Anxiety

What is Anxiety?

Anxiety is a normal response to stress, but it becomes an anxiety disorder when worry or fear is excessive, lasts for months, and interferes with work, relationships or sleep. Anxiety disorders are among the most common mental health conditions and include generalized anxiety disorder, panic disorder and social anxiety disorder.^{[1, 2]}

Common symptoms

The central feature of generalized anxiety is excessive worry that is difficult to control. It is often accompanied by restlessness, fatigue, trouble concentrating, irritability, muscle tension and disturbed sleep.^[1]

• Physical signs such as palpitations, shortness of breath and dizziness^[2]
• Panic attacks, which are sudden waves of intense fear
• Fear of being judged in social situations
• Avoiding places or activities that trigger fear

Causes and risk factors

Anxiety disorders involve dysfunction in brain circuits that respond to danger, and they are shaped by genes and by life experiences.^[3] They often occur together with depression and with physical illnesses, which usually makes symptoms more severe and treatment harder.^[3]

Thyroid problems, some medicines, caffeine and substance use can also cause or worsen anxiety symptoms, which is one reason a medical evaluation matters.

How it is diagnosed and treated conventionally

A physician or mental health professional diagnoses an anxiety disorder from a clinical interview and standard criteria. Short questionnaires such as the GAD-7 can help screen for it.^[2]

First-line treatments are cognitive behavioral therapy and SSRI or SNRI medicines, and both are effective. Choices depend on the person's preferences, other health conditions and past treatment.^{[2, 3]} Many people still have symptoms after treatment, which is why some look to complementary options.^[3]

Why Anxiety calls for a whole-person approach

Anxiety is not only a thought problem. It involves the body's stress response, sleep, muscle tension and the person's other health conditions, and these factors affect each other.

Care that addresses several of them can be a reasonable addition to therapy or medication.

Sleep

Sleep and anxiety feed each other. Insomnia affects about half of people with anxiety, and too little sleep can start or worsen anxiety.^[4] In a meta-analysis of 65 trials, interventions that improved sleep quality also reduced anxiety.^[5]

Stress and the body's alarm systems

The hypothalamic-pituitary-adrenal axis and the sympathetic-adrenal-medullary axis control the body's stress response, and researchers studying ashwagandha propose that it acts partly through them.^[6] Trials of stress and anxiety therefore often measure stress hormones such as cortisol.^[7]

Other health conditions

Anxiety frequently coexists with depression and physical illness, and this combination predicts more severe symptoms.^[3] Treating anxiety well means looking at the whole health picture, not only the worry itself.

Acupuncture for Anxiety

What the research shows

Research suggests acupuncture can reduce anxiety symptoms in the short term, but trial quality varies. A 2026 meta-analysis of 20 randomized trials with 1,462 participants found less anxiety after manual acupuncture than after sham acupuncture or usual care or a waitlist. Benefit over sham lasted at follow-up, but benefit over usual care or a waitlist did not. Results differed widely between trials, and some trials had unclear blinding.^[8]

A 2022 meta-analysis of 27 trials in generalized anxiety disorder (1,782 participants) found lower anxiety scores and fewer side effects with acupuncture than with control treatments. Most trials had unclear risk of bias, and the authors called for larger, higher-quality trials.^[9]

A sham-controlled trial in 70 people with Parkinson disease and anxiety found no difference at the end of 8 weeks of treatment, but a larger reduction in anxiety in the real acupuncture group at follow-up. It was done at one hospital in China.^[10]

How acupuncture may work

How acupuncture might ease anxiety is not settled. The abstracts reviewed for this page do not establish a mechanism. One trial measured salivary cortisol and found morning values fell along with anxiety scores, which fits the idea of a calmer stress response, but this is not proof of how acupuncture works.^[11]

What treatment involves

Treatment uses fine, sterile, single-use needles at points chosen for the individual, usually left in place for about 20 to 40 minutes. A trial of acupuncture for anxiety used 30-minute sessions once a week for 10 weeks.^[11] We reassess after a short course of visits.

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[12] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker, which matters for electroacupuncture.

Ayurvedic medicine for Anxiety

The Ayurvedic view

Ayurveda describes anxiety as a disturbance of the mind, often linked to aggravated Vata and to the mental qualities called rajas and tamas. This is a traditional framework used to choose care, not a biomedical diagnosis.

Therapies that may be used

Care is individual and traditionally combines:

• Regular meals, sleep times and a calm daily routine
• Warm oil massage for relaxation
• Individually prescribed herbs and preparations such as ashwagandha (Withania somnifera) and Brahmi vati, which have been studied for stress and anxiety^{[7, 13]}
• Breathing and relaxation practices

Panchakarma is not appropriate during pregnancy, acute illness or frailty, or during a period of severe anxiety or depression.

What the research shows

The evidence for Ayurveda is limited and comes mainly from ashwagandha. A meta-analysis of 9 placebo-controlled trials with 558 patients found lower scores for perceived stress, anxiety and cortisol with ashwagandha formulations.^[7] A second meta-analysis of 12 trials with 1,002 participants also found less anxiety and stress, but rated the certainty of the evidence as low, with large differences between trials.^[14] A third pooled five trials with 254 participants and found lower anxiety and better sleep measures, with very high variation between trials and a call for larger studies.^[15]

A trial of 56 people with generalized anxiety disorder compared two Ayurvedic preparations, Brahmi vati and Manasmitra vataka. Both groups improved, but there was no placebo group.^[13] Researchers also note that the extracts used vary a lot, so no single preparation has been established.^[6]

Herbal medicine for Anxiety

Herbs and formulas that have been studied

Western herbs studied for anxiety include silexan (a lavender oil preparation), kava, ginkgo and Withania somnifera. Passionflower, saffron, valerian and chamomile have also been tested.^[16] Chinese herbal medicine has been tested in many trials, often against anxiety medicines.^[17]

What the research shows

Evidence for herbs is limited and preliminary. A network meta-analysis of 29 trials of 12 herbs found a significant effect of silexan on anxiety, and kava and Withania somnifera also reduced scores, although kava may not help people with generalized anxiety disorder. Many trials were small, and the authors called the results preliminary.^[16]

A 2025 meta-analysis of 92 randomized trials of Chinese herbal medicine found lower anxiety scores and fewer adverse events than anxiolytic medicines in generalized anxiety disorder. Studies with low risk of bias were available only for that diagnosis, not for panic disorder or OCD.^[17] These trials compared herbs with anxiety medicines, not with a placebo, so they do not show that herbs work better than a placebo.

Safety and herb-drug interactions

Herbs can interact with medicines used for anxiety. Published reports include a semicomatose state when kava was combined with alprazolam, serotonin syndrome when St John's wort was combined with SSRIs, and mania when ginseng was combined with the antidepressant phenelzine.^[18]

Ashwagandha has also been linked to liver injury. A case series described cholestatic hepatitis, and fatal acute-on-chronic liver failure occurred in patients who had existing liver disease.^[19] Tell us about liver disease, pregnancy or breastfeeding, thyroid or diabetes medicines, and every supplement you take. About one fifth of Ayurvedic medicines bought online contained detectable lead, mercury or arsenic, so products should come from tested sources.^[20] Herbs are prescribed individually by a qualified practitioner.

Translating traditional medicine into modern biological language

This is interpretation, not equivalence. Chinese medicine often describes anxiety as stagnation of liver qi, or as disturbance of the heart and spirit, and treatment aims to move and calm. Researchers studying calming herbs and sleep interventions look at the stress hormone axis, the sympathetic stress system and sleep regulation.^{[4, 6]}

Ayurveda's Vata imbalance describes restlessness, racing thoughts and poor sleep. In biological terms, these overlap with the arousal and sleep disruption seen in anxiety.^[4] No study has shown that a dosha or a qi pattern corresponds to a specific biological process.

How this care fits with your medical care

Integrative care for anxiety is complementary. Keep working with your physician, therapist or psychiatrist, and do not stop or change prescribed medicines without your prescriber, because stopping some anxiety medicines suddenly can cause problems. We do not diagnose anxiety disorders, so new or worsening symptoms should be medically evaluated.

Please bring your diagnosis, a full list of medicines and supplements, and recent test results, including thyroid tests if you have them.

When to seek urgent medical care

Anxiety can sometimes overlap with serious medical or mental health problems.

• Thoughts of suicide or of harming yourself or someone else; call or text 988 (Suicide and Crisis Lifeline)
• Chest pain, trouble breathing or fainting, which should not be assumed to be a panic attack
• Confusion, hallucinations or severe agitation
• Anxiety that suddenly appears with a new medicine, drug or alcohol withdrawal
• Symptoms so severe that you cannot eat, sleep or care for yourself

If any of these occur, call 911 or go to the nearest emergency department.