Drug Alternatives For #Anxiety and #Insomnia

Really useful article from Food For The Brain in my messages recently on the natural alternatives to drug therapy for anxiety and sleep problems. An excellent run-down I thought. I’ve included the references for you too in case they are useful.

Anxious about tranquillisers? There are alternatives

One in twelve people in Britain suffer from anxiety, a quarter of which receive treatment [1]. When a person is in a state of anxiety and unable to sleep, far too often tranquillisers, also called ‘hypnotics’, are prescribed. The most potent are the benzodiazapines such as valium, librium and temazepam. These are, however, highly addictive and certainly not recommended for more than a couple of week’s use. Despite this, prescriptions increase and a report by the National Addiction Centre, Kings College London, for prescriptions up to 2009, found that a third of prescriptions were for more than eight weeks. It is estimated that 1.5 million people in Britain are addicted [2].

More commonly prescribed these days are the non-benzodiazepines such as zolpidem, espopiclone and zaleplon on the apparent basis that they are safer.

However, even leaving the addictive nature of these drugs aside a recent study in the British Medical Journal reports that patients prescribed zolpidem, temazepam and other hypnotics suffered four times the mortality compared to matched patients not prescribed hypnotics [3]. “Even patients prescribed fewer than 18 hypnotic doses per year experienced increased mortality, with greater mortality associated with greater dosage prescribed” reports the author Dr Scripps, an expert in insomnia from California. There was also a 35 per cent overall increase in incidence of cancer among those prescribed high doses.

There are several psychological and nutritional alternatives for combatting anxiety and associated insomnia which carry none of these risks, either for addiction or increased mortality of other adverse effects.

These include:

5-HTP, the precursor of serotonin, from which the sleep hormone melatonin is made. Supplementing 100– 200mg one hour before you go to bed helps you to get a good night’s sleep [4]. It’s also been shown to reduce sleep terrors in children when given before bed [5]. It also reduces susceptibility to panic attacks [6].

Melatonin is also highly effective for aiding sleep. In controlled trials, it’s about a third as effective as the commonly prescribed sleeping pills, but has a fraction of the side effects [7]. If you have difficulty getting to sleep, perhaps only going to sleep very late, and you are prone to feeling low, it’s particularly effective both for helping you sleep and for improving your mood [8]. Melatonin can be prescribed by a GP. It is available over the counter in some countries including the US.

Magnesium calms the nervous system and has been reported to help reduce restless legs and insomnia [9].

GABA is both an amino acid and a neurotransmitter that turns off adrenalin. Doses of 1-2 grams have an immediate anti-anxiety effect. The combination of GABA and 5-HTP is even better. In a placebo- controlled trial this combination cut time taken to fall asleep from 32 minutes to 19 minutes and extended sleep from five to almost seven hours [10]. Taking 1,000mg of GABA, plus 100mg of 5-HTP is a recipe for a good night’s sleep. It is available over the counter in some countries, including the US.

Valerian is the most potent GABA-promoting herb and, as such, can also promote daytime drowsiness, so it’s best to take it only in the evening if you have anxiety or insomnia and an inability to ‘switch off’. It is more effective for insomnia than anxiety. It can interact with alcohol and other sedative drugs and should therefore be taken in combination with them only under careful medical supervision. It seems to work in two ways: by promoting the body’s release of GABA and by providing the amino acid glutamine, from which the brain can make GABA. Neither of these mechanisms makes it addictive [11]. One double-blind study in which participants took 60mg of valerian 30 minutes before bedtime for 28 days found it to be as effective as oxazepam, a drug used to treat anxiety [12]. Another found it to be highly effective in reducing insomnia compared with placebos [13]. A review of studies cites six studies that show a significant benefit [14]. To help you sleep, take 150–300mg about 45 minutes before bedtime.

From a diet point of view following a low sugar low GL (glycemic load) diet, and avoiding caffeine, helps to stabilize blood sugar levels and adrenal hormones, thus reducing anxiety.

Buteyko breathing is a highly effective breathing technique, especially good for those who hyperventilate and have panic attacks, which can be exacerbated by the lack of CO2 induced by over-breathing [15].

Psychotherapy helps to deal with the underlying causes of anxiety. Most researched is cognitive behavioural therapy (CBT). Developing mindfulness, a more meditative form of therapy, known as mindfulness behavioural therapy (MBT), can be very effective in helping you to find your way back to a calmer state by allowing you to witness your thoughts, feelings and physical sensations, thereby allowing them to transform. There’s growing evidence, not only that this approach is highly effective [16] but also that developing mindfulness actually changes brainwave patterns towards alpha and theta waves, which are consistent with a more relaxed and creative way of being [17].

Heart Math refers to some simple exercises designed to improve ‘heart rate variability (HRV)’ monitored using a simple device called the EMWave. In a number of studies these techniques have been shown to reduce anxiety. One unpublished study reported substantially reduced levels of anxiety among stressed graduate students [18].

Alpha-wave inducing music is designed to switch the brainwaves from beta waves, associated with adrenalin and excitation, to alpha waves, which is a prerequisite for relaxation and sleep. In a study of patients going to the dentist, this was found to induce less anxiety [19]. A CD called Silence of Peace, composed by John Levine, can be very effective for those unable to relax or go to sleep.

Patrick Holford, CEO, Food for the Brain Foundation

I have long used Patrick Holford’s recommendations for mental health – it is one of his really strong areas of research. The aptly named Chill Food is a good one if you’re not sure where to start looking.

I also like Balance For Nerves, which I think he also designed. As always, check contraindications and with your health professional before starting something new, especially if you are already on a type of drug.

References:

[1] ‘How mental illness loses out in the NHS’ a report by the Centre for Economic Performance’s Mental Health Policy Group, London School of Economics and Political Science, June 2012
[2] www.bbc.co.uk/news/health-14299501
[3] Kripke DF, Langer RD, Kline LE. ‘ Hypnotics’ association with mortality and cancer: a matched cohort study’ BMJ Open 2012;2:e000850. doi:10.1136/bmjopen-2012-000850
[4] T. C. Birdsall, ‘5-Hydroxytryptophan: A clinically-effective serotonin precursor’, Alternative Medicine Review, 1998;3(4):271–80
[5] O. Bruni, et al., ‘L-5-Hydroxytryptophan treatment of sleep terrors in children’, European Journal of Pediatric Neurology, 2004;163(7):402–7
[6] Schruers K, et al., ‘Acute L-5-hydroxytryptophan administration inhibits carbon dioxide-induced panic in panic disorder patients.’ Psychiatry Res. 2002 Dec 30;113(3):237-43
[7] A. Brzezinski, et al., ‘Effects of exogenous melatonin on sleep: A meta-analysis’, Sleep Medicine Reviews, 2005;9(1):41–50
[8] S. A. Rahman, et al., ‘Antidepressant action of melatonin in the treatment of Delayed Sleep Phase Syndrome’, Sleep Medicine, February 2010;11(2):131–6
[9] M. Hornyak, ‘Magnesium therapy for periodic leg movements-related insomnia and restless legs syndrome: An open pilot study’, Sleep, 1998;21(5):501–5
[10] W. Shell, et al., ‘A randomized, placebo-controlled trial of an amino acid: preparation on timing and quality of sleep’, American Journal of Therapeutics, 15 May 2009
[11] M. Spinella, The Psychopharmacology of Herbal Medicine, 2001, MIT Press, London
[12] M. Dorn, ‘Valerian versus oxazepam: Efficacy and tolerability in nonorganic and nonpsychiatric insomniacs – a randomized, double-blind clinical comparative study’,Forschende Komplementarmedizin und Klassiche naturheilkunde, 2000;7:79–81
[13] E. Vorbach, et al., ‘Treatment of Insomnia: Effectiveness and tolerance of a valerian extract’, Psychopharmakotheraphie, 1996;3:109–15
[14] S.Bent,etal.,’Valerian for sleep: A systematic review and meta-analysis’, American Journal of Medicine, December 2006;119(12):1005–12. Review
[15] Artour Rakhimov Ph.D, ‘Normal Breathing – The key to vital health’; see also Robert Fried, ‘The Hyperventilation Syndrome’
[16] A. Chiesa and A. Serretti, ‘A systematic review of neurobiological and clinical features of mindfulness meditations’, Psychological Medicine, 27 November 2009:1–14
[17] J. Lagopoulos, et al., ‘Increased theta and alpha EEG activity during nondirective meditation’, Journal of Alternative and Complementary Medicine, November 2009;15(11):1187–92
[18] D. Climov, ‘Results of a Stress Management Program for Graduate Students based on Relaxation associated with HRV Biofeedback’, 2008, Pedagogical and Statistical Unit, Institut d’Enseignement Supérieur (IES) Parnasse­Deux Alice, Haute Ecole Léonard de Vinci, 2008 (unpublished)
[19] I. Olszewska and M. Zarow, ‘Does music during dental treatment make a difference?’ See: www.silenceofmusic.com/pdf/dentists.pdf