Clinical Question: Which complementary and alternative medicines are effective in the treatment of anxiety disorders?

Setting: Various (meta-analysis)

Study Design: Systematic review

Synopsis: Investigators searched PubMed, PsychLit, and the Cochrane Registry of Controlled Trials to review the effectiveness of complementary and alternative treatments on anxiety. Articles were included if they reported treatment of patients with an anxiety disorder. Independent studies were assessed for validity using standard criteria. Whether the search for, and evaluation of, the articles was done independently by more than one person is unknown, and there was no discussion of possible publication bias.

Very limited, if any, evidence of effectiveness was found for the following treatments: Bach flower essences, berocca, ginger, gotu kola, homeopathy, lemongrass leaves, licorice, magnesium, passion flower, St. John's wort, valerian, vitamin C, aromatherapy, hydrotherapy, humor, prayer, yoga, caffeine reduction, nicotine avoidance, and a carbohydrate-rich/protein-poor diet. Limited evidence of effectiveness was found for inositol, acupuncture, massage (only in children), autogenic therapy, bibliotherapy, dance/movement therapy, exercise, meditation, music, and relaxation therapy. Kava and 5-hydroxyl-l-tryptophan were effective but not recommended because of the risk of severe side effects (i.e., liver toxicity and eosinophilia-myalgia syndrome, respectively).

Bottom Line: The majority of complementary and alternative medicines lack valid evidence of effectiveness in the treatment of anxiety disorders. Some supporting evidence has been found for inositol, acupuncture, massage (only in children), autogenic therapy, bibliotherapy, dance/movement therapy, exercise, meditation, music, and relaxation therapy. Many common herbal and homeopathy treatments lack any evidence of effectiveness. (Level of Evidence: 2a)