HAILEY IS A PATIENT who came into the office and burst into tears. “I’m a mess!” she said. “I yell at my kids all the time, my husband thinks I’m crazy, and I wake up every night worrying about the littlest things. I feel terrible every day, like I don’t have the energy to get anything done. What is wrong with me?”
Feeling like a nervous wreck? Up at night with to-do lists and worry lists running through your head? Or perhaps the opposite: lying in bed, having trouble finding the motivation or inspiration to get up and do anything? Feeling like the daily grind is too much to handle sometimes? Edgy and emotional to the point that you commonly snap at family members or coworkers?
These symptoms of anxiety and/or depression are some of the most common we hear about in our practices. It is of course very common for many people to have times in their lives when they feel particularly anxious or down in the dumps and depressed. There is a range in severity of these symptoms and accordingly there is a range in the type of treatment needed to address them. This is by no means an attempt to provide a comprehensive approach to mental health issues; rather, it is a discussion of how vitamins may be a part of that conversation. There are vitamins for anxiety. However, to contextualize vitamins’ role properly, let’s first discuss how anxiety and depression are typically treated in the United States today.
It goes without saying that severe forms of anxiety and depression, and any indication of wanting to harm oneself or others, are matters that should be addressed by a qualified health-care professional. We focus here not on these more urgent interventions, but on ways in which vitamins may play a role in treating some of these symptoms, either as stand-alone solutions or, more often, as a part of a comprehensive plan that may include prescription medication, lifestyle interventions, and a therapy component.
Anxiety and depression so often go hand in hand. While in some ways these conditions’ symptoms represent opposite ends of the spectrum (anxiety = more wired and hyper; depressed = more lethargic and low energy), there is still a great deal of overlap. In other words, many people experience both either simultaneously or intermittently; therefore, the treatments also have some overlap and some distinctions. Many prescription medications are coindicated for both anxiety and depression, while others are not. Likewise, many supplements have been recommended for use in both conditions, but some are more specific to those with anxiety-type symptoms, while others are more geared toward depression. In our discussion today, we will talk primarily about anxiety and we will address depression separately in a future blog.
Anxiety is a disorder with a huge spectrum of manifestations. This state of feeling unsettled, nervous, and overly concerned can often be accompanied by very physical manifestations. Many people experience chronic low levels of anxiety that underlie their daily lives, while others experience very discrete episodes of full-scale panic attacks with extremely physical symptoms, such as a sensation of palpitations, chest discomfort, or trouble breathing. Needless to say, you should consult with your health-care provider about any of these complaints, since some other medical conditions can cause similar symptoms. If anxiety is in fact determined to be the cause, then there are a number of approaches to consider.
There are lifestyle interventions that can be useful. Getting regular exercise is a wonderful way to blow off steam and help reduce anxiety. During exercise your body senses that it is time to release certain stress hormones and endorphins. These are the hormones that help raise your heart rate and blood pressure and get your mind hyper-focused. This is a strikingly similar experience to a moment of anxiety or panic. With exercise, however, when you stop the activity, the body gradually returns to normal. Doing this on a regular basis keeps your body trained to go through this ritual when exercising, but not so much at other times. Regular exercise actually lowers your resting heart rate between exercise episodes. It has been reported that superstar athletes like Michael Jordan have resting heart rates in the 30s (normal for adults is typically 60–90). Sometimes just taking a vigorous walk can go a long way toward melting away anxiety. Even better if it’s with a friend and you can talk it out a bit!
Beyond cardio exercise, a multitude of other regular habits can be extremely effective in minimizing anxiety. Disciplines in mindfulness and meditation as well as yoga and Pilates are all means to learn breathing techniques and mental strategies that help your body naturally calm itself. These disciplines bear striking similarity to techniques of cognitive behavioral therapy, which teaches practitioners to use their own physical cues and body awareness to promote self-regulated techniques for reducing stress and anxiety. Guided imagery techniques for meditation can accomplish similar results. These are worthwhile pursuits for anyone with anxiety of any type and seem especially helpful for those with situational anxiety (i.e., anxiety triggered in certain predictable situations such as a fear of flying, heights, etc.).
A discussion of prescription medication is well beyond this the scope of this blog, but should be considered under the guidance of a professional. One important thing to understand about medication for anxiety is that there are two distinct, but not mutually exclusive options—daily medication and as-needed-type medications. There are several commonly used classes of daily medications for depression: serotonin-specific reuptake inhibitors (SSRIs), serotonin-norepi- nephrine reuptake inhibitors (SNRIs), and a few others. These are medications that are taken regularly with the hope of preventing symptoms of anxiety (or depression). They can be wonderful, if not life-changing treatment for many people, but often require some trial and error to find the right fit for each individual. They also take some time to stop and start—that is, they take several weeks if not months to build up in your system to be effective. On the back end, they generally require a weaning period to stop them to avoid nasty withdrawal symptoms. In addition, taking daily medication is a commitment, as one should take it for at least six to twelve months.
Medication is certainly not for everyone. However, one common issue we see in practice is that people who are anxiety ridden and may benefit from medication the most are so anxious about taking medication that they do not give it a try. If your health professional recommends that you consider daily medication for a psychiatric concern, you should be open to the option and hold some trust in your provider’s ability to choose a medication that is likely to help your situation. This is a bit of a leap of faith when you are feeling overly concerned about everything around you, but it is sometimes worth that extra push to try something. Staring at a bottle of medication for weeks on end and pondering whether to take it is not going to help your situation at all. Taking action may.
In addition to daily medications, there are as-needed medication options for anxiety (which unfortunately are less useful for depression). These typically are medicine in the class of benzodiazepines or valium-type medications. They work quickly (within minutes) and effectively to minimize anxiety symptoms and last several hours or more. However, they have some major limitations—primarily that they are a quick fix and do not really treat the underlying symptoms. Thus those symptoms can quickly return once the drug wears off. These valium-like medications are also sedating, often impairing one’s ability to function. They should not be taken before driving. Another important concern is that they are habit-forming. Over time you may need to take more and more of the medication to get the desired effect. You may also experience serious withdrawal if you stop them abruptly. In our opinion, there is a limited role for these medications—they should be used only occasionally for extreme circumstances or for very specific anxiety-inducing situations such as fear of flying or heights. They are rarely a long-term solution to anxiety.
The effects of prescription medications may be augmented with certain vitamins for anxiety, or vitamins may even be part of a solution to avoid medication when possible. Some of the most common vitamins recommended for anxiety and depression have considerable scientific data to back their use, while others have less. Our firsthand experiences have guided our recommendations for a few worth trying.
Anxiety, not surprisingly, can be treated with some of the same supplements discussed for aiding with sleep. Both processes involve a reduction of agitation and a relaxation component. Some supplements have been touted for working on various neurotransmitters to stimulate relaxation. These include valerian root, kava, chamomile, and gamma-aminobutyric acid (GABA). All are said to bind to the receptors centered in the relaxation areas of the brain. As with many herbal supplements, the data is somewhat lacking. While some people do find success with these products, it is our experience that most do not see noticeable improvements from using them. In addition, they can present issues with purity and contamination by other unintended ingredients. Vous Vitamin® has not felt comfortable manufacturing or endorsing these particular products because we do not see enough evidence in their favor. If you do feel strongly about trying some of these products, we recommend using only well-made ones from reputable sources.
The other types of vitamins often touted for anxiety are those with anti-inflammatory properties. These include the omega-3s (typically as fish oil) and vitamin C. Both have some decent evidence to suggest that they can be helpful for anxiety. Exactly why inflammation is part of the problem remains unclear. However, given that both omega-3s and vitamin C are generally safe in moderate doses (we believe no more than 2,000 mg of the first and 500 mg of the latter), they are worth considering.
Some other vitamins that might diminish anxiety are vitamin B12 and folic acid. Both of these B vitamins seem to have important roles in nerve function. They may make our nerves function more optimally since their deficiencies lead to a variety of disturbances in the nervous system. It makes sense that replacing them in someone experiencing symptoms of anxiety may be helpful.
The other vitamin that is likely to play an important role in easing anxiety symptoms is magnesium. This essential nutrient plays a key role in optimal cellular function, as it regulates various channels that then allow cells to perform as they should. This seems to aid in reducing anxiety and its physical symptoms. We also often discuss magnesium as it pertains to sleep as, not surprisingly, it helps with sleep as well. It is our finding that daily magnesium supplementation is more useful than occasional as-needed use. At Vous Vitamin®, magnesium is a common component of many of our Personalized Multivitamins™.
Now back to Hailey, our distressed thirty-one-year-old patient. After a long discussion with her about her current symptoms and her emotional and medical history, it became clear she was suffering from a combination of depressive symptoms and anxiety. Her anxiety was disrupting her sleep, and she was exhausted and irritable by day. It was hard to tell what had come first, but clearly both issues needed to be addressed. Through a combination of lifestyle changes (better diet, regular exercise that for her included yoga and meditation), talk therapy, and some specific vitamin suggestions, her situation improved markedly. She returned several months later to report that she was feeling like a new person, employing a combination of magnesium, vitamin D, and B vitamins seemed to help her sleep and alleviated both her anxiety symptoms and her daytime depression.
All in all there are a number of vitamins and supplements that may be helpful in aiding with symptoms of both anxiety and depression. As with any symptoms, it is important to consider a global approach to each person and how different treatments may fit into their lives. A traditional approach to treating mental health concerns can include lifestyle optimization such as exercise and possibly meditation, prescription medication, and psychotherapy. A thoughtful vitamin regimen is an important consideration in treatment of these issues. Vitamins can complement these other modalities and help act as a preventative. They may be an important addition and a useful tool to minimize these distressing symptoms. Taking a good Personalized Multivitamin tailored to your specific needs based on diet, exercise and health concerns can be a great way to get exactly what you need.
Romy Block specializes in Endocrinology and Metabolism and is mother to three active adolescent boys. Arielle Levitan is a Doctor of Internal Medicine with a special interest in Preventive Medicine and Women’s Health. She is a mother of three teen agers. As professional women with active family lives, they recognize that people often neglect their own health needs and are uncertain about what vitamins to take. Each person is different in her diet, exercise and health history, and will benefit from different nutrients. After years of advising their patients about the proper vitamins to take, Drs. Block and Levitan created Vous Vitamin® to provide people everywhere with quality vitamins that are suited to their individual needs. They are authors of the award winning The Vitamin Solution: Two Doctors Clear Confusion About Vitamins and Your Health (She Writes Press, 2015). Take your vitamin survey now to get exactly the right vitamins for your needs.
The statements made in this article have not been evaluated by the Food and Drug Administration. The products offered by Vous Vitamin® are not intended to diagnose, treat, cure, or prevent any disease.
Nothing contained herein is intended to be a diagnosis or constitute medical advice. The symptoms described in this Blog may be a result of a serious medical condition which requires medical treatment. You should consult with your doctor if you are experiencing any of the symptoms mentioned in this Blog and before beginning any vitamin or supplement regimen.