> ## Content Index > Fetch the complete content index at: https://elonmuscular.com/llms.txt > Use this file to discover other available public pages before exploring further. # Stop Worrying All the Time - URL: https://elonmuscular.com/protocol-stop-worrying/ - Published: 2026-09-27T15:00:53.000Z - Updated: 2026-10-12T07:30:15.000Z - Description: Tracks gad-7 score. 32 moves, every one with its trial. - Author: Elon Muscular - Tags: Calm, Protocol [The library](https://elonmuscular.com/library/) / Calm # Stop Worrying All the Time Anxiety and constant worry Also called Generalized anxiety (GAD), Anxious all the time, Worrying about everything, Always on edge 4 min plan75 min with every studyUpdated Sep 27, 2026 Who it's forA man who worries about everything, most of the day, and cannot switch it off. [Plan](#pr2-plan)[Track](#pr2-track)[Studies](#pr2-studies) Your number GAD-7 score Judge self-help at 6 weeks. On this page [Tonight](#pr2-tonight)[The plan](#pr2-plan)[How you'll know](#pr2-know)[Why this happens](#pr2-why)[Week by week](#pr2-week)[What to track](#pr2-track)[Doses at a glance](#pr2-doses)[Deep dives](#pr2-deep)[The studies](#pr2-studies)[Words on this page](#pr2-words) ## Tonight 1. Take the GAD-7 and write the score down 2. Count today’s caffeine, and none after midday tomorrow 3. Pick a 15-minute worry slot for tomorrow, well before bed ## The plan WHAT IFWHAT IFWHAT IFWORRY SLOTREAL PROBLEMNEXT STEPWHAT-IFLET GO **Figure 1.** The worry loop: each what if hands off to the next. The worry slot takes them out of the day, and in the slot each one is sorted: a real problem gets a next step, a what-if gets let go. 32 moves, in order, after 1 check. Tap any row to see how. ### Check first The number to measure: the GAD-7The number to track: seven questions, every two weeksCheck ### The number to measure: the GAD-7 For: Knowing where you stand A 7-question score that shows how much the worry has hold of you, and whether it is easing. #### How to check 1. Answer the 7 questions about the last 2 weeks. 2. Write the score down. It runs from 0 to 21. 3. Repeat every 2 weeks. Take a score of 10 or more to your doctor. ##### 7 questions Over the last 2 weeks, how often have you been bothered by the following problems? 1. Feeling nervous, anxious or on edge 2. Not being able to stop or control worrying 3. Worrying too much about different things 4. Trouble relaxing 5. Being so restless that it is hard to sit still 6. Becoming easily annoyed or irritable 7. Feeling afraid as if something awful might happen **Each one:** Not at all 0 · Several days 1 · More than half the days 2 · Nearly every day 3 The window Last 2 weeks What the score means **5-9** Mild anxiety (cutpoint 5)**10-14** Moderate anxiety (cutpoint 10)**15-21** Severe anxiety (cutpoint 15)**\>=10** Recommended cutpoint for further evaluation when screening for anxiety disorders What it is 7 questions When Every 2 weeks How often For as long as you run the page Reading the number Tracks the trend In the study that built it, the 7 questions caught it 89% of the time. Across 48 studies, a score of 10 or more caught 64%. It is the line for a doctor. ¹ Archives of internal medicine, 2006\. The study is under The science, below. The science In detail Seven questions about worry and nerves over the last two weeks, each scored 0 to 3\. Take it today, then every two weeks, and bring the scores to the doctor. Found **Score of 10: the line.** In the study that built it, checked against a professional interview, the seven questions caught the worry disorder 89% of the time. Pooled across 48 studies, the recommended score of 10 or more caught it 64% of the time, and was clear in 91% without it. Why Constant worry feels like the way things are, so it hides its own trend. A score on paper every two weeks shows whether the moves below are working. How it is done Seven questions; Every two weeks; Today, then every 2 weeks #### The studies A cut point was identified that optimized sensitivity (89%) and specificity (82%). [PMID 16717171](https://pubmed.ncbi.nlm.nih.gov/16717171/?ref=elonmuscular.com) · A brief measure for assessing generalized anxiety disorder: the GAD-7\. · Archives of internal medicine, 2006 The sentence around it A cut point was identified that optimized sensitivity (89%) and specificity (82%). At the recommended cut-off of 10 or higher (or the closest available cut-off), the GAD-7 questionnaire yielded a summary sensitivity of 0.64 (95% CI 0.56 to 0.72) and a summary specificity of 0.91 (95% CI 0.87 to 0.93) in detecting generalised anxiety disorder. [PMID 40130828](https://pubmed.ncbi.nlm.nih.gov/40130828/?ref=elonmuscular.com) · Generalized Anxiety Disorder 7-item (GAD-7) and 2-item (GAD-2) scales for detecting anxiety disorders in adults. · The Cochrane database of systematic reviews, 2025 The sentence around it At the recommended cut-off of 10 or higher (or the closest available cut-off), the GAD-7 questionnaire yielded a summary sensitivity of 0.64 (95% CI 0.56 to 0.72) and a summary specificity of 0.91 (95% CI 0.87 to 0.93) in detecting generalised anxiety disorder. ### Free habits 1Learn how worry worksLearn what worry is, and watch your own scoreModerate evidence ### Learn how worry works For: Just starting Learn what constant worry is and what treats it. Then watch your own score. #### What to do 1. Read what the worry disorder is and how it is treated. 2. Take the GAD-7 every 2 weeks. 3. Note one line a day on how the worry went. How much One read, then the score When This week How long The first few weeks Standard practice The first step is education about the worry disorder and its treatments, then watching symptoms and daily functioning. For milder worry this can be all that is needed. What happened in the studies 1in 9 helped In 4 trials, reading about it alone eased distress and low mood: about 1 extra person better for every 9. ¹ BMC medicine, 2009\. The study is under The science, below. The science In detail Read up on what constant worry is and what treats it, then watch it: the score every two weeks and a line a day on how it went. That is the first step in the UK's NICE guideline, and for milder worry it can be enough. Found Four trials of short, reading-only lessons on worry: distress and low mood fell. About one extra person got better for every nine who read them. It works as a first step before anything else. Why Worry feeds on the belief that it is dangerous and out of your control. Knowing the loop, and seeing your own score move, takes some of that belief away. #### The study The pooled standardized-effect size (four studies, four comparisons) for reduced symptoms of depression and psychological distress at post-intervention was d = 0.20 (95% confidence interval: 0.01-0.40; Z = 2.04; P = 0.04; the number needed to treat: 9). [PMID 20015347](https://pubmed.ncbi.nlm.nih.gov/20015347/?ref=elonmuscular.com) · Psychoeducation for depression, anxiety and psychological distress: a meta-analysis. · BMC medicine, 2009 The sentence around it The pooled standardized-effect size (four studies, four comparisons) for reduced symptoms of depression and psychological distress at post-intervention was d = 0.20 (95% confidence interval: 0.01-0.40; Z = 2.04; P = 0.04; the number needed to treat: 9). They may offer a first-step intervention for those experiencing psychological distress or depression and might serve as an initial intervention in primary care or community models. The sentence around it They may offer a first-step intervention for those experiencing psychological distress or depression and might serve as an initial intervention in primary care or community models. 2A set worry timeFifteen minutes of worry a day, and the rest put off to itEarly evidence ### A set worry time For: Worry all day Give the worry one slot a day. Put every other worry off until then. #### What to do 1. Pick a 15-minute slot, same time each day. 2. When a worry comes, jot two words and put it off to the slot. 3. In the slot, write the worries down and any fix. How much 15 minutes When Same time daily How long Every day Standard practice Set a short worry time, 10 or 15 minutes, every day or so, to write things down and look for fixes. When a worry comes up in the day, set it aside for the worry time. What happened in the studies Large drop in worry In a trial, learning to put worry off to a set time cut worry a lot, and it held a month later. ¹ Clinical psychology in Europe, 2024\. The study is under The science, below. The science In detail Give the worry fifteen minutes a day, same time, same chair, well before bed. When a worry comes up in the day, write two words on your phone and put it off to the slot. In the slot, write the worries and any fix. Found A trial taught worry postponement in two sessions. Worry fell by a large amount against a waiting list, and it stayed down four weeks later. Why Constant worry runs on the belief that you cannot stop it. Putting it off on purpose, again and again, proves you can. The slot also keeps it out of the rest of the day. #### The study WP with a metacognitive rationale seems to be effective in reducing worry in participants with GAD. [PMID 39119056](https://pubmed.ncbi.nlm.nih.gov/39119056/?ref=elonmuscular.com) · Worry Postponement From the Metacognitive Perspective: A Randomized Waitlist-Controlled Trial. · Clinical psychology in Europe, 2024 The sentence around it …Conclusion WP with a metacognitive rationale seems to be effective in reducing worry in participants with GAD. Effects persisted to a four-week follow-up. The sentence around it Effects persisted to a four-week follow-up. 3Train most daysMove most days, aerobic first, lift twice a weekStrong evidence ### Train most days For: Everyone Exercise is one of the strongest things you can do for constant worry. Even short, easy sessions count. #### What to do 1. Walk briskly, jog, cycle or swim most days. 2. Lift weights twice a week. 3. Short and easy counts. Build up from there. How much Most days When Any time How long Every week What happened in the studies Less anxiety Across 1,079 trials, exercise cut anxiety, aerobic work the most. Short, easy sessions counted. ¹ British journal of sports medicine, 2026\. The study is under The science, below. Watch out Build up gradually to avoid injury. The science In detail Move most days: brisk walking, jogging, cycling, a class, and lifting twice a week. Aerobic work did the most for worry, and short, easy sessions counted. Start where you are. Found **Small drop in anxiety.** An umbrella of 1,079 trials and 79,551 people: exercise cut anxiety symptoms by a moderate effect, aerobic work the most. Shorter, lighter sessions were most strongly linked to less anxiety. Why Training burns off the stress chemistry that constant worry keeps running. It also teaches you that a racing heart and hard breathing are safe. Those are the same body signals worry sets off. #### The study Exercise reduced depression (standardised mean difference (SMD)=-0.61, 95% CI -0.69 to -0.54) and anxiety (SMD=-0.47, 95% CI -0.59 to -0.36) symptoms, with aerobic exercise demonstrating the most substantial impact on both depression and anxiety symptoms. [PMID 41667154](https://pubmed.ncbi.nlm.nih.gov/41667154/?ref=elonmuscular.com) · Effect of exercise on depression and anxiety symptoms: systematic umbrella review with meta-meta-analysis. · British journal of sports medicine, 2026 The sentence around it Exercise reduced depression (standardised mean difference (SMD)=-0.61, 95% CI -0.69 to -0.54) and anxiety (SMD=-0.47, 95% CI -0.59 to -0.36) symptoms, with aerobic exercise demonstrating the most substantial impact on both depression and anxiety symptoms. Exercise of shorter duration and at lower intensity was most strongly associated with anxiety reduction. The sentence around it Exercise of shorter duration and at lower intensity was most strongly associated with anxiety reduction. [The deep dive on this](https://elonmuscular.com/resistance-training/) 4CaffeineCount it, then cut it well under 400 mg a dayModerate evidence ### Cut the caffeine For: Coffee all day Caffeine pushes up the same jitters worry runs on. Count it, then cut it. #### What to do 1. Count every coffee, tea, cola, energy drink and pre-workout for a week. 2. Cut to well under 400 mg a day, and none after midday. 3. Step down over 1 to 2 weeks. How much Well under 400 mg When None after midday How long Taper over 1 to 2 weeks Standard practice Coffee, tea, cola and energy drinks contain caffeine, which can disrupt sleep and make anxiety harder to control. For most adults, 400 mg a day is the level not generally linked to harm. What happened in the studies More caffeine, more anxiety In 14 studies, caffeine raised anxiety, and most of all above 400 mg a day. ¹ Frontiers in psychology, 2024\. The study is under The science, below. Watch out Cutting fast brings a headache for a few days. Step it down. The science In detail Count the coffee, tea, cola, energy drinks and pre-workout for a week. Then cut it well under 400 mg a day, and none after midday. Step down over a week or two to dodge the headache. Found **Anxiety up, most above 400 mg.** Fourteen studies, 546 people: caffeine raised anxiety, moderately at low doses and steeply at high doses. The rise was largest above 400 mg. Why Caffeine blocks the tiredness signal and pushes adrenaline up. That brings the racing heart, the jitter and the broken sleep that constant worry already runs on. Watch Cutting fast from a high intake brings headache and tiredness for a few days. Taper it. #### The study In terms of overall effect, the results of the meta-analysis showed that caffeine intake increased the risk of anxiety \[SMD = 0.94, 95% Cl = (0.28, 1.60), p < 0.05\]. [PMID 38362247](https://pubmed.ncbi.nlm.nih.gov/38362247/?ref=elonmuscular.com) · Caffeine intake and anxiety: a meta-analysis. · Frontiers in psychology, 2024 The sentence around it In terms of overall effect, the results of the meta-analysis showed that caffeine intake increased the risk of anxiety \[SMD = 0.94, 95% Cl = (0.28, 1.60), p < 0.05\]. low-dose caffeine intake moderately increased the risk of anxiety \[SMD = 0.61, 95%Cl = (0.42, 0.79), p < 0.05\], whereas high-dose caffeine intake had a highly significant increase in the risk of anxiety \[SMD = 2.86, 95%Cl = (2.50, 3.22), p < 0.05\] The sentence around it …After suspecting that dose size might be responsible for the heterogeneity by sensitivity analysis, we performed subgroup analysis according to dose size and found that low-dose caffeine intake moderately increased the risk of anxiety \[SMD = 0.61, 95%Cl = (0.42, 0.79), p < 0.05\], whereas high-dose caffeine intake had a highly significant increase in the risk of anxiety \[SMD = 2.86, 95%Cl = (2.50, 3.22), p < 0.05\].… [The deep dive on this](https://elonmuscular.com/caffeine/) 5Drinking less without quittingCount the drinks, then cut a levelStrong evidence ### Drinking less without quitting For: Everyone Alcohol feels like relief tonight and drags your mood down tomorrow. #### What to do 1. Count your drinks for a week. 2. Then cut back a level, from most nights to some. 3. Try a month off if the count surprises you. How much One level less When Every week How long A year Standard practice Using alcohol, cigarettes, gambling or drugs to relieve anxiety can all make mental health worse. Harmful or dependent drinking is treated first, as that alone can ease the worry. What happened in the studies Better mental health In 1,383 people followed for a year, every step down in drinking came with better mental health. A bigger cut meant a bigger gain. ¹ Alcoholism, clinical and experimental research, 2017\. The study is under The science, below. Watch out If you drink every day and shake without it, stopping suddenly is a medical danger. See a doctor first. The science In detail Count the drinks for a week, then cut a level: from most nights to some, from some to few. The smaller glass, every round. A month off if the count surprises you. Found **1,383 people, one year.** 1,383 people, one year: every step down the risk-drinking ladder came with fewer alcohol consequences and better mental health, at the end of treatment and a year on. A bigger step meant a bigger gain. Why Alcohol calms for an hour and then rebounds. The next day brings more anxiety, not less, and the drink starts to feel like the only fix. Cutting the count breaks that loop. Watch Physical dependence, where cutting abruptly is a medical event and not a plan #### The study Any reduction in \[…\] risk drinking level during treatment was associated with significantly fewer alcohol-related consequences and improved mental health at the end of treatment and for up to 1 year posttreatment. [PMID 28019652](https://pubmed.ncbi.nlm.nih.gov/28019652/?ref=elonmuscular.com) · Clinical Validation of Reduced Alcohol Consumption After Treatment for Alcohol Dependence Using the World Health Organization Risk Drinking Levels. · Alcoholism, clinical and experimental research, 2017 The sentence around it …Results Any reduction in \[…\] risk drinking level during treatment was associated with significantly fewer alcohol-related consequences and improved mental health at the end of treatment and for up to 1 year posttreatment. A greater reduction in \[…\] risk drinking level predicted a greater reduction in consequences and greater improvements in mental health. The sentence around it A greater reduction in \[…\] risk drinking level predicted a greater reduction in consequences and greater improvements in mental health. [The deep dive on this](https://elonmuscular.com/cutting-down-drinking/) 6SleepSeven to eight hours, at the same timesStrong evidence ### Sleep For: Everyone Better sleep lowers anxiety. Fix your sleep and the worry often eases with it. #### What to do 1. Sleep 7 to 8 hours. 2. Wake at the same time every day. 3. If worry keeps you awake, run [Fall asleep](https://elonmuscular.com/protocol-fall-asleep/) too. How much 7 to 8 hours When Same wake time daily How long For good What happened in the studies Less depression and anxiety In 65 trials with 8,608 people, depression and anxiety fell when sleep got better. The more sleep improved, the more mood did. ¹ Sleep medicine reviews, 2021\. The study is under The science, below. Watch out Sleeping 9 hours or more and still tired is a question for a doctor. The science In detail Seven to eight hours, the same wake time seven days a week. If worry keeps you awake, run [Fall asleep](https://elonmuscular.com/protocol-fall-asleep/) beside this page. Found **g = 0.63 on depression.** Sixty-five trials, 8,608 people: when a treatment improved sleep, depression fell by a medium effect. Anxiety and rumination fell with it. The more sleep improved, the more mood did. Why A short night raises the amygdala's reactivity and cuts the prefrontal brake on it the next day. Regular sleep is the one move here that every other move depends on. Watch Nine hours or more a night that does not refresh is a doctor's question, not a reason to sleep in. #### The study Improving sleep led to a significant medium-sized effect on composite mental health (g+ = -0.53), depression (g+ = -0.63), anxiety (g+ = -0.51), and rumination (g+ = -0.49) [PMID 34607184](https://pubmed.ncbi.nlm.nih.gov/34607184/?ref=elonmuscular.com) · Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials. · Sleep medicine reviews, 2021 The sentence around it Improving sleep led to a significant medium-sized effect on composite mental health (g+ = -0.53), depression (g+ = -0.63), anxiety (g+ = -0.51), and rumination (g+ = -0.49), as well as significant small-to-medium sized effects on stress (g+ = -0.42), and finally small significant effects on positive psychosis symptoms (g+ = -0.26).… We also found a dose response relationship, in that greater improvements in sleep quality led to greater improvements in mental health. The sentence around it We also found a dose response relationship, in that greater improvements in sleep quality led to greater improvements in mental health. [The deep dive on this](https://elonmuscular.com/sleep/) 7Six breaths a minuteSix breaths a minute, ten to twenty minutes a dayModerate evidence ### Six breaths a minute For: Stress, anxiety Slow breathing switches your body out of fight-or-flight. It is the fastest way to calm down. #### What to do 1. Breathe in for 4 seconds and out for 6. 2. Do it 10 to 20 minutes a day, and any time you feel wound up. How much 10 to 20 minutes When Daily, and when stressed How long 4 weeks to judge What happened in the studies Large drop in stress In 24 studies, slow breathing cut stress and anxiety a lot. Done at home, it also lowered depression. ¹ Psychological medicine, 2017\. The study is under The science, below. Watch out If you feel dizzy or tingly, breathe more gently. The science In detail Six breaths a minute: in for four, out for six. Ten to twenty minutes a day, and any time you are wound up. A strap or a wearable that shows the heart rate while you breathe closes the loop. The trials found under twenty minutes a day worked best. Found **g = 0.83 against control.** Twenty-four studies, 484 people: a large drop in self-reported stress and anxiety against control. Eighteen studies, 1,352 people, run at home: depression down by a medium effect and HRV up by the same. Why Breathing near six a minute puts the breath in phase with the blood-pressure reflex, and the heart swings wide with each breath. That swing is the vagal brake being used. Used daily, it stays stronger between sessions. Watch Dizziness or tingling means you are blowing off too much carbon dioxide. Breathe lighter, not deeper. #### The studies The between-groups analysis comparing biofeedback to a control condition yielded Hedges' g = 0.83. [PMID 28478782](https://pubmed.ncbi.nlm.nih.gov/28478782/?ref=elonmuscular.com) · The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis. · Psychological medicine, 2017 The sentence around it The between-groups analysis comparing biofeedback to a control condition yielded Hedges' g = 0.83. Meta-analysis showed a medium effect size of HRV-B for improving both depression (g = - 0.41 \[- 0.049, - 0.772\], p = 0.026, I 2 = 72.623%, k = 10) and HRV (g = 0.443, \[0.718, 0.167\], p = 0.002, I 2 = 56.81%, k = 10) compared to control conditions. [PMID 41310318](https://pubmed.ncbi.nlm.nih.gov/41310318/?ref=elonmuscular.com) · Efficacy and Methodology of Remote Heart Rate Variability Biofeedback Interventions for Mental Health: A Systematic Review and Meta-Analysis. · Applied psychophysiology and biofeedback, 2026 The sentence around it Meta-analysis showed a medium effect size of HRV-B for improving both depression (g = - 0.41 \[- 0.049, - 0.772\], p = 0.026, I 2 = 72.623%, k = 10) and HRV (g = 0.443, \[0.718, 0.167\], p = 0.002, I 2 = 56.81%, k = 10) compared to control conditions. [The deep dive on this](https://elonmuscular.com/lab-slow-paced-breathing-hrv-biofeedback/) 8The eight-week mindfulness courseThe eight-week course, or ten minutes a dayStrong evidence ### The eight-week mindfulness course For: Caught in the loop An 8-week course that trains your mind to step back from worry. In a trial it matched a first-choice pill. #### What to do 1. Join an 8-week mindfulness course, or use a guided recording. 2. Practice 10 minutes a day between classes. 3. Keep sits short and daily. How much One class a week When Daily practice How long 8 weeks What happened in the studies Matched a first-choice drug In a trial of 276 people, the 8-week course eased anxiety as well as escitalopram, a standard anxiety pill. ¹ JAMA psychiatry, 2023\. The study is under The science, below. Watch out Keep sits short. Long silent retreats can stir distress. The science In detail An eight-week mindfulness course, one class a week, with daily home practice from recordings. Or ten minutes a day of the same exercises. It trains you to watch a worry pass without chasing it. Found A trial of 276 people: the eight-week course matched escitalopram, a first-choice drug, on anxiety. Across 47 trials, mindfulness eased anxiety at eight weeks and three to six months. Why Worry pulls the mind into the future. The practice brings it back to what is in front of you, again and again, and the habit of stepping out of the loop grows. Watch Keep the sits short and daily. Long silent retreats can stir distress. #### The studies The results from this randomized clinical trial comparing a standardized evidence-based mindfulness-based intervention with pharmacotherapy for the treatment of anxiety disorders found that MBSR was noninferior to escitalopram. [PMID 36350591](https://pubmed.ncbi.nlm.nih.gov/36350591/?ref=elonmuscular.com) · Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial. · JAMA psychiatry, 2023 The sentence around it …Conclusions and relevance The results from this randomized clinical trial comparing a standardized evidence-based mindfulness-based intervention with pharmacotherapy for the treatment of anxiety disorders found that MBSR was noninferior to escitalopram. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 \[95% CI, 0.12-0.64\] at 8 weeks and 0.22 \[0.02-0.43\] at 3-6 months) [PMID 24395196](https://pubmed.ncbi.nlm.nih.gov/24395196/?ref=elonmuscular.com) · Meditation programs for psychological stress and well-being: a systematic review and meta-analysis. · JAMA internal medicine, 2014 The sentence around it Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 \[95% CI, 0.12-0.64\] at 8 weeks and 0.22 \[0.02-0.43\] at 3-6 months), depression (0.30 \[0.00-0.59\] at 8 weeks and 0.23 \[0.05-0.42\] at 3-6 months), and pain (0.33 \[0.03- 0.62\]) and low evidence of improved stress/distress and mental health-related quality of life.… [The deep dive on this](https://elonmuscular.com/lab-mbsr/) 9YogaTwice a week, breath leading the posesModerate evidence ### Yoga For: Anxiety, low mood Yoga calms anxiety and lifts mood, with the breath leading the moves. #### What to do 1. Take a class twice a week, or do 30 minutes at home. 2. Keep it up for 8 to 12 weeks. How much 30 minutes When Twice a week How long 8 to 12 weeks What happened in the studies Less anxiety In 8 trials, yoga eased anxiety and lifted mood. In 218 trials, it was one of the 3 kinds of exercise that helped depression most. ¹ Depression and anxiety, 2018\. The study is under The science, below. Watch out Strains and overuse injuries. Ease into it. The science In detail A class twice a week, or thirty minutes at home with the breath leading the poses. The trials ran eight to twelve weeks. Found **Small drop in anxiety.** Eight trials, 319 people: anxiety down by a small effect against no treatment and a large one against active comparisons, with a small drop in low mood. In the 218-trial network, yoga was one of the three exercise forms that moved depression most, and among the best tolerated. Why Slow breathing and long holds tip the autonomic balance toward the calming branch, the loading is real training, and the attention is meditation. It is three moves from this page in one hour. Watch Rare serious neurovascular & structural events #### The studies small short-term effects of yoga on anxiety compared to no treatment (standardized mean difference \[SMD\] = -0.43; 95% confidence interval \[CI\] = -0.74, -0.11; P = .008), and large effects compared to active comparators (SMD = -0.86; 95% CI = -1.56, -0.15; P = .02) [PMID 29697885](https://pubmed.ncbi.nlm.nih.gov/29697885/?ref=elonmuscular.com) · Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials. · Depression and anxiety, 2018 The sentence around it …Meta-analyses revealed evidence for small short-term effects of yoga on anxiety compared to no treatment (standardized mean difference \[SMD\] = -0.43; 95% confidence interval \[CI\] = -0.74, -0.11; P = .008), and large effects compared to active comparators (SMD = -0.86; 95% CI = -1.56, -0.15; P = .02).… Strength training and yoga appeared to be the most acceptable modalities. [PMID 38355154](https://pubmed.ncbi.nlm.nih.gov/38355154/?ref=elonmuscular.com) · Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. · BMJ (Clinical research ed.), 2024 The sentence around it Strength training and yoga appeared to be the most acceptable modalities. [The deep dive on this](https://elonmuscular.com/yoga/) ### Over the counter 10Lavender OilThe oral lavender capsule, 80 mg a dayModerate evidence ### Lavender oil capsules For: Mild worry A lavender oil capsule that calms anxiety without making you drowsy. #### What to do 1. Take one 80 mg lavender oil capsule a day. 2. Not the diffuser or pillow spray. 3. Give it 10 weeks. How much 80 mg When Once a day How long 10 weeks What happened in the studies Anxiety down Across trials, lavender eased anxiety more than a dummy pill or no treatment. ¹ Asian nursing research, 2021\. The study is under The science, below. Watch out Burping and stomach upset. It may add to sedatives or sleeping pills. The science In detail The oral lavender oil capsule, 80 mg once a day, for ten weeks before you judge it. Not the diffuser oil or the pillow spray. It calms without making you drowsy. Found **g 0.72 on anxiety.** Across trials of lavender, anxiety fell by a moderate to large effect against placebo or no treatment. The oral capsule trials ran 80 mg a day for ten weeks. Why Its main constituents damp calcium entry at the nerve ending, so less excitatory signal is released. That is a similar target to pregabalin, at a gentler strength. Watch Burping, stomach upset and a lavender aftertaste. It may add to the effect of sedatives and sleeping pills. #### The study Lavender was superior to placebo or no treatment in reducing anxiety (Hedges' ĝ = -0.72, 95% confidence interval \[CI\] -0.90 to -0.55, p value <.001) [PMID 34775136](https://pubmed.ncbi.nlm.nih.gov/34775136/?ref=elonmuscular.com) · Effects of Lavender on Anxiety, Depression, and Physiological Parameters: Systematic Review and Meta-Analysis. · Asian nursing research, 2021 The sentence around it …Results Lavender was superior to placebo or no treatment in reducing anxiety (Hedges' ĝ = -0.72, 95% confidence interval \[CI\] -0.90 to -0.55, p value <.001), depression (Hedges' ĝ = -0.43, 95% CI, -0.59 to -0.27, p value <.001), and systolic blood pressure (Hedges' ĝ = -0.23, 95% CI, -0.41to -0.05, p value = .01).… [The deep dive on this](https://elonmuscular.com/lavender-oil/) 11ChamomileChamomile extract, 500 mg three times a dayModerate evidence ### Chamomile extract For: Mild worry A calming flower extract that eased constant worry in trials, and kept it lower for months. #### What to do 1. Take 500 mg of the extract, 3 times a day. 2. Strong tea is the kitchen version. The trials used the extract. 3. Give it 4 weeks. How much 500 mg, 3 times When Through the day How long 4 weeks What happened in the studies Worry eased In a review of 12 trials, anxiety scores fell at 2 and 4 weeks. In a longer trial, symptoms stayed lower for 26 weeks. ¹ Phytotherapy research, 2019\. The study is under The science, below. Watch out Allergic reactions in some, more with a ragweed or daisy allergy. On a blood thinner or sedatives, ask a doctor first. The science In detail The pharmaceutical-grade extract, 500 mg three times a day, for four weeks before you judge it. Strong chamomile tea is the kitchen version; the trials used the extract. Found **1.8 points off HAM-A at 4 weeks.** Twelve trials reviewed: on the doctor-rated anxiety scale, generalized anxiety scores fell at two and four weeks. Long-term trial, 179 people at 1,500 mg a day: symptoms stayed lower than placebo through 26 weeks, with blood pressure down alongside. Why Apigenin sits on the benzodiazepine site of the GABA-A receptor at a fraction of the affinity, which is a brake without the dependence. Watch Allergic reactions, more likely with a ragweed or daisy-family allergy. It may add to sedatives and can interact with warfarin and other blood thinners. The doses the studies used**1,500 mg** *500 mg three times a day, the long-term trial* 1,500 mg chamomile pharmaceutical grade extract 1500mg (500mg capsule 3 times daily) [PMID 27912875](https://pubmed.ncbi.nlm.nih.gov/27912875/?ref=elonmuscular.com) #### The studies By using HAM-A scale, there was a significant improvement in GAD after 2 and 4 weeks of treatment (mean difference = -1.43, 95% CI \[-2.47, -0.39\], P = 0.007), (MD = -1.79, 95% CI \[-3.14, -0.43\], P = 0.0097), respectively. [PMID 31006899](https://pubmed.ncbi.nlm.nih.gov/31006899/?ref=elonmuscular.com) · Therapeutic efficacy and safety of chamomile for state anxiety, generalized anxiety disorder, insomnia, and sleep quality: A systematic review and meta-analysis of randomized trials and quasi-randomized trials. · Phytotherapy research, 2019 The sentence around it By using HAM-A scale, there was a significant improvement in GAD after 2 and 4 weeks of treatment (mean difference = -1.43, 95% CI \[-2.47, -0.39\], P = 0.007), (MD = -1.79, 95% CI \[-3.14, -0.43\], P = 0.0097), respectively. During follow-up, chamomile participants maintained significantly lower GAD symptoms than placebo (P = 0.0032), with significant reductions in body weight (P = 0.046) and mean arterial blood pressure (P = 0.0063). [PMID 27912875](https://pubmed.ncbi.nlm.nih.gov/27912875/?ref=elonmuscular.com) · Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial. · Phytomedicine, 2016 The sentence around it During follow-up, chamomile participants maintained significantly lower GAD symptoms than placebo (P = 0.0032), with significant reductions in body weight (P = 0.046) and mean arterial blood pressure (P = 0.0063). [The deep dive on this](https://elonmuscular.com/chamomile/) 12AshwagandhaAshwagandha root extract, 300 to 600 mg a dayModerate evidence ### Ashwagandha root extract For: Stressed and wired A calming herb that lowered stress and anxiety by large amounts in trials. #### What to do 1. Take 300 to 600 mg of root extract a day, at night. 2. Give it 8 weeks. How much 300 to 600 mg When At night How long 8 weeks What happened in the studies Anxiety down In 12 trials with 1,002 people, anxiety and stress both fell a lot compared with a dummy pill. ¹ Phytotherapy research, 2022\. The study is under The science, below. Watch out Stomach upset and daytime sleepiness. Stop if your eyes turn yellow, a sign of liver trouble. On thyroid pills or sedatives, ask a doctor first. The science In detail 300 to 600 mg a day of root extract, for eight weeks before you judge it. Take it at night: it sedates a little. Stop at any yellowing of the eyes. Found **Large drop in anxiety.** Twelve trials, 1,002 people: anxiety and stress both fell against placebo, by large effects, with the stress effect sitting between 300 and 600 mg a day. Five trials on sleep: sharper mornings and less anxiety on top. Why Withanolides calm the stress-hormone system. The most repeated finding in people is lower cortisol under load. A GABA-side action carries the sleep half. It is the one daily move here that works on both the wired and the flat. Watch Gut upset and daytime drowsiness. Liver injury case reports cluster around some extracts, so stop at any yellowing of the eyes or dark urine. It can raise thyroid hormone levels: on thyroid pills, ask the doctor first. It may add to sedatives. The doses the studies used**300 to 600 mg** *where the stress effect sat in the dose curve* 300 to 600 mg600 mg and over stress at dose of 300-600 mg/d [PMID 36017529](https://pubmed.ncbi.nlm.nih.gov/36017529/?ref=elonmuscular.com) #### The studies Ashwagandha supplementation significantly reduced anxiety (SMD: -1.55, 95% CI: -2.37, -0.74; p = .005; I 2 = 93.8%) and stress level (SMD: -1.75; 95% CI: -2.29, -1.22; p = .005; I 2 = 83.1%) compared to the placebo. [PMID 36017529](https://pubmed.ncbi.nlm.nih.gov/36017529/?ref=elonmuscular.com) · Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trials. · Phytotherapy research, 2022 The sentence around it …We found that Ashwagandha supplementation significantly reduced anxiety (SMD: -1.55, 95% CI: -2.37, -0.74; p = .005; I 2 = 93.8%) and stress level (SMD: -1.75; 95% CI: -2.29, -1.22; p = .005; I 2 = 83.1%) compared to the placebo. Ashwagandha extract was also found to improve mental alertness on rising and anxiety level [PMID 34559859](https://pubmed.ncbi.nlm.nih.gov/34559859/?ref=elonmuscular.com) · Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis. · PloS one, 2021 The sentence around it Ashwagandha extract was also found to improve mental alertness on rising and anxiety level [The deep dive on this](https://elonmuscular.com/ashwagandha/) ### Next steps 13Switch Off the WorrySwitch Off the Worry: a 66-day guided quest, six lessonsStrong evidence ### Switch Off the Worry For: Want to fix it yourself A guided quest built on the methods tested in trials, worked through on your own: six lessons over 66 days. #### What to do 1. Keep the worry diary each evening: when, what, how strong. 2. Sort each worry: a real problem you can act on now, or a what-if. 3. Real problem: write the next step and do it. What-if: it waits in the slot. 4. Open each lesson as it unlocks, and judge it on day 66. How much Six lessons When A lesson every five days How long 66 days [Start the quest: Switch Off the Worry](https://elonmuscular.com/quest-switch-off-the-worry/) Standard practice A self-help course you work through on your own is a first-line step for constant worry. It runs for at least 6 weeks. What happened in the studies Symptoms down by half In a trial of 338 people, an online course for constant worry cut symptoms by half on average, and doing it alone matched doing it with a guide. ¹ Journal of anxiety disorders, 2015\. The study is under The science, below. The science In detail Start the guided quest, built on the methods tested in trials and worked through on your own. A lesson opens every five days or more. You see the worry loop, give the worry a slot, and sort it into a real problem or a what-if. Then you ask what the worry does for you, live with not knowing, and plan for the slip. Found In a trial of 338 people, an online course for constant worry cut symptoms by half on average, and the self-guided version matched the one with a guide. Low mood and social nerves eased with it. Why Worry feels like problem-solving, but most of it is a chain of what-ifs with nothing to act on. Sorting the real problems from the what-ifs gives the first a next step and lets the second go. #### The study Large reductions in symptoms of GAD (Cohen's d ≥ 1.48; avg. reduction ≥ 50%) [PMID 26460536](https://pubmed.ncbi.nlm.nih.gov/26460536/?ref=elonmuscular.com) · Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for generalized anxiety disorder and comorbid disorders: A randomized controlled trial. · Journal of anxiety disorders, 2015 The sentence around it Large reductions in symptoms of GAD (Cohen's d ≥ 1.48; avg. reduction ≥ 50%) and comorbid major depressive disorder (Cohen's d ≥ 1.64; avg.… [The deep dive on this](https://elonmuscular.com/lab-cbt/) 14Test the worry, face the doubtTest what worry does for you, then practice not knowingStrong evidence ### Test the worry, face the doubt For: Worry feels useful Test the belief that worry protects you, then practice living with not knowing, a little at a time. #### What to do 1. Write down what worry does for you, such as "it keeps me ready". 2. Test it: for one day, put every worry off on purpose, then compare what happened. 3. Face doubt in small doses: send the email without re-reading it, leave one thing unchecked. 4. Write a lapse plan: your early warning signs and your 3 best tools. How much One skill a week When Daily practice How long Weeks 4 to 6 What happened in the studies Large drop in worry In 20 trials of online courses, anxiety and worry fell by large amounts, and the gains looked set to hold. ¹ Depression and anxiety, 2021\. The study is under The science, below. The science In detail The second half of the self-help course. Write down what you believe worry does for you, then test it: a worry-free day on purpose, and a look at what happened. Then face uncertainty in small doses, and finish with a lapse plan. Found **g 0.75 on worry.** Twenty trials of online courses for constant worry: anxiety and worry fell by large effects, and the gains looked likely to hold at follow-up. Why Two beliefs keep worry running: that it protects you, and that you cannot stand not knowing. Testing the first and practicing the second, a little each day, takes away the reasons to keep worrying. #### The study Random-effect models detected large effect sizes for primary outcomes of anxiety (g = 0.79) and worry (g = 0.75) [PMID 33225589](https://pubmed.ncbi.nlm.nih.gov/33225589/?ref=elonmuscular.com) · The effectiveness of Internet-delivered treatment for generalized anxiety disorder: An updated systematic review and meta-analysis. · Depression and anxiety, 2021 The sentence around it Random-effect models detected large effect sizes for primary outcomes of anxiety (g = 0.79) and worry (g = 0.75), favoring treatment.… Maintenance of effects at follow-up seems likely. The sentence around it Maintenance of effects at follow-up seems likely. 15Applied relaxation, self-taughtLearn to relax in seconds, and use it the moment tension startsModerate evidence ### Applied relaxation, self-taught For: Tense all the time Teach yourself to switch off body tension in seconds, the moment worry starts. #### What to do 1. Twice a day, tense and release each muscle group, feet to face. 2. Next, release only, without the tensing. 3. Then pair a slow breath out with a cue word, such as "relax". 4. Use it many times a day, and the moment tension starts. How much Twice a day When At the first sign of tension How long A few weeks to learn What happened in the studies Medium to large drop Across 27 studies, relaxation training cut anxiety by a medium to large amount. Learned from an online course, it worked too. ¹ BMC psychiatry, 2008\. The study is under The science, below. The science In detail Teach yourself to relax the whole body in seconds, then use it at the first sign of tension. Start with a full tense-and-release run twice a day, then release only, then a cue word, then quick relaxation many times a day. Found **d 0.51 against control.** Twenty-seven studies of relaxation training: anxiety fell by a medium to large effect against control. In a trial of online self-help, applied relaxation learned from the screen brought a medium to large drop in anxiety. Why Worry lives in the body as much as the head: a tight jaw, shoulders, gut. Catching the tension early and letting it go stops the body feeding the worry back to the mind. #### The studies Cohen's d was .57 (95% CI: .52 to .68) in the within analysis and .51 (95% CI: .46 to .634) in the between group analysis. [PMID 18518981](https://pubmed.ncbi.nlm.nih.gov/18518981/?ref=elonmuscular.com) · Relaxation training for anxiety: a ten-years systematic review with meta-analysis. · BMC psychiatry, 2008 The sentence around it Cohen's d was .57 (95% CI: .52 to .68) in the within analysis and .51 (95% CI: .46 to .634) in the between group analysis. Internet-administered self-help plus minimal therapist contact via e-mail has a significant medium to large effect (Cohen's d=0.71 for AR [PMID 12899896](https://pubmed.ncbi.nlm.nih.gov/12899896/?ref=elonmuscular.com) · Treatment of panic disorder via the Internet: a randomized trial of CBT vs. applied relaxation. · Journal of behavior therapy and experimental psychiatry, 2003 The sentence around it …Overall, the results suggest that Internet-administered self-help plus minimal therapist contact via e-mail has a significant medium to large effect (Cohen's d=0.71 for AR and d=0.42 for CBT).… ### Early research 16Saffron ExtractSaffron extract, 30 mg a dayEarly evidence ### Saffron extract For: Worry with low mood Early research: a spice extract that eased self-rated anxiety and low mood in trials. #### What to do 1. Take 15 mg of a standardized saffron extract twice a day. 2. Use a named, standardized extract. Saffron is often faked. 3. Give it 6 weeks. How much 30 mg a day When 15 mg twice a day How long 6 weeks What happened in the studies Early signal In 6 trials with 339 people, saffron cut self-rated anxiety more than a dummy pill. ¹ Nutritional neuroscience, 2026\. The study is under The science, below. Watch out Mild stomach or nervous-system effects. Never above the trial dose. On an antidepressant, a blood thinner, or with bipolar disorder: ask first. The science In detail Early research. A standardized saffron stigma extract, 30 mg a day as 15 mg twice a day, for six weeks before you judge it. A standardized extract only: saffron is often faked. Found **5.1 points off BAI.** Thirty-four trials, 1,769 people: on the self-rated anxiety scale, six trials and 339 people, anxiety fell 5.1 points against placebo. Self-rated low mood fell too. Why Crocin and crocetin carry it, and crocetin is small enough to cross into the brain, where it acts on serotonin and stress signaling. Watch Mild stomach and nervous-system effects are the usual ones. High doses are toxic: stay at the trial dose. On an antidepressant, ask the doctor first. With bipolar disorder, ask a doctor first: it can lift mood or agitate. It may raise the bleeding tendency: ask first on a blood thinner. Rarely, an allergy. Products are often adulterated: a standardized extract only. The doses the studies used**30 mg** *15 mg twice a day, twelve weeks: depression score down 8.4 against 3.9* 30 mg 30 mg of Crocus sativus capsules (15 mg twice/day) [PMID 31602695](https://pubmed.ncbi.nlm.nih.gov/31602695/?ref=elonmuscular.com) #### The study the BAI (6 trials; 339 participants; WMD = -5.06, 95% CI: -8.44 to -1.68, p = 0.003, I2 = 94.8%) [PMID 41693488](https://pubmed.ncbi.nlm.nih.gov/41693488/?ref=elonmuscular.com) · Effect of saffron on depression, anxiety and mood disorder: a GRADE assessed systematic review and meta-analysis of 34 randomized controlled trials. · Nutritional neuroscience, 2026 The sentence around it …Saffron supplementation significantly reduced scores on BDI (14 trials; 817 participants; WMD = -4.39, 95% CI: -6.64 to -2.15, p < 0.001, I2 = 92.3%) and the BAI (6 trials; 339 participants; WMD = -5.06, 95% CI: -8.44 to -1.68, p = 0.003, I2 = 94.8%).… the findings suggest that saffron supplementation may be an effective complementary intervention for reducing self-reported depressive and anxiety symptoms in adults. The sentence around it …The certainty of evidence was rated as moderate according to the GRADE Working Group criteria.In conclusion, the findings suggest that saffron supplementation may be an effective complementary intervention for reducing self-reported depressive and anxiety symptoms in adults. [The deep dive on this](https://elonmuscular.com/saffron-extract/) 17Omega-3Fish oil, working up to 2 g a dayEarly evidence ### Omega-3 fish oil For: Mild worry Early research: fish oil may ease anxiety, most at about 2 g a day. #### What to do 1. Take fish oil with food. 2. Work up to about 2 g of omega-3 a day. 3. Give it 8 weeks. How much About 2 g When With food How long 8 weeks What happened in the studies Early signal In 23 trials with 2,189 people, omega-3 lowered anxiety symptoms, most at about 2 g a day. ¹ BMC psychiatry, 2024\. The study is under The science, below. Watch out Higher doses raise the risk of an irregular heartbeat. On a blood thinner, ask a doctor first. The science In detail Early research. Fish oil with food, working up to about 2 g of omega-3 a day, for at least eight weeks before you judge it. Or fatty fish several times a week as the food version. Found **Medium effect per gram a day.** Twenty-three trials, 2,189 people: each gram a day of omega-3 lowered anxiety symptoms by a moderate effect, with the greatest gain at 2 g a day. Nineteen trials: omega-3 might help reduce clinical anxiety. Why Omega-3 fats are built into brain cell membranes and shift the body toward less inflammatory signaling, which is raised in some anxiety. Watch Above 1 g a day, heart trials found a higher risk of an irregular heartbeat, atrial fibrillation, rising with the dose. On a blood thinner, ask the doctor first. Fishy burps and loose stools. #### The studies Each 1 gram per day supplementation with omega-3 fatty acids resulted in a moderate decrease in anxiety symptoms (SMD: -0.70, 95%CI: -1.17, -0.22; GRADE = low). [PMID 38890670](https://pubmed.ncbi.nlm.nih.gov/38890670/?ref=elonmuscular.com) · Efficacy and safety of omega-3 fatty acids supplementation for anxiety symptoms: a systematic review and dose-response meta-analysis of randomized controlled trials. · BMC psychiatry, 2024 The sentence around it Each 1 gram per day supplementation with omega-3 fatty acids resulted in a moderate decrease in anxiety symptoms (SMD: -0.70, 95%CI: -1.17, -0.22; GRADE = low). This review indicates that omega-3 PUFAs might help to reduce the symptoms of clinical anxiety. [PMID 30646157](https://pubmed.ncbi.nlm.nih.gov/30646157/?ref=elonmuscular.com) · Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms: A Systematic Review and Meta-analysis. · JAMA network open, 2018 The sentence around it …Conclusions and relevance This review indicates that omega-3 PUFAs might help to reduce the symptoms of clinical anxiety. [The deep dive on this](https://elonmuscular.com/omega-3/) 18Cannabidiol (CBD), before a speechOne dose of CBD before a speechEarly evidence ### Cannabidiol (CBD), before a speech For: Before a big talk Early research: one dose of CBD before a speech test lowered anxiety in a small trial. #### What to do 1. Keep the main moves going. 2. In the US it is prescription only. 3. Tell the doctor, and ask for liver tests if a doctor prescribes it. How much The trial: 600 mg once When Before a speech How long One event Standard practice The only approved cannabidiol is a prescription seizure medicine, and cannabidiol may not be sold in food or supplements. What happened in the studies Early signal In a small trial of 24 people, one dose of CBD before a speech test lowered anxiety. The evidence is early. ¹ Neuropsychopharmacology, 2011\. The study is under The science, below. Watch out The prescription label warns of liver injury, with liver blood tests first, and more risk with valproate. Sleepiness: no driving until you know how it hits. Allergic reactions. It interacts with other medicines. The science In detail Early research. In the trial, one 600 mg dose of cannabidiol 90 minutes before a speech test, against a dummy dose. In the US it is a prescription seizure medicine, and not lawful in food or supplements. Found **Speech anxiety down, one dose.** A trial of 24 people: one dose of cannabidiol before a public-speaking test cut anxiety, thinking trouble and discomfort during the speech. A review of the human studies found single doses lowered anxiety without sedation. Why Cannabidiol acts on serotonin 1A receptors and the body’s own cannabinoid system, both involved in fear. It does not carry the high of THC. Watch The prescription label warns of liver injury, with liver blood tests before starting, and higher risk beside valproate. It warns of sleepiness and sedation: no driving until you know how it hits. It also warns of suicidal thoughts, and of allergic reactions. It interacts with other medicines. #### The studies Pretreatment with CBD significantly reduced anxiety, cognitive impairment and discomfort in their speech performance, and significantly decreased alert in their anticipatory speech. [PMID 21307846](https://pubmed.ncbi.nlm.nih.gov/21307846/?ref=elonmuscular.com) · Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. · Neuropsychopharmacology, 2011 The sentence around it Pretreatment with CBD significantly reduced anxiety, cognitive impairment and discomfort in their speech performance, and significantly decreased alert in their anticipatory speech. In both populations, acute CBD administration significantly decreased anxiety without co-occurring sedation. [PMID 36875967](https://pubmed.ncbi.nlm.nih.gov/36875967/?ref=elonmuscular.com) · Systematic literature review of human studies assessing the efficacy of cannabidiol for social anxiety. · Psychiatry research communications, 2022 The sentence around it In both populations, acute CBD administration significantly decreased anxiety without co-occurring sedation. 19Passionflower extractPassionflower extract, 45 drops a dayEarly evidence ### Passionflower extract For: Mild worry Early research: a calming plant extract that matched a benzodiazepine in a small trial. #### What to do 1. Take the extract daily, as the trial did. 2. Give it 4 weeks, beside the rest of the page. 3. Not with sedatives, sleeping pills or alcohol. How much 45 drops a day When Daily How long 4 weeks What happened in the studies Early signal In a trial of 36 people, passionflower extract eased the worry disorder as well as oxazepam over 4 weeks. ¹ Journal of clinical pharmacy and therapeutics, 2001\. The study is under The science, below. Watch out Drowsiness in some: care driving. Not with sedatives or alcohol. The science In detail Early research. Passionflower extract as drops, 45 drops a day in the trial, for four weeks. Beside the rest of the page, not in place of it. Not with sedatives or alcohol. Found **Matched oxazepam.** A trial of 36 people with the worry disorder: passionflower extract matched oxazepam, a benzodiazepine, over four weeks, with less trouble at work. Across nine trials, most reported lower anxiety. Why Its flavonoids act on the GABA system, the brain’s main brake, more gently than a sedative drug. Watch Drowsiness and dizziness in some: care driving. Do not combine with sedatives, sleeping pills or alcohol. #### The studies The results suggest that Passiflora extract is an effective drug for the management of generalized anxiety disorder [PMID 11679026](https://pubmed.ncbi.nlm.nih.gov/11679026/?ref=elonmuscular.com) · Passionflower in the treatment of generalized anxiety: a pilot double-blind randomized controlled trial with oxazepam. · Journal of clinical pharmacy and therapeutics, 2001 The sentence around it …Conclusion The results suggest that Passiflora extract is an effective drug for the management of generalized anxiety disorder, and the low incidence of impairment of job performance with Passiflora extract compared to oxazepam is an advantage.… The majority of studies reported reduced anxiety levels following the administration of Passiflora incarnata preparations [PMID 33352740](https://pubmed.ncbi.nlm.nih.gov/33352740/?ref=elonmuscular.com) · Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review. · Nutrients, 2020 The sentence around it The majority of studies reported reduced anxiety levels following the administration of Passiflora incarnata preparations 20Rhodiola roseaRhodiola, 200 mg twice a day, morningsEarly evidence ### Rhodiola extract For: Worry with stress Early research: a herb that eased anxiety and stress in a two-week trial. #### What to do 1. Take 200 mg before breakfast and 200 mg before lunch. 2. Never in the evening. 3. Judge it at two weeks on the GAD-7. How much 200 mg, twice When Morning and midday How long 2 weeks, then judge Standard practice Rhodiola is possibly safe for up to 12 weeks. Side effects include dizziness, headache, insomnia and dry mouth, and an interaction with losartan has been reported. It is sold as a supplement, not approved as a drug. What happened in the studies Early signal In a two-week trial of 80 people, anxiety, stress and low mood fell on rhodiola against no supplement. ¹ Phytotherapy research, 2015\. The study is under The science, below. Watch out Can make you jittery and wreck your sleep if taken late. Dizziness and headache. On blood pressure pills, ask a doctor first. The science In detail Early research. 200 mg twice a day, before breakfast and before lunch, for two weeks before you judge it. Never in the evening: it stimulates. Found **Anxiety down in 14 days.** Eighty people, fourteen days, against no supplement: self-rated anxiety, stress, anger, confusion and low mood all fell, and total mood rose. Why Rosavins and salidroside together shape the stress response and the cell's energy pathways, which is why a stressed, worn-down worrier is where it fits. Watch Dizziness, headache, trouble sleeping, and a dry mouth or extra saliva. It has interacted with losartan, a blood pressure drug. The safety data run to about twelve weeks. The doses the studies used**400 mg** *two 200 mg tablets: before breakfast, before lunch* 400 mg 2 × 200 mg dose [PMID 26502953](https://pubmed.ncbi.nlm.nih.gov/26502953/?ref=elonmuscular.com) #### The study the experimental group demonstrated a significant reduction in self-reported, anxiety, stress, anger, confusion and depression at 14 days and a significant improvements in total mood [PMID 26502953](https://pubmed.ncbi.nlm.nih.gov/26502953/?ref=elonmuscular.com) · The Effects of Rhodiola rosea L. Extract on Anxiety, Stress, Cognition and Other Mood Symptoms. · Phytotherapy research, 2015 The sentence around it …Relative to the controls, the experimental group demonstrated a significant reduction in self-reported, anxiety, stress, anger, confusion and depression at 14 days and a significant improvements in total mood.… [The deep dive on this](https://elonmuscular.com/rhodiola-rosea/) 21L-TheanineL-theanine, 200 to 400 mg a dayEarly evidence ### L-theanine For: Wired on coffee Early research: a calming compound from tea that eased stress and anxiety in trials. #### What to do 1. Take 200 to 400 mg a day through a stressful stretch. 2. It pairs well with your coffee: it takes the edge off. 3. Give it 4 weeks. How much 200 to 400 mg When Daily How long 4 weeks to judge What happened in the studies Early signal In a review of 9 trials, 200 to 400 mg a day eased stress and anxiety under pressure. ¹ Plant foods for human nutrition (Dordrecht, Netherlands), 2020\. The study is under The science, below. Watch out Mild headache, drowsiness or nausea in some. On blood pressure pills or sedatives, ask a doctor first. The science In detail Early research. 200 to 400 mg a day through a stressful stretch, for four weeks before you judge it. It comes from tea, and it takes the edge off caffeine without dulling you. Found **Stress and anxiety eased.** A review of nine trials of L-theanine as a supplement against a control: 200 to 400 mg a day may ease stress and anxiety under stressful conditions. Why It resembles glutamate closely enough to sit on its receptors and slow its transport, which damps excitatory signaling without sedation, and it raises GABA alongside. Watch Mild headache, drowsiness or nausea in some. It may add to sedatives, and it can lower blood pressure a little: on blood pressure pills, ask first. The doses the studies used**200 to 400 mg a day** *the range the review found through a stressful stretch* 200 to 400 mg a day supplementation of 200-400 mg/day of L-THE may assist in the reduction of stress and anxiety [PMID 31758301](https://pubmed.ncbi.nlm.nih.gov/31758301/?ref=elonmuscular.com) #### The study Our findings suggest that supplementation of 200-400 mg/day of L-THE may assist in the reduction of stress and anxiety in people exposed to stressful conditions. [PMID 31758301](https://pubmed.ncbi.nlm.nih.gov/31758301/?ref=elonmuscular.com) · The Effects of Green Tea Amino Acid L-Theanine Consumption on the Ability to Manage Stress and Anxiety Levels: a Systematic Review. · Plant foods for human nutrition (Dordrecht, Netherlands), 2020 The sentence around it Our findings suggest that supplementation of 200-400 mg/day of L-THE may assist in the reduction of stress and anxiety in people exposed to stressful conditions. [The deep dive on this](https://elonmuscular.com/l-theanine/) 22MagnesiumMagnesium, 300 mg a dayEarly evidence ### Magnesium For: Diet low in magnesium Early research: magnesium eased anxiety across a review of 18 studies. #### What to do 1. Eat magnesium foods first: spinach, nuts, whole wheat bread. 2. If you add a supplement, 300 mg a day. 3. Stay at 400 mg a day or less. How much 300 mg a day When Daily How long 8 weeks Standard practice Men need 300 mg of magnesium a day, and a varied diet should give it. Taking 400 mg or less a day from supplements is unlikely to cause harm. More than 400 mg can cause diarrhea. What happened in the studies Early signal In a review of 18 studies, magnesium pointed to less anxiety. ¹ Nutrients, 2017\. The study is under The science, below. Watch out Over 400 mg a day can cause diarrhea. With kidney disease, ask a doctor first. Space it from antibiotics. The science In detail Early research. 300 mg of magnesium a day, for eight weeks. Stay at 400 mg a day or less from supplements. Eat the foods first: spinach, nuts, whole wheat bread. Found **Anxiety eased.** A review of 18 studies: the evidence points to magnesium easing self-rated anxiety. Why Magnesium damps the nerve’s excitatory NMDA receptor and is used in the stress hormone system. Topping up a low intake is the aim. Watch More than 400 mg a day for a short time can cause diarrhea. With kidney disease, do not take it without a doctor. It can cut the absorption of some antibiotics and bone drugs: space them apart. #### The study Existing evidence is suggestive of a beneficial effect of Mg on subjective anxiety [PMID 28445426](https://pubmed.ncbi.nlm.nih.gov/28445426/?ref=elonmuscular.com) · The Effects of Magnesium Supplementation on Subjective Anxiety and Stress-A Systematic Review. · Nutrients, 2017 The sentence around it …Conclusions Existing evidence is suggestive of a beneficial effect of Mg on subjective anxiety in anxiety vulnerable samples.… [The deep dive on this](https://elonmuscular.com/magnesium/) 23CurcuminAn absorbable curcumin, dailyEarly evidence ### Curcumin For: Worry with aches or inflammation Early research: an absorbable curcumin lowered anxiety scores across 8 trials. #### What to do 1. Pick an absorbable curcumin, not plain turmeric. 2. Take it daily with food, at the label dose. 3. Give it several weeks. How much Label dose When Daily, with food How long Several weeks What happened in the studies Early signal In 8 trials with 567 people, curcumin lowered anxiety symptoms more than the control. ¹ Clinical nutrition ESPEN, 2024\. The study is under The science, below. Watch out It raised blood sugar in a trial: with diabetes, ask first. Stomach upset. Rarely, liver injury: stop for yellow skin or dark pee. On a blood thinner, other medicines, or with gallstones, ask a doctor first. The science In detail Early research. Curcumin in a form built to absorb, such as with black pepper extract, daily with food at the label dose. Plain turmeric powder is barely absorbed. Found **Large drop in anxiety.** Eight trials, 567 people: curcumin lowered anxiety symptoms against control by a large pooled effect. Why Curcumin damps inflammatory signaling and the stress hormone response, both raised in some constant worry, and it acts on serotonin and dopamine pathways. Watch Blood sugar rose on curcumin in a memory trial: with diabetes or raised blood sugar, ask a doctor first and watch your HbA1c. Stomach upset. Rare liver injury has been reported with turmeric and curcumin supplements, more with black pepper forms: stop for yellow skin or eyes, or dark urine. Black pepper extract changes how some medicines are cleared. On a blood thinner, or with gallstones, ask the doctor first. #### The study A pooled analysis showed a significant effect of curcumin on anxiety symptoms (SMD: -1.56; 95% CI: -2.48, -0.64, p < 0.001; I 2 = 95.6%, p-heterogeneity< 0.001). [PMID 38857152](https://pubmed.ncbi.nlm.nih.gov/38857152/?ref=elonmuscular.com) · Effect of curcumin supplementation on symptoms of anxiety: A systematic review and meta-analysis of randomized controlled trials. · Clinical nutrition ESPEN, 2024 The sentence around it A pooled analysis showed a significant effect of curcumin on anxiety symptoms (SMD: -1.56; 95% CI: -2.48, -0.64, p < 0.001; I 2 = 95.6%, p-heterogeneity< 0.001). [The deep dive on this](https://elonmuscular.com/curcumin/) 24Lemon balm extractLemon balm extract, 600 mgEarly evidence ### Lemon balm extract For: Mild worry Early research: a calming leaf extract that lowered anxiety scores in trials. #### What to do 1. Take a standardized leaf extract, 600 mg. 2. Give it a few weeks, beside the rest of the page. 3. Not with sedatives, sleeping pills or alcohol. How much 600 mg When Daily How long A few weeks What happened in the studies Early signal In a review of trials, lemon balm lowered anxiety scores more than a dummy pill, without serious side effects. ¹ Phytotherapy research, 2021\. The study is under The science, below. Watch out Drowsiness in some: care driving. Not with sedatives or alcohol. On thyroid pills, ask a doctor first. The science In detail Early research. A standardized lemon balm leaf extract, 600 mg, the dose that raised calm in a stress trial. The anxiety trials ran it daily. Not with sedatives or alcohol. Found **Large drop in anxiety.** A review of trials: lemon balm lowered anxiety scores by a large effect and low mood by a moderate one against placebo, without serious side effects. It worked best for acute anxiety. Why Rosmarinic acid in the leaf slows the breakdown of GABA, the brain’s main brake, so the calming signal lasts longer. Watch Drowsiness in some: care driving until you know how it hits. It may add to sedatives, sleeping pills and alcohol. It may interfere with thyroid hormone: on thyroid pills, ask the doctor first. #### The studies lemon balm significantly improved mean anxiety and depression scores compared with the placebo (SMD: -0.98; 95% CI: -1.63 to -0.33; p = 0.003), (SMD: -0.47; 95% CI: -0.73 to -0.21; p = 0.0005) respectively, without serious side effects [PMID 34449930](https://pubmed.ncbi.nlm.nih.gov/34449930/?ref=elonmuscular.com) · The effects of lemon balm (Melissa officinalis L.) on depression and anxiety in clinical trials: A systematic review and meta-analysis. · Phytotherapy research, 2021 The sentence around it …Based on meta-analysis results, lemon balm significantly improved mean anxiety and depression scores compared with the placebo (SMD: -0.98; 95% CI: -1.63 to -0.33; p = 0.003), (SMD: -0.47; 95% CI: -0.73 to -0.21; p = 0.0005) respectively, without serious side effects.… the 600-mg dose of Melissa ameliorated the negative mood effects of the DISS, with significantly increased self-ratings of calmness [PMID 15272110](https://pubmed.ncbi.nlm.nih.gov/15272110/?ref=elonmuscular.com) · Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm). · Psychosomatic medicine, 2004 The sentence around it …Results The results showed that the 600-mg dose of Melissa ameliorated the negative mood effects of the DISS, with significantly increased self-ratings of calmness and reduced self-ratings of alertness.… ### With a doctor Everything in this group is a decision for you and a doctor who has your history. It is here so you walk in knowing what to ask for. 25Getting men into treatmentBook the doctor, take the diaryStrong evidence ### Getting men into treatment For: Getting help Seeing a doctor is a move, not a failure. It opens the medical options. #### What to do 1. Book a doctor's appointment. 2. Bring your diary: GAD-7 scores, caffeine, drinks, sleep. 3. Ask what is offered at your score before you ask for a pill. How much One appointment When This week How long Then as advised What happened in the studies Half as likely to get help For the same symptoms, men were about half as likely to have a diagnosis. What got men in: plain information and role models. ¹ Journal of affective disorders, 2022\. The study is under The science, below. The science In detail Book your doctor. Take the diary: the GAD-7 scores, the caffeine, the drinks, the sleep, the weeks. Ask what the UK's NICE guideline offers at your score before you ask for a pill. Found **odds 0.54 of a diagnosis.** In the national survey, men were about half as likely as women to hold a professional diagnosis for the same symptoms. The treatments that got men through the door used role models, plain information about symptoms, services signposted, and content built on responsibility and strength. Why Men seek help from a mental-health professional at the same rate as women once they are in front of one. Where they fall behind is in getting there at all. The binding constraint is contact, not willingness. #### The studies Odds of professional diagnosis were lower for men compared with women (adjusted odds ratio \[AOR\] 0.54, 95 % confidence intervals \[CI\] 0.47-0.62). [PMID 36155230](https://pubmed.ncbi.nlm.nih.gov/36155230/?ref=elonmuscular.com) · Associations between sociodemographic characteristics and receipt of professional diagnosis in Common Mental Disorder: Results from the Adult Psychiatric Morbidity Survey 2014\. · Journal of affective disorders, 2022 The sentence around it Odds of professional diagnosis were lower for men compared with women (adjusted odds ratio \[AOR\] 0.54, 95 % confidence intervals \[CI\] 0.47-0.62). Key processes that improved help-seeking attitudes, intentions, or behaviors for men included using role models to convey information, psychoeducational material to improve mental health knowledge, assistance with recognizing and managing symptoms, active problem-solving tasks, motivating behavior change, signposting services, and, finally, content that built on positive male traits (e.g., responsibility and strength). [PMID 31184251](https://pubmed.ncbi.nlm.nih.gov/31184251/?ref=elonmuscular.com) · Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking. · American journal of men's health, 2019 The sentence around it …Regarding quality assessment, three were scored as "strong," five as "moderate," and one as "weak." Key processes that improved help-seeking attitudes, intentions, or behaviors for men included using role models to convey information, psychoeducational material to improve mental health knowledge, assistance with recognizing and managing symptoms, active problem-solving tasks, motivating behavior change, signposting services, and, finally, content that built on positive male traits (e.g., responsibility and strength). [The deep dive on this](https://elonmuscular.com/men-and-help-seeking/) 26Sertraline, the first choiceSertraline on a prescription, the UK guideline's first drugStrong evidence ### Sertraline, the first choice For: Rather take a pill, or self-help not enough A daily prescription pill for constant worry. It takes weeks to work and needs a doctor watching the first month. #### What to do 1. Ask the doctor whether an SSRI suits you. 2. Start at 25 or 50 mg a day, then up as the doctor says. 3. Under 30: a check within a week, then weekly for a month. 4. If it works, stay on it at least a year. Never stop suddenly. How much 25 or 50 mg to start When Once a day How long At least a year if it works Standard practice The first drug in the UK's NICE guideline is an SSRI, sertraline first. Neither its UK nor its US label lists this use. Under 30, the doctor sees you within a week and checks weekly for a month. The drug is reviewed every 2 to 4 weeks for 3 months. If it works, you stay on it at least a year. What happened in the studies 63%against 37% responded In a 12-week trial of 370 people, 63% improved on sertraline against 37% on a dummy pill. ¹ The American journal of psychiatry, 2004\. The study is under The science, below. Watch out Boxed warning: at 24 and under it can raise suicidal thoughts at first; tell someone and call the doctor. Never with an MAOI or pimozide. Dangerous with other serotonin drugs. Bleeding risk with aspirin, painkillers like ibuprofen, or blood thinners. Can trigger a manic high, seizures, or an eye-pressure emergency. Low blood sodium: headache, confusion. Heart-rhythm change. Sexual side effects are common. Never stop suddenly. The science In detail If you choose a medicine, the first choice in the UK's NICE guideline is sertraline, an SSRI, on a prescription. It is used off-label for constant worry. The label starts at 25 or 50 mg a day, rising weekly if needed, up to 200 mg. The trial used 50 to 150 mg. Found A 12-week trial of 370 people: 63% responded on sertraline against 37% on placebo, with gains on every measure by week 4\. A second trial of 326 people on 50 to 200 mg: anxiety fell against placebo. Why SSRIs block the pump that clears serotonin back into the nerve, so more of it stays working. The calm builds over weeks as the brain adapts, which is why it is judged over months. Watch Boxed warning: antidepressants raised suicidal thoughts and behavior in young adults in short trials, 5 more per 1,000 at ages 18 to 24\. Watch closely in the first months and after any dose change. Never with an MAOI, or within 14 days of one, and never with pimozide. Serotonin syndrome with other serotonin drugs, triptans and tramadol among them; tell the doctor about any cocaine use. Bleeding risk with aspirin, NSAIDs or blood thinners. It raises the level of some drugs, warfarin and CYP2D6 drugs among them. Can trigger mania: tell the doctor about any highs. Seizures. Angle-closure glaucoma in narrow-angle eyes. Low blood sodium: headache, confusion, unsteadiness. A heart-rhythm change (QTc) with other risk factors. Sexual side effects: delayed or failed ejaculation, lower drive, erectile trouble. Early jitteriness and poor sleep. Never stop suddenly. #### The study The rate of responders, based on CGI improvement and last observation carried forward, was significantly higher for sertraline (63%) than placebo (37%). [PMID 15337655](https://pubmed.ncbi.nlm.nih.gov/15337655/?ref=elonmuscular.com) · Efficacy of sertraline in a 12-week trial for generalized anxiety disorder. · The American journal of psychiatry, 2004 The sentence around it The rate of responders, based on CGI improvement and last observation carried forward, was significantly higher for sertraline (63%) than placebo (37%). Conclusions Sertraline appears to be efficacious and well tolerated in the treatment of generalized anxiety disorder. The sentence around it Conclusions Sertraline appears to be efficacious and well tolerated in the treatment of generalized anxiety disorder. 27Escitalopram, an SSRIEscitalopram 10 mg a day, the next SSRIStrong evidence ### Escitalopram, an SSRI For: Sertraline did not suit The next SSRI to try, licensed for constant worry. One tablet a day. #### What to do 1. Tell the doctor what sertraline did, good and bad. 2. Take 10 mg once a day. The doctor may raise it to 20 mg. 3. Reviewed every 2 to 4 weeks at first. Never stop suddenly. How much 10 mg When Once a day How long At least a year if it works Standard practice Prescription only, and labeled for generalized anxiety disorder. It starts at 10 mg once a day and can rise to 20 mg after at least a week. The US label carries a boxed warning on suicidal thoughts; the UK label rules it out with a long QT. What happened in the studies Beat a dummy pill In a 12-week trial of 681 people, escitalopram eased anxiety more than a dummy pill, and 10 mg beat paroxetine. ¹ The British journal of psychiatry, 2006\. The study is under The science, below. Watch out Boxed warning: at 24 and under it can raise suicidal thoughts at first. Never with an MAOI, linezolid or pimozide. Not with a long QT heart rhythm, from birth or found on an ECG, or with other drugs that lengthen it. Dangerous with other serotonin drugs. Bleeding risk with aspirin, ibuprofen or blood thinners. Low blood sodium, seizures, manic highs, an eye-pressure emergency. Can slow reactions: care driving. Sexual side effects. Never stop suddenly. The science In detail The next SSRI if sertraline did not work or did not suit, on a prescription, and labeled for constant worry. The label dose is 10 mg once a day, raised to 20 mg after at least a week if needed. Found **Beat placebo at 10 mg.** A 12-week trial of 681 people: escitalopram at 10 and 20 mg beat placebo on anxiety, and 10 mg beat paroxetine. Across the drug trials, escitalopram ranked first for remission among the licensed options. Why Like sertraline, it blocks the serotonin pump. It is the most selective of the SSRIs, which is part of why it is often easy to take. Watch Boxed warning: antidepressants raised suicidal thoughts and behavior at younger ages, 5 more per 1,000 at 18 to 24\. Watch closely in the first months and after dose changes. Never with an MAOI, within 14 days of one, or with linezolid or intravenous methylene blue; never with pimozide. Ruled out with a known long QT, a long QT from birth, or other drugs that lengthen the QT. Serotonin syndrome with other serotonin drugs. Bleeding risk with aspirin, NSAIDs, warfarin or other blood thinners. Low blood sodium. Seizures. Can trigger mania: screened for bipolar first. Can slow thinking and reactions: care with driving and machinery until you know how it hits. Angle-closure glaucoma in narrow-angle eyes. Sexual side effects. Stop slowly, never suddenly. #### The studies Mean change in the primary efficacy measure was greater with escitalopram 10 and 20 mg than with placebo; 10 mg was more efficacious than paroxetine. [PMID 16946363](https://pubmed.ncbi.nlm.nih.gov/16946363/?ref=elonmuscular.com) · Escitalopram and paroxetine in the treatment of generalised anxiety disorder: randomised, placebo-controlled, double-blind study. · The British journal of psychiatry, 2006 The sentence around it …Results Mean change in the primary efficacy measure was greater with escitalopram 10 and 20 mg than with placebo; 10 mg was more efficacious than paroxetine. escitalopram was ranked first for remission (second across all treatments; 26.7%) [PMID 21398351](https://pubmed.ncbi.nlm.nih.gov/21398351/?ref=elonmuscular.com) · Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis. · BMJ (Clinical research ed.), 2011 The sentence around it …In a subanalysis ranking treatments for generalised anxiety disorder currently licensed in the United Kingdom, duloxetine was ranked first for response (third across all treatments; 2.7%), escitalopram was ranked first for remission (second across all treatments; 26.7%), and pregabalin was ranked first for tolerability (second across all treatments; 7.7%).… 28Paroxetine, an SSRIParoxetine 20 mg a day, with a slow stopModerate evidence ### Paroxetine, an SSRI For: Other SSRIs did not suit Another SSRI licensed for constant worry. It needs a slow, planned stop. #### What to do 1. Ask the doctor if it suits you. 2. Start at 20 mg a day. 3. Plan any stop with the doctor. Never stop suddenly. How much 20 mg When Once a day How long At least a year if it works Standard practice Prescription only, and labeled for generalized anxiety disorder, starting at 20 mg a day. In two 8-week trials, 20 mg and 40 mg both beat placebo. The UK's NICE guideline flags its withdrawal syndrome. What happened in the studies 62%and 68% against 46% In an 8-week trial of 566 people, 62% improved on 20 mg and 68% on 40 mg, against 46% on a dummy pill. ¹ The American journal of psychiatry, 2003\. The study is under The science, below. Watch out Boxed warning: at 24 and under it can raise suicidal thoughts at first. Never with an MAOI, thioridazine or pimozide. Dangerous with other serotonin drugs. Bleeding risk with aspirin, ibuprofen or blood thinners. Manic highs, seizures, an eye-pressure emergency. Sexual side effects. Strong withdrawal: never stop suddenly. The science In detail Another SSRI labeled for constant worry, on a prescription. The label starts at 20 mg a day. The UK's NICE guideline flags its withdrawal syndrome, so it is usually further down the list. Found An 8-week trial of 566 people at fixed doses: 62% responded on 20 mg and 68% on 40 mg, against 46% on placebo. Both doses cut the anxiety score more than placebo. Why It blocks the serotonin pump like the others. It also blocks a second receptor that brings drowsiness and a strong withdrawal. That is why the UK's NICE guideline warns about stopping it. Watch Boxed warning: antidepressants raised suicidal thoughts and behavior at younger ages, 5 more per 1,000 at 18 to 24\. Watch closely early and after dose changes. Never with an MAOI or within 14 days of one, linezolid or intravenous methylene blue among them; never with thioridazine or pimozide, which can upset the heart rhythm. Serotonin syndrome with other serotonin drugs. Bleeding risk with aspirin, NSAIDs, warfarin or other blood thinners. Can trigger mania: screened for bipolar first. Seizures. Angle-closure glaucoma in narrow-angle eyes. Sexual side effects, drowsiness and sweating are common. The withdrawal syndrome is among the strongest of these drugs: stop slowly, never suddenly. #### The study Response was achieved by 62% and 68% of the patients receiving 20 and 40 mg of paroxetine, respectively, compared with a 46% response rate in the placebo group. [PMID 12668365](https://pubmed.ncbi.nlm.nih.gov/12668365/?ref=elonmuscular.com) · Paroxetine treatment of generalized anxiety disorder: a double-blind, placebo-controlled study. · The American journal of psychiatry, 2003 The sentence around it Response was achieved by 62% and 68% of the patients receiving 20 and 40 mg of paroxetine, respectively, compared with a 46% response rate in the placebo group. At 8 weeks, reductions in total score on the Hamilton anxiety scale were significantly greater for both paroxetine groups. The sentence around it …Results At 8 weeks, reductions in total score on the Hamilton anxiety scale were significantly greater for both paroxetine groups. 29Venlafaxine, an SNRIVenlafaxine XR 75 mg a day, if an SSRI did not suitStrong evidence ### Venlafaxine, an SNRI For: The SSRIs did not suit A different class of antidepressant, licensed for constant worry. Blood pressure gets checked. #### What to do 1. Ask the doctor about an SNRI if an SSRI did not help. 2. Start at 75 mg once a day with food, or lower for a few days. 3. Dose steps: at least 4 days apart in the US, 2 weeks in the UK. 4. Get your blood pressure checked. Never stop suddenly. How much 75 mg When Once a day, with food How long At least a year if it works Standard practice Prescription only, labeled for generalized anxiety disorder. It starts at 75 mg a day, or at 37.5 mg for 4 to 7 days first. It rises by up to 75 mg at a time, to 225 mg. The steps are at least 4 days apart on the US label and 2 weeks or more on the UK label. Blood pressure is controlled first and checked through treatment. What happened in the studies 3.3pointsmore relief In 14 studies, venlafaxine cut anxiety scores more than a dummy pill, with more men getting well. ¹ PloS one, 2017\. The study is under The science, below. Watch out Boxed warning: at 24 and under it can raise suicidal thoughts at first. Never with an MAOI. Raises blood pressure, so it gets checked. Bleeding, low sodium, seizures, manic highs, an eye-pressure emergency. Sexual side effects. More dangerous in an overdose. Strong withdrawal: taper slowly. The science In detail If an SSRI did not work or did not suit: venlafaxine extended-release, on a prescription, labeled for constant worry. The label starts at 75 mg once a day with food, or 37.5 mg for 4 to 7 days first, up to 225 mg. Steps are at least 4 days apart on the US label, 2 weeks on the UK label. Found **3.3 points off HAM-A.** Fourteen studies against a placebo: venlafaxine cut the anxiety score by 3.3 points more than placebo, with more responders and more remissions. At 75 to 225 mg a day it worked and was well tolerated. Why An SNRI blocks the pumps for both serotonin and norepinephrine. The second chemical adds a push on the brain’s alarm-control circuits that some men respond to when an SSRI did not. Watch Boxed warning: antidepressants raised suicidal thoughts and behavior at younger ages, 5 more per 1,000 at 18 to 24\. Watch closely early and after dose changes. Never with an MAOI or within 14 days of one, linezolid or intravenous methylene blue among them. Serotonin syndrome with other serotonin drugs. Raises blood pressure: it is controlled first and checked regularly. Bleeding risk with aspirin, NSAIDs or blood thinners. Angle-closure glaucoma. Can trigger mania: screened for bipolar first. Seizures. Low blood sodium. Rare lung inflammation: report a new cough or breathlessness. Sexual side effects. More dangerous than the SSRIs in an overdose. A strong withdrawal: taper, never stop suddenly. #### The study venlafaxine XR was significantly more effective than placebo according to mean change of the Hamilton Rating Scale for Anxiety total scores \[mean difference = 3.31, 95% confidence interval(CI) 1.44-5.18, P = 0.0005\], response \[odds ratio(OR) = 1.83, 95%CI 1.58-2.12, P<0.00001\], and remission (OR = 2.55, 95%CI 1.36-4.78, P = 0.003) [PMID 28982121](https://pubmed.ncbi.nlm.nih.gov/28982121/?ref=elonmuscular.com) · Short-term efficacy and tolerability of venlafaxine extended release in adults with generalized anxiety disorder without depression: A meta-analysis. · PloS one, 2017 The sentence around it …As efficacy outcomes, our findings indicated venlafaxine XR was significantly more effective than placebo according to mean change of the Hamilton Rating Scale for Anxiety total scores \[mean difference = 3.31, 95% confidence interval(CI) 1.44-5.18, P = 0.0005\], response \[odds ratio(OR) = 1.83, 95%CI 1.58-2.12, P<0.00001\], and remission (OR = 2.55, 95%CI 1.36-4.78, P = 0.003).… We concluded that venlafaxine XR (75-225 mg/day) is an effective and well-tolerated pharmacological treatment option for adult patients with GAD. The sentence around it …Conclusion We concluded that venlafaxine XR (75-225 mg/day) is an effective and well-tolerated pharmacological treatment option for adult patients with GAD. 30Duloxetine, an SNRIDuloxetine 30 to 60 mg a day, if an SSRI did not suitStrong evidence ### Duloxetine, an SNRI For: Worry with aches, SSRIs did not suit The other SNRI licensed for constant worry. Not for heavy drinkers. #### What to do 1. Ask the doctor about duloxetine if an SSRI did not help. 2. Start at 30 mg (UK) or 60 mg (US) once a day. 3. Tell the doctor honestly how much you drink. Never stop suddenly. How much 30 or 60 mg When Once a day How long At least a year if it works Standard practice Prescription only, labeled for generalized anxiety disorder. The UK label starts at 30 mg, then 60 mg; the US label at 60 mg, or 30 mg for a week. The maximum is 120 mg. It is ruled out with severe kidney impairment, liver disease or uncontrolled blood pressure. What happened in the studies More men got well In 7 trials with 2,674 people, more got better on duloxetine than on a dummy pill, and daily life improved. ¹ Asia-Pacific psychiatry, 2016\. The study is under The science, below. Watch out Boxed warning: suicidal thoughts can rise at first at younger ages. Never with an MAOI. Not with severe kidney trouble, liver disease or uncontrolled blood pressure. Liver damage: not with heavy drinking; stop if your eyes turn yellow. Dizzy on standing, raised blood pressure, bleeding, skin reactions, manic highs, seizures. Sexual side effects. Never stop suddenly. The science In detail The other SNRI labeled for constant worry, on a prescription. The UK label starts at 30 mg once a day, then 60 mg. The US label starts at 60 mg, or 30 mg for a week first. Up to 120 mg. Not for a heavy drinker. Found **Response 1.48 times placebo.** Seven trials against a placebo, 2,674 people: more responders and more remissions on duloxetine, the anxiety score down 3.3 points more, and daily functioning better. It was moderately effective. Why Like venlafaxine, it blocks the serotonin and norepinephrine pumps. The norepinephrine side also damps pain signaling, which is why it helps when worry comes with aches. Watch Boxed warning: antidepressants raised suicidal thoughts and behavior in young adults in short trials. Watch closely early and after dose changes. Never with an MAOI, within 5 days of stopping it or 14 days of stopping an MAOI, and not started on linezolid or intravenous methylene blue. Liver failure, sometimes fatal, has been reported: avoided with heavy drinking or liver disease; stop at any yellowing of the skin or eyes. Dizziness on standing, falls and fainting. Serotonin syndrome with other serotonin drugs. Bleeding risk with blood thinners. Severe skin reactions: stop at blisters or a peeling rash. Can trigger mania. Angle-closure glaucoma. Seizures. Ruled out with severe kidney impairment (clearance under 30 mL a minute), liver disease, or blood pressure that is not under control. Raises blood pressure: checked before and during. Avoid with fluvoxamine, ciprofloxacin and similar CYP1A2 blockers, and with thioridazine. Low blood sodium. Sexual side effects. Taper, never stop suddenly. #### The study Six studies provided data on response, which showed a significant difference between duloxetine and placebo (n = 1,975, RR = 1.48, 95% CI, 1.34-1.63). [PMID 26238298](https://pubmed.ncbi.nlm.nih.gov/26238298/?ref=elonmuscular.com) · Duloxetine in treating generalized anxiety disorder in adults: A meta-analysis of published randomized, double-blind, placebo-controlled trials. · Asia-Pacific psychiatry, 2016 The sentence around it Six studies provided data on response, which showed a significant difference between duloxetine and placebo (n = 1,975, RR = 1.48, 95% CI, 1.34-1.63). Duloxetine is moderately effective in treating GAD with improvement in overall function and well tolerability. The sentence around it …Conclusion Duloxetine is moderately effective in treating GAD with improvement in overall function and well tolerability. 31Pregabalin, if the antidepressants did not suitPregabalin, when SSRIs and SNRIs cannot be takenModerate evidence ### Pregabalin, if the antidepressants did not suit For: Could not take the antidepressants A different kind of calming prescription, for when SSRIs and SNRIs could not be taken. It can be habit-forming. #### What to do 1. Only if SSRIs and SNRIs did not suit. 2. Start at 150 mg a day, split into 2 or 3 doses. 3. Agree a stop plan before you start. Never with alcohol or opioids. How much 150 mg a day to start When In 2 or 3 doses How long The shortest time that works Standard practice Considered when SSRIs and SNRIs cannot be tolerated. Prescription only, a controlled drug in the UK and the US; licensed for the worry disorder in the UK, not in the US. The range is 150 to 600 mg a day in two or three doses, for the shortest time, with a stop plan agreed first. What happened in the studies Beat a dummy pill In 8 trials with 2,299 people, pregabalin eased anxiety more than a dummy pill. ¹ International clinical psychopharmacology, 2017\. The study is under The science, below. Watch out It can be habit-forming, even at the prescribed dose, and it is a controlled drug. Dangerous with opioids, alcohol or sedatives: slowed breathing. Suicidal thoughts, face or throat swelling, dizziness, blurred vision, swollen ankles. Taper over at least a week. The science In detail If you cannot take SSRIs or SNRIs: pregabalin, on a prescription, licensed for constant worry in the UK and used off-label in the US. It starts at 150 mg a day in two or three doses, rising weekly to 300, then 450, up to 600 mg. Found **g 0.37 against placebo.** Eight trials, 2,299 people: pregabalin beat placebo on anxiety. It matched benzodiazepines on response, with fewer dropouts. Why It binds a calcium channel on overactive nerves and turns down the release of excitatory signals. That calms the body side of anxiety within days, not weeks. Watch It can cause dependence and addiction, even at prescribed doses, and misuse is reported. It is a controlled drug in the UK and the US: take only your own, at your dose. Slowed breathing, and a higher risk of opioid overdose death, with opioids, alcohol or other sedatives. Suicidal thoughts, as with other seizure drugs. Swelling of the face, mouth or throat, or a severe rash: stop and get help. Dizziness and sleepiness: no driving until you know how it hits. Blurred vision. Swollen ankles and weight gain. Heart failure in some. Stopping suddenly brings withdrawal: taper over at least a week, with a plan to end it agreed before you start. #### The study In terms of the main outcome, PGB was found to be superior to the placebo group (Hedges' g=0.37; 95% confidence interval 0.30-0.44). [PMID 27643884](https://pubmed.ncbi.nlm.nih.gov/27643884/?ref=elonmuscular.com) · Pregabalin for generalized anxiety disorder: an updated systematic review and meta-analysis. · International clinical psychopharmacology, 2017 The sentence around it In terms of the main outcome, PGB was found to be superior to the placebo group (Hedges' g=0.37; 95% confidence interval 0.30-0.44). PGB was comparable to benzodiazepines in clinical response, but had lower dropout rates than benzodiazepine. The sentence around it PGB was comparable to benzodiazepines in clinical response, but had lower dropout rates than benzodiazepine. 32Buspirone, a non-sedating optionBuspirone, the doctor’s non-sedating optionModerate evidence ### Buspirone, a non-sedating option For: Want to avoid habit-forming pills A prescription anxiety pill that does not sedate or build dependence. The doctor’s call. #### What to do 1. Ask the doctor if buspirone suits you. 2. Start at 7.5 mg twice a day. 3. Give it weeks, not days. No grapefruit juice in large amounts. How much 7.5 mg twice a day When Twice a day How long Weeks to build Standard practice Prescription only. US label: anxiety disorders, starting at 15 mg a day as 7.5 mg twice daily, rising 5 mg a day every 2 to 3 days, up to 60 mg. UK label: short-term management of anxiety. What happened in the studies 1in 4.4 helped Across 36 trials with 5,908 people, buspirone and its class beat a dummy pill: about 1 extra man better for every 4.4 treated. ¹ The Cochrane database of systematic reviews, 2006\. The study is under The science, below. Watch out Never with an MAOI or linezolid. Dangerous with other serotonin drugs. Grapefruit juice and some antibiotics, antifungals and heart pills raise its level. It does not cover coming off benzodiazepines. Dizziness: care driving. No alcohol with it. The science In detail A non-habit-forming anxiety medicine, on a prescription. It is labeled in the US for anxiety disorders and in the UK for short-term use. It is not in the drug order of the UK's NICE guideline, so it is the doctor's call. The label starts at 7.5 mg twice a day. Found Thirty-six trials, 5,908 people: buspirone and its class beat placebo for the worry disorder, about one extra man better for every 4.4 treated. In a 6-week trial of 162 people, anxiety scores fell 2.9 points more than on placebo. Why It acts on serotonin 1A receptors, not the GABA system that benzodiazepines use, so it does not sedate much or build dependence. The effect builds over weeks. Watch Never with an MAOI or within 14 days of one, and not started on linezolid or intravenous methylene blue: serotonin syndrome and a blood pressure rise. Serotonin syndrome with other serotonin drugs, triptans among them. Levels rise sharply with grapefruit juice in large amounts, and with CYP3A4 blockers such as itraconazole, erythromycin, diltiazem and verapamil. It does not cover benzodiazepine or sedative withdrawal: those are tapered first. Restlessness early on in some. Dizziness and sleepiness: care with driving until you know how it hits. Avoid alcohol with it. #### The studies Azapirones, including buspirone, were superior to placebo in treating GAD. [PMID 16856115](https://pubmed.ncbi.nlm.nih.gov/16856115/?ref=elonmuscular.com) · Azapirones for generalized anxiety disorder. · The Cochrane database of systematic reviews, 2006 The sentence around it Azapirones, including buspirone, were superior to placebo in treating GAD. Buspirone is superior to placebo in improving anxiety and depressive symptoms in GAD patients who have coexisting depressive symptoms. [PMID 8666569](https://pubmed.ncbi.nlm.nih.gov/8666569/?ref=elonmuscular.com) · Efficacy of buspirone in generalized anxiety disorder with coexisting mild depressive symptoms. · The Journal of clinical psychiatry, 1996 The sentence around it …Conclusion Buspirone is superior to placebo in improving anxiety and depressive symptoms in GAD patients who have coexisting depressive symptoms. ## How you'll know it's working Track GAD-7 score How to track Seven questions about the last two weeks, scored 0 to 21\. Take it today, then every two weeks, same day of the week. Write the score in the diary. When to judge The self-help course gets at least six weeks. A daily supplement gets four to ten weeks. A medicine is reviewed every 2 to 4 weeks for the first three months. New Heroes The full library. Elon answers every weekday. [Join New Heroes.](https://elonmuscular.com/join/) Cancel anytime. ## Why this happens It starts before you are out of bed: money, work, your health, the people you love, the thing you said yesterday. One worry hands off to the next, all day, and it will not switch off. On a man it often shows in the body first: tight shoulders, a jumpy gut, a racing heart and short sleep. Then a short fuse, and a drink or a scroll to take the edge off. ### The loop Worry feels useful, so the mind keeps doing it. Each "what if" hands off to the next, and checking and reassurance keep it fed. Worry time and the self-help course break the loop by teaching that you can put it down. ### The body Caffeine, drink and short sleep all turn up the alarm, and a tense, wired body sends worry back to the mind. Training, slow breathing, relaxation and the calming supplements turn the alarm down from the body side. ### The chemistry When the worry is heavy or will not shift, the medicines act on serotonin, norepinephrine or overactive nerves. They go through a doctor, and they work best beside the rest. A set worry timeThe self-help courseTest the worryChecking, reassuranceWorry you can put downTraining most daysLess caffeine and drinkApplied relaxation,supplementsWired and tenseA calmer baselineAn SSRIAn SNRIPregabalinWaiting it outThe volume turned downWorry thatno longerruns yourdayWorry thatno longerruns yourdayWorry thatno longerruns yourdayWorry thatno longerruns yourdayThe loopThe bodyThe chemistryA set worry timeThe self-help courseTest the worryChecking, reassuranceWorry you can put downTraining most daysLess caffeine and drinkApplied relaxation, supplementsWired and tenseA calmer baselineAn SSRIAn SNRIPregabalinWaiting it outThe volume turned downWorry that no longerruns your dayWorry that no longerruns your dayWorry that no longerruns your dayWorry that no longerruns your dayThe loopThe bodyThe chemistry **Figure 2.** How the moves lead to worry that no longer runs your day. The dotted orange boxes are the things to cut back. ## Week by week Why this order Learn and watch first, the self-help course next, then applied relaxation, and a medicine with a doctor if the score has not moved. 0246810121416182022Weeks from the startGAD-7, every 2 weeksWorry time, dailyTraining, most daysCaffeine and drink cutSlow breathing, dailyThe self-help courseThe reviewRelaxation skills, or amedicineReview, week 22048121620Weeks from the startGAD-7, every 2 weeksWorry time, dailyTraining, most daysCaffeine and drink cutSlow breathing, dailyThe self-help courseThe reviewRelaxation skills, or a medicineReview, week 22 **Figure 3.** The plan by week: navy bars keep going, orange bars are the moves you add, white bars are checks and decisions. The starburst marks the review at week 22. Swipe sideways to see the whole table | When | Add | Why then | | ----------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------- | | Today | The GAD-7\. Chest pain or fainting with a racing heart: 911. | Safety comes first, then the number that decides where you start. | | Week 0 | Learn how worry works. A 15-minute worry slot each day. Training most days. Caffeine counted and cut, drinks counted and cut, a fixed wake time. | The first step in the UK's NICE guideline is learning and watching. The daily moves start with it because they feed each other. | | Week 1 | Start the self-help course for worry: the worry log, then real problem or what-if. Add slow breathing, and one daily supplement if you want one. | A self-help course is the second step in the UK's NICE guideline, and you can start it tonight. | | Week 7, the review | This GAD-7 against the first. Down: keep going, and test the worry and face the doubt. Flat, or the worry is wrecking work and sleep: add applied relaxation, and see your doctor about a medicine. | The course runs at least six weeks. Heavy worry, or no change, moves to the third step. | | On a medicine | Sertraline first. Under 30, a check within a week and weekly for a month. Reviewed every 2 to 4 weeks for 3 months. If it works, at least a year. Never stop suddenly. | The early weeks carry the suicidality warning, and stopping early brings relapse and withdrawal. | | If the first drug fails | Another SSRI or an SNRI. If none suit, pregabalin. Keep the course skills going beside a drug that half-worked. | The order of the UK's NICE guideline. A partial response adds skills rather than stacking pills. | | If nothing has worked | A community mental health team, for a specialist plan. | | | Any week | Nerves before one big event: [Stay calm](https://elonmuscular.com/protocol-calm-under-pressure/). Low and flat more than worried: [Low mood](https://elonmuscular.com/protocol-low-mood/). Lying awake: [Fall asleep](https://elonmuscular.com/protocol-fall-asleep/). Afraid of being judged: [Social confidence](https://elonmuscular.com/protocol-social-confidence/). | Each rides with constant worry, and each has its own page. | ## What to track One number: the GAD-7 score, every two weeks. Under 5 is the goal, and 10 or more is the line for a doctor. Read the trend over a month, not one score. The diary is a week: minutes of worry time used, days trained, caffeine, drinks, hours slept, and one line on the worst worry of the day. Where the score has not moved by the review, the order above says what to do next. ### The diary, one week Swipe sideways to see the whole table | Day | Worry time used? | Trained today? | Caffeine, mg | Drinks | Hours slept | | --- | ---------------- | -------------- | ------------ | ------ | ----------- | | Mon | | | | | | | Tue | | | | | | | Wed | | | | | | | Thu | | | | | | | Fri | | | | | | | Sat | | | | | | | Sun | | | | | | - The GAD-7 score every two weeks: judged at the review, around week 7, then monthly. - Caffeine and drinks a day: the two columns that move first and fastest. - Days trained out of seven, and worry time used: the habits that hold the gains. - On a medicine: mood, sleep, sex and any new dark thoughts, one line a week. A change is a call to the doctor, not a column to watch. - A thyroid blood test if a racing heart, weight loss and feeling hot came with the worry. It is a check, not a move. ## Doses at a glance The amounts the studies used, move by move. The label or your doctor sets your dose. Swipe sideways to see the whole table | Move | What the studies used | When | How long | Study | | ------------------------------------------------------------ | -------------------------------------- | --------------------------------- | ----------------------------- | ------------------------------------------------------------------------------- | | [1\. Learn how worry works](#e1) | Read, then watch the score | This week | The first few weeks | [PMID 20015347](https://pubmed.ncbi.nlm.nih.gov/20015347/?ref=elonmuscular.com) | | [2\. A set worry time](#e2) | 15 minutes | Same time daily, not near bed | Every day | [PMID 39119056](https://pubmed.ncbi.nlm.nih.gov/39119056/?ref=elonmuscular.com) | | [3\. Train most days](#e3) | Most days; lift twice a week | Any time of day | Every week | [PMID 41667154](https://pubmed.ncbi.nlm.nih.gov/41667154/?ref=elonmuscular.com) | | [4\. Cut the caffeine](#e4) | Well under 400 mg | None after midday | Taper over 1 to 2 weeks | [PMID 38362247](https://pubmed.ncbi.nlm.nih.gov/38362247/?ref=elonmuscular.com) | | [5\. Drinking less without quitting](#e5) | One risk level down | Count first, then cut | Every week | [PMID 28019652](https://pubmed.ncbi.nlm.nih.gov/28019652/?ref=elonmuscular.com) | | [6\. Sleep](#e6) | 7 to 8 hours | Same wake time, seven days | Always | [PMID 34607184](https://pubmed.ncbi.nlm.nih.gov/34607184/?ref=elonmuscular.com) | | [7\. Six breaths a minute](#e7) | Six breaths a minute | 10 to 20 minutes, daily | Every day; judge at 4 weeks | [PMID 28478782](https://pubmed.ncbi.nlm.nih.gov/28478782/?ref=elonmuscular.com) | | [8\. The eight-week mindfulness course](#e8) | One class a week, daily practice | Daily | 8 weeks | [PMID 36350591](https://pubmed.ncbi.nlm.nih.gov/36350591/?ref=elonmuscular.com) | | [9\. Yoga](#e9) | A class, or 30 minutes | Twice a week | 8 to 12 weeks | [PMID 29697885](https://pubmed.ncbi.nlm.nih.gov/29697885/?ref=elonmuscular.com) | | [10\. Lavender oil capsules](#e10) | Oral extract 80 mg | Once a day | 10 weeks | [PMID 34775136](https://pubmed.ncbi.nlm.nih.gov/34775136/?ref=elonmuscular.com) | | [11\. Chamomile extract](#e11) | 1,500 mg extract | 500 mg, three times a day | 4 weeks | [PMID 31006899](https://pubmed.ncbi.nlm.nih.gov/31006899/?ref=elonmuscular.com) | | [12\. Ashwagandha root extract](#e12) | 300 to 600 mg root extract | Night | 8 weeks | [PMID 36017529](https://pubmed.ncbi.nlm.nih.gov/36017529/?ref=elonmuscular.com) | | [13\. Switch Off the Worry](#e13) | Six lessons and a 2-minute daily diary | A lesson every five days or more | 66 days | [PMID 26460536](https://pubmed.ncbi.nlm.nih.gov/26460536/?ref=elonmuscular.com) | | [14\. Test the worry, face the doubt](#e14) | One skill a week | Daily practice | Weeks 4 to 6 of the course | [PMID 33225589](https://pubmed.ncbi.nlm.nih.gov/33225589/?ref=elonmuscular.com) | | [15\. Applied relaxation, self-taught](#e15) | Twice a day to learn it | Then at the first sign of tension | A few weeks to learn | [PMID 18518981](https://pubmed.ncbi.nlm.nih.gov/18518981/?ref=elonmuscular.com) | | [16\. Saffron extract](#e16) | 30 mg standardized extract | 15 mg twice a day | 6 weeks | [PMID 41693488](https://pubmed.ncbi.nlm.nih.gov/41693488/?ref=elonmuscular.com) | | [17\. Omega-3 fish oil](#e17) | About 2 g a day | With food | 8 weeks | [PMID 38890670](https://pubmed.ncbi.nlm.nih.gov/38890670/?ref=elonmuscular.com) | | [18\. Cannabidiol (CBD), before a speech](#e18) | 600 mg once, the trial dose | 90 minutes before | One test | [PMID 21307846](https://pubmed.ncbi.nlm.nih.gov/21307846/?ref=elonmuscular.com) | | [19\. Passionflower extract](#e19) | 45 drops a day, the trial dose | Daily | 4 weeks | [PMID 11679026](https://pubmed.ncbi.nlm.nih.gov/11679026/?ref=elonmuscular.com) | | [20\. Rhodiola extract](#e20) | 200 mg twice a day | Before breakfast and lunch | 2 weeks in the trial | [PMID 26502953](https://pubmed.ncbi.nlm.nih.gov/26502953/?ref=elonmuscular.com) | | [21\. L-theanine](#e21) | 200 to 400 mg a day | Daily | 4 weeks | [PMID 31758301](https://pubmed.ncbi.nlm.nih.gov/31758301/?ref=elonmuscular.com) | | [22\. Magnesium](#e22) | 300 mg a day | Daily | 8 weeks | [PMID 28445426](https://pubmed.ncbi.nlm.nih.gov/28445426/?ref=elonmuscular.com) | | [23\. Curcumin](#e23) | An absorbable form | Daily, with food | Several weeks | [PMID 38857152](https://pubmed.ncbi.nlm.nih.gov/38857152/?ref=elonmuscular.com) | | [24\. Lemon balm extract](#e24) | 600 mg extract | Daily | A few weeks | [PMID 34449930](https://pubmed.ncbi.nlm.nih.gov/34449930/?ref=elonmuscular.com) | | [25\. Getting men into treatment](#e25) | One appointment | This week | Once, then as the doctor says | [PMID 36155230](https://pubmed.ncbi.nlm.nih.gov/36155230/?ref=elonmuscular.com) | | [26\. Sertraline, the first choice](#e26) | 25 or 50 mg to start (label) | Once a day | Reviewed every 2 to 4 weeks | [PMID 15337655](https://pubmed.ncbi.nlm.nih.gov/15337655/?ref=elonmuscular.com) | | [27\. Escitalopram, an SSRI](#e27) | 10 mg (label) | Once a day | Reviewed every 2 to 4 weeks | [PMID 16946363](https://pubmed.ncbi.nlm.nih.gov/16946363/?ref=elonmuscular.com) | | [28\. Paroxetine, an SSRI](#e28) | 20 mg (label) | Once a day | Reviewed every 2 to 4 weeks | [PMID 12668365](https://pubmed.ncbi.nlm.nih.gov/12668365/?ref=elonmuscular.com) | | [29\. Venlafaxine, an SNRI](#e29) | 75 mg (label) | Once a day, with food | Reviewed every 2 to 4 weeks | [PMID 28982121](https://pubmed.ncbi.nlm.nih.gov/28982121/?ref=elonmuscular.com) | | [30\. Duloxetine, an SNRI](#e30) | 30 mg (UK) or 60 mg (US) | Once a day | Reviewed every 2 to 4 weeks | [PMID 26238298](https://pubmed.ncbi.nlm.nih.gov/26238298/?ref=elonmuscular.com) | | [31\. Pregabalin, if the antidepressants did not suit](#e31) | 150 mg a day to start | Two or three doses a day | Reviewed regularly | [PMID 27643884](https://pubmed.ncbi.nlm.nih.gov/27643884/?ref=elonmuscular.com) | | [32\. Buspirone, a non-sedating option](#e32) | 7.5 mg twice a day (label) | Twice a day, same way with food | Weeks to build | [PMID 16856115](https://pubmed.ncbi.nlm.nih.gov/16856115/?ref=elonmuscular.com) | ## Deep dives Each of these has its own page in the library, with its risks, its doses and every study. - [**Train most days**Move most days, aerobic first, lift twice a week](https://elonmuscular.com/resistance-training/) - [**Cut the caffeine**Count it, then cut it well under 400 mg a day](https://elonmuscular.com/caffeine/) - [**Drinking less without quitting**Count the drinks, then cut a level](https://elonmuscular.com/cutting-down-drinking/) - [**Sleep**Seven to eight hours, at the same times](https://elonmuscular.com/sleep/) - [**Six breaths a minute**Six breaths a minute, ten to twenty minutes a day](https://elonmuscular.com/lab-slow-paced-breathing-hrv-biofeedback/) - [**The eight-week mindfulness course**The eight-week course, or ten minutes a day](https://elonmuscular.com/lab-mbsr/) - [**Yoga**Twice a week, breath leading the poses](https://elonmuscular.com/yoga/) - [**Lavender oil capsules**The oral lavender capsule, 80 mg a day](https://elonmuscular.com/lavender-oil/) - [**Chamomile extract**Chamomile extract, 500 mg three times a day](https://elonmuscular.com/chamomile/) - [**Ashwagandha root extract**Ashwagandha root extract, 300 to 600 mg a day](https://elonmuscular.com/ashwagandha/) - [**Switch Off the Worry**Switch Off the Worry: a 66-day guided quest, six lessons](https://elonmuscular.com/lab-cbt/) - [**Saffron extract**Early research: saffron extract, 30 mg a day](https://elonmuscular.com/saffron-extract/) - [**Omega-3 fish oil**Early research: fish oil, working up to 2 g a day](https://elonmuscular.com/omega-3/) - [**Rhodiola extract**Early research: rhodiola, 200 mg twice a day, mornings](https://elonmuscular.com/rhodiola-rosea/) - [**L-theanine**Early research: L-theanine, 200 to 400 mg a day](https://elonmuscular.com/l-theanine/) - [**Magnesium**Early research: magnesium, 300 mg a day](https://elonmuscular.com/magnesium/) - [**Curcumin**Early research: an absorbable curcumin, daily](https://elonmuscular.com/curcumin/) - [**Getting men into treatment**Book the doctor, take the diary](https://elonmuscular.com/men-and-help-seeking/) ## The studies Every study behind this page, newest first. - [Effect of exercise on depression and anxiety symptoms: systematic umbrella review with meta-meta-analysis.British journal of sports medicine, 2026\. PMID 41667154](https://pubmed.ncbi.nlm.nih.gov/41667154/?ref=elonmuscular.com) - [Efficacy and Methodology of Remote Heart Rate Variability Biofeedback Interventions for Mental Health: A Systematic Review and Meta-Analysis.Applied psychophysiology and biofeedback, 2026\. PMID 41310318](https://pubmed.ncbi.nlm.nih.gov/41310318/?ref=elonmuscular.com) - [Effect of saffron on depression, anxiety and mood disorder: a GRADE assessed systematic review and meta-analysis of 34 randomized controlled trials.Nutritional neuroscience, 2026\. PMID 41693488](https://pubmed.ncbi.nlm.nih.gov/41693488/?ref=elonmuscular.com) - [Generalized Anxiety Disorder 7-item (GAD-7) and 2-item (GAD-2) scales for detecting anxiety disorders in adults.The Cochrane database of systematic reviews, 2025\. PMID 40130828](https://pubmed.ncbi.nlm.nih.gov/40130828/?ref=elonmuscular.com) - [Worry Postponement From the Metacognitive Perspective: A Randomized Waitlist-Controlled Trial.Clinical psychology in Europe, 2024\. PMID 39119056](https://pubmed.ncbi.nlm.nih.gov/39119056/?ref=elonmuscular.com) - [Caffeine intake and anxiety: a meta-analysis.Frontiers in psychology, 2024\. PMID 38362247](https://pubmed.ncbi.nlm.nih.gov/38362247/?ref=elonmuscular.com) - [Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials.BMJ (Clinical research ed.), 2024\. PMID 38355154](https://pubmed.ncbi.nlm.nih.gov/38355154/?ref=elonmuscular.com) - [Efficacy and safety of omega-3 fatty acids supplementation for anxiety symptoms: a systematic review and dose-response meta-analysis of randomized controlled trials.BMC psychiatry, 2024\. PMID 38890670](https://pubmed.ncbi.nlm.nih.gov/38890670/?ref=elonmuscular.com) - [Effect of curcumin supplementation on symptoms of anxiety: A systematic review and meta-analysis of randomized controlled trials.Clinical nutrition ESPEN, 2024\. PMID 38857152](https://pubmed.ncbi.nlm.nih.gov/38857152/?ref=elonmuscular.com) - [Mindfulness-Based Stress Reduction vs Escitalopram for the Treatment of Adults With Anxiety Disorders: A Randomized Clinical Trial.JAMA psychiatry, 2023\. PMID 36350591](https://pubmed.ncbi.nlm.nih.gov/36350591/?ref=elonmuscular.com) - [Does Ashwagandha supplementation have a beneficial effect on the management of anxiety and stress? A systematic review and meta-analysis of randomized controlled trials.Phytotherapy research, 2022\. PMID 36017529](https://pubmed.ncbi.nlm.nih.gov/36017529/?ref=elonmuscular.com) - [Systematic literature review of human studies assessing the efficacy of cannabidiol for social anxiety.Psychiatry research communications, 2022\. PMID 36875967](https://pubmed.ncbi.nlm.nih.gov/36875967/?ref=elonmuscular.com) - [Associations between sociodemographic characteristics and receipt of professional diagnosis in Common Mental Disorder: Results from the Adult Psychiatric Morbidity Survey 2014.Journal of affective disorders, 2022\. PMID 36155230](https://pubmed.ncbi.nlm.nih.gov/36155230/?ref=elonmuscular.com) - [Improving sleep quality leads to better mental health: A meta-analysis of randomised controlled trials.Sleep medicine reviews, 2021\. PMID 34607184](https://pubmed.ncbi.nlm.nih.gov/34607184/?ref=elonmuscular.com) - [Effects of Lavender on Anxiety, Depression, and Physiological Parameters: Systematic Review and Meta-Analysis.Asian nursing research, 2021\. PMID 34775136](https://pubmed.ncbi.nlm.nih.gov/34775136/?ref=elonmuscular.com) - [Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis.PloS one, 2021\. PMID 34559859](https://pubmed.ncbi.nlm.nih.gov/34559859/?ref=elonmuscular.com) - [The effectiveness of Internet-delivered treatment for generalized anxiety disorder: An updated systematic review and meta-analysis.Depression and anxiety, 2021\. PMID 33225589](https://pubmed.ncbi.nlm.nih.gov/33225589/?ref=elonmuscular.com) - [The effects of lemon balm (Melissa officinalis L.) on depression and anxiety in clinical trials: A systematic review and meta-analysis.Phytotherapy research, 2021\. PMID 34449930](https://pubmed.ncbi.nlm.nih.gov/34449930/?ref=elonmuscular.com) - [Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review.Nutrients, 2020\. PMID 33352740](https://pubmed.ncbi.nlm.nih.gov/33352740/?ref=elonmuscular.com) - [The Effects of Green Tea Amino Acid L-Theanine Consumption on the Ability to Manage Stress and Anxiety Levels: a Systematic Review.Plant foods for human nutrition (Dordrecht, Netherlands), 2020\. PMID 31758301](https://pubmed.ncbi.nlm.nih.gov/31758301/?ref=elonmuscular.com) - [Therapeutic efficacy and safety of chamomile for state anxiety, generalized anxiety disorder, insomnia, and sleep quality: A systematic review and meta-analysis of randomized trials and quasi-randomized trials.Phytotherapy research, 2019\. PMID 31006899](https://pubmed.ncbi.nlm.nih.gov/31006899/?ref=elonmuscular.com) - [Improving Mental Health Service Utilization Among Men: A Systematic Review and Synthesis of Behavior Change Techniques Within Interventions Targeting Help-Seeking.American journal of men's health, 2019\. PMID 31184251](https://pubmed.ncbi.nlm.nih.gov/31184251/?ref=elonmuscular.com) - [Yoga for anxiety: A systematic review and meta-analysis of randomized controlled trials.Depression and anxiety, 2018\. PMID 29697885](https://pubmed.ncbi.nlm.nih.gov/29697885/?ref=elonmuscular.com) - [Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms: A Systematic Review and Meta-analysis.JAMA network open, 2018\. PMID 30646157](https://pubmed.ncbi.nlm.nih.gov/30646157/?ref=elonmuscular.com) - [Clinical Validation of Reduced Alcohol Consumption After Treatment for Alcohol Dependence Using the World Health Organization Risk Drinking Levels.Alcoholism, clinical and experimental research, 2017\. PMID 28019652](https://pubmed.ncbi.nlm.nih.gov/28019652/?ref=elonmuscular.com) - [The effect of heart rate variability biofeedback training on stress and anxiety: a meta-analysis.Psychological medicine, 2017\. PMID 28478782](https://pubmed.ncbi.nlm.nih.gov/28478782/?ref=elonmuscular.com) - [The Effects of Magnesium Supplementation on Subjective Anxiety and Stress-A Systematic Review.Nutrients, 2017\. PMID 28445426](https://pubmed.ncbi.nlm.nih.gov/28445426/?ref=elonmuscular.com) - [Short-term efficacy and tolerability of venlafaxine extended release in adults with generalized anxiety disorder without depression: A meta-analysis.PloS one, 2017\. PMID 28982121](https://pubmed.ncbi.nlm.nih.gov/28982121/?ref=elonmuscular.com) - [Pregabalin for generalized anxiety disorder: an updated systematic review and meta-analysis.International clinical psychopharmacology, 2017\. PMID 27643884](https://pubmed.ncbi.nlm.nih.gov/27643884/?ref=elonmuscular.com) - [Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial.Phytomedicine, 2016\. PMID 27912875](https://pubmed.ncbi.nlm.nih.gov/27912875/?ref=elonmuscular.com) - [Duloxetine in treating generalized anxiety disorder in adults: A meta-analysis of published randomized, double-blind, placebo-controlled trials.Asia-Pacific psychiatry, 2016\. PMID 26238298](https://pubmed.ncbi.nlm.nih.gov/26238298/?ref=elonmuscular.com) - [Transdiagnostic versus disorder-specific and clinician-guided versus self-guided internet-delivered treatment for generalized anxiety disorder and comorbid disorders: A randomized controlled trial.Journal of anxiety disorders, 2015\. PMID 26460536](https://pubmed.ncbi.nlm.nih.gov/26460536/?ref=elonmuscular.com) - [The Effects of Rhodiola rosea L. Extract on Anxiety, Stress, Cognition and Other Mood Symptoms.Phytotherapy research, 2015\. PMID 26502953](https://pubmed.ncbi.nlm.nih.gov/26502953/?ref=elonmuscular.com) - [Meditation programs for psychological stress and well-being: a systematic review and meta-analysis.JAMA internal medicine, 2014\. PMID 24395196](https://pubmed.ncbi.nlm.nih.gov/24395196/?ref=elonmuscular.com) - [Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients.Neuropsychopharmacology, 2011\. PMID 21307846](https://pubmed.ncbi.nlm.nih.gov/21307846/?ref=elonmuscular.com) - [Efficacy of drug treatments for generalised anxiety disorder: systematic review and meta-analysis.BMJ (Clinical research ed.), 2011\. PMID 21398351](https://pubmed.ncbi.nlm.nih.gov/21398351/?ref=elonmuscular.com) - [Psychoeducation for depression, anxiety and psychological distress: a meta-analysis.BMC medicine, 2009\. PMID 20015347](https://pubmed.ncbi.nlm.nih.gov/20015347/?ref=elonmuscular.com) - [Relaxation training for anxiety: a ten-years systematic review with meta-analysis.BMC psychiatry, 2008\. PMID 18518981](https://pubmed.ncbi.nlm.nih.gov/18518981/?ref=elonmuscular.com) - [A brief measure for assessing generalized anxiety disorder: the GAD-7.Archives of internal medicine, 2006\. PMID 16717171](https://pubmed.ncbi.nlm.nih.gov/16717171/?ref=elonmuscular.com) - [Escitalopram and paroxetine in the treatment of generalised anxiety disorder: randomised, placebo-controlled, double-blind study.The British journal of psychiatry, 2006\. PMID 16946363](https://pubmed.ncbi.nlm.nih.gov/16946363/?ref=elonmuscular.com) - [Azapirones for generalized anxiety disorder.The Cochrane database of systematic reviews, 2006\. PMID 16856115](https://pubmed.ncbi.nlm.nih.gov/16856115/?ref=elonmuscular.com) - [Attenuation of laboratory-induced stress in humans after acute administration of Melissa officinalis (Lemon Balm).Psychosomatic medicine, 2004\. PMID 15272110](https://pubmed.ncbi.nlm.nih.gov/15272110/?ref=elonmuscular.com) - [Efficacy of sertraline in a 12-week trial for generalized anxiety disorder.The American journal of psychiatry, 2004\. 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PMID 8666569](https://pubmed.ncbi.nlm.nih.gov/8666569/?ref=elonmuscular.com) ## Words on this page Standardized mean difference (SMD) A way to put results measured on different scales onto one scale. About 0.2 is a small effect, 0.5 medium and 0.8 large. 95% CI The range the true result probably sits in. The narrower the range, the surer the result. Meta-analysis Many studies pooled into one result. RCT A randomized controlled trial: people put by chance on the treatment or on a dummy version. PMID A study's ID number in PubMed, the public index of medical research. Strong, moderate and early evidence Strong: many human trials agree. Moderate: human studies point the same way. Early: the first small human studies. GAD-7 A seven-question score for constant worry, from 0 to 21\. Ten or more is the usual line for a doctor’s look. Worry disorder Generalized anxiety disorder: worry about many things, most days, hard to control, for six months or more. Applied relaxation A skill you teach yourself: relax in seconds, and use it at the first sign of tension. SSRI Selective serotonin reuptake inhibitor: the first-choice drug class, sertraline and escitalopram among them. SNRI An antidepressant that acts on serotonin and norepinephrine, venlafaxine and duloxetine among them. Boxed warning The strongest warning on a US drug label, printed in a box at the top. Controlled drug A medicine the law restricts because it can be misused, pregabalin among them. Benzodiazepine A fast sedative class, diazepam among them. Habit-forming, so kept for short crises only. The score tonight, the caffeine counted, and a worry slot picked for tomorrow. Training, the self-help course and the slot do the heavy lifting, and a medicine comes next if the score has not moved. Everything else is added one at a time and judged on the score. ## Not this? Try - [**Stay Calm Under Pressure**nerves before one big event](https://elonmuscular.com/protocol-calm-under-pressure/) - [**Lift Your Mood**low mood rides with constant worry](https://elonmuscular.com/protocol-low-mood/) - [**Fall Asleep Faster**worry that keeps you awake](https://elonmuscular.com/protocol-fall-asleep/) - [**Build Your Social Confidence**fear of being judged by people](https://elonmuscular.com/protocol-social-confidence/) When to see a doctor - A racing or pounding heart with chest pain, breathlessness or fainting: call 911\. Never assume it is only anxiety. - New or worse anxiety, agitation or dark thoughts after starting an SSRI or SNRI, or changing the dose: call the doctor right away. - Worry about many things, most days, that you cannot control and that affects daily life, for six months or more: see your doctor. - A racing heart, weight loss, feeling hot and shaky with the worry: ask for a thyroid blood test. On thyroid pills, the dose may be too high. - Worry that got worse with coffee, energy drinks or pre-workout: cut them, then tell the doctor what you took. - Worry that started with cocaine or cannabis use: tell the doctor. Both can make you anxious, panicky and paranoid. - Anxiety that began when you stopped heavy drinking: withdrawal is a medical danger. Get medical help before you stop. - Anxiety after coming off anabolic steroids: tell the doctor. It is a known withdrawal symptom. - Low mood, no interest or no enjoyment most days alongside the worry: tell the doctor. The more severe one is treated first. - Loud snoring, gasping or stopping breathing in sleep, and tired all day: ask about sleep apnea. It brings mood changes and poor concentration. - On a stimulant medicine, ADHD drugs such as methylphenidate among them: new anxiety, tension or a racing heart is a reason to call the doctor. - A GAD-7 still 10 or more after six weeks of the quest, or rising two check-ins in a row: see your doctor. I am not a doctor. This is not medical advice. This is self-education. Every dose on this page is the one a trial or a label used, quoted from the source. It is not a prescription. Talk to a physician who has your history before anything in the With a doctor group. New Heroes The full library. Elon answers every weekday. [Join New Heroes.](https://elonmuscular.com/join/) Cancel anytime.