the Hamilton Anxiety Scale (HAM-A). The HAM-A assigns a total score based on symptoms such as restlessness, nervousness, heart palpitations, stomach discomfort, dizziness, and chest pain. Lower scores indicate reduced anxiety.
Although it took a while for results to develop, by 8 weeks participants who were given kava showed significantly improved HAM-A scores compared to the placebo group. These good results were sustained throughout the duration of the treatment. Interestingly, previous studies had shown a good response in 1 week, especially in menopause-related anxiety. How fast does kava really work? We will need additional research to know for sure, but you should probably give it a couple of months before deciding whether it works for you.
Several double-blind, placebo-controlled studies have specifically tested kava for the treatment of menopause-related anxiety. In the most recent one, 40 women were given either kava plus standard hormone therapy or hormone therapy alone, for a period of six months. The results showed that women given kava experienced greater improvement in symptoms than those given hormone therapy alone.
A 5-week double-blind placebo-controlled trial studied 40 people who had been taking standard antianxiety drugs (benzodiazepines) for an average duration of 20 months. Participants were gradually tapered off their medications and switched to kava or placebo. Individuals taking kava showed some improvement in anxiety symptoms. This would appear to indicate that kava can successfully substitute for benzodiazepine drugs However, participants who were switched from benzodiazepines to placebo showed little to no increase in anxiety, suggesting perhaps that they didnt really need medication after all! Thus, the results of this study are hard to interpret.
Note: This trial involved close medical supervision and very gradual tapering of benzodiazepine dosages. Do not discontinue antianxiety medications without such supervision, as withdrawal symptoms can be life-threatening!
Another study compared kava against standard antianxiety drugs. For a period of 6 weeks, 174 people with symptoms of anxiety were given either kava or one of two antianxiety medications (oxazepam or bromazepam). Improvement in HAM-A scores was about the same in both groups. However, for technical reasons this study didnt actually prove that kava is equally effective as those standard medications.
Although we dont know exactly how kava functions in the body, its method of action seems to involve brain receptors for a substance known as gamma-aminobutyric acid (GABA). This would make it similar to benzodiazepine drugs like Valium and Xanax. GABA is believed to play a role in anxiety that is somewhat similar to serotonins role in depression, although there are many gaps in our knowledge.
For more information, including dosage and safety issues, see the full kava article.
Transitioning from Medications to Kava
If you are taking Xanax or other drugs in the benzodiazepine family, switching to kava will be very difficult. You must seek a doctors supervision because withdrawal symptoms can be severe and even life-threatening. Additionally, if you are taking Xanax on an "as needed" basis to stop acute panic attacks, kava cannot be expected to have the same rapidity of action.
It is easier to make the switch from milder antianxiety drugs, such as BuSpar, and antidepressants. Nonetheless, a doctors supervision is still strongly advised.
Other Proposed Treatments for Anxiety and Panic Attacks:
Valerian: May Provide Calming Effects
The herb valerian is best known as a remedy for insomnia. However, according to one preliminary double-blind study, it also produces calming effects in stressful situations. For more information, including dosage and safety issues, see the full valerian article.
Acupuncture
A preliminary controlled trial found evidence that acupuncture might be helpful for the treatment of anxiety.
Other Herbs and Supplements
A double-blind placebo-controlled trial of 80 healthy male volunteers found that 28 days of treatment with a multivitamin and mineral supplement (containing calcium, magnesium, and zinc) significantly reduced anxiety and sensation of stress.
The supplement 5-HTP is best known as a proposed treatment for depression. An 8-week double-blind placebo-controlled study compared 5-HTP and the drug clomipramine in 45 individuals suffering from anxiety disorders. The results showed that 5-HTP was effective, but clomipramine was more effective.
Based on its ability to promote sleep, melatonin has been tried as a treatment for reducing anxiety while waiting for surgery to begin. A double-blind placebo-controlled study of 75 women waiting for surgery compared melatonin against the standard drug midazolam, and found it effective. Benefits were also seen in a subsequent double-blind trial of 84 women about to receive anesthesia, conducted by the same researcher. Whether melatonin is effective for other forms of anxiety has not been determined.
A 4-week double-blind study of 36 individuals with anxiety (specifically, generalized anxiety disorder) compared the herb passionflower to the standard drug oxazepam. Oxazepam worked more quickly, but by the end of the four week trial, both treatments proved equally effective. Furthermore, passionflower showed a comparative advantage in terms of side-effects: use of oxazepam was associated with more job-related problems. However, because this study lacked a placebo group, it would be premature to conclude from it that passionflower has been shown to be an effective treatment for anxiety.
A double-blind placebo-controlled trial of 40 individuals found that gotu kola reduced the "startle" response to sudden loud noises. This suggests, but doesnt prove, that gotu kola may be helpful for anxiety.
Other herbs or supplements that are frequently recommended for anxiety include chamomile, gamma oryzanol, hops, lemon balm, skullcap, and suma, as well as inositol for panic disorder.
Supplementation with selenium (200 mcg daily) or flaxseed oil (2 to 6 tablespoons daily) is said to help relieve anxiety symptoms in some people. For other dosage and safety issues, see the full selenium and flaxseed oil articles.
GABA: No Evidence That It Is Effective
Because GABA (gamma-aminobutyric acid) is known to play a central role in anxiety, some alternative practitioners suggest simply taking this amino acid as a supplement. However, no scientific evidence suggests that orally ingested GABA gets to where it can do any good.