Yahoo Movies Anxiety supplements: Miracle cure for symptoms or an opportunistic scam?
Vitamin D supplements have been found to help with anxiety - for those who suffer from a deficiency, according to a 2020 study published on Brain and Behaviour. As someone with severe health anxiety, Anna Naughton went straight to her local Tesco and bought a packet. She, her husband and their children took the vitamin daily.
Within a few weeks, she began to notice that the knot of anxiety in her stomach, a near-constant presence for 10 years, had started to unravel. “My anxiety used to be really strong around health stuff: a headache was never just a headache, it was a brain tumour; it wasn’t a tummy ache, it was cancer,” says Naughton, 44.
“The pandemic should have been my worst nightmare, but I was very calm and measured.”
The fact that her husband is a paramedic, exposed to the virus every day, would have been cause for anyone to be anxious, but instead Naughton took the approach that whatever happened, they would cope. “Even though things in the world were getting worse, I seemed to be dealing with it better than I usually did.”
Eight years ago Naughton’s GP prescribed her anti-anxiety medication, which helped enormously, but still, every six to eight months she would have what she calls a “banger” – a two-week period of high anxiety.
Since taking the supplement, however, she has not had any episodes. “It’s been three years since I’ve had a ‘banger’, which coincides with the time I have been taking vitamin D.”
Naughton is not alone in believing vitamin and herbal supplements can help anxiety and depression. Once upon a time, we would take vitamin C for colds and cod liver oil for aching joints, but now products with names such as Ultimate Calm, Happy Me and Destress (which costs $55 – about £46.50 – for 60 capsules) have popped up on pharmacy shelves and stylish lifestyle websites such as Gwyneth Paltrow’s Goop.
Each promises to lift your mood, help you find calm, and combat stress using a “powerful” and “unique blend” of ingredients, some in pharmaceutical-style bottles. Some are modestly priced, while others will cost you more than £100 a month.
Britons spend almost half a billion pounds on supplements each year. According to the market research company Mintel, 60 per cent of British people took them at some point last year – 34 per cent every day. In 2013, we spent £417 million on them in the UK; by 2023, that figure should rise to £477 million. Worldwide, the total will be around £200 billion.
It is a growing area. Global sales of brain health supplements alone are expected to reach $15.74 billion (£13.11 billion) by 2030 as we look for over-the-counter solutions to anxiety and depression, and help with memory and focus.
This boom can perhaps be linked to the growing global prevalence of anxiety and depression, exacerbated by the Covid-19 pandemic. In March, the World Health Organisation reported a 25 per cent rise in these mental health conditions globally during the first year of the pandemic.
Referrals for specialist NHS mental health services, meanwhile, have reached an all-time high, according to the Royal College of Psychiatrists. They found the NHS had 4.3 million referrals for conditions such as anxiety and depression in 2021.
It is little wonder many vulnerable people are turning to supplements, often marketed as a “natural” quick fix. But do they work?
Doctors, unsurprisingly, are sceptical, citing a lack of evidence to support the use of supplements for mental health conditions. Paul Blenkiron, a consultant psychiatrist and fellow of the Royal College of Psychiatrists, says: “I would never blame anybody for wanting to find a solution to their depression or anxiety, especially if nothing else has worked, but I would never recommend something to a member of my family that had not been rigorously tested.”
His concern is that supplements are not required to undergo the same level of research that medication is, which means that you cannot be sure of the quality, purity and quantity of the active ingredient. “So if you look at something like CBD [cannabidiol, a compound found in cannabis plants] supplements, it is by no means certain that the right amount is there to have an effect, even if there might be a benefit at a different concentration,” he says.
What’s more, we might think that “natural” means “safe”, but Dr Blenkiron points out that is not always true. “Botulinum toxin (from bacterium) is used in cosmetic procedures, and digoxin (from the foxglove plant) is a treatment for heart problems,” he says. “Both are 100 per cent natural. But in the wrong amounts and in the wrong hands they can be highly dangerous.”
Other concerns arise around the lack of evidence that some of these products work. “Compared with other treatments, such as traditional medications or psychotherapy, supplements fall short,” says Carmine Pariante, a professor of biological psychiatry at King’s College London.
While some can be harmless, others carry risks if taken in combination with other medications. St John’s Wort, for example, can stop the contraceptive pill from working.
“I work in complementary health, and if someone came to me with depression I would not recommend supplements in the first instance – and never as the only approach,” says Ian Marber, a nutritional therapist.
“First of all, it’s not my remit: I would recommend they speak to their GP first and seek their guidance. Second, the people who give you information about these products are, 99 per cent of the time, the people who sell them, so often what we might read about the potential of supplementary nutrients is sourced from people with a vested interest.
“I am not cynical about these things – I know their potential – but unless people go through a responsible complementary practitioner, they have no way of gauging the outcome. We need someone to agree when to finish with [a supplement]; agree when to review. At the moment they are all too often self-prescribed and people take some supplements ‘just in case’.”
Marber suggests a degree of certainty is needed. “If you have a headache and you take ibuprofen... we know what dosage to take to affect an outcome that we can predict or that we want. Natural products don’t always have that benefit. You can’t necessarily establish the optimum dose, because there are other things at play, such as diet, physiology, medical history and so on.”
No universal remedies
Medical herbalist Pamela Spence agrees that such supplements should be taken with expert supervision. “I absolutely see herbs changing people’s moods and shifting mild to moderate depression,” she says. “But one size does not fit all; all our lifestyles are different.
“St John’s Wort, for example, is a useful herb for mild to moderate depression, but it does not suit everybody. I have come across a couple of people who felt really low after taking it while others swear by it.
“If your depression is linked to hormonal imbalance, then that is what needs to be treated. You have to understand what is happening in the body to cause the symptom. You need to ask, ‘What’s my lifestyle like right now? What’s my diet like?’”
She also suggests there is a reason that, anecdotally, people swear by herbal remedies, yet scientific support for their effectiveness can be weak: laboratories often test just one chemical at a time (for instance, the curcumin in turmeric), while many plants are best when used as a whole.
Spence still urges caution, however. “I would not use herbs to treat deep depression,” she says. “I feel that is a place where pharmaceuticals work far better.”
Pariante and Blenkiron agree with Spence that by self-diagnosing and treating anxiety or depression with over-the-counter remedies, people could be missing an underlying health condition, such as thyroid or hormonal issues or another chronic illness.
They also share concerns around the cost of some of these supplements. “I’ve come across people buying CBD oil for hundreds of pounds,” says Spence. “It should not cost that much.”
Blenkiron agrees. “We used to have various charms and ways of warding off evil spirits,” he says. “We do exactly the same thing these days by going to Boots or Holland & Barrett. Looking at what’s on the shelf, many supplements will include a strong placebo effect.”
The power of placebos
Some experts believe the only reason people report feeling better after taking vitamin supplements is because of their expectations: if a person expects a pill to do something, then it is possible that the body’s own chemistry can cause effects similar to what they expect to happen.
For instance, in one study people were given a placebo and told it was a stimulant. After taking the pill, their pulse rate sped up, their blood pressure increased, and their reaction speeds improved. When people were given the same pill and told it was to help them get to sleep, they experienced the opposite effects.
In another study, published in the journal Psychosomatic Medicine, 40 asthmatics were given an inhaler containing a placebo that was just water vapour, but were told it contained allergens that would restrict their airways. Nineteen suffered considerable constriction of their airways, while 12 of them experienced a full-blown asthma attack. When they were given a different inhaler and told it would relieve their symptoms, it did – even though it was also a placebo.
“Some people think there is a genuine biological effect on the brain and the immune system, but we don’t know exactly why that would be,” says Blenkiron. “And interestingly, even if people know they are being given a placebo, it can help.”
Beyond lab conditions, there are many other reasons a supplement could help, even if the active ingredient is not proven. “Sometimes the person is getting better naturally anyway,” says Blenkiron. “Or it could be that if you expect something to improve you, you then change your behaviour in other ways. So if you think that a supplement will make you feel more energetic, you might go to the gym more.
“You think the placebo has worked, but actually it is the change in behaviour that helps. There is nothing wrong with that.”
He does not believe it is ethical to sell a placebo and pretend it contains active ingredients, however. “I think it would be wrong to pretend it works if there is no scientific evidence,” he says. “I’m not going to stop taking a supplement if it does no harm – but what if it does? Does it have side effects?”
As for Naughton, she admits that the improvement to her anxiety could be down to many factors: the fact that we all had to slow down in the pandemic, for instance; she also took redundancy from a stressful job and now has time to go for walks. But she is sure that vitamin D has played a big part as tests with her GP on the level of the vitamin in her blood showed that while she was in the normal range, she was on the very low end, as many of us are in countries with low sunshine. She told her GP about taking the supplement and her GP supports her.
She will not come off her traditional medication. “I’ve tried to come off the meds a couple of times over the years but I can feel myself get progressively worse – I suspect I’ll be on medication for the rest of my days. But I am OK with that. If I had asthma I’d take an inhaler, and if I had diabetes I’d take insulin – it’s the same with anxiety.”
Vitamin D - too much of a good thing?
Britons spend £200 million annually on vitamin D supplements, whether it is in the form of pills, capsules, gummy sweets, mouth sprays or oils. The Covid pandemic has added fuel to our national obsession, after widespread claims that the vitamin could not only prevent, but also treat the virus. However some studies have found no strong evidence to support the benefit of taking vitamin D – and what’s more, a recent case shows that taken at too high a dose it can do harm.
A middle-aged man from Kent became ill, losing two stone in three months after suffering constant vomiting, diarrhoea and stomach pains, after taking a daily cocktail of 20 over-the-counter supplements. It turned out he was taking 375 times the recommended vitamin D dose. Blood tests showed his vitamin D levels were seven times above normal and he had suffered kidney damage.
The doctors who treated him warned that his case “further highlights the potential toxicity of supplements that are largely considered safe”.
Vitamin D is called the “sunshine vitamin” because we get it through sunlight. It helps to regulate the amount of calcium in the body, keeping bones, teeth and muscles healthy. NHS advice is that everyone should consider taking a daily vitamin D supplement during the autumn and winter. But taking too much can cause excess levels of calcium to build up in the body, making the kidney work harder to filter it.
The traditional route
Traditional medication works for two-thirds of people with mental health issues, while cognitive behavioural therapy, available on the NHS, has also been proven to help. Research also shows that daily exercise and social contact have benefits.
“CBT is a talking therapy that has a pretty big evidence base for many common mental health problems, like anxiety and depression,” says Blenkiron. “It can work in three-quarters of cases, and its effects are probably longer lasting than medication because you are learning new skills and ways of coping. If you add it to prescription tablets, it has a bigger effect. It’s the treatment of choice.”
You can refer yourself for CBT through the Improving Access to Psychological Therapies (IAPT) service on the NHS website. The Royal College of Psychiatrists website also has information on talking therapies.
Lifestyle changes can help too. For anxiety, Ian Marber recommends “removing anything that stimulates the central nervous system, such as caffeine”.
Popular supplements analysed
St John’s Wort
A traditional herbal remedy used to treat low mood.
The proof
Dr Paul Blenkiron says: “There is evidence that it works from at least three randomised controlled trials. However, NICE guidelines for depression don’t recommend it. It’s not because it wouldn’t work; it’s because you can’t guarantee the concentration that would work. When you buy it on the high street, you don’t know how much you are getting.”
He says that he would support a patient using St John’s Wort, but warns it has side effects: “It can cause headaches, or a rash when you’re in the sunlight. It can also reduce the effectiveness of the contraceptive pill, so you should treat it like a medication.”
Vitamin D
Painful joints, depression, cancer and even Covid – vitamin D supplements have been touted as a remedy for all of these, and more.
The proof
Pariante says vitamin D is important for the function of the brain and immune system, but he is unconvinced there is a widespread need for supplements: “There is some evidence, but not all studies are positive. If people have adequate exposure to sun or vitamin D through dietary sources, they shouldn’t take supplements. If you have a very restricted diet and low exposure to sun, it can be taken – but do a measure of vitamin D levels with your doctor.”
Valerian
Valerian is a herb known for its calming, sedative effects. People have claimed that it helps reduce feelings of nervous tension and helps improve sleep.
The proof
Prof Carmine Pariante says: “The quality of the evidence is low, but there is some positive evidence of improving sleeping. We know that it’s been used for years and the risks attached to it are low, so it’s safe to use.”
Medical herbalist Pamela Spence says: “I typically notice a difference in a patient’s symptoms around ten days in, if it’s going to be the right herb for them. Often the quickest thing to change is the feeling of nervous tension.”
Nutritional therapist Ian Marber recommends Valerian tea at night.
Prebiotics and probiotics
Much has been written lately on the “mind-gut” connection, with speculation that boosting good bacteria through prebiotics and probiotics can help our mood.
The proof
Pariante says: “The gut is a super hot area, but on balance [studies on the effectiveness of these supplements] haven’t delivered yet as much proof as one would have hoped. There have been some clinical trials, but the results have been a little bit disappointing. On the positive side, the risk [of taking them] is very low, but they should not be considered as a therapy for depression.”
Omega-3 Fatty acids
Both omega-3 and cod liver oil capsules contain the essential fatty acids EPA and DHA, which are thought to help many aspects of mental and physical health.
The proof
Pariante says: “There is good evidence that it works. They are particularly effective together with other antidepressants. They are anti-inflammatory, which helps reduce any inflammation in the brain and in the body and this facilitates the action of antidepressants. My preferred use is when someone is on antidepressants and is not responding well, or when there is clear evidence of inflammation, which happens with cardiac conditions or metabolic disorders.”
However, he warns, you have to take a lot. “The dose that is effective is much higher than the one you buy in the supermarket. People should really take one gram of EPA.” Standard supplements might have 250 micrograms of EPA – which would mean taking four fish oil tablets a day. There are some studies that a lower dose in the general population can help prevent depression, but they are not strong enough if you are already depressed.”
Spence says: “Every single body needs omega-3 to function, so if your mood issues are caused by the fact that you do not have a diet rich in omega-3, then you will find a difference. But if that is not the case of your problems, taking fish oils will mean you don’t see any difference. It’s about understanding what has caused the problems.”
Marber warns that fish oils might also cause blood thinning and you should consult a doctor before taking them if you are on blood thinners, such as warfarin.
5HTP
5-hydroxy-L-tryptophan, known as 5-HTP, is a naturally occurring amino acid which is a precursor to serotonin, a neurotransmitter involved in mood regulation and appetite.
The proof
Blenkiron says: “It does have an evidence base for working and I have prescribed it. It’s gone out of fashion a bit because first line antidepressants, like SSRIs (Selective Serotonin Reuptake Inhibitors) are more likely to be effective.”
Pariante says: “It could help people who have treatment-resistant depression – who have tried different antidepressants and they don’t work – but I wouldn’t recommend it for most people. There are risks associated with it. If you take it with an antidepressant and are not supervised by a doctor, you can have too much serotonin in the brain, which can make you become anxious. Serotonin isn’t always good.”
CBD oil
CBD, or cannabidiol, is a legal cannabinoid that comes in many forms, the most popular being an oil – which users spray under their tongue – or gel tablets, which melt slowly in the mouth. It is marketed as a way to relieve anxiety.
The proof
Blenkiron says: “I think it has been overcooked as a solution to problems. I’m not aware of any strong evidence that CBD oils sold in health food stores have health benefits, and I do know there are side effects: it can cause sleepiness, impact movement, and cause weight gain.”
Spence chooses not to work with CBD. “It’s OK for some people, but not for everyone. There are so many other herbs that are less complicated and less controversial.”
Marber says: “Thankfully the love affair with CBD is over. The trials were iffy and the claims were unsubstantiated.”
The low-down on pricey brands
From left: Solgar Ultimate Calm, £29.99; Nue Co DeStress 360, £45; J S Health Anxiety + stress formula, £31.99; HappyMe, £36.99
Solgar Ultimate Calm, Cult Beauty
Dr Blenkiron says: “It claims to ‘help promote a positive mood’ which is not a definite promise of any specific effect, but I wouldn’t discourage someone from taking it if it was helping.”
Medical herbalist Pamela Spence says: “I like the ingredients, especially ashwagandha, which is proven to help with stress.”
Nue Co DeStress 360
Blenkiron says: “This has a long list of ingredients. If one of those substances really worked, why would you need all of them? There are possible benefits, but a placebo-controlled trial would be the way to sort out whether this would give you better mental health than a dummy pill.”
Spence says: “Too flash, and trying to do too many things.”
JS Health Anxiety + stress formula
Blenkiron says: “It says it ‘supports mental wellbeing, helps the body adapt to stress, promotes serenity’ – these words are sufficiently loose that it would be hard to disprove them.”
Spence says: “It includes passionflower which stands up well in trials, helping with anxiety and insomnia.”
HappyMe, Vesa
Blenkiron says: “The name may well help people believe it will work, and it is hard to say it will not support your wellbeing if you believe it will. This is more about marketing than science.”
Spence says: “It contains schisandra and rhodiola, which are well-studied as herbs that help us cope with stress.”
This article is kept updated with the latest information.
