Complementary Medicine, Exercise, Meditation, Diet, and Lifestyle Modification for Anxiety Disorders: A Review of Current Evidence

Table 2

Summary of nutraceuticals reviewed.

Nutraceutical	Study references^*	Study type	Evidence level	Outcomes	Duration	Sample	Mechanisms
Herbal medicine
Bacopa (Bacopa monnieri)	Stough [39]	2	Limited; Positive	STAI	3 months	Healthy	5HT2c, metal chelation,; antioxidant and anti-inflammatory effects.; Possible cholinergic effects
Chamomile (Matricaria recutita)	Amsterdam [40]	2	Limited; Positive	HAM-A	8 weeks	GAD	GABA receptor binding and; modification of monoamine pathways
Ginkgo (Ginkgo biloba)	Woelk [41]	2	Limited; Positive	HAM-A	4 weeks	GAD or; ADWAM	Antioxidant and anti-inflammatory properties,; effects on GABA and; monoamine systems
Kava (Piper methysticum)	Pittler [42]; Witte [43]	1	Positive	HAM-A	Various	Various	Blocks calcium and sodium; channels, bind to GABA; receptors, and inhibits; noradrenalin uptake
Lemon balm (Melissa officinalis)	Kennedy [44]; Kennedy [45]	2	Limited; Positive	Self-rated; calmness	Acute	Healthy	Inhibition of GABA-T and MAO-; A. Cholinergic receptor binding; demonstrated in vitro
Passion flower (Passiflora incanata )	Movafegh [46]; Akhondzadeh [47]	2	Limited; Positive	Numerically; rated anxiety,; HAM-A	Acute,; 4 weeks	Surgery patients, GAD	Binds to GABA-A receptors and; modulates GABA-A and GABA-; C pathways
Scullcap (Scutellaria lateriflora )	Wolfson [48]	2	Limited; Positive	Self-designed; scale	Acute	Healthy	Possible bindings to the; benzodiazepine site of; the GABA-A receptor as well as; antioxidant activity
St John’s wort (Hypericum perforatum)	Kobak [49],; Kobak [50]; Volz [51];	2	NonSignificant; in; all studies	HAM-A,; LSAS,; YBOCS	6 weeks	Depression,; somatoform; disorders, OCD,; social anxiety	Modulation of monoamine, serotonin, dopamine, and; norepinephrine pathways
Nutrients
Combined nutrients	Carroll [52]; De Souza [53]; Gosney [54]; Kennedy [55]; Kennedy [56]; Smith [57]	2	Mixed; Evidence	State anxiety,; self-rated; calmness,; HADS	28 days–12 months	Healthy, healthy; with premenstrual; symptoms,; participants in aged; care	Antioxidant effects and; enhanced metabolism of; various neurotransmitters
Inositol	Benjamin [58]; Fux [59]; Palatnik [60]	2	Limited; Mainly; Positive	Severity and frequency of; panic attacks,; agoraphobia; and OCD	4–6 weeks	Panic disorder with or without agoraphobia, OCD	Precursor in the; phosphatidylinositol cycle modulating 5HT2c receptors.; Administration affects; serotonergic, noradrenergic, and muscarinic functioning in vitro
Aromatherapy	Lee [61]	1	Limited; Positive	Various.; State anxiety the most; common	Various	Various	Possible effect on the GABA; system

^*First author, 1: metaanalysis or systematic review, 2: double-blind randomised controlled trial, STAI: state trait anxiety inventory, GAD: generalized anxiety disorder, GABA: gamma-aminobutyric acid, HADS: hospital anxiety and depression scale, HAM-A: hamilton anxiety rating scale, LSA: liebowitz social anxiety scale, YBOCS: yale-brown OCD scale, OCD: obsessive compulsive disorder, ADWAM: adjustment disorder with anxious mood, MAO-A: monoamine oxidase A.