I wasn’t planning to write about anxiety today. But yesterday’s events at the Boston Marathon just flipped a switch in me. I realized how much just being alive these days gives all of us ample reason to be anxious – random acts of violence, difficult economics, increasing rates of diseases, even just keeping up with all of the things in our food and environment that might harm us or our loved ones … Add to this our caffeine-driven, over-stressed work lives … Who wouldn’t be anxious?

There are many types of anxiety – from occasional circumstantial anxiety, for example, stomach butterflies before an important event, stage fright, or going-to-the-dentist jitters, to full blown generalized anxiety disorders (GAD) with panic attacks and debilitating phobias.

Anxiety also has various guises: insomnia, depression, fatigue, addictions (often used to self-medicate), job or relationship paralysis for fear of taking a chance or making a change. Anxiety can also cause illnesses – for example, chronic anxiety can lead to stress which leads to cortisol dysregulation which leads to insulin resistance and even diabetes. It can also lead to heart disease. Takotsubo syndrome, which causes structural changes in the heart, can be a result of chronic anxiety.

I’ve treated hundreds of patients struggling with anxiety from mild to severe. They’ve come to me taking (sometimes dangerous and addictive) medications just to be able to get out of bed and face the day, drive to work, give a presentation, or get to sleep. For many it is a tortured way to live.  Others are self-medicating with food, alcohol, marijuana, or any number of substances just to cope and function.

It’s a tough world we live in.

Learning how to manage anxiety is like learning a new language of the mind. It may take time. But it is learnable and it is a worth the investment in yourself. It is also a worthy skill set to impart to children from a young age, if you are a parent.

Over the years I’ve developed tools that I share with my patients. If your anxiety is mild to moderate, these 7 tips may be all you need; if you have severe anxiety – I think you will still find great relief but you may need additional help from an integrative physician and a therapist. These tips are meant to be practiced in conjunction.

Anxiety can affect us in so many ways, from causing us to be chronically worried and distracted by our problems to the point of disrupted sleep and eating, all the way to the extreme of keeping us from getting out there and living life. Life is a precious gift. It is too easy to fritter it away with worry when we can instead learn to live it joyously, with greater ease and comfort. We can’t necessarily change all of the world’s problems – but we can refuse to live as victims. 

 

AnxietyWheelFinal

 

[Anxiety Wheel copyright Aviva Romm 2013]

Tip #1: Anxiety is just a feeling. Recognize the feeling.

The first step to overcoming anxiety is to recognize it for what it is – a set of feelings that are the result of a series of biological responses to a perceived threat.

Pay attention to what happens when you become anxious? Your heart rate increases, your breathing accelerates, you may start to sweat, and your mouth might get dry. You may feel that you are going to pass out. Or you may have an urge to run, flee. You may have difficulty concentrating or experience memory lapses. You may experience nausea, chest pressure or pain. At bedtime you may be unable to fall asleep. You may feel a sense of impending doom – even that you are going to die. But you are not. These are the signs of anxiety. It is your body’s flight-or-fight response kicking in.

Tip #2: Get your mind-body mojo in motion. Practice meditation, biofeedback, learn CBT skills, journal.

The more you pay attention to the anxiety symptoms I described above, the more quickly you’ll recognize when they are coming on. The more you practice mind-body interventions for kicking that reaction in the butt – the better you’ll be at getting over it.

When the feelings start to raise their ugly head,  tell yourself, “I am safe – these are just feelings.” Tell it to yourself several times as you are doing very deep, slow breathing in and out. They are just feelings. They are just feelings. They are just feelings.

Try to actually use your breathing to slow your heart rate and breathing down. Do something to interrupt the cycle like slowly drink some cool water. Deliberately relax. Intentionally feel your feet on the ground. Anxiety is just feelings and you are OK!

You have just learned some biofeedback skills! You can learn to consciously practice biofeedback skills using a home biofeedback monitor. HeartMath is one we use with patients in my clinic. If you suffer from more severe anxiety, consider Cognitive Behavioral Therapy (CBT) – a technique that helps you to change your thought patterns from the anxiety chatter to more productive, self-affirming ones. CBT skills are really just great life-skills that I think all kids should be taught from Grade 1! Biofeedback and CBT therapists can be found around the US.

Keep a journal of your experiences as you learn to use these tools – I bet you’ll find that you are starting to succeed in reducing your anxiety!

Tip #3: Understand your genetics. Your history. And your triggers. And work with them.

Your genetics: Many of us are born with small variations in our genetic make-up that make us predisposed to anxiety and don’t allow us to clear anxiety neurotransmitters as well as others without these variations. So for some of us, our anxiety tends to come on a little easier, be worse and hang on a little longer. One of these genetic variations is the COMT polymorphisms. If you have this you’re probably someone whose heart races after caffeine, and maybe can’t even tolerate the adrenaline rush of a scary movie or roller coaster. You can get a simple genetic test, but it’s expensive and won’t change what you do.

The herbs and supplements below can be of extra help to you. So can avoiding the things that are likely to set you off.

Your history: Some of us grow up in environments that were very anxiety provoking – high stress homes, parents with substance or emotional abuse problems, bullying at school. We grew up actually accustomed to anxiety as our baseline internal milieu – and as a result it weirdly becomes our natural default comfort zone emotion. But it actually doesn’t feel good or comfortable at all. If your childhood hardwired you for anxiety – you can change this simply by deciding you don’t want to feel this way anymore. Good for you! Follow all of the other steps in this article to achieve freedom from anxiety!

Your triggers: Whether your mom’s house at Christmas or a TED talk you have to give – we all have triggers that spark our anxiety. Learning what triggers you have can help you avoid the avoidable and prepare well for what you must experience. Preparation might include getting extra rest and exercise ahead of time, working with a therapist to develop a tailored set of skills for the event, and using herbs and supplements to bolster your stress response system prior to the time.

Tip #4: Worry Watchers: Count Your Worry Minutes and Learn to live in the Present.

Most of our anxiety is due to worrying about the future. The reality is that most people spend about 90% of their time worrying about the future or fretting the past – not living in the present. What’s going to happen if… when?

Here’s a way to stop that whole pattern. Allow yourself a certain amount of worry time every day. You can start with an hour and work your way down to 15 minutes. I give myself what I call “my moment of doubt.” It’s like Weight Watchers except it’s Worry Watchers. Instead of being allowed calories, you’re allowed worry minutes.

Set a timer. Find a place to go and worry. I have one patient with 5 kids who goes into her walk-in closet to do it to get some time away from her family. Another who uses her laundry room. Try not to do your worrying in your bedroom or other places you want to associate with relaxation. During your allotted time, worry as hard as you want to. Write your worries down in a worry journal. Knock yourself out. But really, seriously do it. When the time is up, so is your worry for the day. One exception – if you are a pre-sleep worrier, take 5-10 minutes of extra worry time just before bed. Again, not in your bedroom. Write down all of your worries in a journal. Then leave them behind and go to sleep peacefully.

The rest of the time is about redirecting your thoughts to the present moment. Learn to be mindful of your environment – take in what you see, what you feel around you, and in your body. Stay focused on the tasks at hand. If your mind starts to stray to worry – save those thoughts for your next worry session. If you start to have those worry feelings in your body – back to Tips 1 and 2.

Tip #5: Exercise

This is simple. Exercise helps your body get rid of anxiety hormones and neurotransmitters like cortisol, epinephrine and norepinephrine more quickly. Walk it off. Dance it off. Do yoga. Jump rope. Go for a run. Punch a punching bag. Do ten push-ups. Repeat. Exercise regularly to help reduce anxiety. Even just 30 minutes a few times a week can make a difference. Breaking a sweat gives you bonus points!

Tip #6: Keep your blood sugar balanced, eat real food, and take some supplements.

Hypoglycemia causes the same symptoms as anxiety. Seriously. Because when your body is low in glucose your brain goes into red alert to let you know that energy is needed or you could eventually die. Keeping your blood sugar steady lets your brain know you’re ok and prevents those anxious feelings.

Here are the basics: Eat a balanced, non-sugary breakfast and don’t skip meals. Eat a good quality protein at each meal and snacks, eat something every few hours, and include high quality fats (olive oil, walnut oil, coconut oil, nuts and seeds) at each meal. Avoid foods (and non-food junk) that lead to blood sugar drops. Sugar, white carbohydrates, and caffeine are the most common examples.

It gets a little more complicated in that food sensitivities and gluten intolerance can cause inflammation in your body, and when inflammation runs amuck, it fuels anxiety. So an elimination diet can sometimes help you get to the bottom of your anxiety and there might be certain foods that you need to avoid to support your mental well-being. There’s a strong connection between gut health and mental health, too.

Supplements to reduce anxiety:

Essential Fatty Acids: Our nervous system requires essential fatty acids for healthy functioning. They can be obtained from foods that contain them, for example, cold water fish, walnuts, and flax seed oil all contain different types. They can also be obtained by supplementation – which I recommend as an addition to a healthy diet if you have anxiety symptoms. There are many excellent brands. I recommend Nordic Naturals most often.

Magnesium: (150 – 600 mg/day of Magnesium citrate or glycinate). Magnesium deficiency is quite common and not only contributes to anxiety, but to heart palpitations associated with anxiety attacks. Magnesium also reduces insomnia. It’s my most commonly recommended supplement for anxiety.

B-Complex: B vitamins are necessary for the production and breakdown of neurotransmitters involved in modulating anxiety. I recommend my patients to take B-complex with active folate and B-12 daily.

L-theanine: L-theanine is an amino acid derived from green tea. Able to cross the blood-brain barrier, at recommended doses it safetly imparts a sense of calm and well-being, reduced mental stress and anxiety, and improves memory and cognitive function. It may interact with GABA and dopamine receptors in the brain, explaining its actions. While it is found in tea and coffee, the supplement allows you to get the benefits without the caffeine – which worsens anxiety for many.

Taurine: Taurine is an amino acid that helps quiet down excitatory signals in the brain. A typical dose is 250 mg- 1000 mg/day.

nervine collageTip #7: Use Herbs

Adaptogens: If you suffer from chronic anxiety, or if you have that genetic variation I mentioned earlier, adaptogens are for you!

Adaptogens are a class of herbs that safely, gently, and effectively regulate the body’s stress response via their tonic actions on the adrenal glands. Examples include Ashwagandha (Withania somnifera), Rhodiola (Rhodiola rosea), Eleutherococcus (Eleutherococcus senticosus) , Reishi mushroom, Ginseng (Panax ginseng) , and Schisandra (Schisandra chinensis). One of my favorite blends is Vital Adapt by Natura Natural Products. It contains these adaptogens as well as additional supporting herbs. Stress Response by Gaia Herbs is also excellent, and contains Holy Basil, another reliable adaptogen.

Adaptogens were first scientifically evaluated for their ability to reduce stress and improve stamina and strength in high performance athletes and workers in the former Soviet Union. Many of them are herbs that have long been used traditionally in Asia and Europe. They are meant to be taken daily, over a period of 3 months to a year for optimal results.

They are safe for pretty much all adults (not for pregnant women, and if you are on medications for an autoimmune disease talk with your doctor first) and some can be used with children, too (check with your child’s doc).

Lavender Oil: The beautiful, fragrant lavender is also one of our most effective medicines for the treatment of chronic – and even acute – anxiety. Taken on a regular basis about an hour before sleep, the European lavender extract product Lavela has demonstrated efficacy favorable to that of benzodiazapines in reducing anxiety, with none of the side effects or addictive potential. It is fast becoming a mainstay in my medical practice. I have recommended it to family members, and plan to use it to prevent my own test anxiety when I next take my family medicine boards – it has been shown to help reduce text anxiety in nursing students!

Lavender oil can also be used as aromatherapy in a diffuser. On your pillow before sleep, in a bath, or a few drops applied topically to reduce acute anxiety symptoms. You might want to carry a small bottle of the oil with you in your bag.

Additional herbs that I use in my clinical practice to reduce anxiety include

  • Passion Flower (Passiflora incarnata)
  • Lemon balm (Melissa officinalis)
  • Chamomile (Matricaria recutita)
  • St. John’s wort (Hypericum perforatum)

Typically these herbs are combined in a liquid extract and taken together, about 2-5 mL one to several times/day depending on the severity of the anxiety and at the higher end to promote sleep.

Kava kava (Piper methysticum) is an excellent “emergency remedy” for a panic attack, and is great for use when there is stage fright, test anxiety, or fear of flying. Three to five drops is often a sufficient dose of kava. I do not recommend it for regular or long-term use due to the rare potential for liver damage.

If you are on medications for anxiety, please work with a skilled physician, licensed naturopath, or herbalist if you wish to transition to using herbs as an adjunct or replacement. This can be done successfully, but must also be done safely, and some of these herbs can interact with commonly used medications. Also, please do not try to go off of benzodiazapines without medical help; they must be properly tapered to avoid severe and potentially dangerous withdrawal symptoms. If you have severe anxiety, it is important to work with a skilled therapist.

I know how tough anxiety can be. I also know it does not have to be a paralyzing problem for you. Learning to understand and heal your anxiety isn’t necessarily a fast or easy road. But it is a road to self discovery and life much more fully lived. I invite you to embrace this challenge – consider it an adventure and enjoy the journey!

I always love hearing from you in the comments below. And if you like this info, please like this blog – it’s my best guide to providing you with the information you want to hear about.

With love always,

AJR Sig

 

 

 

 

 

 

77 Comments

  1. Aviva, thanks. Very helpful. One question: what do you think about lavender’s supposed estrogenic effects? Should women with a tendency toward high estrogen, low progesterone avoid lavender?

    Yours warmly, Chara

    • This is an excellent question. I would still use it because the estrogenic effects of lavender are relatively mild – unless someone has a history of ER+ breast cancer – and then you might consider an alternative herb from the article.

  2. How do you find that the Stress Response and /or Vital Adapt work with amino acids? I recently read The Mood Cure by Julia Ross and experienced a lot of relief with amino acids. I absolutely love herbs so I want to try the other aminos you mentioned along with one of the above. Do you find it works with OCD? By the way, God bless you for your work and what you do. I love reading your articles.

    • Amino acids can be an amazing help. The herbs and amino acids go well together. OCD is sort of like anxiety on steroids if you know what I mean – so by all means, approach the same way. And thank you so much! 🙂

  3. Thank you very much for writing this informative article with all its practical tips. I have a question concerning the adaptogen herbs: you mention that they’re not safe for pregnant women- what about nursing moms? I have found contradictory opinions on the Internet and I wouldn’t know who to trust. Are there any safe herbs among them?

    • Hi Maria,
      Great question. There is little specific evidence but no data to suggest that they would not be safe during breastfeeding. Ginseng might be a little stimulating to the baby, though. I do recommend them in my practice when mom is exhausted and stressed.

  4. Aviva, I just wanted to let you know how inspiring and helpful I find your blog and the webinars you have done with Learning Herbs/Herb Mentor. You have inspired me to continue my study of herbs and encouraged my daughter in her midwifery training. Thank you!

  5. Thank you for this post! Just ordered the iOS HeartMath Inner Balance device- you’re the second person to recommend heartmath so I figured I should check it out!

    • What exactly does the IOS Heartmath do, Mel??? I’m curious. I have OCD and have been trying various amino acids and herbs to help. Aviva, I’m so thankful for your post for some new herbs to try. God bless you for your informative articles… Thanks in advance for your help.

      • The HeartMath is a device that shows you how you are doing working with breathing, relaxation, and other mind-body methods to bring your heart rate in to a healthy zone. It is based on biofeedback. They have quite a bit of educational info on their main site. Love to hear what folks who try it think!

  6. Thanks Aviva, great subject and info!

    Some SSRI (selective seretonin re-uptake inhibitors) such as paroxetine may also need to be tapered down over a period of time, as they too can be dangerous to stop abruptly.

    Sara

  7. Thanks for the post. A great summation of the variety of tools available to us. I’m concerned about your comment on Lavela, however. Not because of that product, but because it might encourage someone to ingest any of the other essential oils being recommended these days by multilevel marketing schemes I won’t name. Can you expand on it a bit, for safety’s sake?

    • Yes, that is why I specifically mentioned that product – it is high quality and was looked at in studies. It is specifically what I recommend to patients, friends, and family with anxiety.

  8. Hi Dr Aviva, Ive been enjoying your blog for a few months now-thanks for your generosity with both time and advice. Is it safe to take anti anxiety herbs and supplements when youre breastfeeding? Thanks, Aoife

    • Hi Aoife,
      It really depends on which ones… but many of the ones I have mentioned in the article -passion flower, chamomile, lemon balm, and lavender, B vitamins, magnesium, and fish oil are ABSOLUTELY safe! Be well! Aviva

      • Thank you for this response! I feel more anxious when breastfeeding but will try some of these suggestions now knowing they are safe.

  9. Hi, thank you for the article. Is magnesium carbonate okay? It is in a buffered c I am taking at 215 mg, so not sure if I should add more and the other types you suggest.
    Thank you!

  10. Great blog – sums up how we anxiety prone people suffer and gives great suggestions (love the Worry Watchers). My question is whether it is safe to take some of the herbs you have mentioned in combination. I would like to try St John’s Wort for example but wonder if it’s safe to add kava kava as needed as well. Or can I use l-theanine (something I have heard of before) or Lavela and SJW?? Also wondered if there are any risks of herbs interacting with other vitamins and supplements? Thank you for your time.

    • Yes, the herbs and supplements I mentioned all go beautifully together. SJW can interfere with some medications, but there is no concern with these particular supplements.

  11. Aviva —
    which of the products you recommend in the article would be best for OCD?? I really want natural alternatives. I’ve never taken RX meds for it, but have tried various remedies. Thanks in advance…

  12. Hi Aviva
    Thanks so much for sharing your wisdom & experience on herbs. I’ve read Holy Basil has a temporary anti-fertility effect and should be avoided in those trying to conceive. Is this accurate? How long does the “anti-fertility” effect last if one stops taking it?
    Thanks, Carmen

    • Hi Carmen, I have not heard this and this is not a typical action of adaptogens- they generally support fertility. Will look into it and let you know if I find anything… Aviva

  13. Just read through this for the second time and am finding the infomation to be so very useful. I have struggled with a pretty intense anxiety flare-up over that last year or so and used a lot of the suggestions you have above plus some great acupuncture. I am feeling so much better now. I really appreciate the part where you talk about anxiety being a feeling and the worry watchers part is great too. Even though I am doing so much better, I find I am still having anxiety around menses. Wondering if you have any specific suggestions for dealing with that? Oh, also having rescue remedy with me at all times helps me deter anxiety if I take it right when I feel anxiety coming on. Thanks for all your amazing advice and love!

    • Hi Angela,
      Check out my blog tomorrow on breast tenderness for the section on hormone balancing -the sections on elimination, hormone balance, and liver support especially. A lot of this can have to do with drops in estrogen just before your period. I usually recommend increasing magnesium to even 1000 mg/day for about 5 days before the menses is due – this can help a lot.
      Best wishes!
      aviva

  14. Hi,

    Thanks for this information; I work for a large Natural Grocers and sell vitamins for a living, so I’m always happy to see someone supporting them. I also have OCD, and you’re right, it is like anxiety on steroids. I have taken the Gaia Stress Response (or Adrenal Health as it’s also called) for a long time. I did notice it gets less effective over time – can your body get used to these things? I also love L-Theanine, but have also noticed a decrease in effectiveness. Can that happen as well?

    Thanks a lot for your time.

    Ashley

    • Yes, your body can acclimate – or because we feel better we increase our external stress level and then need a new level of herbal support to me the new demand! Gaia products are terrific. 🙂

  15. Hi Aviva,
    Thank you so much for sharing so much wisdom on your website! Would you recommend L-Theanine and/or Taurine supplementation in pregnancy?

    • I don’t usually suggest single amino acids during pregnancy – usually a complete blend just to be sure everything stays in proper balance.

  16. Dr Aviva. I m so garte full to u that what u have described and provided information regarding anxiety is nothing but superb. It is very motivating solution.
    Best regards.

  17. Dear Aviva,
    I have anxiety from my job. I m doing marketing in sales since 12 hours but now i have got fatigue and anxious due to over load of work. Should i quit the job?

    • That’s a tough one. There are some great resources out there on living the life you love and maybe talking with a life coach would be a good idea so you make a wise decision!

  18. Hi Aviva, How much Lavela can you take a day? When might you see effects if it’s going to work? What product is best to buy?

    Thank you,

    Adam

    • I’ve only used the recommended amount of 1 capsule/daily. It can work immediately for some people, others it can take a couple of weeks. Lavela is the brand. Best, Aviva

  19. Hello.. i always fell anxious about everything.If my friends make a little fun with me..like if they called me in a funny name or if they act something like that they do not do usually do sometimes..(maybe they are in a bad mood)..i always think i have made a wrong..and i kept anxious about it..So do you knoe any solution about..?i am really felling very bad about it.

  20. A couple of questions on this great article I just discovered. As to amino acids (theanine and taurine), do you generally recommend that people start with one or the other, or both? And as to the two adaptogenic blends you recommend, are there any criteria for choosing one over the other? Thanks very much.

  21. Hi Aviva-
    How should the lavender oil be taken? In water? A few drops?
    Also, any thoughts on iron deficiency being a culprit to some anxiety?

  22. Hi Aviva,
    Can one take a B complex vitamin as well as Gaia Herb Stress Response? I’m currently taking both, but I just started. I’m trying to reduce stress since I have a great deal of it currently. I’ve been on Lexapro and Xanax in the past and want to go natural without the addictive priorites. I’m also taking Magnesium, Omega 3, Vit D, and CuraMed.
    Thank you inadvance for your response. I’m new to your website and absolutely love it.

    • Thank you Leslie! Try Amazon for Lavela; or ask a local ND if she/he can get it thru Emerson Ecologics for you. Once my online store is set up in 2016, I will carry it there! Any magnesium brand is really ok. 🙂

  23. Can you touch on the use of these herbs during pregnancy for anxiety and/or insomnia? I took an herbal workshop for student midwives a few years ago, but there is so much conflicting information on the internet. I’d love your take on it.

  24. Thank you very much Aviva

    I have gone through your article, it is really very much helpful and surely I will share this informative article

    Regards

  25. Hi Aviva! First of all I have Aviva envy and you are such an important mentor to me. I’m a functional Med FNP and CNM and life coach and you make me want to go back to Med school at 42 so I can emulate you;)

    I was wondering what full spectrum blend of amino acids you recommended for pregnant women (vs the single amino acids)? I know so many pregnant women that struggle w anxiety in my practice.

    PS I applied for your course w a friend and can’t wait to hear back and get going!

    • Hi Ana,

      This is Megan from Aviva’s team! I would bring this question to the HMW forum!

      Warm wishes,
      Megan Aviva Romm’s Executive Assistant and Online Nutrition Expert

  26. Hello! First, thank you for all the information you’ve provided in this post. I saw one other question about breastfeeding, but am wondering if it would be okay to take something like Stress Response by Gaia Herbs while breastfeeding? I am trying to avoid anxiety and fatigue as I prepare for a new baby soon. I already have a toddler, an 8 year old, and a 6 year old, homeschool, and my husband runs his own business full time. Thank you for your help! 🙂

    • Hi Liz,

      This is Megan from Aviva’s team. Thank you so much for your questions and congrats on the soon to be new baby! I highly suggest taking a look at Aviva’s blog on adaptogens, it is loaded with so much good information and if you scroll through the comments, Aviva chimes in on what is safe to take while breastfeeding.

      I hope this helps!

      Megan- Aviva Romm’s Executive Assistant and Online Nutrition Expert

  27. Aviva,

    I just had a quick question about taking adaptogens. I’m struggling with anxiety and I am taking Siberian Ginseng tea with a few other herbs such as St. Johns Wort and Valerian. May I add on one of the adaptogens that you recommended? How many herbs is too much? Thank you for your help.

    • Hi Denis, Traditional Chinese formulas use 15 or more herbs and often patients take more than one a day – so you’re still way in the reasonable zone. I usually combine not more than 7 or so herbs in a formulation, and may recommend up to 2 or more daily. The herbs you mention go beautifully together. Best, Aviva

  28. Hi there! I have a quick question about the adaptogens. You mention that that one should use them “over a period of 3 months to a year for optimal results.” After one year, do adaptogens need to be phased out? Rotated? Or can we continue to use them indefinitely? Thanks!

    • There’s really no hard data on this. I recommend continuing if they are still helping; if the effects have waned, switch them up. But one can stay on adaptogens as a regular daily tonic if they are working well for you.

  29. Hi,
    I have phobic anxiety, and have been on 15 mg of Buspar (very low dose) for about 5 months now. I would like to transition off of it and onto each of the supplements you mentioned and the adaptogens. Do you know if I could start on any of these now, before weaning off the Buspar? I appreciate you and your help!

    • Hi Margaret!
      I am the nurse practitioner in Dr Romm’s practice, and I often hop in to answer comments and questions since Dr Romm doesn’t always have time to get to them all!
      It would be best to consult with an integrative or functional medicine practitioner, particularly one with a specialty in psychiatry, to guide you along this process! A list of practitioners can be found here: https://www.functionalmedicine.org/practitioner_search.aspx?id=117
      Best of luck!
      ~amanda, APRN

  30. Dr. Aviva–
    Is there anything tailored to Depressions rather than Anxiety instead of Rhodiola? I am depressed, but I don’t feel I need medication or anything, I just don’t have much energy or motivation. I am extremely stressed. Dealing with Adrenal PCOS. What a minute–could Lavela increase DHT? Surely hoping not. I am avoiding Ashwagandha as I have read it can be Androgenic in some cases. Thanks!

    • Hi Justine,
      More to come on my website about depression. Sorry you’re suffering with it. My new book might be a really good start: The Adrenal Thyroid Revolution. And make sure you’re working with someone supportive! Aviva

  31. i take Dr. Christopher’s Mindtrac for depression and anxiety and it is a godsend. I tried prescription medicine, and it made me have dangerous thoughts and I was violently ill. Mindtrac has these herbs and has worked like magic. Only side effect was a bout with acid reflux for a month, and mild headaches occasionally. I’ve been on it for 6 months now. The relief is incredible. My only question is… if I decide to have a baby, can I still take the stuff? While pregnant and while breast feeding. I’m not comfortable taking doctor prescribed depression meds. They are way too strong for me and made life unlivable.

  32. Hello! I have been struggling with anxiety for many years and am now struggling with ocd. My therapist recommended Ashwaganda, Rhodiola, and L- Theanine. I am currently breastfeeding my 2 year old and he was unsure if I could use these. Are they all safe to take? Should I just take one or all 3?

    • Rhodiola classic for anxiety but not for bipolar. All considered generally safe while BF’ing though studies not really done to prove safety. These are often used in combination – though starting with one and seeing how you tolerate it is always a reliable approach, only then adding in additional herbs one at a time.

  33. Hi there! Thanks for the great information, as always 🙂 Can you tell me what dose of fish oil you could recommend someone who struggles with anxiety and depression? Is there a higher dose one should be taking?

    Thanks!!

    • Hi Steph, I do use higher doses – my favorite product for higher dosing is Ultimate Omega by Nordic Naturals and I typically use 2 tsp daily – but it is best to work with someone who can help you on dosing optimally and make sure you’re getting the right treatment you need. Best. Aviva

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