Chronic Stress & Anxiety
CASE STUDY 1: Stress and Anxiety
SUBMITTED BY: Katie Donnelly
PATIENT: Female, 39 years old
INITIAL PRESENTATION:
Female client experiencing symptoms of ongoing anxiety and stress. This has been increasing in intensity over the past six months and is becoming more intrusive in her day-to-day life. Waves of anxiety can be overwhelming and she finds it is impacting her ability to do her job, which is a source of a lot of her stress.
She describes a happy home life with a supportive husband and two children, aged six and seven. Her seven-year-old child is on the autism spectrum and experiences extreme emotional outbreaks. She does worry for him sometimes.
Her diet varies and there is a tendency for emotional eating and binge eating. Bowel motions are regular but digestive discomfort does occur on occasion. She relies on coffee to wake up (2 flat whites per day) and red wine to calm down (usually 2 glasses but up to one bottle daily).
Sleep schedule is undisturbed and she typically sleeps from 8.30pm to 6:00am.
Takes anti-depressant medication (past six months) and anti-inflammatory (2 per day for past three months) for an old recurring injury.
HERBAL TREATMENTS
Herbal Blend (210mL)
Lemon balm (Melissa officinalis) 1:2 70 mL
Skullcap (Scutellaria lateriflora) 1:2 60 mL
Lavender (Lavandula angustifolia) 1:2 40 mL
Chamomile (Matricaria recutita) 1:2 40 mL
Daily Dosage
5mL x 3 - 4 times per day.
ADDITIONAL TREATMENT RECOMMENDATIONS
- Reduce coffee intake to 1 per day to start with and reduce wine to maximum 1-2 glasses per day. Introduce more water (aim for 2L) – this can be flavoured with sliced lemon or orange, or have a cold brew herbal tea.
- Include increased proteins throughout the day to balance blood sugars and reduce the tendency to binge on carbohydrates and refined sugars. Aim to have eggs, quality meats (over deli meats), legumes, nuts or nut butters, quinoa. Combine these with a variety of vegetables and include fruits as a snack food.
- Eat and drink at separate times to support adequate digestion. Set a specific time to have a meal rather than eating and driving, for example.
- Take regular breaks throughout the work day, take exercise breaks and move regularly.
- Debrief with a trusted colleague (if appropriate) or professional when experiencing tough times at work to support the emotional stress.
FOLLOW-UP: After 2 weeks
The client has been regularly taking the herbal formula with a small amount of apple juice to dilute. Has also been adding it to her water bottle on occasion. Has found that the ritual of taking it has been helpful, and she feels as though she has another ‘tool’ to fall back on when things feel as though they are getting out of hand.
She has made some changes to her diet, with a focus on including more of what is helpful rather than focusing on restricted eating. Has found smoothies to be a great breakfast. Have suggested she could add some hemp or other protein powder to this.
Suggested diaphragmatic breathing exercises and reaffirmed the importance of prioritising exercise as a release.
FOLLOW-UP: After 4 weeks
The client is still having bouts of anxiety but feels as though they are less intense and more manageable. She has invested time into a free counselling service and advised that this has been a huge release for her.
Added Withania somnifera to her formula for adaptogenic actions. The client wishes to slowly reduce anti-depressant medication so have referred her back to her doctor to discuss suitability. Have advised that we can alter the herbal formula as needed if she chooses to go ahead with this decision.
CASE STUDY 2: Stress and Anxiety
SUBMITTED BY: Sharlene Bennett
PATIENT: Child, 12 year
INITIAL PRESENTATION:
A young pre-teen child presenting with low moods, multiple food sensitivities and intolerances, including eggs, fish, dairy, gluten and nuts. Already seeing a nutritionist and following a diet, some improvement has been noted. However, trouble sleeping and has anxiety attacks during the day. She takes Rescue Remedy as required during the day to help with feelings of overwhelm and tension.
HERBAL TREATMENTS
1. Stress Support Blend (100mL)
Passionflower (Passionflora incarnata) 3:2 30 mL
Withania Standardised (Withania somnifera) 3:2 20 mL
Lemon balm (Melissa officinalis) 1:2 20 mL
Magnolia (Magnolia officinalis) 1:2 20 mL
Licorice (Glycyrrhiza glabra) 10 mL
Daily Dosage
5mL x 1-2 times daily. Take before breakfast and in the afternoon, if required.
2. Sleep Support Tonic (100mL)
Skullcap Herb (Scutellaria lateriflora) 1:2 30 mL
Californian Poppy Herb (Eschscholtzia californica) 1:2 30 mL
Lavender (Lavandula officinalis) 1:2 30 mL
Flavouring Mix or NZ Boysenberry Syrup 10 mL
Daily Dosage
5mL x 1 times daily. Add to a small amount of water to dilute if needed, hour before bed. If wake repeat if needed.
OTHER RECOMMENDATIONS:
Take a mineral powder with magnesium and tart cherry powder at night to help alkalise the body, support the stress response and induce a better night’s sleep.
FOLLOW-UP: After 4 weeks
Experiencing better sleep at night and less anxiety on waking in the mornings, starting to feel better. Changed the way she is eating, focusing on whole foods, including lean or fresh sources of protein, and eating three meals daily now. Starting to have less anxiety during the day if taking the stress-support herbal blend and sleep-support herbal blend twice nightly.
FOLLOW-UP: After 4 weeks
She has noticed less anxiety again on waking and sleep has improved, to at least 8 hours daily per night.
Taking herbs 2 x daily and using the sleep support herbs at 5 mL once per night now instead of twice nightly. Noting more energy and fewer feelings of overwhelm. Feeling more balanced and less stressed. Advised to continue with the same dosage until next month’s appointment and will reassess dosage and situation once more.
CASE STUDY 3: Stress & Anxiety
SUBMITTED BY: Phil Rasmussen
PATIENT: Male, 32 years old
INITIAL PRESENTATION:
A patient I treated several years ago for mild depression and fatigue, came to see me again for herbal support for anxiety. He had been trying to work on his anxiety and mental health for the past few years. He had seen a therapist for some time, which had been really helpful. Last year he had taken the SSRI escitalopram for a few months but had stopped it 3 weeks prior, due to concerns about being on it long-term, and potential dependency and adverse events.
While he felt he had made good progress and was enjoying and achieving well in his career, his job was very busy, and he was under a lot of pressure. This had increased lately with a new large project and he was struggling to keep afloat with the level of cognitive sharpness and decision-making this required. He had also experienced a couple of episodes of extreme sweating and almost panic attacks during particularly stressful occasions at work, and was embarrassed and concerned about these. He wanted to try a herbal approach, before reverting to an SSRI such as escitalopram or fluoxetine.
There was also some relationship stress with his partner, and while he was very health conscious and ate and exercised well (gym 5x/week), his sleep had been terrible the past couple of weeks. He felt he was missing a sense of calmness in his day-to-day activities, both work-wise and personally.
He had stopped the 3-4 cups of coffee he’d been having a few days prior, and felt somewhat better.
HERBAL TREATMENT
Main Mix (100 mL)
Withania (Withania somnifera) 1:1 35 mL
Ginkgo (Ginkgo biloba) 3:2 25 mL
Zizyphus (Zizyphus spinosa) 1:2 35 mL
Liquorice (Glycyrrhiza glabra) 1:1 5 mL
Dosage
8mL twice daily, with water or juice.
Relaxant Mix: (100 mL)
Kava (Piper methysticum) 1:2 STD 60 mL
Passionflower (Passiflora incarnata) 1:2 30 mL
Liquorice (Glycyrrhiza glabra) 1:1 10 mL
Dosage:
5-10 mL if needed during the day; 10-15 mL with water or juice at night.
ADDITIONAL TREATMENT RECOMMENDATIONS
We discussed the potential benefits of him returning to some counselling and talking with his partner about booking a holiday together, within the next couple of months. Also, exploring whether a more relaxing but still physical activity such as yoga or Tai Chi may be a better fit than quite so many gym activities. Consideration of massage, with a massage practitioner, was also suggested.
The ‘Relaxant Mix’ was to be used prophylactically if he was having a particularly stressful time at work. Otherwise, a larger dose could be taken at night, if his sleep remained disrupted. The importance of taking the main mix regularly was emphasised.
FOLLOW-UP
3-weeks later: He was feeling better as he had started seeing the previous counsellor again, and had a massage, both of which were helping. Work had continued to be full-on, but he had only taken the ‘Relaxant Mix’ once during the day at work. It reduced the acute anxiety. He’d also used it 3-4 times at night soon after the first visit, but hadn’t needed it since.
We agreed to repeat the ‘Main Mix’ for a further four weeks, but while a repeat of the ‘Relaxant Mix’ was offered, he didn’t feel the need for this.
1 year later: The patient didn’t obtain a repeat mixture(s) the following month and wasn’t heard from for a further year, after going through another period of high stress and associated anxiety. He had been back on escitalopram, but stopped this a month prior. He had tried taking a CBD preparation for several weeks but felt no better. He had resorted to taking lorazepam on 3-4 occasions over the past couple of weeks, as recommended by his GP. He wasn’t sleeping well at all, and work pressure was again mounting up.
HERBAL TREATMENT
Main Mix (100 mL)
Withania STD (Withania somnifera) 3:2 35 mL
Ginkgo (Ginkgo biloba) 3:2 25 mL
Kava (Piper methysticum) 1:2 20 mL
Baical Skullcap (Scutellaria baicalensis) 1:2 20 mL
Liquorice (Glycyrrhiza glabra) 1:1 5 mL
Dosage
10mL twice daily, with water or juice.
Sleep Mix: (100mL)
Kava STD (Piper methysticum) 1:2 66 mL
Hops (Humulus lupulus) 1:2 25 mL
Liquorice (Glycyrrhiza glabra) 1:1 10 mL
Dosage:
10-15mL with water or juice if required at night.
ADDITIONAL TREATMENT RECOMMENDATIONS
During this consultation, I reiterated the importance of taking the ‘Main Mix’ herbal formula regularly, and recommended he continue to take it on a medium to long-term basis. The safety considerations, and preference for taking a natural herbal medication/tonic rather than a drug-based anxiolytic (such as an SSRI or benzodiazepine), were discussed at some length. While the patient had a history of only taking herbal treatments for 1-2 months at a time before stopping them again, the recurrent nature of his challenges with managing stress and anxiety, and how he responded favourably to each course of herbal treatment, made a strong case for ongoing herbal treatment.
The importance of providing reassurance to the patient, particularly concerning the herbal mixture not being prone to causing physical dependency, and trying to better understand his anxiety which itself contributed to this intermittent compliance, were key issues discussed with this most recent consultation.
While it is still relatively early days, he has continued to request repeats, for the past few months, and seems to be coping well with both work and his personal life.
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