Condition
Generalized Anxiety Disorder (GAD)
Do any supplements help generalized anxiety disorder (GAD)? A few show modest benefit, but none replaces the first-line treatments: cognitive behavioral therapy and the antidepressants called SSRIs and SNRIs. Lavender oil taken as a capsule (silexan) has the strongest trials: in 5 placebo-controlled trials with 1,213 adults, it lowered anxiety scores over 10 weeks. Chamomile extract helped a little in a trial of 57 people with GAD. Kava eased anxiety in short trials, but in a 16-week trial of 171 people with GAD it did no better than placebo, and it can injure the liver. Saffron and ashwagandha trials are smaller or weaker and mostly not limited to GAD.
Sources: PMID 36573969; PMID 36717399; PMID 19593179; PMID 31813230; PMID 20720265; PMID 41693488; PMID 39083548
- Supplements studied
- 11
- Graded outcomes
- 8
- Trials
- 13
- People studied
- 739
What the evidence says
- Lavender oil capsules (silexan) have the strongest trial support. In a 10-week trial of 539 adults with GAD, 80 mg and 160 mg a day both lowered anxiety scores more than placebo, while the antidepressant paroxetine only trended toward a difference in the main analysis. A review of 5 placebo-controlled trials with 1,213 adults who had GAD, mixed anxiety and depression, or milder anxiety found 1.34 times as many responders with silexan, and side effects were no more common than with placebo. The extract is proprietary, and both papers list authors employed by industry.
- Chamomile extract: limited evidence. In an 8-week trial of 57 people with mild to moderate GAD, anxiety scores fell more with chamomile than with placebo, and the authors called the effect modest. In a longer study, 93 of 179 people improved on chamomile and were then randomized to keep taking it or switch to placebo for 26 weeks. Relapse was not significantly less likely with chamomile, though symptoms stayed lower.
- Kava: mixed results. A 2003 Cochrane review of 11 trials with 645 people found kava eased anxiety more than placebo, and a 6-week trial of 75 people with GAD found a moderate benefit. But in a larger 16-week trial of 171 people with diagnosed GAD, kava did no better than placebo: 17.4% were in remission on kava and 23.8% on placebo. Abnormal liver tests, memory complaints and tremor were more common with kava, and a 2022 network analysis of 29 herbal trials found kava possibly ineffective in GAD.
- Saffron and ashwagandha: limited evidence, mostly from trials not limited to GAD. In a 2026 review of 34 trials with 1,769 adults, saffron lowered self-rated anxiety (6 trials, 339 people) but not anxiety rated by clinicians, and an earlier review found signs of publication bias. In 5 trials with 254 people who had anxiety or insomnia, ashwagandha lowered anxiety scores, but results varied widely between trials and the reviewers asked for larger studies.
- Passionflower: too little evidence to judge. Our database grades it B for anxiety, but that rests on small studies, one in 40 people having lower wisdom teeth removed and one in 30 people with GAD in which passionflower added to an antidepressant made no difference between groups on reaction-time tests. A Cochrane review found only 2 trials with 198 people, too few for any conclusion, and the 2022 network analysis found no significant drop in anxiety scores.
- Other herbs rest on single small studies. Tulsi (holy basil, 35 people) and gotu kola (33 people) were each given for 60 days, and neither abstract describes a placebo group. In a pilot trial of 36 people with GAD, valerian did no better than placebo on the main anxiety score. L-theanine added to antidepressants did not ease anxiety more than placebo in 46 people with GAD.
Safety and when to see a clinician
- Kava can injure the liver. A review of 14 cases found the risk rose with overdose, long use, and taking it with other medicines or supplements, and Germany banned some kava extracts in 2002. Serious skin and nerve reactions have also been reported, and kava may interact with benzodiazepine sedatives. Ask a clinician before using it, especially if you have liver disease or take other medicines.
- Ashwagandha has caused liver injury in rare cases. In 5 reported cases, jaundice and itching began 2 to 12 weeks after starting it, and liver tests returned to normal within 1 to 5 months in 4 of them. Stop it and see a doctor if your skin or eyes turn yellow.
- Don't stop or swap a prescribed anxiety medicine for a supplement on your own. Ask your prescriber or a pharmacist first, especially before adding an herb to an antidepressant or a sedative.
- Thoughts of suicide or self-harm need help now: call or text 988 in the US, or your local emergency number. See a clinician if worry fills most days, disrupts work or sleep, or comes with panic attacks or heavy drinking.
- If you are pregnant, breastfeeding or under 18, ask a clinician before taking any supplement for anxiety.
Evidence by supplement
- Strong
- Moderate
- Limited
- Very limited
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Anxiety Symptoms Moderate Improvement | Improves (the measure goes down) | Moderate effect | 6 studies | 66 people | ||
Studies that measured anxiety symptoms
| ||||||
| Reaction Time | Improves (the measure goes up) | 30 people | ||||
Ashwagandha
- Anxiety Symptoms: improves
- Insomnia Signs and Symptoms: improves
- Memory: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Anxiety Symptoms Moderate Improvement | Improves (the measure goes down) | Moderate effect | 3 studies | |||
Studies that measured anxiety symptoms
| ||||||
| Insomnia Signs and Symptoms | Improves (the measure goes down) | 1 study | 86 people | |||
Studies that measured insomnia signs and symptoms | ||||||
| Memory | Improves (the measure goes up) | 86 people | ||||
| Subjective Well-Being | Improves (the measure goes up) | 86 people | ||||
Theanine
- Anxiety Symptoms: improves
- Insomnia Signs and Symptoms: improves
- Depression Symptoms: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Anxiety Symptoms Small Improvement | Improves (the measure goes down) | Small effect | 2 studies | 46 people | ||
| Insomnia Signs and Symptoms | Improves (the measure goes down) | 1 study | 46 people | |||
Studies that measured insomnia signs and symptoms | ||||||
| Depression Symptoms | Improves (the measure goes down) | 46 people | ||||
Tulsi
- Anxiety Symptoms: improves
- Depression Symptoms: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Anxiety Symptoms Small Improvement | Improves (the measure goes down) | Small effect | 1 study | 35 people | ||
Studies that measured anxiety symptoms | ||||||
| Depression Symptoms | Improves (the measure goes down) | 35 people | ||||
Gotu Kola
- Anxiety Symptoms: improves
- Attention: improves
- Depression Symptoms: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Anxiety Symptoms Small Improvement | Improves (the measure goes down) | Small effect | 1 study | 33 people | ||
Studies that measured anxiety symptoms | ||||||
| Attention | Improves (the measure goes up) | 33 people | ||||
| Depression Symptoms | Improves (the measure goes down) | 33 people | ||||
| Stress Signs and Symptoms | Improves (the measure goes down) | 33 people | ||||
Kava
- Aggression: improves
- Anxiety Symptoms: improves
- Subjective Well-Being: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Aggression Small Improvement | Improves (the measure goes up) | Small effect | 141 people | |||
| Anxiety Symptoms | Improves (the measure goes down) | 7 studies | 238 people | |||
| Subjective Well-Being | Improves (the measure goes up) | 3 studies | 141 people | |||
Studies that measured subjective well-being
| ||||||
| Depression Symptoms | Improves (the measure goes down) | 60 people | ||||
Apigenin
- Anxiety Symptoms: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Anxiety Symptoms Moderate Decrease (via chamomile extract containing apigenin) | Improves (the measure goes down) | Moderate effect | 179 people |
Lavender
- Anxiety Symptoms: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Anxiety Symptoms | Improves (the measure goes down) | 4 studies | 77 people | |||
Studies that measured anxiety symptoms
| ||||||
Valerian
- Anxiety Symptoms: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Anxiety Symptoms | Improves (the measure goes down) | 1 study | 36 people | |||
Studies that measured anxiety symptoms | ||||||
Ginkgo Biloba
- Anxiety Symptoms: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Anxiety Symptoms | Improves (the measure goes down) | 1 study | 82 people | |||
Key findings
- Anxiety SymptomsImproves (the measure goes down)
- AggressionImproves (the measure goes up)
The Generalized Anxiety Disorder (GAD) protocol
2 primary supplements · 6 supporting supplements
- Kava (Piper methysticum)120–250 mg kavalactones daily (divided doses)
- Passionflower (Passiflora incarnata)400–900 mg extract daily or 1–2 g dried herb as tea
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Studies cited
22 studies from PubMed
- Anxiety Disorders: A Review.
- Lavender oil preparation Silexan is effective in generalized anxiety disorder--a randomized, double-blind comparison to placebo and paroxetine.
- Efficacy of Silexan in patients with anxiety disorders: a meta-analysis of randomized, placebo-controlled trials.
- A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder.
- Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial.
- Kava extract for treating anxiety.
- Kava in the treatment of generalized anxiety disorder: a double-blind, randomized, placebo-controlled study.
- Kava for generalised anxiety disorder: A 16-week double-blind, randomised, placebo-controlled study.
- Medicinal herbs for the treatment of anxiety: A systematic review and network meta-analysis.
- Effect of saffron on depression, anxiety and mood disorder: a GRADE assessed systematic review and meta-analysis of 34 randomized controlled trials.
- Effect of saffron supplementation on symptoms of depression and anxiety: a systematic review and meta-analysis.
- Safety and efficacy of Withania somnifera for anxiety and insomnia: Systematic review and meta-analysis.
- Passiflora for anxiety disorder.
- Effects of passiflora incarnata and midazolam for control of anxiety in patients undergoing dental extraction.
- Effects of Passion Flower Extract, as an Add-On Treatment to Sertraline, on Reaction Time in Patients with Generalized Anxiety Disorder: A Double-Blind Placebo-Controlled Study.
- Controlled programmed trial of Ocimum sanctum leaf on generalized anxiety disorders.
- A clinical study on the management of generalized anxiety disorder with Centella asiatica.
- Effect of valepotriates (valerian extract) in generalized anxiety disorder: a randomized placebo-controlled pilot study.
- L-theanine in the adjunctive treatment of generalized anxiety disorder: A double-blind, randomised, placebo-controlled trial.
- Kava hepatotoxicity--a clinical review.
- A systematic review of the safety of kava extract in the treatment of anxiety.
- Ashwagandha-induced liver injury: A case series from Iceland and the US Drug-Induced Liver Injury Network.