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Copyright © 2020 Natural Medicines (www.naturalmedicines.com)
May 2020

Natural Medicines for Anxiety During COVID-19 Pandemic

Stress and anxiety related to the coronavirus disease 2019 (COVID-19) pandemic continue to increase for many people. Be prepared to discuss natural medicines and mind-body practices that might help patients cope.

Some patients might consider lavender oil. Lavender oil may modestly reduce anxiety when used in aromatherapy. The essential oil is usually added to a diffuser or diluted in a carrier oil and applied to the skin. Supplements containing lavender oil might also help when taken by mouth, although this is supported by only low-quality evidence. For patients considering lavender oil aromatherapy, recommend they inhale the scent of lavender oil for 15-30 minutes, 2-3 times per week. For patients wanting to try oral formulations, consider recommending products containing a specific lavender oil ingredient called Silexan. This ingredient is the only one studied for oral use. It is included in products such as CalmAid or Lavela WS 1265. Best evidence is for doses of 80-160 mg daily for up to 10 weeks. It may take up to 2 weeks to work. There aren’t any major safety concerns if patients want to give lavender supplements or lavender oil aromatherapy a try for a short time. But note, parents shouldn’t use topical lavender oil on young boys – it seems to have estrogenic effects that could disrupt normal hormones in a boy’s body. Also make sure to keep essential oil products out of the reach of children - they can be toxic when taken orally. Only products intended for oral use should be taken by mouth.

Some patients might also ask about popular ingredients such as valerian, passion flower, or German chamomile. Valerian extract might help patients fall asleep slightly faster. Best evidence is for doses of 400-900 mg up to 2 hours before bedtime. But it’s unclear if valerian extract improves anxiety. While passion flower extracts might reduce anxiety and improve sleep in some patients, there’s not enough data to know which specific products or doses work best. Similarly, German chamomile extract might help reduce anxiety, but it’s unclear which product or dose works best. And there’s no evidence German chamomile extract improves sleep. In general, trying any of these products short-term shouldn’t pose any major safety concerns. Some patients may be interested in teas that contain these ingredients. Be aware that there are very few studies evaluating these teas for anxiety or sleep. But there’s also no reason to expect any safety concerns. Teas usually contain a lower amount of active constituents than extracts. So if patients want to give them a try, risks are unlikely.

Kava is another popular natural medicine for anxiety. Most research shows that taking kava extract can lower anxiety. It might work as well as some prescription anti-anxiety medications. But there are concerns about liver injury. Some patients, including those taking hepatotoxic drugs, including alcohol, and those with a history of liver disease, shouldn’t use kava. If other patients would like to try it, recommend taking 50-100 mg three times daily of products standardized to 70% kavalactones. This dose seems to be most effective and is rarely linked with liver injury.

Keep in mind that some natural medicines can actually make anxiety worse. Tell patients to limit caffeine intake, particularly coffee. Regular coffee drinkers might benefit from switching to tea to reduce overall caffeine intake. And make sure to take breaks from watching news stories and reading about the pandemic – focus on eating a well-balanced diet, exercising regularly, and getting proper sleep. Also note that many mind-body practices, such as mantra meditation and music therapy, might be useful tools for both patients and healthcare providers during this stressful time. For more details, check out our CE/CME course on Natural Medicines for the Clinical Management of Anxiety. Also review our Comparative Effectiveness Charts for Stress and Anxiety.

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The information in this brief report is intended for informational purposes only, and is meant to help users better understand health concerns. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions. Copyright © 2020 Natural Medicines Inc. Commercial distribution or reproduction prohibited. Natural Medicines is the leading provider of high-quality, evidence-based, clinically-relevant information on natural medicine, dietary supplements, herbs, vitamins, minerals, functional foods, diets, complementary practices, CAM modalities, exercises and medical conditions. Monograph sections include interactions with herbs, drugs, foods and labs, contraindications, depletions, dosing, toxicology, adverse effects, pregnancy and lactation data, synonyms, safety and effectiveness.