By Dr. Jessica Springhetti / September 29, 2023
For every person diagnosed with anxiety, there are several more who suffer in silence. Shockingly, recent estimates suggest that nearly 63% of individuals with anxiety disorders do not receive treatment (1).
According to the National Institute of Mental Health (NIMH) statistics from that time, approximately 18.1% of adults (about 40 million people) in the U.S. aged 18 and older experience an anxiety disorder each year (5).
This hidden challenge invites us to shed light on anxiety, its impact on our bodies, the hormonal influences with this widespread concern, and the diverse spectrum of treatments available.
Although anxiety might seem burdensome, it is fundamentally a deeply rooted ancient survival mechanism within us. This instinctual "fight-or-flight" reaction shapes the way anxiety manifests in our bodies.
This primal response has been employed across generations to ensure survival in moments of imminent peril through either confrontation or evasion. This triggers the activation of your sympathetic nervous system, which oversees automatic bodily functions such as heartbeat and respiration. Consequently, this activation leads to the discharge of stress hormones such as adrenaline and cortisol. These hormonal surges contribute to the physical manifestations frequently linked with feelings of anxiety.
However, in today’s fast paced world, this response can become hyperactive, leading to persistent stress on the body and mind. When it becomes continual or overwhelming, it starts to creep into the territory of an anxiety disorder. (2).
Anxiety: a Healthy Emotion in Moderation
In balanced amounts, anxiety is a natural and beneficial response that drives purposeful actions, maintains focus, and serves as motivation for problem-solving. This inherent trait, molded by evolution, is like an instinct that guides us to protect ourselves and make positive changes.
Anxiety disorders involve complex clinical pictures – an interplay between biological factors, environmental influences and psychological mechanisms.
Before we can discuss how we treat anxiety disorders, it is important to recognize the imbalances that can occur in the brain leading to this common diagnosis.
Symptoms of anxiety disorders are believed to arise from an imbalance within the emotional processing hub of the brain. This emotional processing hub is known as the limbic system (12). It encompasses key components like the hippocampus, amygdala, hypothalamus, and thalamus. These components play a crucial role in the treatment of anxiety. For those experiencing an anxiety disorder, there might be increased activity in these specific areas, contributing to their state (4).
Hyperactivity of the amygdala (the emotional processing area for fear) and hypothalamus (a main regulation center of the brain) increases what is known as corticotropin releasing hormone (CRH) (8). Prolonged elevation of CRH can lead to elevated levels of cortisol (8). Cortisol is a hormone that helps the body respond and address stress adaptation. Patients with anxiety have been linked to having abnormal levels of salivary cortisol (30).
Cortisol, the primary stress hormone, plays a pivotal role in our body’s response to stress. This response is orchestrated by the HPA axis, short for the hypothalamic-pituitary-adrenal axis. This vital communication pathway within the body links the hypothalamus and pituitary gland located in the brain with the adrenal glands that sit atop the kidneys. Its primary role revolves around regulating the body's response to stress, triggering the production of cortisol. Although cortisol is naturally generated in varying amounts throughout the day, the HPA axis is responsible for orchestrating the "fight-or-flight" response. Cortisol naturally increases alertness, mobilizes energy reserves, and sharpens focus to help you respond to the threat effectively. In acute situations, this response is adaptive and beneficial. This mechanism is designed to effectively handle short-term stressors. Notably, dysfunction of the HPA axis can be a significant underlying factor of chronic stress, anxiety, and anxiety-related disorders.
Chronic stress can lead to a persistent release of cortisol, disrupting the body's natural balance through the HPA axis. This constant demand for cortisol leads to an insufficient amount of cortisol to respond adequately to stressful situations. This can result in heightened anxiety and difficulty coping with stress. Elevated cortisol levels can be a key diagnostic marker for anxiety disorders as numerous studies have identified a link between elevated cortisol levels and various anxiety disorders such as generalized anxiety disorder (GAD), post traumatic stress disorder (PTSD), and panic disorder (33). In situations of chronic stress, the demand for cortisol throughout the day can skyrocket. Consistently elevated morning cortisol can eventually lead to depletion resulting in consistently low morning cortisol with a chronic stress picture. Chronic stress and cortisol dysregulation can also reduce GABA receptor sensitivity, making it less effective in calming the nervous system. As cortisol levels remain dysregulated, the body may prioritize the production of stress-related neurotransmitters over those associated with relaxation and well-being, perpetuating the cycle of anxiety.
Adrenaline, also known as epinephrine, shares a symbiotic relationship with cortisol in the context of anxiety. Together, these hormones initiate the “fight or flight” response experienced during moments of stress or fear. As adrenaline surges, it prepares the body for rapid action, while cortisol helps sustain this heightened state of alertness. Adrenaline can cause several physical symptoms such as increased heart rate, sweating, and trembling. This interconnectedness between adrenaline and cortisol illustrates the dynamic response anxiety triggers within the body, priming it for survival in perceived threatening situations. Medications like beta-blockers can be prescribed to block the effects of adrenaline, reducing physical symptoms like elevated heart rate and trembling associated with anxiety.
The relationship between serotonin and anxiety is a complicated one with conflicting evidence in research on its mechanism of influence. Serotonin is a neurotransmitter that has a key role and is best known for boosting mood. When serotonin levels are low, this regulatory function may be compromised, potentially leading to mood disturbances, including increased susceptibility to anxiety. Serotonin is involved in various processes in the brain, including the modulation of other neurotransmitter systems. One important connection is between serotonin and the GABA system. Low serotonin levels may disrupt the balance between excitatory and inhibitory neurotransmitters, leading to increased neural excitability. This heightened neural activity can contribute to feelings of restlessness and anxiety. However, high levels of serotonin can also induce distressing emotions like anxiety (11). This is likely due to evidence of serotonin modulating the amygdala in events of conditioned fear and anxiety (12). This explains why even though serotonin reuptake inhibitors (SSRIs) are often prescribed to treat anxiety, they can also cause or worsen anxiety symptoms in some individuals (11). The relationship between serotonin and anxiety remains a subject of ongoing research and debate, with conflicting evidence pointing to its dual role as both an anxiety reducer and a potential anxiety inducer.
It details the complexity of the brain's neurotransmitter systems and highlights the need for personalized treatment approaches tailored to each individual's unique neurobiological profile and circumstances to determine the most suitable treatment strategy for anxiety management.
Gamma-aminobutyric acid (GABA) is the primary inhibitory neurotransmitter in the central nervous system. Its main role is to reduce neuronal excitability, calming down overactive nerve signals. GABA acts like a sponge to soak up excess adrenaline and stress in the body. It helps regulate the balance between excitation and inhibition in the brain, playing a pivotal role in maintaining emotional stability and promoting relaxation.
GABA can become depleted for several reasons leading to increased neural excitability and anxiety. Some explanations include the influence of chronic stress and cortisol, neuroinflammation, and low progesterone levels. We will dive into this influence in further detail under “our hormones and anxiety” section.
Dopamine is associated with feelings of pleasure, reward, and motivation. It's released when we engage in enjoyable activities, such as eating a delicious meal or achieving a personal goal. However, the constant exposure to certain stimuli, like social media and television, can affect dopamine levels and have consequences for mood and anxiety. A dopamine deficiency has been linked to anxiety and depression (34). In 2005, only 5% of American adults used at least one social media platform; today that number has skyrocketed to 72%, or about 7 out of every 10 Americans (31). The constant connectivity and information overload associated with social media can create a sense of chronic stress. This state of chronic stress connects back to our story about cortisol dysregulation aggravating anxiety as discussed above.
Just as with substance addiction, repeated exposure to high levels of dopamine can lead to tolerance. To achieve the same pleasurable effect, individuals may spend increasing amounts of time on social media or seek out more interactions. This continuous quest for rewards can result in heightened anxiety, as users may fear missing out on notifications or interactions, contributing to feelings of restlessness and apprehension.
Limiting screen time, setting boundaries, and practicing digital detoxes can help individuals maintain a healthier relationship with social media, reduce anxiety triggers, and promote overall well-being.
Any other connections of dopamine to anxiety?
Unfortunately with an anxiety disorder, our bodies do not differentiate between an actual and immediate threat in our surroundings (which triggers fear) and a perceived or anticipated threat in the upcoming future (which leads to anxiety). This can lead to physical manifestations in the body.
Anxiety’s impact is not limited to the mind– it can manifest as physical symptoms such as:
This mind-body connection underscores the importance of a naturopathic approach (3). Oftentimes, conventional medicine does not look at the connections between physical manifestations of anxiety. The function of our brain can only be fully understood when looking at the whole-body.
When feelings of anxiety become intense, persistent, and affect daily tasks, you may want to seek a provider for a potential diagnosis and treatment of an anxiety disorder.
There are numerous types of anxiety disorders and each type has a specific criteria for diagnosis. Some common types include social anxiety disorder, panic disorder, phobias, obsessive-compulsive disorder, and post-traumatic stress disorder. Other common causes of anxiety that warrant a clinical diagnosis and treatment include PCOS and hyperthyroidism.
As previously mentioned, we all experience a touch of anxiety now and then – that flutter of nerves before a big moment or the excitement mixed with apprehension when we achieve something significant. It's a shared human experience that can even boost our motivation.
However, if anxiety refuses to budge, clinging to us and casting a shadow over our daily lives, even when there is no true threat in sight, diagnosis and treatment may be indicated. When the worry is affecting the quality of your daily life, you may have something called generalized anxiety disorder (GAD). The National Institute of Mental Health describes GAD as a chronic pattern of constant worry and fear without the presence of a true threat (6). Criteria for diagnosis occurs when someone has 3 or more signs (listed below) of anxiety for at least 6 months on an almost daily basis(7).
Signs lasting 6 months or longer include:
It is important to note that before diagnosing GAD, there should be investigation into any underlying causes of anxiety such as hyperthyroidism, PCOS, or menopause. Notably, the DSM-5 (diagnostic and statistical manual of mental health disorders, 5th edition) recognizes that individuals can have co-occurring disorders. For example, a person could be diagnosed with GAD while also experiencing symptoms related to hyperthyroidism, a medical condition (we will discuss in detail shortly) caused by an overactive thyroid gland. Hyperthyroidism leads to GAD-like symptoms along with other symptoms such as increased heart rate, weight loss, and sweating. Identifying such co-occurring or individual conditions is crucial, as it necessitates tailored treatment approaches.
People living with GAD may find it hard to control or stop anxiety once it has gained momentum. This ongoing elevated stress can really take a toll on your physical health with hormonal changes leading to imbalances and even inflammation. GAD can leave you feeling tired, restless or irritable constantly. Your muscles, head, and stomach might ache, and relaxation, sleep, and concentration might seem impossible.
That is why at Natural Med Doc we conduct thorough healthcare visits to evaluate and assess where the anxiety is coming from, even if from multiple conditions. This is crucial for effective management and recovery. We recognize that GAD is a complex disorder and may require a complex treatment targeting areas of lifestyle, nutrition, herbals, and more! Collaboration between mental health providers and our clinic may be necessary in certain cases to ensure you are receiving the best comprehensive care.
Panic disorder is characterized by recurrent and unexpected panic attacks, along with persistent concern of future attacks and consequences.
Panic disorder stands out among other anxiety disorders due to its hallmark characteristic – recurrent and unexpected panic attacks, coupled with persistent apprehension about future attacks and their consequences (7).
Central to panic disorder are panic attacks—sudden, overwhelming episodes of fear and discomfort that surge without warning and peak within minutes. These attacks are notably more intense than the anxiety experienced in Generalized Anxiety Disorder (GAD) (7). During a panic attack, individuals may endure an array of distressing symptoms, including:
These distinctive symptoms, coupled with the unpredictable nature of panic attacks, make panic disorder a unique challenge for those affected. Recognizing the specific traits of panic disorder is vital for targeted treatment approaches (26).
Within the spectrum of anxiety-related conditions, obsessive-compulsive disorder (OCD) presents a unique challenge. It is characterized by the persistent intrusion of unwanted thoughts, known as obsessions, which trigger repetitive behaviors or mental rituals called compulsions. These obsessions can manifest in various forms, from fears of contamination to concerns about harm to yourself or others, and even an overwhelming need for symmetry. To ease the anxiety arising from these obsessions, individuals with OCD engage in compulsions, such as excessive hand washing, checking, counting, or arranging objects meticulously (7). These rituals often consume significant time and disrupt daily life, causing considerable distress and impairing relationships and work. Despite recognizing the irrationality of their actions, those with OCD struggle to control or resist them effectively, leading to a cycle of obsession and compulsion. Some may also avoid triggering situations. Understanding OCD within the context of anxiety-related conditions is essential, as it underscores the interconnectedness of these disorders and highlights the potential for treatment.
Post-Traumatic Stress Disorder (PTSD) is an anxiety-related disorder that develops in response to exposure to a traumatic event that involves actual or threatened death, serious injury, or a threat to one's physical integrity. The mechanism underlying PTSD involves complex interactions between the brain, emotions, and memories. Dysregulation of the amygdala due to trauma processing is thought to play a central role in the intense feelings of anxiety experienced by PTSD patients (32). The amygdala becomes hyperactive, amplifying the emotional impact of traumatic memories and perpetuating the cycle of anxiety (32). These intricate mechanisms, along with the specific criteria, contribute to the profound and often debilitating nature of PTSD.
Criteria for diagnosis encompass experiencing a traumatic event, the re-experiencing of the trauma through distressing memories, nightmares, or flashbacks, avoidance of trauma-related stimuli, negative alterations in mood and cognition, and heightened arousal and reactivity (7).
As we’ve discussed earlier, excess cortisol can have quite an impact on anxiety. Looking at the diagram below, progesterone can be stolen and converted into cortisol. The body does not differentiate between major and minor stressors. With repeated daily stressors (both large and small), the release of cortisol is repeatedly stimulated due to the body prioritizing stress hormones over reproductive hormones. The body does this because it is more important when we are in crisis to be able to run away than to prepare the womb for a baby. With chronic stress, our calming hormone released after ovulation, progesterone, can decline, leading to and/or worsening hormone imbalances.
Symptoms and conditions related to low progesterone:
Progesterone has numerous functions beyond its role in menstruation and pregnancy. One of its key functions is its interaction with GABA. As previously discussed, GABA plays a vital role in calming the brain, promoting relaxation, and reducing anxiety. Think of progesterone as a conductor fine-tuning GABA's soothing effects, aiming to keep anxiety at bay.
When there is a decline in progesterone availability which occurs with cases of the progesterone steal, menopause, hormonal birth control, and anovulation, GABA deficiency or reduced function can occur. This can lead to a subsequent amplification of anxiety-related symptoms.
Estrogen is an essential hormone that plays various roles, including regulating the menstrual cycle, fertility, bone health, and heart health. It even impacts our mood. While estrogen has been linked to positive mood effects at a balanced level in the body, having too much of this hormone can lead to feelings of anxiety and tension.
To better understand this, let’s consider an average 28-day menstrual cycle. During the first half of menstruation, from the first day of bleeding, estrogen takes the lead. Its role at this time is to build the lining of the uterus while a follicle develops in preparation for ovulation. Just before ovulation, estrogen levels peak, then gradually decrease.
On the other hand, progesterone, another crucial hormone, remains low until ovulation. It starts to rise in the second half of the menstrual cycle, preparing the uterus to receive a fertilized egg and support a potential pregnancy. If fertilization does not occur, progesterone levels drop, signaling the beginning of a new cycle, ultimately leading to the next menstruation.
It is very important to have balanced progesterone and estrogen levels throughout the different phases of the menstrual cycle to not only optimize menses and ovulation, but a vast variety of symptoms such as sleep, mood, anxiety, brain fog, and energy.
When estrogen dominance occurs, estrogen levels remain high compared to progesterone. When this happens, the calming effects of progesterone are suppressed. As discussed with progesterone deficiency and GABA disruption, low progesterone levels can lead to a deficiency of our calming neurotransmitter, GABA. Additionally, elevated levels of estrogen have been shown to decrease the sensitivity of GABA and increase our primary stress hormone cortisol. With low progesterone and high estrogen levels, this can further exacerbate anxiety symptoms.
Estrogen dominance can also contribute to concerns such as:
If you're experiencing irregular periods, excessive hair growth, acne, weight gain, and/or infertility, it's important to consider the possibility of Polycystic Ovary Syndrome (PCOS) as an underlying cause. However, what many may not realize is that PCOS, characterized by anovulation, excess androgen production, and insulin resistance, can also significantly contribute to anxiety.
In fact, a study published in the journal "Psychological Medicine" revealed that anxiety is a common companion for individuals diagnosed with PCOS. Approximately 50% of PCOS patients report struggling with anxiety, at a rate higher than the 39% observed in individuals without PCOS (10). This connection between PCOS and anxiety can be attributed to the hormonal disruptions inherent to the condition.
Normally, during a typical menstrual cycle in an ovulating female, the ovaries produce two primary hormones: estrogen and progesterone. Progesterone is primarily produced by the corpus luteum, a temporary structure formed after ovulation. When ovulation is infrequent or absent, in those with PCOS, the production of progesterone is compromised, further exacerbating the hormonal imbalance.
These interconnected hormonal disruptions create a domino effect within the endocrine system. Elevated levels of estrogen, combined with inadequate progesterone production, can lead to heightened cortisol levels. As previously discussed, high cortisol levels are associated with heightened stress and anxiety responses. Consequently, individuals with PCOS have been shown to have higher-than-normal cortisol levels, further exacerbating their anxiety symptoms (10).
Notably, dysfunction of the HPA axis leading to elevated cortisol levels can be a significant underlying factor in PCOS. When this occurs, it is often termed "adrenal PCOS." In cases of adrenal PCOS in women, there is typically an observed elevation in cortisol and DHEA-S (Dehydroepiandrosterone sulfate) levels compared to normal levels. DHEA-S, an androgen similar to testosterone, is produced by the adrenal glands. High levels of cortisol and DHEA-S have been associated with increased risk of anxiety disorders (45). This underscores the intricate link between PCOS, elevated DHEA and cortisol levels, and anxiety.
Additionally, another study in a sample of women with PCOS found greater concentrations of DHEA with those who had a co-occuring diagnosis of generalized anxiety disorder when compared to PCOS patients without any mood-related disorders (45). This suggests that high levels of androgens in PCOS individuals may contribute to the higher rate of anxiety and co-occurring anxiety disorders.
The approach to treating anxiety in PCOS patients revolves around addressing these hormonal imbalances. The primary goals include improving insulin sensitivity, decreasing systemic inflammation, regulating stress response, and ultimately balancing androgen levels.
If you are suddenly experiencing unexplained persistent anxiety, especially when never experienced in the past, it’s essential to consider the possibility of an overactive thyroid. When overactive, our thyroid gland causes excessive metabolism which is known as hyperthyroidism.
Hyperthyroidism occurs when the thyroid gland produces an excessive amount of thyroid hormones, known as thyroxine (T4) and triiodothyryonine (T3). These hormones play a vital role in regulating metabolism, and when they are in excess, it can lead to a stimulatory response causing several physiological and psychological changes.
One of the most prominent manifestations is an increased heart rate, known as tachycardia or palpitations. Additionally, excessive sweating that is profuse and unprovoked, nervousness, restlessness, irritability, and insomnia are seen in hyperthyroidism (38). Significant and unexplained weight loss is a frequent symptom of hyperthyroidism, often accompanied by an increased appetite. In contrast, individuals with other anxiety-related-disorders may not experience such rapid and unexplained weight changes and unprovoked excessive sweating (38).
Menopause is a significant life stage for women, marked by the cessation of reproductive cycles and a decline in the production of key hormones, primarily estrogen and progesterone. These hormonal changes can have a profound impact on various physiological systems, including the brain's intricate network of neurotransmitters and receptors (11).
During menopause, progesterone levels decline alongside estrogen. This reduction in progesterone availability can lead to decreased GABA activity, potentially making individuals more susceptible to anxiety and heightened stress responses. The diminished progesterone-GABA interaction can contribute to symptoms like restlessness, sleep disturbances, and increased overall anxiety (11). One of the most potent treatments for relieving anxiety in menopausal women is progesterone bioidentical hormone replacement therapy (BHRT) which we will discuss under treatment below.
It's important to note that hormones don't operate solo; they interact with one another and influence neurotransmitter pathways. The decline in estrogen and progesterone levels can affect not only progesterone and GABA but other factors like serotonin, cortisol, epinephrine, and norepinephrine are also impacted.
Estrogen has an intricate relationship with serotonin, as it has been shown to influence the production and regulation of serotonin receptors in the brain. When estrogen levels drop during menopause, it can impact the availability and functioning of serotonin, potentially leading to mood disturbances like anxiety and depression. Serotonin is involved in memory and concentration. Therefore menopausal women experiencing fluctuations in serotonin levels may report “brain fog” or difficulties with focus and memory. These cognitive changes can contribute to feelings of anxiety.
The activity of the body’s autonomic nervous system, (related to the fight or flight response) where key players like cortisol, norepinephrine, and epinephrine operate, may play a role in anxiety experienced by some menopausal women. Cortisol levels tend to naturally increase in age with both men and women (40). Cortisol increases particularly in the late menopausal transition stage due to fluctuations in estrogen and FSH (follicle-stimulating hormone) levels. Estrogen appears to have a regulatory effect on cortisol levels therefore the lower levels of estrogen that naturally occur at this time, can lead to a dysregulation of cortisol, exasperating stress and anxiety. One study found that this elevation in cortisol is independent of social stressors and is likely due to these hormonal fluctuations that occur (40). They also found epinephrine and norepinephrine, indicators of sympathetic nervous system activation, were significantly related to the elevated cortisol levels found in menopausal women (40). Studies of women experiencing hot flashes, a common menopausal concern, indicate that a cortisol rise follows hot flashes (40). Dysregulation in these neurotransmitter systems can further contribute to mood disturbances and anxiety (11). A lack of estrogen can also lead to vaginal dryness, weight gain, depressed mood, brain fog, and more. Additionally, it raises chances of developing osteoporosis, cardiovascular issues, and dementia. If you struggle with any of these symptoms along with anxiety at this stage of life, treatment with combined estrogen and progesterone BHRT may be an effective treatment option for you! After receiving comprehensive lab testing, we work to identify what hormones may be in need of a boost to bring your body back to a calm and balanced state.
Addressing these hormonal and neurotransmitter imbalances through a comprehensive naturopathic approach can offer valuable support in managing anxiety during this life stage.
Conventional treatments tend to target the hyperactivity of emotional processing centers in the brain such as the amygdala and increase the availability of “feel-good” neurotransmitters like serotonin and increase inhibitory neurotransmitters that promote relaxation like GABA.
For example, SSRIs (selective serotonin reuptake inhibitors) and SNRIs (selective norepinephrine reuptake inhibitors) which include Paxil, Zoloft, Prozac, and Lexapro are designed to target this hyperactivity in the brain. They are considered the first-line medication for GAD. SSRIs generate multiple billions of dollars in sales each year and are not without side effects.
SSRI common side effects and risks include:
However, studies show that 30-40% of people who take SSRIs and SNRIs for anxiety do not improve (9). This finding reflects that the underlying cause of patients’ anxiety may be often overlooked.
Although Benzodiazepines may have a calming effect on the body, they are highly addictive and can lead to several symptoms, particularly in individuals who abuse them. Almost every month, new information is released about the risks of hypnotic and sedative medications (also known as sleeping pills). Benzodiazepines belong to a sedative class of drugs and are the most commonly prescribed class of anxiolytic drugs and considered a second-line medication for GAD. Examples include Xanax, Ativan, and Valium. They work to target GABA receptors. While they have been proven to be effective for short term use (2-4 weeks), they are unsafe for continuous use (26). The recommended doses objectively increase sleep quality only slightly, while daytime performance for individuals often worsens, and the lack of general health benefits is commonly misrepresented in advertising (42). Due to the natural effects of building tolerance in the body, individuals will eventually require higher doses as time goes on while taking them, leading to greater risk of side effects, accidental overdose, and addiction (43).
Regular use of benzodiazepines may cause (43):
When/if the dose is cut down, withdrawal symptoms tend to emerge. This can become dangerous and even life-threatening.
Withdrawal of benzodiazepines can lead to the following symptoms (43):
Often times hypnotics are prescribed to help improve sleep dysfunction associated with chronic anxiety.
These pharmaceuticals come with a host of adverse effects, including disruptions to the natural sleep cycle, compromised nervous system functioning, lingering sedative effects throughout the day, insomnia, respiratory issues, and even risks to one's immunity (37). Shockingly, the use of sedative drugs can lead to an increased risk of cancers by up to 30% after 2 or more years use. The mechanism that is proposed to cause this increased risk is through sedative-hypnotic drugs' ability to transform normal cells into cancer through disruption or breakages of chromosomes (42). Furthermore, habitual use of sleep medications can lead to the development of tolerance, resulting in withdrawal symptoms and increased insomnia upon discontinuation (37).
Due to the wide-array of side effects, limited proven anxiolytic benefits, and failure of these medications to target the underlying cause, it is imperative, in accordance with the naturopathic principle of ‘first, do no harm,’ to look to alternative and complementary therapies to impact the pathophysiology of anxiety. At Natural Med Doc, we provide both safe and effective treatment options for bringing you back to a balanced and calm state of mind.
A naturopathic approach to anxiety begins with careful observation of the underlying causes and contributing factors to the condition. Since the causes of anxiety are complex and not always treatable using a universal approach, treatments at Natural Med Doc start with strategic and comprehensive lab testing and analysis. This gives insight to the multi-dimensional nature of physiologic manifestations contributing to anxiety.
With an oftentimes complex picture of anxiety, we take a complex treatment approach. Depending on the cause of anxiety, naturopathic treatments may include lifestyle and dietary changes, herbal supplementation, hormone replacement therapy, and vitamin and mineral supplementation.
High levels of anxiety can often be traced back to an imbalance of hormones. Bioidentical hormone replacement therapy (BHRT) is a form of hormone replacement therapy that uses human identically structured hormones to help correct excess or deficiency of sex hormones. To
BHRT is tailored to our patients’ hormonal needs and medical history with a thorough intake. A naturopathic provider experienced in hormone therapy will assess the individual's hormone levels through comprehensive lab testing, and thorough history taking to determine the appropriate dosage and regimen of bioidentical hormones.
Research into BHRT is ongoing, but encouraging findings suggest that BHRT may effectively enhance sleep patterns, reduce anxiety levels, and provide increased energy (14). These promising results indicate that hormone imbalance therapy holds the potential to alleviate symptoms of anxiety.
In addition, we see these positive effects of BHRT on anxiety, sleep, and energy in our practice at Natural Med Doc on a daily basis.
It's important to note that while BHRT can provide relief for some individuals with anxiety, it may not be effective for everyone. Anxiety is a complex condition with various underlying factors, and its management often involves a comprehensive approach that may include therapy, lifestyle changes, and supplementation.
Let's explore the significant impact of BHRT in addressing the dysregulation of hormones such as progesterone, estrogen, and testosterone, along with other natural strategies for precision-targeted anxiety treatment.
As previously discussed, progesterone enhances mood and helps relieve anxiety. Anxiety tends to rise as a result of hormonal imbalances involving lower progesterone levels, such as menopause, estrogen dominance, PCOS, and the progesterone steal.
Bioidentical progesterone replacement can help treat these conditions and more, including but not limited to PMDD, migraines, endometriosis, adenomyosis, and climacteric symptoms, brain fog, low energy, weepiness, depression, sleep dysfunction.
Progesterone replacement therapy helps to treat PCOS by lowering androgens, such as testosterone and helping to restore ovulation (10).
Researchers have shown that progesterone appears to be the most potent anti-anxiety hormone for menopausal women (13).
A study conducted by the University of Texas Health Center’s Women's Wellness Center found that women who received BHRT experienced “significant relief” of anxiety symptoms, depression, and the physical changes associated with menopause (14).
The amount of research displaying the vast benefit of progesterone replacement is already substantial and continues to grow. In addition to research based evidence supporting the benefits of bioidentical progesterone replacement, we regularly see the dramatic changes in our own patients.
Progesterone levels naturally decline during menopause, perimenopause, and even ovulating cycling women which can lead to increased anxiety.
BHRT helps restore the natural hormonal balance, and supplementing with bioidentical progesterone can mitigate the impact of these fluctuations on mood and anxiety. If you struggle with anxiety or the symptoms listed above, callI today to see if you are a good fit for Progesterone replacement therapy.
Estrogen replacement therapy and mood:
Recent research indicates that estrogen administration exhibits improved cognitive performance and reduced anxiety in menopausal women (41). 80% of menopausal women randomized to estrogen and progesterone combined HRT reported significantly decreased mood symptoms after three or six weeks, compared to only 22% of women on placebo (46). Estrogen can influence the production and activity of neurotransmitters including serotonin, often referred to as the “feel good” neurotransmitter because it can contribute to feelings of well-being and happiness. Estrogen replacement therapy can potentially enhance serotonin function, leading to improved mood and reduced anxiety. Estrogen also has neuroprotective properties, meaning it can help protect and maintain nerve cells in the brain. Some research suggests that estrogen may have a role in preserving cognitive function and emotional stability (41). By supporting brain health, estrogen replacement therapy may help mitigate anxiety-related symptoms such as cognitive difficulties and mood disturbances.
Other benefits of estrogen replacement therapy:
Estrogen also plays a crucial role in maintaining the health, lubrication, and elasticity of vaginal tissues. If you are experiencing vaginal dryness, estrogen therapy may be the answer. Additionally, signs of low estrogen in menopausal women like hot flashes, low libido, weight gain, and brain fog can be targeted through estrogen replacement therapy.
Once your period stops in menopause, the uterine lining remains in place. Taking estrogen causes the lining to thicken which can increase risk of endometrial cancer. Therefore, adding progesterone to estrogen BHRT keeps the uterine lining thin and reduces the risk of cancer.
Testosterone is a hormone that is typically associated with male reproductive health and sexual function, but it also plays a role in overall well-being and mental health for both men and women. While the relationship between testosterone and anxiety is complex and not fully understood, there is evidence to suggest that testosterone levels can influence mood and anxiety.
Some studies suggest that low testosterone levels may contribute to mood disturbances, including increased anxiety and irritability (15). Testosterone replacement in individuals with clinically low testosterone levels might help improve mood stability and overall emotional well-being. Individuals with low testosterone levels might be more susceptible to stress-related anxiety (15). By restoring testosterone levels through TRT, some individuals may experience improved stress tolerance and reduced anxiety.
Research has shown that men with hypogonadism who undergo testosterone replacement therapy (TRT) experience a notable reduction in anxiety (16). While part of this positive change might stem from the alleviation of additional symptoms such as depression and sexual dysfunction, the impact of testosterone on anxiety levels is believed to be independent of other factors—and this influence is not exclusive to men.
In a study published in Psychoneuroendocrinology in 2016, a significant correlation was revealed between testosterone levels and anxiety in women. The study found that women diagnosed with social anxiety disorder (SAD) exhibited diminished gaze avoidance and reduced aversion to images of angry faces—two fundamental characteristics of SAD—after undergoing testosterone treatment (17).
A healthy testosterone level is often associated with traits such as confidence, assertiveness, and self-esteem. Higher testosterone levels might contribute to a sense of self-assuredness, which could indirectly influence anxiety levels by enhancing an individual's ability to cope with stressors and challenging situations.
At Natural Med Doc we find Testosterone replacement therapy to be highly beneficial for both our male and female patients to help resolve symptoms such as anxiety, fatigue, low libido, low confidence, and low motivation. Reach out today if this sounds like you!
Selank is a synthetic peptide therapy from tuftsin which is a naturally occurring peptide vital for immune system regulation. Selank is an anxiolytic peptide that stimulates GABA receptors and regulates cortisol levels in the body. Research has shown that Selank can also help regulate healthy levels of serotonin and dopamine in the brain (18). By balancing these chemicals, Selank may help promote feelings of relaxation and calmness.
Peptide therapies are newer cutting edge therapies that may not be offered by your PCP. If you are interested in Selank or learning more about the peptides Natural Med Doc offers call our office today!
L-theanine is a naturally occurring amino acid first discovered in green tea leaves and a well-known anti-anxiety supplement with proven benefits (19). L-theanine directly boosts GABA and other calming brain chemicals we’ve discussed like serotonin and dopamine. L-theanine additionally enhances alpha brain waves (20). Alpha brain waves are known to promote a state of “wakeful relaxation” which makes L-theanine attractive for its ability to relax individuals without feeling groggy or fatigued during the day.
Suggested dose: 200-400 mg (26).
As we mentioned, GABA is the brain primary inhibitory neurotransmitter that stimulates as feeling of relaxation. A GABA deficiency can lead to feeling easily overstimulated, overwhelmed, and stressed. Supplements that contain synthesized GABA may help remedy this. Anxiolytic drugs like xanax and valium as well as benzodiazepines work to help GABA bind to appropriate receptors in the brain. As we know these drugs can have several unwanted side effects, making synthetic GABA a natural alternative. GABA supplementation has also been shown to increase alpha brain activity and boost immune function in individuals who are predisposed to stress (21).
Suggested dose: 500-750 mg 30 minutes before bedtime (26).
The benefits of ashwagandha have become more and more popular. Ashwagandha is an herb known best for its adaptogenic properties, meaning it helps the body adapt to stress. Several studies have shown that ashwagandha has positive effects in calming stress and anxiety (22). It is hypothesized to have stress-reducing qualities by targeting the hypothalamic-pituitary adrenal (HPA) axis to regulate stress hormones. It also influences GABA levels in the brain. There are several other potential benefits of this well-researched herb such as improving athletic performance (23), blood sugar regulation (24), and anti-inflammatory effects (25). A noteworthy clinical study conducted by Cooley et al. contrasted naturopathic care involving the supplementation of Ashwagandha with standardized psychotherapy. In this randomized clinical trial, the group receiving naturopathic care exhibited notably superior enhancements in anxiety indicators when compared to the psychotherapy group (28).
Suggested dose: 500 - 600 mg daily (standardized extract 1.5% withanolides) (26).
Cortisol Manager by Integrative Therapeutics contains a blend of ashwagandha, L-theanine and other adaptive and balancing herbs like Magnolia (Magnolia officinalis) and epimedium (Epimedium koreanum), as well as phosphatidylserine from soy lecithin which have been shown to help adapt to stress and decrease cortisol levels (29). This blend is designed to restore natural healing systems of the body to help overcome and resist both mental and physical stress symptoms.
There is substantial literature suggesting that chamomile (and several of its flavonoid components) may have anxiolytic and antidepressant activity in the body (35). Chamomile may produce an anxiolytic effect by targeting GABA, adrenaline, dopamine, and serotonin through its flavonoid constituents. One study found that a derivative of chamomile was 30-times more potent than diazepam at a benzodiazepine receptor in the body, producing a potent anxiolytic response (35). With benzodiazepines being the mainstay therapy for GAD, chamomile and other well-researched anxiolytic herbs may provide an alternative approach to anxiety management.
Suggested dose: 800-1600 mg 30 minutes before bed (26).
In the realm of non-pharmaceutical solutions for anxiety disorders, particularly in the context of sleep disturbances, Valerian Root emerges as a potent botanical remedy. Extensive research has shown the substantial benefits of Valerian in enhancing not only the quality of sleep but also in alleviating symptoms of anxiety and depression (36). This discovery holds immense significance, particularly when we consider that sedative and hypnotic drugs are frequently prescribed to combat anxiety-related sleep disorders, such as insomnia (37).
Remarkably, Valerian Root has demonstrated its efficacy in aiding the onset of sleep and enhancing sleep quality, even among children struggling with mental disorders like anxiety, ADHD, and depression (36). The mechanism through which Valerian achieves these therapeutic effects appears to involve the inhibition of neurotransmitter uptake and the stimulation of release, particularly in the case of GABA (36). Additionally, recent findings suggest that Valerian acts as a partial agonist on adenosine and serotonin receptors (36), shedding light on its ability to improve sleep quality and soothe an anxious mind.
Suggested dose: 300-600 mg before bedtime (26).
Clinical studies have shown that kava and kavalactones are effective in the treatment of anxiety at subclinical and clinical levels, anxiety associated with menopause, social anxiety disorder (SAD), and GAD (39). Kava has demonstrated anxiolytic properties of promoting relaxation and improving sleep quality through a proposed mechanism of enhancing GABA and diminishing adrenaline (39). One study revealed reduced symptoms of SAD with individuals reporting feeling more relaxed in social settings (39). Some studies have found that kava can help individuals with SAD feel more relaxed in social situations. Another study indicated that kava had the potential to enhance libido in menopausal women, which correlated with reduced anxiety levels (27).
Suggested dose: 200-250 mg kava lactones daily (26).
In this fast-paced world we live in today, anxiety has become a common shadow for many. While it is a natural and beneficial emotion in moderation, it can spiral into an anxiety disorder when left unchecked. This complex condition is often driven by an interplay of biological factors, psychological mechanisms, and environmental influences which make it crucial to explore comprehensive and personalized treatment options. Conventional and common treatments for anxiety like SSRIs and sedatives may not address the underlying causes of anxiety and can come with severe side effects.
Here at Natural Med Doc, we emphasize a naturopathic approach that starts with a deep understanding of each individual’s unique health picture and circumstances. Through a thorough intake and lab testing, naturopathic doctors analyze to uncover the multidimensional nature of psychological manifestations that contribute to anxiety. Reach out to your local naturopathic doctor today!
Our treatment strategies encompass a wide range of options that will be personalized to best suit each individual supported by both research and anecdotal evidence. These include lifestyle and dietary changes, herbal supplementation, bioidentical hormone replacement therapy (BHRT), and vitamin and mineral supplementation. We aim to guide you on your journey to return home to a balanced and calm state of mind.
If you are interested in getting started today, or have more questions. Click the link below to schedule a 15 minute free consultation with our health advisor or call our new patient line at 480-630-9093 Ext 1.
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