Wellness

Kava and l-theanine for COVID-19 Anxiety  

Both are safe and effective alternatives to benzodiazepines.

This is the second post in a series of non-pharmacologic management of anxiety during the COVID-19 pandemic. In the first post, I commented on the limited efficacy of benzodiazepines for anxiety and highlighted the medical and psychiatric risks associated with benzodiazepine use, which are greater during the COVID-19 pandemic. In this post, I briefly review the evidence for kava-kava and l-theanine, two natural products widely used for stress and anxiety. In future posts, I will review the evidence for other non-pharmacologic approaches for stress and anxiety.

Kava (Piper methysticum)

In traditional Polynesian culture, the herbal Kava is used for ceremonial purposes and as an inebriant. In contrast to prescription benzodiazepines, individuals who take Kava at doses recommended for anxiety (between 60 and 300mg/day) do not experience sedation, mental slowing, or impaired cognitive functioning. Kava is believed to reduce anxiety by interfering with norepinephrine reuptake and binding with GABA and NMDA receptors in the brain. Kava preparations standardized to 70% kavalactones at doses between 70mg to 240mg/day effectively reduce symptoms of “stress” and moderate generalized anxiety but are probably not effective against severe anxiety. An early systematic review of 11 controlled double-blind studies concluded that Kava was superior to placebo for the short-term management of generalized anxiety (Pittler & Ernst 2003). A comprehensive review of the safety and efficacy of Kava for anxiety published in 2011 found significant positive effects in 4 out of 6 randomized placebo-controlled studies (Sarris & Schweitzer 2011).

Kava compares favorably to benzodiazepines and other conventional anti-anxiety medications. The findings of a small double-blind controlled study suggest that persons who have generalized anxiety adequately manage their symptoms by gradually increasing their daily dose of kava (up to 300mg/day) while slowly tapering off of a benzodiazepine such as lorazepam (Ativan™) or diazepam (Valium™), without experiencing worsening anxiety or withdrawal (Malsch &Kieser 2001). A randomized placebo-controlled multi-center study enrolling 129 outpatients concluded that a standardized Kava preparation (LI 150) was as effective as two commonly prescribed anti-anxiety agents (Buspirone™ and Opipramol™) for the treatment of generalized anxiety (Boerner, Sommer, et al 2003). Three-fourths of patients in both the Kava group and the conventional treatment group were classified as “treatment responders,” and experienced 50% or greater reductions in standardized measures of anxiety.

Rare safety problems

Rare cases of liver toxicity have been reported with Kava use. Researchers subsequently confirmed that kava hepatotoxicity was due to a hepatotoxic mould that contaminated poor raw material prior to processing, and not the active ingredients of Kava (Teschke, Sarris & Schweitzer 2012). Kava is generally well tolerated. Uncommon adverse effects include gastrointestinal upset, rash, headaches, and dizziness (Schulz 2001). Individuals who take Kava on an ongoing basis should limit their alcohol intake and use conventional sedative-hypnotic medications only under supervision from a physician.

L-theanine

Green tea contains the amino acid L-theanine. The anti-anxiety benefits of L-theanine are achieved through enhanced alpha brain wave activity and increased synthesis of GABA, the brain’s principal inhibitory neurotransmitter. Increased brain levels of GABA affect other brain neurotransmitter levels, resulting in general feelings of calm and well-being. Changes in brain electrical activity as measured by EEG recordings are related to the dosage of l-theanine and are comparable to beneficial changes observed during meditation. Calming effects of l-theanine are often experienced within 30 to 40 minutes after the amino acid is taken at a dose of 50 to 200mg, and may last 8 to 10 hours. Moderate symptoms of generalized anxiety often improve when l-theanine is taken at a dosage of 200mg once or twice daily. More severe anxiety may require doses up to 600mg to 800mg daily taken in increments of 100mg to 200mg spaced over the day. 

Research findings on l-theanine for stress and anxiety

A small placebo-controlled study found that daily l-theanine 200mg/day has beneficial effects on anxiety and cognitive performance related to stress in healthy adults (Hidese, Ogawa, et al 2019). A systematic review of 9 randomized placebo-controlled studies found that l-theanine in daily doses of 200 to 400mg reduced symptoms of stress and anxiety (Jackson, Everett, et al 2020). In addition to its anxiety-reducing benefits, emerging findings suggest that l-theanine has beneficial effects on mood, sleep, and cognitive performance in depressed individuals (Hidese, Wakabayashi, et al 2017).

No reported safety issues

l-theanine is generally safe when used at doses known to be beneficial for symptoms of stress and anxiety. There have been no reports of l-theanine causing serious adverse effects or interactions with other natural supplements, benzodiazepines, or other prescription medications. In contrast to prescription anti-anxiety medications such as benzodiazepines, l-theanine does not cause drowsiness or impair concentration, and there is no risk of addiction.

Bottom line

During this time of widespread stress and anxiety due to the COVID-19 pandemic, many people are relying on prescription benzodiazepines. Although benzodiazepines are sometimes beneficial, they have limited effectiveness and significant safety risks. The herbal Kava and the amino acid l-theanine are safe and effective alternatives to benzodiazepines for the management of moderately severe symptoms of stress and anxiety.



More Resource Articles

Managing Anxiety During COVID-19

This post is the first in a series on the management of anxiety during the COVID-19 pandemic. Millions of people have been relying on benzodiazepines such as alprazolam (Xanax™), clonazepam (Klonopin™), lorazepam (Ativan™) and other prescription drugs to manage symptoms of stress and anxiety. While some medications are safe and effective treatments of anxiety, they have limited overall efficacy and potentially serious safety concerns.
READ MORE

Parenting In a Pandemic

The coronavirus pandemic has thoroughly changed the time spent with our families. With parents and children working and learning from home, many of us are getting more family time than we ever expected. Furthermore, the coronavirus threatening public health as well as the current conditions breeding economic and political uncertainty are significant stressors on parents and children alike.
READ MORE

The Relationship Between Immune Health and Mental Health

The importance of cultivating a strong immune system has become evident as we navigate the coronavirus pandemic. It is no secret that a strong immune system can help defend against illnesses, but there may also be a hidden benefit to mental wellbeing. 
READ MORE

COVID-19 Pandemic Fatigue

It’s hard to believe that we are nearly one year into the COVID-19 pandemic. The initial panic and hoarding of toilet paper have worn off, yet for many the psychological impacts of the pandemic are still very much present and may last longer than the pandemic itself.
READ MORE

Locus of Control and COVID-19

The COVID-19 pandemic is causing enormous stress for countless millions of people in all world regions. There has been no crisis of comparable magnitude within living memory. Individuals, communities, and entire populations are acutely aware of "loss of control" over their health, their finances, and their daily activities. The impact of "loss of control" on our mental health is made even worse by uncertainty over the future that is unprecedented in modern times...
READ MORE

Lifestyle Choices for Good Mental Health During COVID-19

Simple lifestyle choices can enhance mental health Because of widespread unemployment and the closing of mental health clinics due to the pandemic, millions of individuals struggling with anxiety, depression, and insomnia do not have access to, or cannot afford psychotherapy or medications. These circumstances may continue for months or even years, depending on how soon effective antivirals and vaccines become available...
READ MORE

Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity)...
READ MORE

Bipolar Disorder

Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks. Symptoms of bipolar disorder are severe. They are different from the normal ups and downs that everyone goes through from time to time...
READ MORE

Depression

Everyone occasionally feels blue or sad. But these feelings are usually short-lived and pass within a couple of days. When you have depression, it interferes with daily life and causes pain for both you and those who care about you. Depression is a common but serious illness...
READ MORE

Eating Disorders

An eating disorder is an illness that causes serious disturbances to your everyday diet, such as eating extremely small amounts of food or severely overeating. A person with an eating disorder may have started out just eating smaller or larger amounts of food, but at some point, the urge to eat less or more spiraled out of control. Severe distress or concern about body weight or shape may also signal an eating disorder...
READ MORE

Generalized Anxiety Disorder

All of us worry about things like health, money, or family problems. But people with generalized anxiety disorder (GAD) are extremely worried about these and many other things, even when there is little or no reason to worry about them...
READ MORE

Panic Disorder

People with panic disorder have sudden and repeated attacks of fear that last for several minutes. Sometimes symptoms may last longer. These are called panic attacks. Panic attacks are characterized by a fear of disaster or of losing control even when there is no real danger...
READ MORE

Post-traumatic Stress Disorder

When in danger, it’s natural to feel afraid. This fear triggers many split-second changes in the body to prepare to defend against the danger or to avoid it. This “fight-or-flight” response is a healthy reaction meant to protect a person from harm. But in post-traumatic stress disorder (PTSD), this reaction is changed or damaged. People who have PTSD may feel stressed or frightened even when they’re no longer in danger...
READ MORE

Social Phobia (Social Anxiety Disorder)

Social phobia is a strong fear of being judged by others and of being embarrassed. This fear can be so strong that it gets in the way of going to work or school or doing other everyday things...
READ MORE

Obsessive Compulsive Disorder

Everyone double checks things sometimes. For example, you might double check to make sure the stove or iron is turned off before leaving the house. But people with obsessive-compulsive disorder (OCD) feel the need to check things repeatedly, or have certain thoughts or perform routines and rituals over and over. The thoughts and rituals associated with OCD cause distress and get in the way of daily life...
READ MORE