Kava for Anxiety

February 6, 2013 Written by JP       [Font too small?]

In the healthcare field, there is a myth known as the “magic bullet”. Essentially, it is the holy grail of all therapies, one that heals a disease or relieves symptoms without producing any adverse reactions. Both alternative and conventional therapies have been assigned this designation throughout the years. In the mid-1990′s, an extract from the root of the kava plant (Piper methysticum) was widely considered a magic bullet for mild-to-moderate anxiety. However, as the popularity of kava increased, so did the occasional reports of serious, liver related side effects. And, while these incidents appeared to be very rare, and were often disputed, the perceived threat was great enough for certain countries (Canada, England, Germany, etc.) to call for the removal dietary supplements containing kava from the market. Interestingly enough, the United States did not require that kava be removed from store shelves. However, the FDA demanded that all kava extracts sold in the US carry a warning about the possible liver risk associated with regular kava use. To this day, these very same warnings are carried on the labels of kava products currently available in the United States.

Several new studies emanating from Australia add some new and much needed information to the on-going debate about kava’s safety as an anxiolytic aid. The latest, published in Phytotherapy Research, determined that a twice-daily dosage of kava extract (standardized for a total of 240 mg/day of kavalactones) reduced anxiety in patients diagnosed with generalized anxiety disorder over a 6 week period. Also of note is that no change in liver function/health was documented, and improved sexual function was observed in female participants. Two additional trials from 2012 and 2013 reveal that: a) an acute dose of kava failed to reduce anxiety in the same way as chronic supplementation; b) a single dosage of 180 mg of kavalactones does not seem to impair driving ability, whereas prescriptive anti-anxiety medications sometimes do. All told, these Australian studies are, perhaps, the most accurate and realistic data published about kava in many years.

Although kava is now back on the market, prominent figures in the alternative and integrative health community are still expressing some concern. In fact, some experts are calling for carefully controlled methods of growing and processing kava in order to avoid possible contaminants and hepatotoxins, such as mold. Dr. Tieraona Low Dog, a famed herbalist and colleague of Dr. Andrew Weil, recommends looking for “high quality aqueous extracts” of kava commercially sold by such companies as Eclectic Institute. My personal view is that kava, and most other supplements used to address anxiety, is only appropriate for short-term use, if at all. Good quality kava supplements are unlikely to cause harm, if used on a temporary basis and not combined with alcohol or prescription medications. Nevertheless, it’s far preferable to find a mind-body or psychological approach to reduce chronic anxiety, panic and stress. There are many clinically validated, non-toxic options to choose from, including so-called tapping techniques which go by the popular names, “Emotional Freedom Technique” and “Thought Field Therapy”. I’ve been recommending and using a similar practice recently with very positive results.

To learn more about the studies referenced in today’s column, please click on the following links:

Study 1 - Time Magazine: The Root of Tranquility (link)

Study 2 - Kava for the Treatment of Generalized Anxiety Disorder RCT (link)

Study 3 - The Acute Effects of Kava and Oxazepam on Anxiety, Mood(link)

Study 4 - Does a Medicinal Dose of Kava Impair Driving? A Randomized (link)

Study 5 – Proposal for a Kava Quality Standardization Code (link)

Study 6 - Contaminant Hepatotoxins as Culprits for Kava Hepatotoxicity(link)

Study 7 – Dr. Andrew Weil: Keen On Kava? (link)

Study 8 – Thought Field Therapy (TFT) as a Treatment for Anxiety Symptoms (link)

Study 9 - The Effect of Emotional Freedom Techniques on Stress Biochemistry (link)

Study 10 - The Immediate Effect of a Brief Energy Psychology Intervention (link)

Measures That May Reduce the Liver Risk Associated w/ Kava Use

Source: Br J Clin Pharmacol. 2011 March; 71(3): 445–448. (link)

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Posted in Alternative Therapies, Mental Health, Nutritional Supplements

4 Comments & Updates to “Kava for Anxiety”

  1. Rob Says:

    I have no doubts kava works well for anxiety/stress – traditional use data, many clinical trials, and the high plausability based on known pharmacological properties of the plant support it. I’m pretty sceptical of EFT though. Sitting with a nice friendly EFT practitioner holding your hand and giving you some kind of treatment you are expecting to help you will in itself naturally calm and reduce stress for most people – add in some candlelight, soft music, spa/treatment setting, etc. and the effect is enhanced even more. What would be more revealing would be to compare the EFT technique to a sham placebo version – after all, you want to know what benefit the specific techniques (tapping I believe) used in EFT have rather than just plain physical touch of some kind.

  2. JP Says:

    Hi Rob,

    I’d like to see a placebo-controlled tapping trial as well – preferably one that also features a crossover and randomized design. Having said that, please note that tapping doesn’t necessarily require the assistance of a practitioner. I’ve benefited from practicing this technique on myself and on family members – no fee, formal office setting or other “bells and whistles”.

    Be well!

    JP

  3. JP Says:

    Update 05/18/15:

    http://www.sciencedirect.com/science/article/pii/S2090123213001112

    J Adv Res. 2014 Sep;5(5):587-94.

    Enhanced efficacy and reduced side effects of diazepam by kava combination.

    The long term use of antiepileptic drugs possesses many unwanted effects; thus, new safe combinations are urgently mandated. Hence, the present study aimed to investigate the anticonvulsant effect of kava alone or in combination with a synthetic anticonvulsant drug, diazepam (DZ). To this end, female Wistar rats were divided into two subsets, each comprising 6 groups as follows: group (i) received 1% Tween 80 p.o. and served as control, while groups (ii) and (iii) received kava at two dose levels (100 and 200 mg/kg, p.o.). The remaining three groups received (iv) DZ alone (10 mg/kg p.o.) or kava in combination with DZ (v) (5 mg/kg, p.o.) or (vi) (10 mg/kg, p.o.). Results of the present study revealed that kava increased the maximal electroshock seizure threshold (MEST) and enhanced the anticonvulsant effect of diazepam following both acute and chronic treatment. Moreover, neither kava nor its combination with DZ impaired motor co-ordination either acutely or chronically. Furthermore, kava ameliorated both the reduction in locomotor activity as well as changes in liver function tests induced by chronic administration of DZ. Moreover, no elevation was shown in the creatinine concentration vs. control group following chronic administration of kava or DZ either alone or in combination with kava. In conclusion, the present study suggests the possibility of combining a low dose DZ with kava to reduce harmful effects and might be recommended for clinical use in patients chronically treated with this synthetic anticonvulsant drug.

    Be well!

    JP

  4. JP Says:

    Updated 09/25/16:

    http://online.liebertpub.com/doi/10.1089/acm.2015.0316

    J Altern Complement Med. 2016 Sep 19.

    A Randomized Controlled Comparison of Emotional Freedom Technique and Cognitive-Behavioral Therapy to Reduce Adolescent Anxiety: A Pilot Study.

    OBJECTIVE: The objective of this pilot study was to compare the efficacy of Emotional Freedom Techniques (EFT) with that of Cognitive-Behavioral Therapy (CBT) in reducing adolescent anxiety.

    DESIGN: Randomized controlled study.

    SETTINGS: This study took place in 10 schools (8 public/2 private; 4 high schools/6 middle schools) in 2 northeastern states in the United States.

    PARTICIPANTS: Sixty-three high-ability students in grades 6-12, ages 10-18 years, who scored in the moderate to high ranges for anxiety on the Revised Children’s Manifest Anxiety Scale-2 (RCMAS-2) were randomly assigned to CBT (n = 21), EFT (n = 21), or waitlist control (n = 21) intervention groups.

    INTERVENTIONS: CBT is the gold standard of anxiety treatment for adolescent anxiety. EFT is an evidence-based treatment for anxiety that incorporates acupoint stimulation. Students assigned to the CBT or EFT treatment groups received three individual sessions of the identified protocols from trained graduate counseling, psychology, or social work students enrolled at a large northeastern research university.

    OUTCOME MEASURES: The RCMAS-2 was used to assess preintervention and postintervention anxiety levels in participants.

    RESULTS: EFT participants (n = 20; M = 52.16, SD = 9.23) showed significant reduction in anxiety levels compared with the waitlist control group (n = 21; M = 57.93, SD = 6.02) (p = 0.005, d = 0.74, 95% CI [-9.76, -1.77]) with a moderate to large effect size. CBT participants (n = 21; M = 54.82, SD = 5.81) showed reduction in anxiety but did not differ significantly from the EFT (p = 0.18, d = 0.34; 95% CI [-6.61, 1.30]) or control (p = 0.12, d = 0.53, 95% CI [-7.06, .84]).

    CONCLUSIONS: EFT is an efficacious intervention to significantly reduce anxiety for high-ability adolescents.

    Be well!

    JP

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