Submitted by: Phil Rasmussen
Client: 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 workwise and personally.
He had stopped the 3-4 cups of coffee he’d been having a few days prior and felt somewhat better.
Herbal formula:
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 herbal formula (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 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 formula:
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 herbal formula (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 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.