Ginkgo for Anxiety

Ginkgo biloba, commonly used as an anti-dementia agent that enhances cognitive functioning and stabilizes mood in cognitively impaired elderly subjects, may also help treat anxiety related to cognitive decline, a new study reports.

Ginkgo biloba has been used medicinally for thousands of years. Today, it is one of the top selling herbs in the United States.

Ginkgo is used for the treatment of numerous conditions, many that are under scientific investigation. Available evidence demonstrates Ginkgo's efficacy in the management of intermittent claudication, Alzheimer's/multi-infarct dementia and "cerebral insufficiency" (a syndrome thought to be secondary to atherosclerotic disease, characterized by impaired concentration, confusion, decreased physical performance, fatigue, headache, dizziness, depression and anxiety).

Although not definitive, there is promising early evidence favoring the use of Ginkgo for memory enhancement in healthy subjects, altitude (mountain) sickness, symptoms of premenstrual syndrome (PMS) and reduction of chemotherapy-induced end-organ vascular damage.

Researchers from Germany conducted a study with 107 patients with generalized anxiety disorder (82 patients) or adjustment disorder with anxious mood (25 patients), according to the diagnostic and statistical manual of mental disorders, third edition - revised (DSM-III-R). The patients were randomized to daily doses of 480 milligrams EGb 761 (Ginkgo extract), 240 milligrams EGb 761 or placebo for four weeks.

Intention-to-treat (ITT) analyses were performed on the primary outcome measure, the Hamilton rating scale for anxiety, the secondary variables, the clinical global impression of change (CGI-C), the Erlangen anxiety tension and aggression scale (EAAS), the list of complaints (B-L') and the patient's global rating of change. The Hamilton rating scale for anxiety total scores decreased by -14.3 (+/-8.1), -12.1 (+/-9.0) and -7.8 (+/-9.2) in the high-dose EGb 761, the low-dose EGb 761 and the placebo group, respectively. Changes were significantly different from placebo for both treatment groups. Regression analyses revealed a dose-response trend.

The study authors concluded that the Ginkgo extract (EGb 761) was significantly superior to placebo on all secondary outcome measures. It was safe and well tolerated and may thus be of particular value in elderly patients with anxiety related to cognitive decline.

For more information on Ginkgo biloba, please visit Natural Standard's Herbs & Supplements database.

Comments

[Frederica]

This study isn't that surprising to me. Several studies have found that ginkgo can help treat symptoms of cerebral insufficiency, including poor concentration, confusion, forgetfulness, decreased physical performance, fatigue, headache, dizziness, depression, and anxiety.

[Brit]

I prefer not to take medications or herbs for anxiety because I only experiences very mild symptoms from time to time. Instead, I prefer CAM therapies, such as music therapy, art therapy, relaxation therapy, or yoga. I've also heard that hypnosis might help some people, but I'm not sure I'd respond well to it.

[Stella]

I actually read this study and what was not clearly mentioned in the abstract is that symptom reduction was seen as early as 4 days. Although this was a significant reduction, it is not immediate, as is expected with benzodiazepines.

[Sara]

Could it be that when your brain is working properly, you have less anxiety, and therefore, it is not a direct effect of the ginkgo?

[Mark]

I would love to see nursing homes try this out!

[Catherine]

I'd be cautious when taking ginkgo, considering how many standard and alternative medicines it can potentially interact with.

[Justin A.]

What sort of standard medicines does ginkgo interact with? I thought since it is sold as a supplement in a lot of places, it was relatively safe? Do the amounts of ginkgo differ in these products and supplements? If so, is that why they vary in how dangerous they are?

[Theresa Cabrina]

Justin,

Ginkgo can potentially interact with a lot of commonly used supplements and OTCs. Even taking a simple painkiller, such as aspirin, while taking ginkgo could increase your risk of bleeding. Ginkgo also interacts with many supplements, such as cranberry, echinacea and warfarin. Just because ginkgo is common does not mean it is safe. Some people can take aspirin and ginkgo and experience no effects, but the potential for interaction exists. Also, when people experience side effects, they are of varying degrees, which may leave many cases unreported. Other times, patients and physicians don't link their ailment to the supplement they are taking, as they are under the assumption that it is safe. Ginkgo supplements may not all contain the same ingredients as most dietary products are not regulated in the same manner as conventional medicines. While CAM therapies provide many health benefits, one should do their research before they commit to a supplemental regimen.

[Sam]

Theresa,

You might be interested to know that the FDA issued a final rule establishing requirements for the production of dietary supplements this June.

The new rule requires certain activities in manufacturing, packaging, labeling and holding of dietary supplements to ensure that a dietary supplement contains what it is labeled to contain and is not contaminated with harmful or undesirable substances, such as pesticides, heavy metals or other impurities. It also requires certain activities that will ensure the identity, purity, quality, strength and composition of dietary supplements to help assure consumers that they are purchasing the type and amount of ingredients declared.

More info available at: http://www.cfsan.fda.gov/~dms/dscgmps7.html

[Brainiac]

I could not help but wonder what the anxiolytic mechanism for ginkgo might be. A quick search left the question unanswered... most references eluded to its circulatory enhancing effects, thereby improving overall brain function. That said, I guess one blogger's comment may be part of the answer: Perhaps a brain that is receiving good blood supply and functioning well is a more balanced brain overall, which may result in less anxiety as well as clearer memory and concentration.

If any one does know about possible mechanisms for anxiety relief, please share it with us!

[dalz]

Is it possible that ginkgo's mechanism of action is the same for both dementia and anxiety?

[David]

It sounds like ginkgo can interact with many medications. Does anyone know if it can interact with mood stabilizers?

[Shannon]

Is ginkgo more effective when it's combined with ginseng?

[Michelle]

I'm not sure that individuals with memory loss would be able to fill out most of those anxiety scales. People with Alzheimer's, for instance, usually have trouble remembering what they did this morning or last week, while much older memories remain. It would be interesting to look at any changes in anxiety that might occur giving a sugar pill to normal patients vs. those with memory loss.

Also, we had ginkgo trees growing up and down the street where I grew up. Those fruits sure did stink.

[Linda]

Shannon,

Ginkgo is commonly combined with ginseng. I'm not sure if it's more or equally effective as ginkgo alone. However, I think that this combination may cause decreases in systolic blood pressure at low or high doses and decreases in diastolic blood pressure at high doses. Theoretically, the combination of ginkgo and ginseng may lead to additive effects.

[Jora]

David,

If you search on Natural Standard's Interactions database, you can reference ginkgo among common mood stabilizing medications. I did a quick search against Depakene and Lamictal, two mood stabilizing drugs, and found potential interactions with both.

[Lee]

What a promising study! Memory loss and degenerative memory diseases, such as Alzheimer's, can be devastating. I hope this gets researched further.

[yellow ochre]

Studies that I've found on ginkgo and ginseng don't really show much of an effect - but it's hard to tell. The combination use makes it very difficult to tell. Here are some examples I found:

Ito et al. used ArginMax® which contains extracts of Ginkgo, ginseng, damiana, L-arginine, multivitamins, and minerals for sexual dysfunction

Persson et al. used Ginkgo biloba and ginseng for learning and memory, but neither were very effective. (I'm not sure if this study was high-quality or not.)

[Shannon]

Thanks yellow ochre. Since the available research on ginseng/ginkgo combo products seems inconclusive, I think I'll just try it for myself and see if I get any sort of benefit.

[Maria]

I'm with Justin A. I had no idea that ginkgo and other herbal supplements that I see often in drug stores could be so dangerous and that there could be so many potential interactions. It is easy for one to assume that one ginkgo supplement is the same as the one sitting next to it, but I guess not!

[Pete]

Does anybody know how to prepare ginkgo for use as a supplement? I see ginkgo trees all over, and I sure could use a better memory!

[Abelmoschus moschatus]

Does anybody have recipes for cooking with ginkgo? Maybe I could have some ginkgo every morning for breakfast to keep my memory sharp. I think this would work better for me than remembering to take all of those pills.

[Karen]

Does ginkgo help with memory recall in cognitive degeneration or only in memory function?

[Adam]

Brainiac,

Some more insight to your question about ginkgo’s anxiolytic mechanism: Ginkgo has been found to increase serotonin levels in humans as well as inhibit monoamine oxidase in animals. These two mechanisms are similar to those of antidepressants, which are often used to treat anxiety disorders. Perhaps these contribute to the mechanism of ginkgo’s anxiolytic properties.

[Charlie]

What is an intention to treat analysis? I’ve never heard of this. How can ginkgo have intentions? I don’t usually think of fruit as being very conscious of anything!