| Short-term use of kava is recommended for patients with mild to moderate anxiety disorders who are not using alcohol or taking other medicines metabolized by the liver, but who wish to use “natural” remedies. | A | 4, 5 | Cochrane systematic review of seven RCTs (n = 380), with findings supported by five lower-quality trials (n = 320); side effects were rare and mild; same results with only extract WS1490 trials |
| Use of inositol in a dosage of 12 to 18 g per day is a treatment option for panic disorder. | B | 24, 25 | Effectiveness similar to SSRI and better than placebo for reducing intensity and frequency of panic attacks; side-effect profile comparable to SSRI; supported by two RCTs, although both were small |
| Inositol, 12 to 18 g per day, may be used to treat obsessive-compulsive disorder but not in combination with SSRIs. | B | 26, 27 | In trials of patients with treatment-resistant OCD, inositol by itself was better than placebo in reducing OCD symptoms26 but not in reducing anxiety scale scores; when added to SSRIs, inositol had no additional effect27 |
| Physicians should not encourage the use of St. John's wort, valerian, Sympathyl, or passionflower for anxiety based on small or inconsistent effects in small studies. Side-effect profiles are benign. | B | 16–23 | Small, unreplicated trials with design flaws suggest some limited effectiveness |
| All other nutritional supplements have no research evidence suggesting a positive effect on anxiety disorders. Physicians should recommend other treatments. | C | — | No evidence beyond testimonials, effects on nonclinical groups, or hypothetical mechanisms of action |