Looking for over-the-counter anti-anxiety medication.

May 7, 2008 11:52 PM

What are some over-the-counter drugs (or herbal medicine) that can be taken to treat severe anxiety until I can get some health insurance?

I'm looking for something to treat my (severe) social anxiety until I can get a job and health insurance. I don't care if it's a drug (the legal kind, that is), or if it's herbal. All that matters to me is that it's effective, over-the-counter, affordable, and preferably lacking in any weird and/or severe side effects.

I had heard about something called "Kava", so I looked it up on Wikipedia, but was greatly turned off after reading the risks. If anyone has had any experience using this, I'd like to hear about it.

If it matters, I live in the United States, and am not allergic to anything (as far as I know).

posted by Rhadamanthus to health & fitness (32 answers total)

Kava is fine in small doses, you probably want Valerian root.

You wouldn't believe the number of things you can snort from your health food powdered herb isle...

Go with Valerian root pills.
posted by zengargoyle at 12:30 AM on May 8, 2008

Oh, and find some Rescue Remedy... it's a mix of various herbal extracts that people swear by. You need to be alcohol tolerant (most extracts are in like at least 80 proof alcohol extracts, it's just a couple of drops but may cause some people some problems), there are a few non alcoholic tinctures.

YMMV, I worked in the crazy section of the health food store with the little bottles of stuff for a while. I still keep Kava and Valerian around as my "non-prescription valium/xanex" things I'd rather take once in a while than go on meds.

(Seriously, next time you're around, snort a bit of Cardamon root (sp?)...)
posted by zengargoyle at 12:39 AM on May 8, 2008 [1 favorite]

Sublingual GABA pills have an instant, if limited, effect, and if you can find them I recommend them highly (I think they sell them at Whole Foods if you're near one).

Tincture of valerian root, which will be sold at pretty much any health food store, has a mild tranquilizing effect.

I've taken Kava, and it does have a mixed reputation. People have been taking it in the South Pacific for a zillion years, but I think some of the ways it's packaged for sale in the West have been kind of crappy. Kava, unlike GABA or Valerian, gives you a feeling kind of like getting tipsy.
posted by hungrytiger at 12:41 AM on May 8, 2008

Also, some non-edible anti-anxiety tricks:

When you breathe in, you stimulate your sympathetic (adrenaline-oriented, fight-or-flight) nervous system. When you breathe out, you stimulate your parasympathetic (calming) nervous system. So as an anti-anxiety measure, try what's called the "7-11" breath: breathe in for seven slow counts and then out for eleven slow counts. Try to breathe into your stomach. More about that here.

And I've had great success with guided relaxation and self-hypnosis; perhaps you would too.

Finally, a cognitive behavioral therapist might help if you can find one you can afford; you might also consider checking your local library or this book.
posted by hungrytiger at 1:05 AM on May 8, 2008 [3 favorites]

I wouldn't worry much about kava....I assume you're talking about the liver damage theories? I think that's generally considered horseshit.

I've tried some stuff.....kava tea seems to be the only thing which mightnoticeably help outside of Rx. Tried smoking blue lotus, smoking lemongrass, mmm other stuff. Nothing worked great except pot, which was short term, and then started freaking me way out.
posted by Darkenon at 1:52 AM on May 8, 2008

Rescue Remedy is good, but mainly because it's brandy. Just get some brandy.
posted by turgid dahlia at 2:08 AM on May 8, 2008 [1 favorite]

I don't think there are any good options that won't act primarily by just putting you to sleep. Kava may indeed do some good, but if you need more than a small dose you'll find it's a pretty potent sedative, on top of its not-unlike-alcohol effects.

Another snoozy option is doxylamine succinate, which is one of the old sedating antihistamines; it's a common ingredient in over-the-counter sleeping pills and will calm you right down (and help with your hay fever!), but probably not then leave you in a very employable state. But heck, if you're vibrating with anxiety then it may just pull you back down into the normal range. There'd be no harm in giving it a try on a Saturday when you've nothing else to do; doxylamine pills are also dirt cheap generic medicine, well-studied and safe.

If valerian does any good - and there's little evidence that it's got any real action beyond placebo - then it seems to pretty much just sedate you, too. I tried it years ago and thought it maybe did a little bit of something. When that's all you think a pill does, it's in all probability a placebo.

And Rescue Remedy is, indeed, just booze. But it's magic booze! It's a Bach Flower remedy, and that's some pretty hilarious nonsense right there.
posted by dansdata at 3:36 AM on May 8, 2008

St John's Wort (Hypericum) has long been used to treat depression/anxiety.

The jury is still out as to its efficacy. But it is known to have little to no side effects, so no harm in trying.
posted by TheOtherGuy at 3:59 AM on May 8, 2008

If you're taking Rescue Remedy as directed, then the alcohol content is minimal. Somewhere around 0.36% if I recall correctly.
posted by Don-da-lah at 4:09 AM on May 8, 2008

I've tried GABA-- including letting it dissolve under the tongue--the effect was mild but uncomfortable.

My valerian experience is that it's good for knocking you out, but my system seems to get accustomed to it fairly quickly, so I don't take it often. I like it, I keep it around, once in a while for a little deeper sleep is fine. The first time I took it, the morning after I was so groggy that I was a little worried about driving.

Damiana is another possibility, as are chrysin, inositol or passion flower. The problem with experimenting is that the costs can start to add up while the benefits to you can be uncertain. Many of these items seem to fall into the "work for some people, not for others" category that makes them poor candidates for prescription.

Note also that some herbal products and supplements can react with prescription medications. A little research in advance can help, talk to your doctor/pharmacist of course, you might plan on being off them for a little time before starting the prescription meds just in case.

Try searching PubMed for anxiolytic and herbal for further suggestions to try or things to avoid. One example, there are lots more.
posted by gimonca at 4:21 AM on May 8, 2008

catnip
skullcap
motherwort
damiana
passionflower

I've smoked 4 of the above with eh results. Better than nothing. For sheer anxiety - running, doing really strenuous work in the garden, controlled breathing as mentioned, accupressure - done on self is helpful, wine. Red or white.
posted by watercarrier at 5:21 AM on May 8, 2008

Magnesium supplements
B-complex supplements
Omega-3s
Meditation

I've tried probably most stuff posted in this thread (not all of it) and have found those three to be most efficacious. Meditation probably being most effective.
posted by norabarnacl3 at 5:29 AM on May 8, 2008

Benadryl is one of the aforementioned old sedating antihistamines, and it's cheap and pretty much harmless to boot. Don't take one and drive, though, till you know what it does to you. If I'm in the middle of a mini anxiety attack that's enough to calm me down a bit, and if I am too wired to go to sleep it works for that, too. Works like a charm.
posted by fiercecupcake at 6:02 AM on May 8, 2008 [1 favorite]

A plain old multi-vitamin, along with a balanced diet, could help.
posted by gauchodaspampas at 6:04 AM on May 8, 2008

Benadryl really whacks me out, but I've also found that long term use depresses me. Be careful.

I've taken Kava- never really felt anything from it.

Same with GABA- got the flushing, but never really noticed it helping.

Not for nothing, judicious use of alcohol can be helpful as well. A glass or two of wine with dinner helps bring everything down. I find that anxiety is additive- a bad day at work plus an unpleasant evening makes the next day even worse.

And eating well- I find that I feel best when eating a high protein, low processed carb diet. Vegetables and meat, basically. YMMV.

Also, until you get official treatment, try to keep a low profile with yourself. For example, since getting a job is your goal, focus on that and stay away from other situations that sap your social energies. Make your calls, do your interviews and then take some time to recover and meditate, whatever that means for you.
posted by gjc at 6:47 AM on May 8, 2008 [1 favorite]

If you can afford a trip to the doctor, you can ask for a prescription to Buspirone. It's on WalMart and Target's $4 prescription list. It has mixed reviews for its effectiveness in controlling anxiety but it has a better chance at working on extreme anxiety than anything sold over the counter.

Call around for a doctor or clinic that deals with low income or no insurance patients. The walk in clinic I've gone to in Dallas, Texas for minor ailments only costs $70 per visit for new patients and $45 for follow up visits.
posted by Ariadne at 6:50 AM on May 8, 2008

You may want to be careful when taking St. John's Wort, depending on other medications you may be on at the time. Personally, I've tried many of the things posted and have had some success with a program of omega-3s and valerian root. Kava, I've found, is far too sedating to be helpful. Otherwise, breathing and exercise can go a long way.
posted by youarenothere at 6:50 AM on May 8, 2008

And I'm no hippie, but if the side effects of some herbs put you off, you might be frightened by what the real drugs can do.
posted by youarenothere at 6:52 AM on May 8, 2008 [1 favorite]

Forgot to add- I've also used St. John's Wort, with similar results.

All of the things I mentioned didn't do anything bad for me, so it's worth trying.

The thing that has helped me the best is keeping a good sleeping schedule. If it's light out, I'm awake. Don't stay up so late that you can't get up with the sun. Do your productive things during the day- trying to do work at night causes me to get in a groove and all of a sudden it's 2am and I can't sleep.

Along with that, I do use melatonin to keep my sleep regulated. That really does work for me. I take it something like 10 hours before I need to wake up, and then I don't do anything besides read and watch TV and casually internet surf. I hit the sack when I'm tired and then wake up refreshed.
posted by gjc at 6:54 AM on May 8, 2008

It's not a drug, but I have dealt with SEVERE social anxiety, and cannot recommend the Shyness & Social Anxiety Workbook enough. It has CBT (cognitive behavioral therapy) exercises in it that made a world of difference to me.
posted by tastybrains at 7:00 AM on May 8, 2008

After being a very low-key person my whole life, I had my first ever anxiety attack in November 2007. I was at a party with people I didn't know very well, and my dad was scheduled to have quadruple bypass surgery very soon (this was unexpected.) I had only had one glass of wine.

I couldn't breathe and felt like I was having a heart attack. I had no idea it was anxiety, and was convinced I was going to drop dead any second. I went to the emergency room and they confirmed that it was a panic attack, and gave me some lorazepam (in the Ativan/Valium/benzodiazepene family I believe)

You can't take it on a regular basis, but I am comforted to know that it is around if I ever need it, and it works almost instantly.

It is also very cheap. I live in Canada, and while we have OHIP to cover hospital and doctors visit, I am currently in a not great job with no drug plan, so I pay the total costs myself. So I'm not sure what your costs would be, but for me with no drug plan, it was under $10 for a bottle of about 20 I think.

Gravol will also work to a much lesser degree, and it makes you sleepy.

Personally, I am more inclined to go with "Western medicine" whenever possible, and avoid herbal remedies which may or may not work.
posted by Flying Squirrel at 7:05 AM on May 8, 2008 [1 favorite]

Pricing this stuff out on drugstore.com, traditional anti-anxiety drugs are not that expensive.

Clonazepam (generic klonopin. 0.5 mg, not extended release): $13.99 for 30 tablets, $26.99 for 90.
Alprazolam (generic xanax, 0.5 mg, not extended release): $13.95 for 90 tablets

You can pair these with an SSRI on WalMarts $4 generics list ($10 for 3 months) - your choice, citalopram (celexa), fluoxetine (prozac), paroxetine (paxil).

These are probably *cheaper* than a supplement routine (decent omega3s are pricy!!!). You can find a way to do a single office visit for <$100. If you are getting health insurance in the next 3-6 months for follow up visits, I highly recommend this route. It will probably be cheaper than supplements and more likely to work.
posted by crazycanuck at 7:34 AM on May 8, 2008

There's a whole askme thread on 5-HTP. That's where I first heard of it, and it seems like it might be helping me.

(Kava and St John's Wort never seemed to help.)

What helps best of all is cutting back severely on carbs. I had a plate of potatoes yesterday that is STILL affecting me, badly.
posted by iguanapolitico at 7:41 AM on May 8, 2008 [1 favorite]

Ditto on the St. John's Wort. In fact, I found it worked so well that I had to cut back, because it "evened" out my moods TOO well - I wasn't having anxiety really at all, but neither was I thrilled when good things happened. I found about 1/2 the recommended dose worked better for me over the long term. YMMV.

St John's Wort does take about a week or two, with no missed doses, to really kick in, though - it's not a "quick fix".
posted by twiki at 8:00 AM on May 8, 2008 [1 favorite]

St. John's Wort can make you sun-sensitive so watch out for that.

Exercise, a 10 minute walk a day even, is the #1 thing recommended by therapists.

This lady is really good for hypnosis CD's, I have one or two of hers. I like her voice, you can listen to a sample on her site.

L-Glutamine, an amino acid, takes the edge off for me. Take it on an empty stomach and before bed (GNC sells it, I believe, I get it at my local drug store). I don't get much from the 5HTP or GABA precursors (does that stuff cross the blood brain barrier?). Some people use green tea instead of coffee or regular tea. Caffeine is not the best thing so try to go decaf with everything (wean it slowly if you are on it now to avoid headaches).

Aura Cacia essential oils: I have Lavender, and I mix 30 drops to one oz. of distilled water or witch hazel (that's toning if you have oily skin, double benefit). I spray it on my wrists and face with eyes closed. Very relaxing. Ylang Ylang is also good. Citrus oils, orange or lemon, are good but they can also make you sun-sensitive so they are better put in a diffuser, not directly on your skin. Whole Foods sells the essential oils and the little spray bottles, as well as diffusers.

Get a good picture in your mind of a time you felt great. Mine is when I went parasailing in Jamaica, over the bay in Ocho Rios. Experience your good place/good feeling for a full minute (set a timer). While you're doing that, when you get good and relaxed and smiling, press your thumb and middle finger together (either hand, just pick one). Next time you're anxious, press your thumb and middle finger together. Instant recall of the good feelings. Old hypnosis trick. Do it every day for at least a week.

The small high protein meals throughout the day is good too, keep your blood sugar stablized. When you get insurance, ask about seeing a nutritionist if you need help there.

Passionflower tincture is pretty good as well.

If you're in a situation that you can't get out of (work related, etc.), excuse yourself and go to the bathroom and put cold water on your wrists. Wet a paper towel and put that on the back of your neck. Breath. Look in the mirror and practice smiling. Take another breath. Realize that a lot of people are just like you and they are not as focused on you as much as you think. They are worrying about themselves.

I'd avoid brandy if I were you, unless you want some awesome rebound panic the next day. Good luck!!!
posted by Marie Mon Dieu at 8:23 AM on May 8, 2008 [2 favorites]

This may be off the wall, but I've found whatever's in Multisymptom Pamprin that reduces "irritability" chills me right out. It makes me a little mentally slow, but just for a 3 count - enough to not freak out.
posted by Gucky at 9:51 AM on May 8, 2008

My legitimate medical doctor suggested 1000mg/day of fish oil, which I've found works really well and has all sorts of other ancillary health benefits.
posted by judith at 11:16 AM on May 8, 2008

This is not an answer to your specific question, but the generic version of Xanax (alprazolam) is super-cheap (doesn't Wal-Mart sell all generics for $3, now?), if you can find a free or low-cost clinic to give you a prescription for it. General practitioners are used to prescribing stuff like this, so you shouldn't have any problems. If you're concerned about the cost of the doctor's visit, consider that herbal stuff like Rescue Remedy ain't cheap (and it never worked for me) and it may actually be cheaper to go to a doctor and get something you know will work.
posted by chowflap at 11:24 AM on May 8, 2008

Should have previewed -- so the generics at Walmart are $4. Still, super cheap, and effective while you work out your issues via CBT (also a great way to deal, though it takes time to see results).
posted by chowflap at 11:27 AM on May 8, 2008

My legitimate medical doctor suggested 1000mg/day of fish oil, which I've found works really well and has all sorts of other ancillary health benefits.

This is very true. Flax seed oil is almost as good, and the added bonus with flax seed oil is your inevitable burps don't smell like a tuna boat.
posted by turgid dahlia at 3:27 PM on May 8, 2008 [1 favorite]

Thanks. I'll look into trying these out.
posted by Rhadamanthus at 3:21 PM on May 14, 2008

FWIW, St. John's wort really seems to be putting me on an even keel. Even my eczema has calmed down. I've only been on it for a few weeks, but I'm feeling better now than I have in over a year. Hope it lasts. Oh, I've also been trying to seriously reduce complex carbs too, so there are the inevitable multiple factors at play here. I'm still itchy in response to stressful situations, but less so. And every hour of not-itching that goes by allows my skin to heal a little bit more so that when I do itch, it is less traumatic. I've been able to cut down on topical steroid usage to the point that I'm totally off prescription-strength, just using over-the-counter hydrocortisone ointment.
posted by markhu at 9:03 PM on March 5, 2009