Agoraphobia

GABA and Silexan (an oral lavender product) for anxiety, panic attacks, agoraphobia, insomnia and stressful events like travel/social events

February 24, 2023 By Trudy Scott 29 Comments

When sharing a study on the benefits of Silexan, a proprietary formulation of oral lavender essential oil (used as a supplement), I received this feedback from Kat. She uses both Silexan and GABA with success, depending on the situation:

I used Silexan (CalmAid) here in the USA, for 7 weeks and had wonderful results!!

I was having daily constant panic attacks… agoraphobia and insomnia. They put me on several SSRIs to which I had severe reactions to. The Silexan saved me! I was able to get my life back. I used it nightly and it helped tremendously with sleep and anxiety. I heard about it through The Carlat Report Psych podcast and website after a desperate search to find something to help.

It’s a product that I highly recommend to everyone I know who suffers with anxiety. I now use it only as needed. There are no side effects except a perfume burp but that’s tolerable for me! It can be stopped without any withdrawal effects.

And this is how she responded when I asked if she had previously done a trial of GABA or tryptophan and how Silexan compared to the amino acids.

I use the GABA during times where the panic is increasing (GABA Calm 1/2 tablet, sublingually).

I use the Silexan when I have something stressful planned like travel, social events etc. Silexan works so well without any side effects and can be stopped without any withdrawal effects.

The GABA is an immediate effect vs the Silexan which is slower acting but lasts throughout the day.

What wonderful results for Kat. I thanked her for sharing and voiced my concern with CalmAid and some of the other products that contain Silexan: they contain canola oil. I just wish they stopped making this with canola oil! I share more about this below and another product option that doesn’t use canola oil.

GABA or Silexan? Kat’s sweet spot, serotonin and pyroluria

If you’re wondering where you should start – GABA or Silexan? If you’ve been following my work or even starting to use GABA, you’ll know I always start clients with GABA when they have low GABA symptoms of physical anxiety and tension.

I agree with Kat – it’s very typical for GABA to provide immediate results. I did also share with her that in order to get longer lasting effects GABA does need to be used 3-4 x day, between meals. This means that, for her, GABA may offer similar results to Silexan by slowly building up her GABA levels.

However, Kat has found the sweet spot she needs by using this combination so I would stick with this approach.

If she did decide to stop using Silexan in the future, tryptophan may be needed too – for low serotonin worry-type anxiety symptoms. She did mention that she doesn’t currently use tryptophan and Silexan also affects serotonin levels.

I do love that Kat plans for stressful events and uses Silexan in these situations. She does mention needing it for social events so I’d suggest looking into pyroluria too. More here on this social anxiety condition and how zinc, vitamin B6 and other key nutrients can help.

Kat’s dietary changes, no caffeine, no sugar and cravings?

I also asked if she has also made dietary changes and quit caffeine, alcohol and sugar. Kat shared that she doesn’t drink any caffeine and hasn’t since 2015. Good for her – caffeine is a major anxiety trigger. She does recognize that her anxiety gets worse when she’s eating a lot of processed foods/gluten/dairy/soy and she limits these.

I said it’s best to avoid these trigger foods altogether. This is often easier said than done! The amino acids help so much to break the addiction and eliminate the need to use willpower: GABA for stress-eating, tryptophan or 5-HTP if her cravings happen mostly in the afternoon and evening, and DPA if comfort foods are her reward. More on the amino acids and cravings here.

I thanked Kat for sharing her wonderful results and asked for permission to share as a blog. I always appreciate being able to do this so I can continue to educate and inspire. This also shows how there is no-one size fits all.

Silexan research on anxiety and insomnia

This is the study I shared on Facebook – Prescription of Silexan Is Associated with Less Frequent General Practitioner Repeat Consultations Due to Disturbed Sleep Compared to Benzodiazepine Receptor Agonists: A Retrospective Database Analysis

The prescription of Silexan to adult patients consulting general practitioners (GPs) for disturbed sleep results in less frequent repeat consultations than Z-drugs (including zolpidem, zopiclone, and zaleplon).

This may support Silexan’s role as an efficacious, self-enabling, well-tolerated, and sustained treatment option.

Because Silexan is a proven anxiolytic, its impact in improving undiagnosed anxiety disorders may have had a lasting effect for certain patients.

As explained in this same paper, “Silexan is an active substance with an essential oil produced from Lavandula angustifolia flowers.” It’s a proprietary lavender oil that complies with and exceeds the European Pharmacopoeia quality definition for the monograph lavender oil. “Several studies have shown positive effects of Silexan on symptoms of subsyndromal/mild anxiety or GAD [generalized anxiety disorder] compared to conventional treatment or placebo groups.”

Silexan and other oral lavender products

The proprietary product of Silexan, with 80mg of Lavandula angustifolia essential oil, is found in a number of products:

Nature’s Way CalmAid ® (this is the product Kat used/uses)
Integrative Therapeutics Lavela ™
Seremind ® (in Australia)

This supplement, NFH Lavender SAP, does not use the proprietary Silexan but does contain 80mg of organic lavender (Lavandula angustifolia) essential oil. This product is my preference since it contains olive oil and not canola oil like the others mentioned above.

All of the above are available in my online supplement store (for US purchases only). Nature’s Way CalmAid ® is also available on iherb.

Dosing recommendations for adults is 1 softgel once or twice daily with a full glass of water. There is a caution not to use while pregnant, nursing, or for children under 12 years of age.

GABA for anxiety, insomnia, sugar cravings, sensorimotor skills and immunity

I share case studies and research about GABA all the time so I’ll just share links to some of the past GABA blogs in case you’re new to GABA (a calming amino acid and neurotransmitter):

Resources if you are new to using GABA and other amino acids as supplements

If you are new to using GABA or any of the other amino acids as supplements, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see all the symptoms of neurotransmitter imbalances, including low GABA and low serotonin).

If you suspect low levels of any of the neurotransmitters and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the practitioner/health team you or your loved one is working with.

There is an entire chapter on the amino acids and they are discussed throughout the book in the sections on gut health, gluten, blood sugar control, sugar cravings, self-medicating with alcohol and more.

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the amino acids that I use with my individual clients and those in my group programs. You can find them all in my online store. The above oral lavender products are available in my online store too.

If, after reading this blog and my book, you don’t feel comfortable figuring things out on your own (i.e. doing the symptoms questionnaire and respective amino acids trials), a good place to get help is the GABA QuickStart Program (if you have low GABA symptoms). This is a paid online/virtual group program where you get my guidance and community support.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. This is also a paid online/virtual program with an opportunity to interact with me and other practitioners who are also using the amino acids.

Have you found that an oral lavender product such as Silexan (used as a supplement) helps with your anxiety, panic attacks and/or sleep?

Have you used the NFH Lavender SAP product with similar success to other Silexan products?

Do you also use the amino acid GABA (sublingually) and in what situations do you use GABA vs oral lavender?

How much of each do you use?

If you have other questions and feedback please share them here too.

How much GABA should I use for my anxiety? It depends on your unique needs (and there is an extremely large variation in dosing)

February 25, 2022 By Trudy Scott 54 Comments

GABA is a calming amino acid, used as a supplement, to ease low GABA levels. With low GABA you’ll experience physical-tension and stiff-and-tense-muscles type of anxiety, panic attacks and insomnia. You may feel the need to self-medicate to calm down, often with alcohol but sometimes with carbs and sugary foods. GABA also helps with muscle spasms and provides pain relief when muscles are tight.

One of the most common questions I get from individuals who are excited to hear about the benefits of GABA but are totally new to using this amino acid is: “How much GABA should I use for my anxiety?” Even individuals who may be familiar with GABA and have even experimented with it themselves and are seeing some benefits may also have this question.

Most are not aware of the extremely large variations in dosing that may work for different individuals. Today I’ll share some examples to illustrate both the wonderful benefits and this range of dosing which can be as much as a 1000x to 2000x variation in some instances!

Syd gets sleep and body anxiety benefits with just 1.5 mg to 3 mg GABA

As you can see in this first example, Syd gets sleep and body anxiety benefits with just 1.5 mg to 3 mg GABA. She shared this on a recent blog post where I discussed how using too much GABA can cause a niacin-like flushing sensation

I think it’s useful to note that some, like me, start out with tiny doses and still get benefits with no side effects. I take around 1.5 mg to 3 mg GABA at a time and it works for me! Really helps me sleep at night.

I also take approximately 1.5mg if I feel body anxiety. I divide a melt-able 25mg tablet into 8ths or less. (Very approximate, of course. Sometimes it’s just crumbs!)

Right now, anything higher and I’m a wet noodle the next day, meaning I feel super depleted and can hardly stand up. But, no niacin flush-like symptoms.

I appreciate her sharing and I’m so glad she found her ideal dose. As you can see it’s really really low. We call folks like Syd “pixie dust” people because they do really well with tiny tiny doses. It also shows that some folks get flushed with too much GABA and some don’t. Syd just feels depleted.

In case you’re wondering which product Syd is using, it’s the Kal 25 mg GABA, which she breaks apart.

To give this perspective, a typical starting dose is 125mg GABA for adults and half that for children. I share more below on this and how to use the symptoms questionnaires and do a trial.

Christina’s agoraphobic client was able to leave the house with 3000 mg GABA

A colleague, Christina Veselak, MS, LMFT, CN shared this feedback about her client who had agoraphobia i.e. fear of outdoor spaces:

I once had a profoundly anxious, agoraphobic client who I sent home with instructions to trial GABA until she either got relief from her anxiety or an adverse reaction. She came back a few days later to say that she had arrived at 3000 mg of GABA in the morning as her ideal dose.

That dose allowed her not only to leave her bedroom but also leave her house, socialize and babysit her hyperactive grandsons!

Most of my other clients could not tolerate anything near to that dose without getting an adverse reaction but it was perfect for her.

This really adds perspective to the range of doses that folks may respond to. This dosage is 1000x higher than Syd’s maximum dose and 2000x higher than her lowest dose!

Let’s address this question: How much GABA should I use for my anxiety?

The answer is this – it depends on your unique needs and biochemistry. I know it’s not the answer you (and almost everyone else too) probably want to hear but there really is no one-size-fits-all when it comes to GABA and the other amino acids.

The best way to determine if you may have low GABA and may benefit from using GABA is to look at the low GABA symptoms, rate them on a scale of 1-10, with 10 being worst, do a trial of GABA and rate the symptoms again right afterwards (in the next 2 to 30 minutes).

Here are the symptoms.

From there you continue to adjust up (or down) over the next few weeks to find your ideal dose. If you go too high you may experience an uncomfortable tingling niacin-like flush.

I can share this: for GABA, 125mg is a typical starting dose for adults that I use with my clients. Half that or less is a good ballpark for starting a trial for children. As with all the amino acids, they are always best used sublingually and taken away from protein.

Below is an example from someone who figured out 1-3 of the 125 mg GABA Calm product was ideal for her own needs.

Melissa is much calmer, sleeps well and stopped craving sweets with 125 mg to 375 mg GABA Calm a day

Melissa started using Source Naturals GABA Calm in anticipation of holiday travel and holiday gatherings and shared how much she benefited:

I have been taking 1-3 per day for two weeks. I’m glad I bought it before traveling home for Christmas – I was cool as a cucumber at the airport and was much calmer when visiting family and friends compared to last year!

The true test of its efficacy will be in two weeks when the semester starts. For now, I notice a general calmness and am sleeping well.

An unexpected result was that I stopped craving sweets after about a week of taking it!

And how wonderful for her! And we have much appreciation for her sharing her success.

These results at this dosage are pretty typical for the majority of my clients. Of course there may need to be adjustments seasonally (possibly needing less after the holidays and closer to spring) or more around her period or more with added stresses in her life.

You can read more about the GABA Calm product she used here (you can find it in my online supplement store too).

Resources if you are new to using GABA as a supplement

If you are new to using the the amino acid GABA as a supplement, here is the Amino Acids Mood Questionnaire from The Antianxiety Food Solution (you can see the low GABA and other low neurotransmitter symptoms)

If you suspect low levels of GABA or low serotonin and do not yet have my book, The Antianxiety Food Solution – How the Foods You Eat Can Help You Calm Your Anxious Mind, Improve Your Mood, and End Cravings, I highly recommend getting it and reading it before jumping in and using amino acids on your own so you are knowledgeable. And be sure to share it with the team you or your loved one is working with.

The book doesn’t include product names (per the publisher’s request) so this blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the GABA products that I use with my individual clients and those in my group programs.

If you don’t feel comfortable reading my book, doing the low GABA symptoms questionnaire and doing trials of GABA on your own, you can get guidance from me in the GABA Quickstart Program.

If you are a practitioner, join us in The Balancing Neurotransmitters: the Fundamentals program. AS you’ve learned today, there are many nuances and best practices when using the amino acids. And it’s an opportunity to interact with me and other practitioners who are also using the amino acids.

What have you found to be your ideal dose of GABA? And how has it helped you?

What dose did you start with and did you go too high and then have to back down again to get to your ideal dose? (be sure to share which product worked for you too)

Are you surprised to learn about this huge variation in dosing GABA? And if yes do you feel inspired to experiment with your current dosing?

If you’re a practitioner have you seen these variations?

Feel free to ask your questions here too.

Hydroxychloroquine and chloroquine (antimalarial drugs): quinism and the risk of sudden and lasting neuropsychiatric effects

July 31, 2020 By Trudy Scott 80 Comments

The Quinism Foundation, a nonprofit charitable organization “promotes and supports education and research on quinism, the family of medical disorders caused by poisoning by mefloquine, tafenoquine, chloroquine, and related quinoline drugs.”

Executive Director of the foundation, Dr. Remington Nevin, MD, MPH, DrPH, is a Johns-Hopkins trained psychiatric epidemiologist and drug safety expert and former U.S. Army public health physician. He has published extensively on the subject.

The foundation share the symptoms of chronic quinoline encephalopathy, also known as neuropsychiatric quinism:

The term “quinism” may seem new, but the symptoms of poisoning by mefloquine (previously marketed as Lariam®), tafenoquine (marketed as Krintafel® and Arakoda™), chloroquine (marketed as Aralen®), and related quinoline drugs are all too familiar: Tinnitus. Dizziness. Vertigo. Paresthesias. Visual disturbances. Gastroesophageal and intestinal problems. Nightmares. Insomnia. Sleep apnea. Anxiety. Agoraphobia. Paranoia. Cognitive dysfunction. Depression. Personality change. Suicidal thoughts.

These symptoms are not “side effects,” they are symptoms of poisoning by a class of drug that is neurotoxic and that injures the brain and brainstem. This poisoning causes a disease, and this disease has a name: Chronic quinoline encephalopathy — also known as quinism.

In March they published this press release: The Quinism Foundation Warns of Dangers from Use of Antimalarial Quinolines Against COVID‑19. Here are some highlights:

A risk of sudden and lasting neuropsychiatric effects from the use of antimalarial quinolines against COVID‑19, the disease caused by the novel coronavirus
In susceptible individuals, these drugs act as idiosyncratic neurotoxicants, potentially causing irreversible brain and brainstem dysfunction, even when used at relatively low doses

What is concerning is lasting neuropsychiatric effects and the fact that even low doses can cause irreversible effects. The Foundation “has urged policy makers, physicians, and members of the public to be alert to such effects.”

Dr. Nevin states that “these are not safe drugs” and “While it may be tempting to attribute anxiety, depression, paranoia, or other mental health symptoms to the psychological effects of the COVID‑19 pandemic, these symptoms may be an early warning sign of idiosyncratic neurotoxicity, and must be taken seriously.”

You can read the entire March 2020 press release here. It contains a link to U.S. Food and Drug Administration’s MedWatch program for reporting adverse effects.

Another press release published late July also cautions the use of tafenoquine against COVID-19 which The Qunism Foundation states “is a neurotoxic quinoline antimalarial drug with a similar adverse effect profile to mefloquine.”

New COVID-19 research on chloroquine and hydroxychloroquine

It’s encouraging to see that new research published on COVID-19 and these medications also highlights the possibility of neuropsychiatric side effects (even through the authors state it’s considered uncommon): Psychiatric Aspects of Chloroquine and Hydroxychloroquine Treatment in the Wake of COVID-19: Psychopharmacological Interactions and Neuropsychiatric Sequelae

…neuropsychiatric side effects are very uncommon but possible, and include a potentially prolonged phenomenon of “psychosis following chloroquine.” Hydroxychloroquine has less information available about its neuropsychiatric side effects than chloroquine, with psychosis literature limited to several case reports

Case reports on psychiatric symptoms induced by hydroxychloroquine

Here is one of these case reports: Psychiatric symptoms induced by hydroxychloroquine. A 36-year-old woman was diagnosed with Systemic Lupus Erythematosus (SLE) and antiphospholipid syndrome, and was treated with prednisone 10 mg and hydroxychloroquine 200 mg every 24 hours. Her arthritis improved but

One month after initiation of treatment, the patient began with generalized anxiety, suicidal ideation and the appearance of auditory and kinaesthetic [tactile] hallucinations.

She had similar adverse effects 5 years later when hydroxychloroquine (without prednisone) was prescribed following an outbreak of cutaneous SLE

A week later, the patient was admitted to the Department of Psychiatry because of suicidal ideation, self-harm and kinaesthetic and auditory hallucinations, which improved after withdrawal of hydroxychloroquine and treatment in a psychiatric setting.

Since then, the patient has not been taking hydroxychloroquine and has had no further episodes of kinaesthetic [tactile] or auditory hallucinations.

Here are two other case reports: Hydroxychloroquine-induced acute psychosis in a systemic lupus erythematosus female and Hydroxychloraquine-induced acute psychotic disorder in a female patient with rheumatoid arthritis: a case report.

Risk factors for susceptibility

This review article from 2018, Neuropsychiatric clinical manifestations in elderly patients treated with hydroxychloroquine: A review article mentions that these adverse events can range from less severe nervousness to “actual psychosis and suicidal tendencies.”

It also lists possible risk factors that may make certain individuals more susceptible:

co-exposure to interacting drugs, alcohol intake, familial history of psychiatric diseases, female gender, and the concomitant use of low-dose glucocorticoids [such as prednisone].

Malaria drug causes brain damage that mimics PTSD

I first learned of this neuropsychiatric connection a number of years ago when I read about the “case of a service member diagnosed with post-traumatic stress disorder but found instead to have brain damage caused by a malaria drug.” You can read about this here – Malaria drug causes brain damage that mimics PTSD: case study.

A few years ago I also blogged about the anti-malaria medication mefloquine and how it was known to contribute to neuropsychiatric symptoms in susceptible individuals: PTSD from 3 tours in Afghanistan: Can GABA help with the anxiety?

My concerns about long-term prophylactic use and lack of awareness

My concerns are long-term prophylactic use. There are a number of clinical trials planned or in progress for long-term use in healthcare workers. If they are stressed, anxious, depressed and exhausted because of the COVID-19 work they have been doing, they may incorrectly attribute some of their symptoms to all that rather than the medication side-effects. And if they do get COVID-19, they may confuse the neurological and psychiatric effects of COVID-19 with those of chloroquine or hydroxychloroquine.

What also concerns me is the lack of awareness. None of the advocates of this class of medications mentions quinism, the possible neuropsychiatric side-effects and long-term risks, or who may be susceptible.

I would be very happy if chloroquine or hydroxychloroquine is found to be a solution (or part of a solution) for COVID-19 – alone or in combination with zinc – for certain individuals.

But I believe we do need to be very aware about side-effects as serious as these. I’d also like to see education for healthcare providers and the consumer, as well as informed consent for the consumer.

Similar concerns with other medications

In the past I’ve written about similar concerns with other medications such as benzodiazepines, SSRIs and fluoroquinolone antibiotics:

Your feedback and questions so we can all learn

I encourage you to keep all this in mind as you navigate what you hear in the news, read on social media and/or read in the research on hydroxychloroquine.

Keep all this in mind too if you have future plans to travel to a malaria area for a vacation in the future (wouldn’t we love that – a trip!?).

Have you used chloroquine or hydroxychloroquine for COVID-19 and experienced psychiatric side-effects? Or know someone who has?

Have you used antimalarial medications in the past and experienced psychiatric side-effects? Was this a short-course or long-term prophylactic use?

Have you used these medications for lupus or rheumatoid arthritis with success and without psychiatric side-effects? Or have you experienced adverse effects and had to stop?

If you have had adverse psychiatric effects please share which medication, dosage and frequency? Also do you have any of the predisposing risk factors: alcohol intake at the time, history of psychiatric diseases (you or family members), are female, and were also prescribed low-dose glucocorticoids such as prednisone, and/or other medications (and which ones)?

Feel free to post your questions here too.