Everything I Know: Anxiety

Welcome to this post containing everything I know about anxiety. The reason that I have made this post is because when I was researching the Buteyko breathing and magnesium topics covered elsewhere on this blog, I came across many anxiety forums. It seemed that many of the people that were using both Buteyko and magnesium also had anxiety of some form. By going through these forums I came across a wealth of information. Eventually it got to the point where I would be looking up a particular magnesium supplement and I would find that the people on these forums were asking each other questions about other natural methods and treatments for anxiety that I had already come across and knew a fair amount about. Once I realised this I started to go to Youtube videos where people were talking about their anxiety and how it was affecting their lives, and I would try to tell them various things that I had picked up from the forums. However, no one ever responded. I eventually became so frustrated at the lack of response that I just stopped trying and decided to make this post instead. Here you will find everything I ever came across with regard to anxiety, with all of the medical studies I could find, with details of how people on forums responded to them and their relative safety and efficacy. If you try anything that I talk about here please comment below to tell me if it helped, made your condition worse, or had no effect. Also bear in mind that everybody is different, and something that worked for somebody else may not necessarily work for you.

- Breathing in general: breathe through your nose at all times and into your belly. Breathing slowly allows carbon dioxide to accumulate which is calming. Breathe only as slow as is comfortable, but still as slow as you can. When feeling stressed make a conscious effort to extend your exhales, many people find stress-relief from breathing in for 4 seconds and breathing out as slowly as possible until there is an air hunger. You will probably feel a lot less anxious if you breathe in for 4 seconds and out for, say 10 seconds. Remember: 1) always breathe through your nose and 2) always breathe into your abdominal area.

- Buteyko breathing: this goes back to the time that I went through Buteyko forums to see if there were enough anecdotal reports to justify myself trying it as an experiment. What I found was that out of the 33 positive reports that I gathered, 14 of these were anxiety-related. You can find all the information you need about Buteyko breathing on the internet but caution is advised if you attempt this without a practitioner. Breathing is a very important part of living, and its easy to underestimate its importance and cause damage by trying to carry out this breathing method alone. I also advise never doing a maximum control pause (this has caused panic attacks in some people) and remember that the function of a normal control pause is for measurement and helping beginners get used to air hunger, it is not a necessary tool for adapting to this technique. I would rate Buteyko breathing as 4 out of 5. There was one negative report on Buteyko breathing in which a person said breath holding caused a panic attack. This is why I have made it clear that the maximum control pause and even the ordinary control pause aren't necessary. The others all said that Buteyko helped them, with some stating that this technique was a huge help in dealing with severe anxiety. I recommend this once you have done a little research on the importance of breathing. It has minimal chance of causing harm as long as you listen to your body. In my opinion you should only ever create a slight level of air hunger in order to adapt to this technique. Also, I do not believe that the theory behind this method is correct, i.e. that it raises carbon dioxide levels to the extent that its practitioners believe. My opinion is that it raises carbon dioxide significantly, but only to the extent that occurs when switching from mouth breathing to nose breathing. However, I stand by this method completely in saying that it is effective for both anxiety and asthma, though I presently don't know why.

For the following supplements, if you are considering taking them, make sure you do your own research into the side effects. There were too many for me to list each one's potential adverse effects. Make sure that if there is a potential danger to these supplements that you confirm with a medical professional that they are, in fact, safe. Take special care if you are pregnant. I have also added my own rating based upon the studies and anecdotes that I came across for each one, this is almost entirely subjective but I feel that it would help you in deciding which things to try, considering there are so many listed below.

Vitamin D: Came across a few people that used vitamin D to cure panic disorder, I didn't know this was possible. Safe doses are 3,000 to 4,000 IUs. I once came across a story from a scientist giving a lecture on vitamin D supplementation who said that vitamin D intoxication is  hard to do, he spoke of a man who used a supplement where the manufacturers had forgotten to dilute the vitamin D. Once he had tested the supplement he found that the man had taken around 1,000,000 IUs of vitamin D per day. Source: http://www.youtube.com/watch?v=Cq1t9WqOD-0 (about 39:30 into this video_

- Niacinamide/Nicotinamide/Nicotinic acid amide: these terms all refer to the same thing, an amide version of the B vitamin niacin. Niacinamide differs from niacin in that supplementation with the former vitamin does not cause a flushing reaction. Some people notice profound lessening of anxiety immediately with niacinamide, others do not. Some sources say that it could take up to a month to feel the therapeutic benefits of niacinamide (I found that if people took a dose of 500 mg and it had no effect, they would take a higher dose of around 2 grams and if that didn't work, they would stop supplementing with niacinamide altogether). I am not sure if everyone with anxiety would benefit from niacinamide. If you are considering this supplement please check with a doctor beforehand and make sure that your liver is healthy. Niacinamide does not typically cause side effects in moderate doses; around 500 mg to 1,500 mg per day but it is better to check this with a medical health professional just in case. I rate niacinamide as being 4 out of 5. While it is unknown whether it is beneficial for everyone, those who had no alleviation of their symptoms didn't take it longer than around a week. Other people had complete removal of moderate to severe anxiety within this same timeframe. Tolerance seems to build slowly, over months.

- Tea: green (try decaffeinated as caffeine is a major contributor to anxiety), the theanine in green tea is a known anxiolytic (anxiety-splitting) agent. Alternatively, skip the tea and supplement with theanine alone. Other beneficial teas include; chamomile, valerian, and Linden, though I'm sure there are more.

- Chamomile: Based on what I've seen on chamomile it does seem to be an effective agent in reducing anxiety. However, take care if you have asthma, are pregnant, or are allergic to plants in the daisy family. Apart from this, chamomile is described as being one of the safest herbs to take. Low doses typically help anxiety while higher doses help you get to sleep. I rate Chamomile as being 2 out of 5. It is beneficial for mild and perhaps moderate anxiety but a tolerance does build up quite quickly to it (within a week or 2) and high doses can cause diarrhoea.

- Valerian: this is a herb that is generally regarded as being safe to use. Some say it has helped their anxiety though it doesn't seem to have much effect in treating severe anxiety. Fresh roots seem to have the greatest effect. I rate Valerian as being 3 out of 5. If you wish to try this, make sure you get fresh roots. Tolerance can build up within a couple of weeks.

- Theanine: this has effects as a neurotransmitter and while it is calming, it has a similar shape to an excitatory neurotransmitter; glutamate. However, theanine has a weak affinity for glutamate receptors in neurons, so it doesn't cause excitability in moderate doses. There is scientific evidence to show that theanine can reduce anticipatory anxiety and also stress when performing tasks while improving focus and helping patients with ADHD sleep. It seems that the only form of theanine supplementation that is effective is called "suntheanine". This appears to be effective in reducing anxiety for most, but not all people, though a moderate tolerance to it is quickly induced. This supplement may cause headaches. I rate this as being 2 out of 5. Despite having numerous studies supporting its beneficial effects, this supplement induces a rather rapid tolerance (within 1 or 2 weeks), may cause headaches, and its best effect is more to increase concentration than to alleviate anxiety. It may be a useful additive that could be taken a few times per week but isn't overly effective by itself.

- Omega-3: based on medical studies and forum reports where people supplemented with omega-3; I think that this would be a worthwhile supplement for anxiety and also depression. Everyone that I came across (and also in the studies) used around 3 grams of omega-3 supplements per day to alleviate depression and anxiety. Below this, mental health wasn't improved. I rate this as being 3 out of 5. This is mostly for its lack of side effects. This could be a relatively safe additive and I at least haven't heard of any tolerance being built up.

- Magnesium: there was a study in which mice were deprived of magnesium from their diets and showed both depression and anxiety-like symptoms. I'll include this study at a later stage, right now I'm just firing out everything I know that could possibly help. Also, when I went through many forum posts on magnesium I found that probably around half of the people were using magnesium supplements for either relaxation or anxiety-related reasons. I rate magnesium as being 3 out of 5 for anxiety, although it could be a lot better than I realise. Studies have shown that when we are anxious we excrete extra magnesium as well as phosphorus. Therefore, those suffering from anxiety must consume more magnesium than an otherwise healthy individual.

- Glycine: this is an amino acid that also acts as an inhibitory neurotransmitter. Inhibitory neurotransmitters decrease the activity of neurons and can reduce anxiety. Glycine also acts as a co-agonist along with glutamate for NMDA receptors. Therefore, while moderate dosages of glycine can have a calming effect, too much can cause increased anxiety.

- Magnesium Glycinate: I felt that this was important enough to have its own section. Combining magnesium and glycine in this way allows the magnesium to be better absorbed within the body. It also provides anxiolytic properties from each component for added efficacy.

- Dairy products: if you have anxiety, cut down on these and see if it makes a difference, they contain high levels of calcium, a mineral that doubles as an excitatory neurotransmitter. If you have an excess of excitatory neurotransmitters, you can end up feeling anxiety for no reason. The chances are that you already gain enough calcium from your diet to avoid the necessity of supplementation, for those of you that are considering, or are already taking, calcium supplements.

- GABA: this is an amino acid that is also the most important inhibitory neurotransmitter within mammals. Increasing the level of GABA within the central nervous system can increase the amount of alpha waves that the brain produces. This causes a person to feel more relaxed yet alert. GABA's role as an inhibitory neurotransmitter is of critical importance to anxiety disorders. By increasing the amount of GABA, you decrease the amount of anxiety in people. Two of the main GABA supplements that I came across are called Phenibut and Picamilon. I personally consider these to be unsafe but I may be wrong. I suggest that if you consider GABA supplementation to be of possible benefit, then you should research both of these supplements rigorously and then speak to a medical professional about their safety. Make sure that if you do take them that you know their effects on the drugs that you may also be taking in conjunction with them. I noticed with Phenibut especially that anecdotal reports claim you can become tolerant to this if you use it more than 2-3 times per day and can experience withdrawal symptoms if you use it every day for only one week. Withdrawal symptoms can include severe anxiety and this supplement should be taken with caution. I rate GABA supplements as being 2 out of 5. They seem highly effective, but I am wary of their side effects and addictive nature. I wouldn't recommend these though they certainly do reduce anxiety.

- Kava-kava: this is made from the roots of a plant and is well known for its relaxing qualities. It can relieve anxiety, reduce pain, and help with sleeplessness. It seems to be used by a lot of people with anxiety who say it has noticeable relaxing effects. However, caution should be taken when using this drug as it may cause liver damage. For this reason it shouldn't be used in conjunction with alcohol. It also shouldn't be used with many prescription medications as it could adversely interact with these as well. From what I've seen and heard, the kava root powder or paste appear to be the best forms, taking these after consuming oily foods may improve their effectiveness. I found mixed results for people supplementing with kava, it seems to be a case of finding a very good source, though this is very difficult considering it was banned quite recently and manufacturers might take a while to invest into it again. I rate kava as 3 out of 5, just make sure that you buy it from a well-known company and check the reviews of the product to make sure that it is effective. Also, tolerance to this can build quickly so it shouldn't be taken everyday of the week.

- St. John's Wort: this is a herbal remedy that has been used for both depression and anxiety. In some studies it has been shown to be just as effective as prescription medication and more than placebos for people suffering from depression. However, care should be taken when combining St. John's Wort with SSRIs (selective serotonin re-uptake inhibitors) or serotonin-boosting medication as serotonin toxicity may result. The Mayoclinic considers St John's Wort to have "strong scientific evidence" for use in treating mild to moderate depressive disorders. However, it also states that there is unclear scientific evidence for its application for anxiety disorders. I rate St. John's Wort as 1 out of 5 for anxiety, there was no clear evidence, scientific or anecdotal, of its benefit for anxiety disorders. It may work however, but this is just my opinion.

- Passionflower: this is another herb that is considered to be quite safe. It seems to be of benefit to many people with anxiety and this is backed by scientific research although more studies are needed for proof. I recommend trying this once you are aware of the side effects and possible drug interactions. I rate passionflower as 3.5 out of 5. This is because some people used it to successfully reduce severe anxiety and it has a relatively low chance of side effects. Again, care should be taken to avoid building up a tolerance.

- Alcohol: I would suggest cutting down on alcohol if you have elevated anxiety. Using alcohol as a coping mechanism can lead to a dependency and alcohol addiction in itself is a major cause of anxiety. Also, even if you aren't taking it to such a huge extent, the hangovers can wear you out and this will definitely increase your anxiety.

- High glycemic foods (sugars): These can cause huge blood sugar spikes which can make your mind race and wander and isn't desirable for those suffering from anxiety. Also, the inevitable sugar crash can leave you feeling drained and lethargic.

Correct Breathing: (This breathing section is an extract from "Everything I Know: Breathing", and is covered more fully on that page.)

Close your mouth and press your tongue against the back of your two front teeth, breathe entirely through your nose. Make sure that you are breathing into the lower portion of your lungs. To check that you are doing this correctly, place the palm of your left hand on your belly button and your right hand on your chest. As you breathe in, notice which hand moves most. Ideally, your left hand should be pushed out by your inhale and your right hand should barely move, if at all. This should be how you should be breathing in all circumstances, apart from real danger (being chased by a lion for example). If you have a panic attack, probably the fastest way to stop the panic is by changing to this style of breathing. To get the best anti-stress results from breathing you should aim to breathe in for around 4 seconds and then breathe out for as long as is comfortable. In general, inhalations stimulate the sympathetic nervous system while exhalations stimulate the parasympathetic nervous system. Therefore, if your exhalations are longer than your inhalations you will feel much calmer. If you practise this you can get to a point where you will breathe in for 4 seconds and out for over 20 seconds. As you do this you'll notice that all of the muscles in your body become naturally inclined to relax.

Diaphragmatic breathing:

It is important to breathe into the diaphragm as this is where the highest proportion of blood vessels are within the lungs. It has been shown that the upper 7% of your lungs will only take in 4 ml of oxygen per minute whereas the lower 13% of your lungs will take in around 60 ml per minute. Also, using diaphragmatic breathing requires so much less energy to perform that it requires less than 5% of total oxygen intake. If you are over-breathing  the energy requirement goes up massively, when volunteers were told to hyperventilate on purpose they used up 30% of their oxygen intake just to breathe in this way. So by breathing into the diaphragm, you not only take up a significantly larger volume of oxygen into your blood, but you also reduce the amount of oxygen (and energy) that you waste in performing the breathing itself.


Nasal breathing:

The nose is the narrowest place in the respiratory tract, it creates a bottleneck that results in airflow being restricted before it travels into the lungs. Compared to the mouth, it requires 1.5 times the amount of energy to pull the same volume of air through the nose.

Within the nasal cavity are bony projections called turbinates  They heat and humidify air that is drawn through the nose and into the lungs. This reduces the damage that air causes to the lungs. The nose is also useful in breathing because it filters the air that is drawn into it. This takes place because there are many small hairs on the inside of the nose. This means that we take in less bacteria every time we breathe and consequently, our immune systems are less likely to become overworked. It is estimated that when these particles are caught in the nose hairs and/or mucus within the nose, that they are removed from the body within 15 minutes. However, if they travelled to the lungs they would take a few months to remove. Every time you breathe through your mouth you send these particles to your lungs and increase your chance of having a lung infection.

It is said that while breathing through your nose, if you are breathing through the right nostril you will be more inclined towards energetic pursuits, or those involving aggression. Conversely, breathing through the left nostril is associated with feelings of calm and introspection. Over the course of a day, the airflow between the nostrils will change of its own accord. You may wake up, for example, breathing through the left nostril and by midday realise that there is more air coming out of your right nostril.

In a study in which volunteers were subjected to a stress test, with some participants breathing through their mouth and the others through their nose, those who breathed nasally experienced brain wave activity that indicated greater relaxation.

Nitric oxide is also present in the nose and the slowing of air as it enter the nasal cavity allows nitric oxide to mix with the incoming air. This causes nitric oxide to be taken into the lungs where it dilates the blood vessels (bronchodilation). This allows significantly more oxygen to be taken in by these blood vessels and is very beneficial to the overall health of the organism.

Breathing through the nose is also beneficial in that it forces our breathing to slow down and as a result, our bodies follow suit. This helps us to reduce stress and think more clearly.


Carbon dioxide:

Carbon dioxide is commonly referred to as a 'waste gas' from respiration. I feel that this is highly disrespectful to carbon dioxide. Your body requires a delicate balance of carbon dioxide, generally within 35 and 45 mmHg (millimetres of mercury at sea level, a pressure measurement) within the blood. If you breathe too quickly you approach the lower end of this scale and feel dizzy and if you breathe too slowly you approach the upper end of this scale and feel breathless. You need around 40 mmHg or above, if you have adapted to higher pressures of carbon dioxide, to function normally. Below this your cells aren't getting adequate oxygen. The reason for this is illustrated by the Bohr effect. Without going into too much detail, the essence of this is that your blood cells offload their oxygen (this is desirable) around cells that are producing more carbon dioxide. Hence, if you breathe too rapidly you deplete your body of carbon dioxide and the blood cells continue to carry oxygen around the body without giving it to cells and tissues that require it. The result of hyperventilation is an impaired ability to think, among many other signs. This is primarily because the brain is suffering from oxygen deprivation (even though you are breathing rapidly and getting a lot of oxygen into the body), because your level of carbon dioxide is inadequate.

In order to understand why correct breathing doesn't come naturally to many of us we need to consider the type of lifestyle that we all live. It is primarily one of emotionally suppression and stress, both of which cause us to tense our stomach muscles and breathe into our chest. This is a manifestation of the body's fight or flight response. I think a more illustrative way of thinking of the fight or flight responses are to consider them as being a response to Anticipated Exertion. This way it becomes easier to understand why our bodies react in the way that they do. For example, if we were to undergo physical activity then our cells would greatly increase their carbon dioxide production. If our body anticipates that we will undergo physical activity then it naturally begins to breathe in a way that causes this carbon dioxide to be expelled. The problem occurs when our stressors are imaginary and we stay still. This causes us to lose carbon dioxide without producing more of it. The result is hyperventilation and strangely, increased stress.

Passionflower

Passionflower is a herb that is commonly used as an alternative treatment for anxiety. It is believed that its anxiolytic properties stem (no pun intended) from its ability to increase GABA within the brain. It is typically used in conjunction with other herbs, for example, Valerian root. While passionflower is generally considered safe, it may cause nausea, vomiting, drowsiness, rapid heart rate and sluggishness. It may also cause liver failure in rare cases.

Very few people said that passionflower had no effect on them and this may be due to where they bought it from, though maybe even the best source doesn't work for everyone. Many people used passionflower successfully to treat even severe anxiety and cure mild anxiety.

http://www.ncbi.nlm.nih.gov/pubmed/11679026 - in a study of 36 people diagnosed with generalised anxiety, a passionflower extract was compared against oxazepam. Both approaches showed similar improvements but passionflower took longer to take effect yet caused less impairment of job performance.

http://www.ncbi.nlm.nih.gov/pubmed/21294203 - passionflower may improve sleep quality, a 41 person study.

http://www.ncbi.nlm.nih.gov/pubmed/12244887 - a review of studies on passionflower implying it has proven sedative and perhaps anxiolytic effects.

http://www.ncbi.nlm.nih.gov/pubmed/11679027 - 65 opiates addicts received either clonidine plus passiflora extract in a tablet or clonidine plus placebo in a tablet. Both treatments were equally effective in treating the physical effects of withdrawal but the addition of passiflora extract showed a marked improvement in treatment of the mental symptoms.

Valerian


Valerian is a herb that may have anxiolytic effects. There  are many types of Valerian but the one considered to be the most effective is Valeriana officinalis. Typical dosages for Valerian range from around 250 mg to 600 mg per day. The calming effects of Valerian are thought to arise from this herb's ability to increase the amount of GABA within the brain. A tolerance can be built up to this herb (you begin to require ever higher dosages to gain the same beneficial effects) so it is recommended that you don't take it for more than a few weeks without a break. It is considered generally safe within the recommended dosage, however it may adversely react with or exacerbate the effects of medications and alcohol.

According to anecdotes, the best results come with fresh Valerian roots and consequently a lot of company forms of Valerian which aren't fresh, seem ineffective. The general consensus on Valerian supplementation is that it can cause a small to moderate reduction in anxiety, but seems ineffective in cases of extreme anxiety.

http://www.ncbi.nlm.nih.gov/pubmed/17054208 - a randomised control trial involving 36 participants with generalised anxiety disorder, those taking Valerian had no significant decrease in anxiety compared to placebo.

http://www.ncbi.nlm.nih.gov/pubmed/20042323 - a study on mice: Valerian extract and valerenic acid caused a significant reduction in anxiety-related behaviour compared to an ethanol control group.

GABA

*From what I've seen regarding Phenibut and Picamilon, I would be very cautious with both of them. Picamilon seems to me to be the safer alternative, though studies are lacking. I'm afraid I wouldn't recommend either of these but if you feel that it would be beneficial then please do a lot of your own research first and then check with a medical professional. It may be that I came across some negative anecdotal reports at the start of reading into these supplements and this put me off them completely.

GABA is considered to be the most important inhibitory neurotransmitter in mammals. For this reason it is considered to be fundamentally important in the treatment of anxiety disorders. Most if not all of the supplements that I have currently looked into have had some connection with GABA receptors. There are 2 main oral supplements utilising the effects of GABA: Phenibut and Picamilon. Both of these were made with the purpose of passing through the blood-brain barrier.It is believed that GABA has difficulty in doing this by itself (I have not seen proof of this) and this is necessary for inhibition of neuronal excitation, therefore supplementation of a GABA form that can enter the brain is important.

http://www.ncbi.nlm.nih.gov/pubmed/16971751 - this is a review of 2 studies involving a total of 21 study subjects. In the first study it was found that GABA administration caused a change in brain activity, by increasing the alpha waves produced by the participants. This occurred within an hour of the administration. People producing more alpha brain waves experience a more relaxed and alert state of mind. In the second study it was found that those who took GABA instead of a placebo had significantly higher immunoglobin A while facing a phobia (they crossed a bridge and were afraid of heights). The significance of this is that when we are afraid our immune systems decrease in activity. The fact that GABA maintained a higher level of immunoglobin A in these participants shows that their immune systems were less affected by the situation and strongly implies that the GABA induced relaxation. Together, these studies provide evidence that GABA is beneficial against anxiety, though in total only 21 participants have been tested.

http://www.ncbi.nlm.nih.gov/pubmed/12467378 - an abstract pointing out that glutamate is the main excitatory and GABA is the main inihibitory neurotransmitter within the brain.

- Phenibut

Phenibut is a chemical that mimics the effects of GABA. According to anecdotal reports from users, it seems that tolerance to phenibut is easily attained and withdrawal effects can occur even if you have only been taking the supplement for about a week. The withdrawal symptoms seem pretty horrific, with one of the worst symptoms being extreme anxiety. For this reason many people use phenibut about twice per week. Phenibut may also increase the effects of sedative drugs and alcohol and ideally shouldn't been taken in conjunction with these. There also seems to be the possibility of liver damage and probably many other side effects that haven't yet been discovered. I couldn't find human studies on this drug and for that reason I would be wary of trying it.

http://www.ncbi.nlm.nih.gov/pubmed/11830761 - phenibut is used in Russia for a variety of ailments, particularly in relation to stress, e.g. anxiety, depression, PTSD etc.

- Picamilon

Picamilon is a chemical that is formed from the combination of GABA and niacin. It crosses the blood-brain barrier and is subsequently hydrolysed to GABA and niacin. Apart from the potential anxiolytic effects of GABA, the niacin can also act as a vasodilator. This means that picamilon could also be beneficial for migraines. Anecdotal reports claim that this supplement is quite safe, and may relieve headaches. As far as anxiolytic effects go, the results are mixed. Some people report significant benefit and others very little.

Niacinamide


Niacinamide and nicotinamide and nicotinic acid amide are three names used for the same compound, an amide of nicotinic acid, also known as niacin. Nicotinamide is a B vitamin with potential anxiolytic effects. It is not to be confused with niacin, as this molecule can cause a flushing reaction in which a person's face, neck, chest, and maybe even whole body turns red and becomes warmer. Nicotinamide rarely causes this same reaction and is the preferred form used for anxiety treatment. I have seen people on forums taking around 500 mg to 2,000 mg per day. Some of these people have noticed an instant effect whereby their extreme anxiety is practically eliminated, and others notice no effect whatsoever. According to a few websites it can take up to a month for the therapeutic benefits of niacinamide to be felt. I am unsure if this is a beneficial treatment for everyone with anxiety. Dosages of 500 mg to 3,000 mg may be be safe though some people take up to 6,000 mg from what I've seen. I don't know what side effects would occur from such high doses and recommend that if you are considering taking niacinamide that you check with a doctor beforehand. Side effects are considered uncommon with this supplement but could occur at higher doses, for example, liver damage.

http://www.ncbi.nlm.nih.gov/pubmed/7913840 - nicotinamide has anxiolytic effects and reduces fights in conflict situations.

http://www.ncbi.nlm.nih.gov/pubmed/6101294 - nicotinamide might interact with the benzodiazepine receptors in the brain. Others believe that nicotinamide has a weak affinity for this receptor but may bring about anxiolytic effects in a different way to benzodiazepine.

http://www.ncbi.nlm.nih.gov/pubmed/6125374 - a possible alternative mechanism whereby molecules like nicotinamide may cause anxiolytic effects, by acting on receptor sites associated with benzodiazepine receptors as opposed to acting on the benzodiazepine receptors themselves.

Chamomile

From what I've seen on chamomile, and based on its relative safety, I would suggest chamomile as being beneficial for most people with anxiety. It is by no means a cure but it should help. Just make sure that you aren't allergic to it or have any health conditions that may be adversely affected.

http://www.ncbi.nlm.nih.gov/pubmed/19593179 - 28 patients with mild to moderate generalised anxiety disorder took Matricaria recutita (chamomile) extract for 8 weeks. A "significantly greater reduction in mean total HAM-A" (subjective anxiety rating) was observed.

http://www.ncbi.nlm.nih.gov/pubmed/16628544 - this review states that animal studies show some anxiolytic effects of chamomile, though human studies testing chamomile tea are non-existent.

There have been surprisingly few human studies on chamomile but I've seen loads of people take it and no one has mentioned side effects. The vast majority of people report noticeable calming and find it easier to get to sleep when taking chamomile tea. This is also considered to be one of the safest herbs that you can take, although care is advised for pregnant women as it may increase the risk of miscarriage and there can be allergic reactions to it. It may also exacerbate asthmatic symptoms. There will be a trial ending in June 2014 that will last 38 weeks, to determine the long-term effects of chamomile. This will give an indication of what sort of tolerance is built up to chamomile.

Kava-kava

Searching through the forums on this one was utterly confusing. There were so many forms of kava and added to the fact that there are so many companies and qualities of each individual source, I cannot say for sure which kava form is the most effective. However, it seems like the kava root powder or kava paste are among the best and for best results some people suggest taking oily foods or supplements beforehand as these forms are oil-soluble and this aids absorption. I can't comment on the effectiveness though, so many people had tried each form of kava with wildly different results.

http://www.ncbi.nlm.nih.gov/pubmed/12076477 - A review of 7 trials involving kava was made. Kava was found to have significant effects in reducing anxiety and with only mild, adverse reactions to the extract.

http://www.ncbi.nlm.nih.gov/pubmed/12535473 - A review of 11 trials found the same results; significant reduction of anxiety and only mild adverse effects.

http://www.ncbi.nlm.nih.gov/pubmed/23348842 - a 6 week study showing no adverse effects due to kava.

http://www.ncbi.nlm.nih.gov/pubmed/1930344 - 29 patients with anxiety syndrome took kava extract (WS 1490), 300 mg per day, and found it caused significant reduction in anxiety after only 1 week of treatment. No adverse events occurred due to the drug.

There were many more studies done on kava, all of the ones that I came across pointed to the same conclusion, that kava causes statistically significant reductions in anxiety with only mild adverse effects. The potential problem with kava is that it may cause liver toxicity in rare cases. It is unsure at this stage whether the liver toxicity was caused by the kava alone, or in combination with other medications, drugs, or viruses etc. It may also be that the form of kava used by these people was unsafe or impure. It seems that the toxicity of the kava plant may be avoided by using the rhizomes. The stem and leaves apparently contain much more toxic substances. This would explain why locals who use kava experience much fewer and less severe side effects through using only the rhizomes, whereas when the drug was imported, it contained extracts taken from the stem, leaves and rhizomes combined.

Omega-3

Summary: based on what I've seen on forums, people seem to benefit most from 3 to 4 grams of omega-3 supplementation per day. These people notice benefits with regard to anxiety and depression and it also keeps their skin healthier. I am unsure what the long-term effects of this level of supplementation are.

http://www.ncbi.nlm.nih.gov/pubmed/23051591 - 935 women were asked to give a detailed description of their diets. Those with the highest intake of DHA had a calculated 50% reduced chance of having an anxiety disorder. This study suggested a linear link between DHA intake and anxiety and as this was a very large trial it can't be easily discarded.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191260/ - 68 medical students were sorted into either a placebo or omega-3 supplement group. Those who received 2.5 grams of omega-3s (containing around 2 grams of EPA and 350 mg of DHA) per day had statistically significant reductions in anxiety.

http://www.ncbi.nlm.nih.gov/pubmed/17110827 - 24 substance abusers were splint into a placebo or test group. 13 supplemented with 3 grams of omega-3 PUFAs (polyunsaturated fatty acids). Those receiving the omega-3 capsules had a progressive decrease in anxiety as the trial went on (it lasted 3 months). 6 of these supplementers were then followed for an additional 3 months and were found to maintain a significantly decreased level of anxiety.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2275606/ - 22 substance abusers were split into a placebo or test group, the test group supplemented with 3 grams of omega-3 PUFAs daily, this lowered both their anxiety and anger levels. A higher plasma EPA correlated with decreased anxiety and higher DHA correlated with decreased anger.

I think probably the main problem with omega-3 consumption is that after going through the forums, everyone is taking around 1 gram per day. Upon further looking, everyone that I came across that noticed no benefit either didn't state their dosage or said they were taking up to around 1.2 grams of omega-3 per day. Everyone that said they were taking 3 or 4 grams had noticed significantly reduced anxiety.

Theanine

Summary: theanine seems to work for some people, the best source appears to be 'suntheanine', though some people still notice no benefits with this supplement. For those who do notice the benefits, a tolerance appears to be quickly induced, diminishing the effect within a couple of weeks. It's best effect seems to be in improving concentration as opposed to anything else. The only conclusive side effect that I came across was headaches.

These are all the studies that I could find which tested theanine's anxiolytic effects.

http://www.ncbi.nlm.nih.gov/pubmed/15378679 - some reduction in anticipatory anxiety but no effect during stressful situation (extremely small study, practically meaningless).

http://www.ncbi.nlm.nih.gov/pubmed/16930802 - theanine prevented heart rate increase in stressful situation (extremely small study, practically meaningless).

http://www.ncbi.nlm.nih.gov/pubmed/16759779 - no signs of toxicity or other adverse effects in mice given 4000 mg per kilogram of bodyweight over 13 weeks. This suggests that humans supplementing with theanine would be incredibly unlikely to suffer any adverse effects.

http://www.ncbi.nlm.nih.gov/pubmed/22214254 - theanine significantly improved sleep for patients with ADHD. No significant adverse effects. This was a moderately sized trial and was placebo-controlled (2 groups undertook the experiment, one group took the substance to be tested and the other took a placebo) and was double-blind (neither the volunteers nor the people in charge were aware of who received the substance under test or the placebo).

http://www.ncbi.nlm.nih.gov/pubmed/22819553 - theanine administration caused increased nitric oxide production in blood vessels leading to vasodilation of blood vessels. This improves blood flow and reduces blood pressure. This would be beneficial to people suffering from hypertension.

http://www.ncbi.nlm.nih.gov/pubmed/22707502 - theanine reduces adrenal hypertrophy in male mice housed with other males. It also reduced stress, depression and blocked the negative effects of caffeine. This suggests that drinking green tea may not cause the usual nervousness associated with caffeine intake as this would be counteracted by the theanine found within green tea.

http://www.ncbi.nlm.nih.gov/pubmed/23395732 - multiple beneficial effects of theanine on mice that were trapped (causing restraint-induced stress), this shows theanine can reverse some cognitive impairment in mice that have undergone stress, and most likely in humans as well.

http://www.ncbi.nlm.nih.gov/pubmed/23107346 - multiple benefits to theanine administration in human participants with a tendency toward high-stress responses while performing a mental task.

I also looked over a few forums and saw mixed results, I'd say around half of the people using theanine experienced reductions in anxiety while the rest noticed no change. Also, most of the people that used it said that they quickly developed a tolerance to it (usually within a couple of weeks). However, a lot of people said that the only good quality form of theanine was something called suntheanine, and I'm sure that most of the people on these forums hadn't used this particular form. The people who did use this form usually said it was effective.