I’ve struggled with mental illness all my life and a big part of that has been anxiety. One of my earliest memories is separation anxiety as a small child, and it’s been a constant presence in my life ever since. This has affected huge parts of my life, leading me to miss out on many valuable experiences, such as travelling overseas with friends, taking on challenging roles at work etc. During my adolescent years, due to recurring panic attacks, I got so bad I ended up being confined to my house for over 6 months. Although I’ve improved significantly since then (at least I can go outside now), it’s often a daily struggle to do many of the things others consider ‘normal’, going to busy places, parties, even talking on the phone can be a challenge. As such, I’ve decided to put in place a plan to try to overcome some of this during the next 3 months. Which I thought I’d share in the hopes it helps someone else.
When I say ‘overcome it’, I want to be clear I don’t plan on, or seek to eliminate anxiety; that would be unrealistic. Fear has its place, it stops us from doing stupid shit and often protects us. But when it becomes a controlling factor in one’s life, that’s when it has become an issue.
That’s where this project comes in. I plan to attack my anxiety on many fronts;
- ‘Other’ strategies, i.e. philosophical reading etc.
By dealing with anxiety on many fronts, I hope to ensure a measurable change. Although unfortunately, this isn’t the most scientific method, adding so many variables in all at once, the main point for me is the result — less anxiety. As opposed to evaluating how much each effort affected the overall goal. What effort contributed most can be figured out down the road.
I want to premise this that I’ll have the support of both a psychiatrist and a psychologist along the way. Both of which I’ve been working with for a long time. This will take care of the prescribed medication along with talk therapy methods; cognitive behavioural therapy (CBT) and Acceptance and Commitment Therapy (ACT). This should be where everyone starts in my opinion (after seeing your primary care doctor) who is suffering from any sort of mental illness.
Please note, I’m not a doctor and information provided is for informational purposes only and is not meant to substitute for the advice provided by your own physician or other medical professionals.
Hopefully, someone reading this will be able to gain some sort of benefit from my experience and this process.
I think undertaking any sort of effort like this you need to set clear goals to define your success; otherwise, it’s easy to forget how far you’ve come and can feel like you’ve barely achieved anything if progress slows. This is especially true with something like anxiety, which can always be changing and evolving. I know for myself during the heightened emotions of an anxious state, reality can become a bit warped, and we can end up disregarding our progress so far. So that’s the first step for me — define clear goals.
Many of you will have probably heard of SMART goals, corporate places love to talk about these, but I think they’re a highly useful way to set clear and concise goals.
“SMART is an effective tool that provides the clarity, focus and motivation you need to achieve your goals. It can also improve your ability to reach them by encouraging you to define your objectives and set a completion date. SMART goals are also easy to use by anyone, anywhere, without the need for specialist tools or training.”(Mindtools.com, 2017)
SMART stands for;
Specific — your goal should be clear, coherent and precise this way you’ll be able to focus your efforts and to feel motivated to achieve it.
Measurable — You need to have quantifiable goals, tracking your progress will help you stay motivated and stay on track.
Achievable — there’s no point setting goals which are impossible. You should stretch yourself, but still, remain in the realm of what’s possible.
Relevant — make sure your goals are relevant to you, this again will help you stay motivated and keep you accountable.
Time-bound — set a timeframe that you want to achieve your defined objectives. This part of the SMART goal framework assists in preventing everyday tasks from taking priority over your long-term goals. Make this challenging but again within the realm of possibility.
So what do mine look like?
Specific- I want to reduce my anxiety to the point I can do things that other people find normal, fun and natural. In this case, specifically regularly going to BJJ classes.
Measurable- Going to BJJ classes twice per week.
Relevant- Yes. BJJ is something I really want to participate in and have tried on and off for the past few years. However, I’ve never been able to attend regularly due to the high level of stress I experience (mostly social anxiety).
Time-bound- You might have already guessed it but….3 months. I think this is an achievable time frame to implement all my plans and have them take effect.
Many of you may look at this goal and think how silly, or how simple etc. But for me, this is a good representation of many of the things anxiety stops me from doing. Going to social events, small talk with strangers, basically doing new social things in general. I used this example because I think it’s trackable and will express a change in my overall mentality if accomplished. The main thing I want to achieve by setting defined goals is something I can easily track my progress against. This will help me action plan in case I miss my targets later on down the road and also analyse what worked and what didn’t to apply to other areas in my life.
Diet is the first place I’m going to analyse, and although my diet is not “bad”, there’s definitely room for improvement. After much research, I believe this is going to be vital in reducing not only acute anxiety symptoms but generalised anxiety as well. I know this isn’t going to be a quick fix as “dietary changes often affect brain function rather slowly and the full impact of any diet may take many months to be realised.”(Psychology Today, 2017). I’ve looked through various diets from Atkins to Zone Diet and narrowed it down to 2 possibilities. I do, however, want to mention I also examined ketogenic (‘keto’) diet, but there’s already been a much better write up of the current research and results then I could do here: https://www.frontiersin.org/articles/10.3389/fpsyt.2017.00043/full
My reasoning for not trying this diet is it takes a bit of work to monitor if you’re in proper ketosis and is especially challenging if you consume a lot of protein. There’s also the zero-carb/carnivore diet which I’ve seen popularised lately and supposedly helps some people with issues from autoimmune diseases to depression; however, I’m not educated enough, and the research just isn’t out there to properly comment on it at the moment. I am concerned about how you could get all your micronutrient requirements in. I also worry about the environmental impacts (especially water use) of consuming purely meat in this diet. So with that said here are the 2 I’m looking at;
These both have many positive reported health benefits, and I believe each could be used effectively in this program. Because I think they each have their merits, I’ll go into a bit about each and then I’ll explain which I’ve chosen and why.
Palaeolithic often referred to as ‘paleo’, is a diet which aims to mimic the diet of our cavemen ancestors. It does this by removing grains, refined sugar (so only sugar from fruit is ok) and processed foods. So what does the food you’ll be eating look like?
Meat — Grass-fed is probably preferable. Grain can cause similar problems in animals as they do in humans.
Fowl — Chicken, duck, hen, turkey.
Fish — Wild fish, as mercury and other toxins can be an issue in farmed fish.
Eggs — Look for cage-free eggs.
Vegetables — As long as these aren’t deep-fried, eat as many as you want.
Oils — Olive oil, coconut oil, avocado oil — think natural.
Fruits — Rich in vitamins and fibre.
Nuts — High in calories, so they’re good to snack on, but don’t consume bags and bags of them if you’re concerned about weight.
Tubers — Sweet potatoes and yams. Higher in calories and carbs, so these are good for right after a workout to replenish your glycogen levels. (Nerd Fitness, 2017)
All of this is purported to have many health benefits, one of which being improvements in mental health. A quick google search reveals many anecdotal success stories of people who implemented this diet:
“From personal experience with battling short bouts of depression and anxiety my entire life, changing my diet to paleo has made the single greatest difference to my mental state.” (Childs, 2017)
It’s postulated that results such as this could come from two changes, improved gut health
“The results of recent studies have consistently shown that, compared to Westernized urbanites, rural dwellers and hunter-gatherers in Africa and South America have higher levels of microbial richness and diversity.”(Alan C Logan 2014)
And a reduction in inflammation. Both of which have been related to improving mood disorders, such as anxiety and depression.
One 2014 piece of research examined the possible ramifications the modern diet has compared to a palaeolithic diet. Although the research is very early, and still developing rapidly, they found that 3 main changes from our ancestral diet to the modern diet could be contributing to mood disorders like anxiety
“a potential evolutionary mismatch between our ancestral past (Paleolithic, Neolithic) and the contemporary nutritional environment. Changes related to dietary acid load, advanced glycation end [AGE] products and microbiota via dietary choices and cooking practices may be of relevance to depression, anxiety and other mental disorders.”(Logan AC, Jacka FN. 2014).
The changes in dietary acid load, switching to a more acidic diet, i.e. increased consumption of processed food, sugary drink and so forth, seems to potentiate a possible cortisol response which in turn increases inflammation which is routinely linked to mood issues. Again the problem seems to be a lack of microbial diversity in the gut, as compared to our ancient counterparts (funnily enough confirmed by something called a “paleostool” analysis”). One interesting study referenced showed people with depression, anxiety and schizophrenia have low blood levels of a soluble receptor for AGEs. The receptor is tasked with binding and essentially halting some of the destructive consequences of AGEs, one of which being chronic inflammation. AGEs are elevated by cooking without water; baking, frying etc. Switching to a more traditional way of cooking, such as stewing,
“[Lowered] the AGE burden by approximately 50%, significantly reducing systemic inflammation and oxidative stress” (n=26).(Luévano-Contreras 2013)
This expands the discussion from not only food but how we cook that food compared to historical methods. Anecdotally, I’ve noticed increased anxious symptoms during weeks where I’ve consumed a lot more processed foods.
The Mediterranean Diet is abundant in fruits, vegetables, whole grains, legumes and olive oil. It features fish and poultry — lean sources of protein — over red meat. Red wine is consumed regularly however in moderate amounts. It’s based on the traditional foods that people used to eat in countries like Italy and Greece during the ’60s.
So what does this diet look like?
Vegetables: Tomatoes, broccoli, kale, spinach, onions, cauliflower, carrots, brussels sprouts, cucumbers, etc.
Fruits: Apples, bananas, oranges, pears, strawberries, grapes, dates, figs, melons, peaches, etc.
Nuts and Seeds: Almonds, walnuts, macadamia nuts, hazelnuts, cashews, sunflower seeds, pumpkin seeds and more.
Legumes: Beans, peas, lentils, pulses, peanuts, chickpeas, etc.
Tubers: Potatoes, sweet potatoes, turnips, yams, etc.
Whole Grains: Whole oats, brown rice, rye, barley, corn, buckwheat, whole wheat, whole grain bread and pasta.
Fish and Seafood: Salmon, sardines, trout, tuna, mackerel, shrimp, oysters, clams, crab, mussels, etc.
Poultry: Chicken, duck, turkey.
Eggs: Chicken, quail and duck eggs.
Dairy: Cheese, yoghurt, Greek yoghurt, etc.
Herbs and Spices: Garlic, basil, mint, rosemary, sage, nutmeg, cinnamon, pepper, etc.
Healthy Fats: Extra virgin olive oil, olives, avocados and avocado oil.
The best thing about this diet is that it has been researched extensively lately and linked to improved mood and mental health. A team at the University of Melbourne inspected over 1000 randomly selected women, ages 20–93, assessing for symptoms of depression and anxiety and compared “traditional” diets to “western” diets. They established that the women who ate a “traditional”, i.e. the Mediterranean, a diet of vegetables, fruit, meat, fish, and whole grains had reduced symptoms of depression and anxiety than those who ate a “western” diet, characterised by processed or fried foods, refined grains, and sugary products. A four year long 2009 study (n=10,094) in Spain also showed that an intake rich in vegetables, fruits, fish, and whole grains and low in red meat and dairy was associated with a lower risk of depression (Sánchez-Villegas A).
As much as I liked the idea of the Paleo diet and may try it later down the track, the fact that the Mediterranean diet has such a wealth scientific evidence behind it, really made me prioritise attempting this first. Along with that, it also will be easier to implement, hence I think, stick to in the long term.
After diet is solidly in place, supplementation will be the next area I’ll be looking to tweak to obtain a boost from. Following hours of searching through the internet, from Reddit to PubMed, I’ve managed to find a few compounds that repeatedly sprung up along my searches.
- Magnesium 400mgs
- L-theanine 200mgs
- Selan-K 250–500 mcgs
- Ashwagandha 600mgs
- CBD (Cannabidiol) 200mgs
- Rhodiola 450mgs
- Phenibut 750mgs MAX TWICE PER WEEK
Please also consult with your doctor before trialling any of these as they may have interactions with any medication your on causing problems such as ‘serotonin syndrome’. Here is a helpful resource to assist: https://www.drugs.com/drug_interactions.php
L-theanine is an amino acid that is rare in our daily diets. Its classed as a non-dietary amino acid. L-theanine is a relaxing agent without the associated sedation with such supplements. This is why it’s often coupled with caffeine to boost cognition without the common side effects of stimulants and acts synergistically. It can be found in tea leaves, namely green-tea, which contains about 8mgs. L-theanine is considered extremely safe and has been designated as a Generally Recognized as Safe supplement (GRAS) by the Food and Drug Administration (FDA) in the United States. L-theanine relieves anxiety primarily because it resembles the brain-signalling chemical glutamate. However, L-theanine produces the opposite effect in the brain, while glutamate in the brain is an important excitatory neurotransmitter, L-theanine binds to the same brain cell receptors which block them to glutamate’s effect. This action produces inhibitory effects. That inhibition of brain overactivity has a calming and relaxing effect. In addition to this, L-theanine also stimulates the production of the inhibitory neurotransmitter GABA.
One study examined the effects of chronic L-theanine administration in patients with major depressive disorder an open-label study (n=20) found; “..chronic (8-week) L-theanine administration is safe and has multiple beneficial effects on depressive symptoms, anxiety, sleep disturbance and cognitive impairments in patients with Major Depressive Disorder.”(Hidese S, 2017)
An 8-week, double-blind, randomised, placebo-controlled study (n=40), also remarked; “L-theanine augmentation was associated with a reduction of anxiety (P = .015; measured by the HARS [Hamilton Anxiety Rating Scale] scale) and positive (P = .009) and general psychopathology (P < .001) scores (measured by the PANSS 3-dimensional model).”(Ritsner MS, 2017)
Ashwagandha is an adaptogenic herb popular in Ayurvedic medicine (a traditional form of medicine native to India). Adaptogens are a unique category of herbal ingredients used to improve the health of our adrenal system, the system that’s in charge of managing your body’s hormonal response to stress. The name adaptogen stems from their ability to ‘adapt’ to the specific needs of the body. Ashwagandha has been referred to as ‘Indian Ginseng’, due to its ability to enhance mental stamina and boost resilience.
A systematic review of human trials using Ashwagandha (also called Withania somnifera, Sensoril™ and KSM-66™ — patented extracts); concluded that
“All five studies concluded that Withania somnifera intervention resulted in greater score improvements (significantly in most cases) than placebo in outcomes on anxiety or stress scales…[However] current evidence should be received with caution because of an assortment of study methods and cases of potential bias.”(Pratte et al., 2017)
Another study (n=64) measured the serum cortisol levels (a hormone often elevated during high levels of stress) in a group of chronically stressed people. They were given 300 mg of high strength Ashwagandha, two times per day, for 600mgs in total, for 60 days.
“[Participants] exhibited a significant reduction (P<0.0001) in scores on all the stress-assessment scales on day 60, relative to the placebo group. The serum cortisol levels were substantially reduced (P=0.0006) in the Ashwagandha group, relative to the placebo group.”(Chandrasekhar, Kapoor and Anishetty, 2017)
Rhodiola Rosea also was known as; Arctic root, Rose root/Rosenroot, Orpin Rose, or Golden root, is also adaptogenic. It has traditionally been used in Europe and Asia to reduce fatigue and improve vitality. It’s even said to have been used by the Vikings to preserve their physical strength during battle. Along with reducing fatigue, it’s been linked to; anxiety reduction, longevity, improved cognition and to be neuroprotective against toxins.
Ten participants with a diagnosis of GAD (Generalised Anxiety Disorder), were recruited from the UCLA Anxiety Disorders Program. Participants were given a total daily dose of 340 mg of Rhodiola extract for 10 weeks. They were assessed using; Hamilton Anxiety Rating Scale (HARS), the Four-Dimensional Anxiety and Depression Scale, and the Clinical Global Impressions of Severity/Improvement Scale. The results of the study achieved were;
“Individuals treated with R. rosea showed significant decreases in mean HARS scores at endpoint (t=3.27, p=0.01).”(Bystritsky A, 2008).
A Swedish study (n=60) examined the effects of 576 mg Rhodiola Rosea supplemented daily for 28 days, on patients with suffering from stress-related fatigue. They saw a significant improvement on questionnaire results related to the quality of life, depression, attention and fatigue. Along with this, they observed a drop in cortisol response to awakening stress. They concluded that
“..repeated administration of Rhodiola extract SHR-5 exerts an antifatigue effect that increases mental performance, particularly the ability to concentrate, and decreases cortisol response to awakening stress in burnout patients with fatigue syndrome.”(Olsson EM, 2009)
Magnesium is an essential dietary mineral and is the second most prevalent electrolyte in the body, after sodium. Magnesium is one of the most essential minerals to overall health, it is involved in over 300 biochemical functions in the body. These range from; regulating heartbeat rhythms to assisting neurotransmitter functions. Worryingly this is one of the leading nutrient deficiencies in adults with an estimated 80 per cent being deficient (Recommended Daily Intake of around 400mgs for men and 300mgs for women). Lowered levels of magnesium have been linked to a variety of issues, including mood disorders, such as anxiety.
A Russian study examined 62 patients with anxiety disorders and reviewed their blood samples. They noticed a high prevalence of low magnesium levels compared to the control.
“..use of Magne B6 Forte [a magnesium, 100mgs and vitamin b6, 2mgs, supplement] (4 tablets/day, 30 days, then 2 tablets/day for 1 year) resulted in a significant increase in the Magnesium levels in the plasma and erythrocytes, the compensation of anxiety and depressive symptoms, improvement of sleep and general health of the patients, with the reduced consumption of antidepressants (by 30% on average).”(Kopitsyna UE, 2015)
It’s worth noting that a recent study (n=91) suggests that fixing magnesium deficiency may take over 3 months to reach full effect:
“Overall symptomatology, assessed through a magnesium status questionnaire, improved 28% over 30 days and 63% over 90 days.”(Weiss, Brunk and Goodman, 2018)
Mice and rat studies suggest similar findings as to Russian research, but also show that even the gut microbiota can be affected by magnesium deficiency.
“We demonstrated that the gut microbiota composition correlated significantly with the behaviour of unchallenged dietary mice. A magnesium-deficient diet altered the gut microbiota, and was associated with altered anxiety-like behaviour, measured by decreased latency to enter the lightbox.”(Pyndt Jørgensen B, 2015)
Phenibut acts upon the central nervous system by binding to GABA-B receptors in the brain, which impedes the effects on the excitatory neurotransmitter glutamate, which has a calming effect on the central nervous system. It has been referred to as both a nootropic (nootropics are a group of supplements that are used to affect brain chemistry to produce a desired physiological and/or subjective feeling) and a tranquilliser. It is classified as a gabapentinoid. Gabapentinoids are a class of chemical compounds that are derivatives of gamma-aminobutyric acid, more commonly referred to as GABA. GABA is classed as an amino acid; “a carbon chain with an amine group at one end and then a carboxylic acid at the other, which block α2δ subunit-containing voltage-dependent calcium channels” (PsychonautWiki). Developed during the 1960s in the Soviet Union, Phenibut has been used to treat a range of illnesses from alcoholism to PTSD. It is still used clinically in Russia today but is classed as a nutritional supplement, or scheduled narcotic in some countries (Australia for one).
Aside from a vast array of anecdotal experiences found on many online forums, it’s been surprisingly hard to find studies which specifically examine the use of phenibut on anxiety (check out r/nootropics to see some of these). The best I could seem to find when it came to the anxiolytic effects of phenibut was 2 rodent studies.
Firstly, a study completed in 2009 by Cui et al. noted significant reductions in wakefulness time and slept latency in physically-stressed rats who were given baclofen (a pharmaceutical version of phenibut). It also pointed out that the effect of psychological stress on total REM sleep was also reversed.
Secondly, a study in 2007 by Lhullier et al. treated hyperactive rodents induced by cocaine administration (score!) with baclofen and examined the decrease in movement afterwards. Rodents with hyperactivity exhibited a significant dose-dependent reduction in movement activity after they were administered baclofen, as is evidenced by a decrease in the distance travelled.
[WARNING] Phenibut is a potent drug, and you can build up tolerance and addiction very quickly. As such, it should only be used once or twice per week max and never over 1g. [WARNING]
Selank is a neuropeptide, small protein-like molecules (peptides) used by neurons to communicate with each other. Selank is a synthetic derivative of the body’s naturally produced tetrapeptide called Tuftsin which is a hexapeptide with a wide range of uses. Selank was first synthesised in the late 1990s at the Institute of Molecular Genetics of the Russian Academy of Science.
Selank is employed as an anxiolytic in the therapy of anxiety and phobic disorders and shown to be of particular use in cases of GAD. Its action is compared to that of mild benzodiazepines but without the associated sedative effects. As a selective anxiolytic with a nootropic component and even antiviral properties, Selank is often used as a treatment for depression, fear and general anxiety. Selank has passed all phases of clinical trials and is now being prepared for registration and mass production.
Dosages for subcutaneous injection seem to range from 250mcgs — 1mg. As for the nasal spray, it is generally available as a 0.15% spray, with 75 μg of Selank in each spray. The recommended dosage is 2 or 3 sprays per dose with 3 doses per day (for a total of around 675 mcgs per day).
It is postulated that Selank works via its ability to inhibit enkephalin hydrolysis. Enkephalin is implicated in the receptor-dependent modulation of adaptive behavioural responses to stressful or threatening environmental stimuli. A 2001 study performed by the Center of Mental Health, Russian Academy of Medical Sciences, Moscow:
“..demonstrated a considerable shortening of enkephalin half-life and reduced total enkephalinase activity in the blood during generalised anxiety…Selank (Thr-Lys-Pro-Arg-Pro-Gly-Pro), which attenuates behavioural anxiety reactions and does not cause side effects typical of most anxiolytics, dose-dependently inhibited enzymatic hydrolysis of plasma enkephalin.”(Zozulya AA 2001)
Selank has also been shown to work as an adjunct treatment with commonly used pharmaceutical anxiety treatments such as the use of benzodiazepines;
“..combined treatment decreased the level of undesirable side-effects of phenazepam [a Russian benzodiazepine] (attention and memory, asthenia, sedation, increase in sleep duration, sexual disorders, anhedonia and orthostatic hypotension [low blood pressure when standing up]) during the course of treatment and after the tranquiliser withdrawal. Taken together, the therapeutic efficacy and reduction of side-effects had a positive impact on the quality-of-life of the patients treated.”(Medvedev VE, 2018)
Interestingly Selank also demonstrates an ability to increase learning ability, peaking on the third day of administration, during times of stress;
“..results obtained here with data on the anti-anxiety actions of Selank suggested the potential for its use in optimising mnestic functions in conditions of elevated emotional tension.”(Kozlovskii & Danchev 2003)
Although it should be noted that this study was at significantly higher doses and in rats.
Cannabidiol (CBD) is a compound coming from cannabis plants. CBD binds to the same receptors as Tetrahydrocannabinol (THC is the main psychoactive part of marijuana) however, does not produce the high. Instead, it is proposed as a treatment for many health issues, including anxiety. CBD may boost signalling through serotonin receptors. It’s also been shown regular dosing may help the hippocampus regenerate neurons, which could be useful for treating anxiety or depression. Scans of patients suffering from depression and/or anxiety often show a reduced hippocampus. The hippocampus may be linked to emotional regulation, and successful treatment of depression is often associated with the birth of new neurons (neurogenesis) in the hippocampus. Finally, CBD has been shown to reduce chronic inflammation, which has also been linked to issues such as depression and anxiety.
A study (n=24) from Department of Neuroscience and Behavior, University of São Paulo examined the effect of administering 600mgs CBD and measured the levels of distress in people with Generalized Social Anxiety Disorder (GSAD) during a simulation public speaking test. The results were gauged by both subjective tests, along with health markers such as BP and heart rate. It was observed,
“Pretreatment with CBD significantly reduced anxiety, cognitive impairment and discomfort in their speech performance, and significantly decreased alert in their anticipatory speech.”(Bergamaschi, M. M. 2011)
They also noted that with the use of CBD, the GSAD’s group response was similar to that of the healthy control.
A review of 40 CBD studies, including both rodent and human models, was conducted by Alexandre Rafael de Mello Schier and colleagues. Although they concluded more research into dosing and mechanisms involved were needed, they found
“..studies using animal models of anxiety and involving healthy volunteers clearly suggest an anxiolytic-like effect of CBD. Moreover, CBD was shown to reduce anxiety in patients with a social anxiety disorder”(Schier, A. R. 2012)
So my stack looks like this;
I’ll be splitting those two and having evening doses to increase my sleep quality hopefully (and to potentially mitigate any GI issues the magnesium may cause). I may take these all at once if I believe I’m going to be having a particularly stressful event coming up.
Thus ends part 1 of this post. Part 2 will look at; exercise, meditation, strategies for developing an overall better mindset and the full list of references.
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