"Dr. Katie, does magnesium work for anxiety?" This questions, and variations of it, is one of the most common off the cuff questions I get asked, both in my practice and when I'm out in the community. In some ways the answer is straightforward, the evidence of efficacy (or if something works) for a particular ingredient (say magnesium) is easy enough for me to assess. However, the full answer is more complicated. Many factors contribute to whether or not a particular supplement is effective for anxiety. This is complicated by the fact that when someone asks "does something work for anxiety?" they are almost always asking "will this work for me?"
These are related but different questions. "Will this work for me?" is a more complicated question involving not only the efficacy of the supplement but an individualized assessment of each person's experience, and a deeper understanding of how each supplement effects an individuals mind body and spirit. This process doesn't lend it's self well to lists, but I've done my best, and so here it is, the seven things I always consider when answering "does this work for anxiety" for my patients.
This is the first thing I consider when someone asks "does something work." Evidence comes in a variety of forms, which are graded in Evidence Based Medicine. Evidence ranges from historical use of a product, to our understanding of how something would support normal body functions, to case reports, clinical trials and meta-analysis (where the results of several clinical trials are amalgamated.) Some remedies have been studied in clinical trials, when that has been done it is important to include that information in assessing whether a supplement will work for an individual. Regardless of whether or not a meta analysis is available, the highest level of evidence available is used to determine the supplements efficacy.
The form of a supplement is something that can greatly impact efficacy, even between two of the "same" supplements. When it comes to herbal medicine there are a variety of ways to take different herbs. Some herbs may be available in a tea, some in a capsule, and others in an alcohol extract called a tincture. Different herbs are more effective when extracted in water vs alcohol or vice versa. Knowing what form is going to be effective is an important part of know which anxiety supplement is going to work. In nutrition supplementation, different forms of vitamins and minerals are more readily absorbed by the body. Some individuals may require or respond better to forms of vitamins that are in their most active form, especially if they are unable to activate them themselves. These factors are important, because the right dose of an effective ingredient is not helpful if it is not effectively absorbed. Form can greatly impact the efficacy of a supplement and is an important consideration when asking "does this supplement work?"
Dosing is another important factor when considering the effectiveness of a supplement. If an ingredient is effective, but a supplement does not have sufficient amounts of the at ingredient, the supplement may not work. This is not a fault of the ingredient it's self but a reflection of the amount of the ingredient in the product. Also dosing may be different for the same supplement for different conditions and for different individuals. For example, the dosing of NAC is not the same in OCD as it is for influenza, even though NAC is effective for both conditions.
Quality of supplements is also a factor when determining if something is going to work. In herbal medicine, where and how the plant was grown, how it was harvested, stored and prepared can all impact the medicinal effects of the supplement. I am quite partial to herbs that have been wild harvested or grown organically. The struggle of the herbs to grow in their natural environment encourages the creation of the medicinal compounds in the plant.
Anxiety doesn't look the same in everyone. Some people have difficulty breathing, Others experience more tension in their bodies, some may be unable to concentrate due to repetitive thoughts and worries. Some experience digestive discomfort. Each of these presentations can be labeled "anxiety", but different supplements are more indicated for certain presentations of anxiety. How severe someone's anxiety is informs the dosing and choice of a supplement. While some individuals may respond best to gentler treatment, others may need a more aggressive approach. Something that works well for someone may not be the best dose to work for someone else. Anxiety is something that encompasses a variety of different diagnosis. Some individuals experience anxiety all the time, such as in Generalized Anxiety Disorder, others may experience anxiety in only certain social situations. The supplement and dosing used in each of these situations is different, and should be different.
I almost didn't include this one because it is so obvious but it is the most important. If a supplement is going to be effective, it has to be safe for the patient to take. Safety in supplements is not something I take lightly. Just because you can pick something up off the shelf at a health food store does not mean it is without risk. We are lucky in Canada as all of our supplements are quite highly regulated and are unlikely to be contaminated however, just because a supplement is what it says on the bottle does not necessarily make it a good choice, or a good choice for you. A supplement may be safe for some people and not others. It's always a good idea to consult a health care provider when taking a new supplement especially if you have a disease or disorder, you are taking pharmaceutical or over the counter medication, or you are pregnant or breastfeeding.
Lastly, I think it's very important to take into account your own intuition about what is happening in your body and what you think will help you. In my practice I value what my patients think about their bodies and acknowledge that they have access to their own bodies wisdom. I also consider my own intuition, not above issues of safety and evidence of efficacy, but alongside the patients experience. In this way I strive to find the supplement that matches the patient not only in their body, but is an energetic or spiritual match as well.