Upcoming Issue Highlights

Stressed Out

Stress & Anxiety Stress & Anxiety

Caring for patients with long-term stress and anxiety disorders is best accomplished with a comprehensive treatment plan.

Occasional bouts of stress and anxiety are normal. But anxiety disorders go beyond short periods of worry or fear, remaining present in the everyday lives of patients and possibly worsening over time. People with anxiety disorders like generalized anxiety disorder (GAD) and social anxiety disorders have feelings and reactions that interfere with life, often effecting relationships and work performance.

According to the National Institute of Mental Health, anxiety disorders are the most common mental illness in the United States affecting 40 million Americans ages 18 and older, and just under 23 percent of those cases are considered severe. Though anxiety disorders are treatable, only about one third of those affected receive treatment.

“Stress and anxiety problems can be caused by an array of psychological, biological, social and lifestyle factors,” said Dr. Adrian Lopresti, a clinical psychologist at Murdoch University in Perth, Australia. He further explained that lifestyle factors such as poor nutrition, lack of physical activity, alcohol and drug use, along with bad quality of sleep can negatively impact brain chemistry, leading to symptoms of stress and anxiety. “People with anxiety problems often have exaggerated beliefs and thoughts associated with harm and safety,” Dr. Lopresti continued.

What we do to manage stress and anxiety matters. “People who engage in regular relaxation practice (e.g., yoga or meditation), take regular time outs during the day, and engage in regular pleasurable and soothing activities are less likely to suffer from anxiety problems,” Dr. Lopresti stated. Jacob Teitelbaum, MD, medical director at the Practitioners Alliance Network, agreed and added that even regular walks in the sunshine can be helpful. A comprehensive medical approach including these practices coupled with proper supplementation and structural treatments, Dr. Teitelbaum shared, is the best way for practitioners to help their patients who suffer from chronic stress and anxiety.

Approaches to Treatment

Stress and anxiety disorders are treatable, and most people who seek professional care can be helped. Treatment must be individualized and may be complicated or take longer if patients suffer from multiple mental health disorders or other conditions, which is why treatment must be tailored specifically for each individual.

“I think that practitioners are uniquely positioned to help their patients,” said Cheryl Myers, chief of education and scientific affairs at Wisconsin-based EuroMedica, supplement supplier to health care professionals. “They have an excellent sense of the whole health of the person in question, [and] can recommend a number of ways to deal with anxiety. For instance, cognitive behavioral therapy (CBT) can help a person work through their responses to every day occurrences that seem to set off anxiety. And talk therapy for those with more serious conditions like GAD is essential.” Then, there are other lifestyle factors, such as avoiding excessive amounts of caffeine and alcohol, as well as getting enough sleep. These benefit everyone and are especially helpful for those who combat stress and anxiety.

“Medical websites will tell you that stress and anxiety are highly treatable, but the treatment is usually with one or more of the 84 anti-anxiety drugs with harmful side-effects that do not make them a viable option,” said Carolyn Dean, MD, ND, medical advisory board member of the Nutritional Magnesium Association. “Because medicine has no cure for stress and anxiety, natural stress and anxiety remedies are more relevant than ever. Magnesium, a vital mineral nutrient known as the anti-stress mineral, is perhaps one of the most important natural stress and anxiety remedies because of its effectiveness, record of safe use, and availability,” she continued.

Dr. Dean explained that magnesium is a potent anti-inflammatory mineral, which eliminates brain irritation that can bring on behavioral changes such as stress and anxiety, and that magnesium also helps make energy in the brain that is vital for mental health. “Magnesium is involved in hundreds of enzyme reactions in the body; the most important enzyme reaction involves the creation of energy by activating adenosine triphosphate (ATP), the fundamental energy storage molecule of the body,” she said. “A magnesium deficiency can magnify stress because serotonin, the feel good brain chemical that is boosted artificially by some medications, depends on magnesium for its production and function.”

The No. 1 selling magnesium supplement in the natural products industry is Natural Calm from Texas-based Natural Vitality, according to the company. The organic, vegan and gluten-free powdered formula easily mixes into any drink to provide a dose of ionic magnesium citrate, which is created from a highly absorbable proprietary blend of citric acid and magnesium carbonate.

A good daily multivitamin is also important to recommend to patients, according to Dr. Teitelbaum, making sure that it contains at least 50 milligrams of each of the B vitamins. Myers also emphasized that the omega-3s, peptides and phospholipids from fish are unbeatable for stress and anxiety. “Omega-3s with phospholipids and peptides help maintain the structure of brain cells and keep neurons firing properly,” she explained. “Most people don’t get enough of these nutrients in their diets, so I think supplementation is definitely in order.”

EurOmega-3 from EuroMedica offers a balance of omega-3s, phospholipids, and peptides in a single tablet or capsule. “Peptides reduce anxiety and phospholipids provide strong brain support on their own,” said Myers. And while taking a fish oil supplement has become common, the sources of some fish oils are questionable, which could lead to negative effects on the brain. “The brain needs phospholipids and DHA to develop properly and age well because these fats help protect the brain and the way it functions.” She pointed to an in-vitro study published in the Journal of Neurochemistry, where researchers pre-treated neuronal cells with DHA from the same phospholipid-bound omega-3 source found in EurOmega-3 for 48 hours before exposing these cells to oligomers that are known to cause the brain cell damage associated with Alzheimer’s disease. The study found that DHA pretreatment greatly increased neuronal survival and reduced damage, which lead the researchers to conclude that The researchers that “such neuroprotective effects could be of major interest in the prevention of Alzheimer’s and other neurodegenerative diseases.”

“The process for EurOmega-3 also makes it a concentrated supplement, requiring just one per day,” said Myers. “It is practically a multiple for cognitive health. This is why I think it has an advantage over other forms of omega-3s. Unless you’re eating fresh salmon at least three times a week, every week, I don’t think you can get a more intensively focused brain-friendly form of omega-3s.”

Herbal Ingredients

Ashwagandha, also referred to as Withania somnifera or Indian ginseng, is a powerful adaptogenic herb used in ayurvedic medicine to increase the body’s resilience to stress. According to Myers, studies have shown ashwagandha both reduces corticosterone hormone levels and increases antioxidant activity resulting in less of a “fight or flight” feeling and more of a sense of calm.

Rhodiola rosea is another adaptogen that has a long history of use. The species-specific compounds in the plant have both stress-reducing and energizing effects. Randomized, double-blind, placebo-controlled studies have found rhodiola effective at symptoms of stress, including stress-related fatigue.

Curcumin, the active ingredient from the spice turmeric, is also known to help with anxiety. Results from a 2014 study published in the Journal of Affective Disorders showed that curcumin reduced overall symptoms of depression functioning as an anxiolytic as well when used for more than eight weeks. In a press release, lead study author Dr. Lopresti stated that the positive antidepressant and anti-anxiety effects of curcumin were likely due to its ability to normalize specific physiological pathways. He also believed in curcumin’s ability to increase levels of neurotransmitters like serotonin, while lowering stress hormones like cortisol.

Rebel Herbs, located in Indiana, offers an ashwagandha powder that can be added to smoothies, water or sprinkled on food. The company also carries a variety of capsules containing ashwagandha and other potent herbal ingredients, including Imunade. In addition to ashwagandha root extract, Imunade (available in 30- and 60-ct.) contains turmeric and other herbal extracts concentrated by a powerful technology that combines CO2 extracts with hydrophilic extracts delivered in a vegetarian capsule form.

Rebel Herbs also offers Turmeric+ capsules, a supplement containing curcuminoides and turmerones, as well as piperine or black pepper extract which may have some anti-depressant activity.

EuroMedica combines both ashwaganda and Rhodiola rosea in Adaptra, a capsule-based supplement that helps maximize energy while relieving stress and promoting healthy adrenal function.

Another herbal ingredient effective at reducing stress is a special extract of Echinacea angustifoliae, which Dr. Teitelbaum shared was more effective than the tranquilizer Librium, according to recent research. A 2012 study published in Phytotherapy Research showed that this unique extract reduced subjects’ State-Trait Anxiety Inventory (STAI) scores within just three days and remained stable for the duration of the treatment period and the two weeks following treatment. Another study using Echinacea angustifoliae on subjects diagnosed with generalized anxiety disorder found that the number patients who were considered severely anxious dropped from 11 to zero over a three-week time frame.

This particular echinacea extract is available in AnxioCalm, a product from Wisconsin-based Europharma’s Terry Naturally brand. The fast-acting tablets provide relief from anxiety, stress and nervous symptoms without causing drowsiness.

“These natural options can normalize several hormones that influence stress and anxiety,” said Dr. Lopresti. “They can lower the stress hormone, cortisol. Mood-lifting and calming neurotransmitters such as GABA, serotonin and dopamine can also be increased by these herbs and nutrients. Research over the last decade has confirmed that mental health problems are also associated with excess inflammation and oxidative stress. Herbs and nutrients are especially important here, as they are generally potent anti-inflammatories and antioxidants.”

Homeopathic Medicines

“Homeopathic medicines are highly diluted plants, animals and minerals that relieve the same symptoms they cause at full strength,” explained Christophe Merville, DPharm, director of education and pharmacy development at Boiron USA in Pennsylvania. For example, a micro-dose of a coffee bean may be given to help with symptoms of nervousness. Homeopathic medicines have been used for more than 200 years, and the safety profile is excellent. They are known to be safe when taken along with conventional medications, herbal remedies and other supplements and are often recommended to complement other therapies.

Boiron’s Sedalia is a proprietary blend of six homeopathic medicines used to treat stress symptoms. The active ingredients in this product include Aconitum napellus for restlessness and agitation, belladonna for hypersensitivity to stress, Calendula officinalis for relief of nervous fatigue, Chelidonium majus to relieve digestive symptoms due to stress, Jequirity for feelings of uneasiness and Viburnum opulus for nervousness and restless sleep.

“Homeopathy takes into consideration the different ways people react to stress,” said Merville. “Some of us become agitated, when others are more inhibited. The symptoms are also very different from one individual to the other. One will have difficulty breathing, with a lump in the throat, the other will have digestive problems, and another will have trouble falling asleep. There are homeopathic medicines adapted to each of these cases.”

Merville further explained that the homeopathic approach to treating stress, tension and insomnia is to understand the symptoms in order to correct an imbalance. “Rather than knocking you out, a homeopathic formula will help you restore balance to your body’s own responses to stress with low risk of side effects.”

Cranial Electrotherapy

Another option for practitioners to consider as first-line therapy or adjunct treatment is cranial electrotherapy stimulation (CES).

Daniel Kirsch, PhD, DAAPM, FAIS, chairman of Texas-based Electromedical Products International, Inc., manufacturer of a CES device called Alpha-Stim, said, “not all physiological processes are chemical. In fact, there’s a lot more electrical and electrochemical activities going on everywhere, regulating everything in the body.”

Dr. Kirsch explained that Alpha-Stim works by injecting a wide range of biofrequencies into the brain and body between the electrodes. “Ligands, such as drugs or nutritional supplements, that vibrate at the same frequencies as the neuronal receptors, activate the receptors in a group of nerves in proximity. The challenge is to balance the neuronal clusters so the brain and body can maintain or achieve health. Most pills augment or replace chemical messengers. Alpha-Stim both increases or decreases brain functions as necessary to rebalance a certain patient population.”

The Alpha-Stim device is cleared by the FDA (U.S. Food and Drug Administration) for licensed health care professionals treating anxiety and depression.

Patient Support

“Given our stress-inducing lifestyles, stress and anxiety problems are only likely to rise,” said Dr. Lopresti. His advice for practitioners? “Listen to your patient. Hear his or her story to work out ways that you can best treat the specific cause of the patients’ stress and anxiety.”

Myers agreed. “Not everyone responds to the same treatment plan, so understanding the best course for each person, based on their health history and abilities is key. I believe that keeping current on nutritional elements to mental health and anxiety makes a big difference—as well as being open to a patient’s initiative in finding healthy ways to work with the condition.”

Resources:

Chandrasekhar, K., Kapoor, J., & Anishetty, S. (2012). A prospective, randomized double-blind, placebo-controlled study of safety and efficacy of a high-concentration full-spectrum extract of ashwagandha root in reducing stress and anxiety in adults. Indian Journal of Psychological Medicine, 34(3), 255.

Darbinyan, V., Kteyan, A., Panossian, A., Gabrielian, E., Wikman, G., & Wagner, H. (2000). Rhodiola rosea in stress induced fatigue—a double blind cross-over study of a standardized extract SHR-5 with a repeated low-dose regimen on the mental performance of healthy physicians during night duty. Phytomedicine, 7(5), 365-371.

Florent, S., Malaplate‐Armand, C., Youssef, I., Kriem, B., Koziel, V., Escanyé, M. C., … & Pillot, T. (2006). Docosahexaenoic acid prevents neuronal apoptosis induced by soluble amyloid‐β oligomers. Journal of Neurochemistry, 96(2), 385-395.

Lopresti, A. L., Maes, M., Maker, G. L., Hood, S. D., & Drummond, P. D. (2014). Curcumin for the treatment of major depression: a randomised, double-blind, placebo controlled study. Journal of Affective Disorders, 167, 368-375.

For More Information:
Anxiety Disorders Assocation of America, www.adaa.org
Boiron, www.boironusa.com
Electromedical Products International, Inc., www.alpha-stim.com
EuroMedica, www.euromedicausa.com
EuroPharma, www.europharmausa.com
Natural Vitality, naturalvitality.com
Rebel Herbs, www.rebelherbs.com