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Anxiety

Everything in the library studied for it, medical and holistic together. Within each kind, what was shown to help comes first, strongest evidence first. What was tested and not shown to help stays on the list.

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Medication25 Peptides and SARMs1 Supplements18 Therapies15 Practices8 Daily life8 Food and drink1

Medication

Atypical antipsychoticsStrong

Generalized anxiety

Shown to lower generalized anxiety scores by 3.6 points more than placebo on quetiapine, the largest effect in a network meta-analysis, with more dropouts than placebo.

The numbers and sources

Effect: In a network meta-analysis of 89 trials, quetiapine lowered Hamilton anxiety scores by 3.60 points more than placebo (95% credible interval 2.39 to 4.83), the largest effect of 22 drugs, and was poorly tolerated against placebo (OR 1.44, 95% credible interval 1.16 to 1.80) [11]. A pooled analysis of 3 trials found quetiapine gave a 26% greater likelihood of at least 50% improvement on the same scale than placebo [12].
Population: 25,441 patients in 89 trials [11]; 3 quetiapine trials within a review of 162 off-label trials [12].
Sources: [11], [12]
Caveats: Not an approved use. The evidence is for quetiapine. Adverse events were common [12].

BenzodiazepinesStrongVery common

Panic disorder

Shown to raise response in panic disorder, with about 4 treated for one extra response in short trials that reviewers rated low quality.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: Response was more likely on a benzodiazepine than placebo (RR 1.65, 95% CI 1.39 to 1.96), a number needed to treat of 4 (95% CI 3 to 7). Remission was also more likely (RR 1.61, 95% CI 1.38 to 1.88), and fewer people dropped out than on placebo (RR 0.50, 95% CI 0.39 to 0.64) [1]. In a network meta-analysis, benzodiazepines raised remission against placebo (RR 1.47, 95% CI 1.36 to 1.60) and ranked first among drug classes for remission. Adverse events were also more frequent than on placebo (RR 1.76, 95% CI 1.50 to 2.06) [2]. In the clonazepam label trials, 74% on 1 mg a day were free of full panic attacks against 56% on placebo in one study, and 62% against 37% in the other [3].
Population: 4,233 adults in 24 studies [1]; 12,800 participants in 87 studies of 12 drug classes [2]; adults with panic disorder in two trials of 6 to 9 weeks [3].
Sources: [1], [2], [3]
Caveats: The Cochrane review rated the evidence low quality and judged 20 of 24 studies at high risk of bias in at least one area [1]. Almost every study in the network analysis had some concern over bias [2]. Trials were short.

BenzodiazepinesStrong

Generalized anxiety

Shown to reduce generalized anxiety symptoms more than placebo in short trials, with a moderate effect size of 0.50.

The numbers and sources

Effect: Across 23 trials, benzodiazepines lowered generalized anxiety symptoms against placebo with an effect size of 0.50, larger than for SSRIs (0.33) or SNRIs (0.36) [4]. In 23 trials of diazepam, lorazepam or alprazolam, fewer people stopped for lack of effect than on placebo (RR 0.29, 95% CI 0.18 to 0.45), while stopping for any reason did not clearly differ (RR 0.78, 95% CI 0.62 to 1.00) [5]. A network meta-analysis found benzodiazepines lowered anxiety scores more than placebo and had more dropouts than placebo [6].
Population: 1,149 participants on benzodiazepines in 23 trials, within 56 studies of 12,655 adults [4]; 23 trials against placebo [5]; 25,441 adult outpatients in 89 trials [6].
Sources: [4], [5], [6], [7], [8]
Caveats: Effect sizes fell with later year of publication [4], and year of publication explained 74% of the variation between trials [5]. The trials were short. The lorazepam and diazepam labels state that use beyond 4 months has not been assessed [7][8].

BuspironeStrongVery common

Generalized anxiety

Shown to reduce generalized anxiety symptoms more than placebo, with about 4 to 5 treated for one extra person improved in trials of 4 to 9 weeks.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: In generalized anxiety disorder, azapirones, the drug group that buspirone belongs to, lowered anxiety scores more than placebo (MD -4.91, 95% CI -5.91 to -3.90, 22 studies) and raised response (RR 1.64, 95% CI 1.45 to 1.86, 9 studies) [1]. A Cochrane review found azapirones, including buspirone, superior to placebo, with a number needed to treat of 4.4 (95% CI 2.16 to 15.4) on a global improvement scale [2]. In a network meta-analysis of drugs for generalized anxiety, buspirone beat placebo, in a small sample [3].
Population: 2,567 participants in 22 placebo-controlled studies, within a review of 70 studies [1]; 5,908 participants in 36 trials lasting 4 to 9 weeks, one lasting 14 [2]; 25,441 adult outpatients in 89 trials of 22 drugs [3].
Sources: [1], [2], [3], [4]
Caveats: The pooled figures are for azapirones as a group. The label states that benefit beyond 3 to 4 weeks has not been shown in controlled trials [4], and the Cochrane authors called for longer studies [2].

GabapentinoidsStrong

Anxiety

Shown to reduce symptoms of generalized anxiety disorder more than placebo on pregabalin, by about 2.8 points on the Hamilton anxiety scale.

The numbers and sources

Effect: Across 8 trials, pregabalin reduced anxiety symptoms more than placebo (Hedges' g 0.37, 95% CI 0.30 to 0.44), with no difference in dropout rates [11]. In a network meta-analysis, pregabalin lowered Hamilton anxiety scores by 2.79 points more than placebo (95% credible interval 1.91 to 3.69), and was among the better-tolerated drugs in the analysis [12]. A further review found a consistent but not universal effect of gabapentinoids across anxiety conditions, and that pregabalin (SMD -0.55, 95% CI -0.92 to -0.18) and gabapentin (SMD -0.92, 95% CI -1.32 to -0.52) reduced anxiety before surgery [13].
Population: 2,299 participants in 8 trials [11]; 25,441 patients in 89 trials of 22 drugs [12]; 55 double-blind trials across bipolar disorder, anxiety and insomnia [13].
Sources: [11], [12], [13]
Caveats: Not an FDA-approved use for either drug. The generalized anxiety evidence is for pregabalin. For gabapentin the evidence is mainly from anxiety before surgery [13].

SNRIsStrongVery common

Generalized anxiety disorder

Shown to lower anxiety scores in generalized anxiety disorder, by about 3.1 Hamilton points more than placebo on duloxetine and 2.7 on venlafaxine.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: In a network meta-analysis, duloxetine lowered Hamilton Anxiety scores more than placebo (MD -3.13, 95% CrI -4.13 to -2.13), as did venlafaxine (MD -2.69, 95% CrI -3.50 to -1.89) [6]. Across antidepressants, response was more likely than on placebo (RR 1.41, 95% CI 1.29 to 1.55), a number needed to treat of 7 (95% CI 5 to 9), with similar findings when classes were compared separately. Dropouts for adverse effects were more frequent (RR 2.18), a number needed to harm of 17 [7]. Across anxiety, obsessive-compulsive and stress disorders, SSRIs and SNRIs lowered symptoms against placebo (SMD -0.56, 95% CI -0.62 to -0.51) [8].
Population: 25,441 adult outpatients in 89 trials [6]; 12,226 adults in 37 RCTs of 4 to 28 weeks [7]; 30,245 adults and children in 135 studies [8].
Sources: [6], [7], [8], [9]
Caveats: [7] pooled SNRIs with other antidepressants. Desvenlafaxine has no generalized anxiety approval on its label [9].

SSRIsStrongVery common

Generalized anxiety disorder

Shown to raise response in generalized anxiety disorder, with about 7 treated for one extra response across antidepressants. Escitalopram lowered anxiety scores 2.45 points more than placebo.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: Antidepressants raised the rate of a 50% or greater drop on the Hamilton Anxiety scale against placebo (RR 1.41, 95% CI 1.29 to 1.55), a number needed to treat of 7 (95% CI 5 to 9), with similar findings when classes were compared separately. Dropouts for adverse effects were more frequent on antidepressants (RR 2.18, 95% CI 1.81 to 2.61), a number needed to harm of 17 [7]. In a network meta-analysis, escitalopram lowered Hamilton Anxiety scores more than placebo (MD -2.45, 95% CrI -3.27 to -1.63). Sertraline and fluoxetine also beat placebo, in small samples. Paroxetine beat placebo and had more dropouts than placebo [8]. Across anxiety, obsessive-compulsive and stress disorders, SSRIs and SNRIs lowered symptoms against placebo (SMD -0.56, 95% CI -0.62 to -0.51) [9].
Population: 12,226 adults with moderate to severe generalized anxiety disorder in 37 RCTs of 4 to 28 weeks [7]; 25,441 adult outpatients in 89 trials [8]; 30,245 adults and children in 135 studies [9].
Sources: [7], [8], [9]
Caveats: [7] pooled SSRIs with other antidepressants and enrolled few people with other psychiatric conditions. The clearest single-drug estimate is for escitalopram [8]. Most trials in [9] had moderate risk of bias.

HydroxyzineModerate

Generalized anxiety

Shown to reduce generalized anxiety scores more than placebo over 4 to 12 weeks, by about 2.5 to 3.5 points on the Hamilton anxiety scale.

The numbers and sources

Effect: A Cochrane review of 5 studies found hydroxyzine more efficacious than placebo for generalized anxiety disorder (OR 0.30, 95% CI 0.15 to 0.58), and equivalent to chlordiazepoxide (OR 0.75, 95% CI 0.35 to 1.62) and buspirone (OR 0.76, 95% CI 0.40 to 1.42) [1]. In a 12-week trial of 50 mg a day, Hamilton anxiety scores fell by 12.16 points on hydroxyzine and 9.64 on placebo, with responder and remission rates also favoring hydroxyzine and no significant difference from the benzodiazepine bromazepam [2]. In a 4-week trial, scores improved by 10.75 points on hydroxyzine and 7.23 on placebo, and buspirone did not differ from placebo on that measure [3]. In a second 4-week trial, anxiety scores were lower than placebo from the first week [4].
Population: 884 participants in 5 studies [1]; 334 outpatients with generalized anxiety disorder [2]; 244 primary care patients, 70% women, mean age 41 [3]; 133 patients [4].
Sources: [1], [2], [3], [4]
Caveats: The Cochrane authors found a high risk of bias, few studies and small samples, and did not consider hydroxyzine a reliable first-line treatment on that basis [1]. The label states that use as an antianxiety agent beyond 4 months has not been assessed in systematic clinical studies [5].

SSRIsModerateVery common

Panic disorder

Shown to raise response in panic disorder in adults, with about 7 treated with an antidepressant for one extra response.

The numbers and sources

How common: Very common: more than 1 in 10 people.
Effect: Antidepressants as a group lowered the risk of failing to respond against placebo (RR 0.72, 95% CI 0.66 to 0.79), a number needed to treat of 7 (95% CI 6 to 9), and the same finding held when classes were compared with placebo. SSRIs produced more dropouts for adverse effects than placebo [10].
Population: 8,252 adults with panic disorder in the placebo-controlled arms of 41 RCTs [10].
Sources: [10]
Caveats: The review rated the response evidence low quality. Some trials were funded by drug companies, and only short-term outcomes were assessed [10].

Beta-blockersLimited

Performance anxiety and stage fright

Small trials found propranolol removed physical symptoms of stage fright in musicians and raised performance quality as scored by critics.

The numbers and sources

Effect: In two double-blind trials in musicians, propranolol removed the physical impediments to performance caused by stage fright, including dry mouth, and the quality of performance as judged by experienced music critics improved significantly [17].
Population: 29 musicians in two trials [17].
Sources: [17]
Caveats: Two small trials from 1982, and the abstract gives no effect sizes. Not an FDA-approved use. For diagnosed anxiety disorders, see the next block.

Methylene blueLimited

Depression and anxiety in bipolar disorder

One trial found lower depression and anxiety scores in bipolar disorder when added to lamotrigine, against a low comparison dose.

The numbers and sources

Effect: Added to lamotrigine, methylene blue 195 mg lowered depression scores (MADRS P = 0.02, HAM-D P = 0.05) and anxiety scores (HAM-A P = 0.02) against a 15 mg comparison dose. Cognitive symptoms did not change significantly [5].
Population: 37 people with bipolar disorder in a 6-month crossover trial [5].
Sources: [5]
Caveats: One small trial using last observation carried forward. The abstract gives P values without effect sizes.

TrazodoneLimited

Generalized anxiety

One trial found 69% of completers on trazodone reported moderate to marked improvement in generalized anxiety over 8 weeks, against 47% on placebo.

The numbers and sources

Effect: Among completers, moderate to marked improvement was reported by 69% on trazodone, 73% on imipramine, 66% on diazepam and 47% on placebo. Diazepam led in the first 2 weeks, and trazodone reached a comparable effect from week 3 to week 8. People on the antidepressants reported more adverse effects than people on diazepam [10].
Population: Outpatients with generalized anxiety disorder in an 8-week placebo-controlled trial [10].
Sources: [10]
Caveats: One trial from 1993, reported for completers only, which its authors said needed replication. Not an approved use.

BenzodiazepinesModerate

Anxiety treatment beyond three months

Mixed results: in trials of 13 weeks or more, anxiety scores did not differ from placebo, while fewer people stopped a benzodiazepine than placebo.

The numbers and sources

Effect: In 8 studies lasting 13 weeks or more, the change in Hamilton Anxiety scores did not differ significantly between benzodiazepines and placebo. Fewer people discontinued a benzodiazepine than placebo, and constipation and dry mouth were more frequent. Among people who had responded in the first 8 weeks, benzodiazepines and antidepressants did not differ on any outcome [13].
Population: 1,228 people with anxiety disorders in 8 randomized or maintenance studies [13].
Sources: [13]
Caveats: Few studies. The abstract gives no effect sizes [13].

BuspironeModerate

Compared with benzodiazepines

Mixed results: anxiety scores fell as much as on benzodiazepines, while response was slightly less likely and more people stopped treatment.

The numbers and sources

Effect: Against benzodiazepines in generalized anxiety, azapirones gave the same reduction in symptoms (MD -0.12, 95% CI -0.70 to 0.45, 34 studies) and a slightly lower response rate (RR 0.94, 95% CI 0.90 to 0.99). More people stopped azapirones (RR 1.33, 95% CI 1.16 to 1.53). Azapirones caused less sedation, fatigue, drowsiness, weakness and cognitive complaints than benzodiazepines, at a level resembling placebo, and more headache and nausea [1]. An earlier Cochrane review judged that azapirones may reduce anxiety less than benzodiazepines and found fewer people stopped benzodiazepines [2].
Population: 3,160 participants in 34 studies comparing azapirones with benzodiazepines [1]; 36 trials [2].
Sources: [1], [2]
Caveats: Confidence in the comparison with benzodiazepines was rated moderate to low [1]. Short trials.

MirtazapineModerate

Anxiety

Mixed results: mirtazapine matched SSRIs and benzodiazepines for generalized anxiety in small trials, with no placebo comparison among the pooled results.

The numbers and sources

Effect: In a meta-analysis of 37 studies, mirtazapine did not differ from SSRIs in generalized anxiety disorder (SMD -0.14, 95% CI -0.38 to 0.09) or from benzodiazepines (SMD -0.03, 95% CI -0.83 to 0.77). In people with major depression, it reduced anxiety symptoms slightly more than SSRIs (SMD -0.16) [10]. Before surgery it reduced anxiety against placebo or ondansetron (SMD -1.4, 95% CI -2.56 to -0.23) [8].
Population: 330 participants in 5 comparisons with SSRIs and 233 in 4 with benzodiazepines in generalized anxiety disorder, and 1,732 in 10 comparisons in depression [10].
Sources: [10], [8]
Caveats: Not an approved use. Matching another drug is not the same as beating placebo, and heterogeneity was high in the benzodiazepine comparison (I² 85.9%).

Ketamine and esketamineLimited

Anxiety disorders

Small trials found mixed results: ketamine raised response in social anxiety disorder, but not significantly in PTSD.

Compared with control infusions in randomized trials [9]

The numbers and sources

Effect: Four of six trials found anxiety scores fell more on ketamine than control. Response was more likely in social anxiety disorder (OR 28.94, 95% CI 3.45 to 242.57) but not in PTSD (OR 2.03, 95% CI 0.67 to 6.15). Doses of 0.5 mg/kg or more reduced social anxiety more than lower doses [9].
Population: 6 acute randomized trials: 2 in social anxiety disorder, 3 in PTSD, 1 in OCD [9].
Sources: [9]
Caveats: Very small trials, shown by the very wide intervals [9]. Not an FDA-approved use.

Beta-blockersModerate

Anxiety disorders

Not shown to reduce anxiety symptoms in social phobia or panic disorder against placebo, in two systematic reviews of small trials.

The numbers and sources

Effect: A 2025 systematic review found no evidence of a benefit of beta-blockers against placebo or benzodiazepines in social phobia or panic disorder, with all pooled comparisons non-significant (p of 0.54 or higher) [18]. A 2016 review of propranolol found no significant difference from benzodiazepines in short-term treatment of panic disorder, and no effect on symptoms of post-traumatic stress disorder [19].
Population: 10 studies, 5 pooled with 179 participants [18]; 8 trials in panic disorder (130 people), specific phobia (37), social phobia (16) and post-traumatic stress disorder (19) [19].
Sources: [18], [19]
Caveats: Small trials with missing data and high or unclear risk of bias [18]. Performance anxiety outside a diagnosed disorder is covered in the block above.

BuspironeModerate

Panic disorder

Not shown to help panic disorder: two reviews found no benefit over placebo, and more people dropped out on buspirone.

The numbers and sources

Effect: In three trials of buspirone, dropout for any reason was about twice as frequent as on placebo (RR 2.13, 95% CI 1.11 to 4.07). Effects on general anxiety (MD -2.20, 95% CI -5.45 to 1.06) and agoraphobia were uncertain, and no trial gave usable response data [10]. A later meta-analysis found azapirones did not outperform placebo in panic disorder or social anxiety disorder [1].
Population: 170 adults with panic disorder in 3 trials [10]; trials of azapirones across anxiety disorders [1].
Sources: [10], [1]
Caveats: Few small trials, all rated at high risk of attrition bias [10].

BuspironeModerate

Anxiety in children and teenagers

Not shown to reduce generalized anxiety symptoms in children and teenagers in two placebo-controlled trials of 559 patients aged 6 to 17.

The numbers and sources

Effect: In two 6-week trials at 15 to 60 mg a day, buspirone and placebo did not differ on symptoms of generalized anxiety disorder [4]. A reanalysis of the two trials found buspirone did not separate from placebo in the fixed-dose trial or the flexible-dose trial, and more children dropped out for adverse events on buspirone [11].
Population: 559 pediatric patients aged 6 to 17 with generalized anxiety disorder [4]; the same two trials, with 341 and 227 participants [11].
Sources: [4], [11]
Caveats: The reanalysis judged both trials underpowered to detect small effects [11].

ClonidineLimited

Anxiety and PTSD

Small trials of guanfacine found no difference from placebo on anxiety scales in children or on PTSD symptoms in veterans.

Compared with placebo [11][12]

The numbers and sources

Effect: In children with anxiety disorders, anxiety rating scale scores did not differ between guanfacine and placebo, while clinicians rated more children as much improved (54.2% against 31.6%), in a study not designed for statistical testing [11]. In veterans with PTSD, guanfacine did not differ from placebo on clinician-rated or self-reported outcomes [12].
Population: 83 children aged 6 to 17 with anxiety disorders over 12 weeks [11]; a small sample of mostly male combat veterans over 8 weeks [12].
Sources: [11], [12]
Caveats: Both were pilot trials. No trial of clonidine for anxiety disorders was located.

HydroxyzineLimited

Sudden anxiety and as-needed use

One trial found adding hydroxyzine to morphine did not significantly lower anxiety in 140 people with severe acute pain. No trial in panic attacks was located.

The numbers and sources

Effect: Among people with severe acute pain treated before reaching hospital, 91% given hydroxyzine with morphine reported no more severe anxiety against 78% given placebo with morphine, a difference that was not statistically significant. Pain relief at 15 minutes did not differ, at 51% against 52% [6]. The label states that clinical effects are usually noted within 15 to 30 minutes of an oral dose [5].
Population: 140 prehospital patients with acute pain scored 6 or more out of 10 [6].
Sources: [6], [5]
Caveats: One trial in an emergency setting, with hydroxyzine added to an opioid. It does not test a single dose taken for panic or everyday anxiety, and no such trial was located.

HydroxyzineLimited

Calming before surgery

One trial found hydroxyzine did not lower anxiety before surgery against placebo in 165 children aged 2 to 16.

The numbers and sources

Effect: Anxiety scores at the time of anesthesia induction did not differ between hydroxyzine and placebo (39.2 against 37.0 on a preoperative anxiety scale, P = 0.788), with or without clowns as a distraction [7]. Sedation before and after general anesthesia is a labeled use, and the label states that hydroxyzine may potentiate meperidine and barbiturates given with it [5].
Population: 165 children aged 2 to 16 having outpatient surgery [7].
Sources: [7], [5]
Caveats: One trial in children, all accompanied by their parents. No recent placebo-controlled trial in adults was located.

Peptides and SARMs

SemaxGrey marketUntested

Anxiety and mood

Not studied in people. In rats under chronic stress, semax reversed loss of interest in sweetened water, a depression-like sign, and restored hippocampal BDNF.

No study in people. This rests on animal studies, how it acts in the body.

The numbers and sources

Effect: In male rats under chronic unpredictable stress, daily semax injections reversed or reduced stress-induced anhedonia, the stress-related slowing of weight gain, adrenal enlargement and the fall in hippocampal BDNF. It did not change immobility in the forced swim test [11]. FDA's review notes antidepressant-like and anxiety-reducing effects in rodents [3]. In 52 healthy adults, a single dose of semax or the related peptide selank changed resting connectivity between the right amygdala and temporal cortex on fMRI, against placebo [12].
Population: Male Sprague-Dawley rats [11]. Rodent studies reviewed by FDA [3]. 52 healthy adults [12].
Sources: [11], [3], [12]
Caveats: Rodent models of stress do not show what happens to anxiety or mood in people. The fMRI study measured brain connectivity, not symptoms [12]. FDA lists a meeting abstract of semax given with therapy to 120 children with depression, with no full results available [3].

Supplements

B-complex vitaminsModerate

Stress and mood

Shown to improve stress slightly in healthy and at-risk adults over 4 weeks or more, with no change in depression or anxiety. Bayer funded the review.

The numbers and sources

Effect: Across trials of 3 or more B vitamins for 4 weeks or longer, stress improved slightly (SMD 0.23, 95% CI 0.02 to 0.45). Depressive symptoms did not significantly change (SMD 0.15, 95% CI -0.01 to 0.32), nor did anxiety (SMD 0.03, 95% CI -0.13 to 0.20) [5].
Population: 16 trials with 2,015 participants, healthy and at-risk, 12 pooled [5].
Sources: [5]
Caveats: Funded by Bayer HealthCare, which sells B-complex products [5].

CBDModerate

Anxiety

Shown to lower anxiety in people with anxiety disorders across 8 small studies, with a confidence interval close to zero.

The numbers and sources

Effect: A meta-analysis of 8 studies (316 participants) found CBD lowered anxiety (Hedges' g -0.92, 95% CI -1.80 to -0.04) across generalized anxiety, social anxiety and PTSD [6].
Population: People with anxiety disorders [6].
Sources: [6]
Caveats: Small total sample, and the authors urge caution [6]. The confidence interval runs close to zero.

IronModerate

Mood and thinking

Shown to improve anxiety, memory and intelligence scores modestly in iron-deficient children and menstruating adults, with no effect in those without deficiency.

The numbers and sources

Effect: In RCTs of non-anemic children, adolescents and menstruating adults, iron improved anxiety symptoms (d 0.34), physical well-being (d 0.42), cognitive intelligence scores (d 0.46) and short-term memory (d 0.53), and did not change attention or depression [5]. An umbrella review of 17 systematic reviews in children found modest gains in intelligence, memory and attention in anemic children, negligible or uncertain effects in children without deficiency, and no consistent change in broader mental development or school achievement [8].
Population: 1,408 participants in 18 studies [5]. Children in 17 systematic reviews, 3 rated high confidence [8].
Sources: [5], [8]
Caveats: The two reviews studied different groups. The 2025 abstract gives effect sizes without confidence intervals, and the effects were absent in participants without iron deficiency [5].

ProbioticsModerate

Depression and anxiety

Shown to lower depression and anxiety in adults with diagnosed disorders, with effect sizes varying widely. Anxiety did not change in children.

The numbers and sources

Effect: In clinically diagnosed samples, probiotics lowered depression (18 trials, SMD -0.96, 95% CI -1.31 to -0.61) and anxiety (9 trials, SMD -0.59, 95% CI -0.98 to -0.19) [29]. In 13 trials of major depression (710 patients), the pooled effect favored probiotics by an SMD of 0.38 [30]. A network meta-analysis put probiotics at SMD -0.62 against placebo in major depression [31]. A 2026 review found no significant effect in trials of 12 weeks or less and an effect in 2 longer trials [32]. In 7 RCTs of children and adolescents (912 participants), anxiety did not differ from placebo (SMD -0.09) [33].
Population: Adults with depression or anxiety disorders [29][30][31][32]. Children and adolescents [33].
Sources: [29], [30], [31], [32], [33]
Caveats: Effect sizes differ more than twofold between reviews, and heterogeneity was high [29][32].

TurmericModerate

Depression and anxiety symptoms

Shown to lower depression scores against placebo in people with depression or depressive symptoms, with effect sizes varying widely across reviews.

The numbers and sources

Effect: Across 10 trials (594 patients), curcumin lowered depression scores (SMD -0.32, 95% CI -0.50 to -0.13, I² 15%) and raised response rates (OR 3.20, 95% CI 1.28 to 7.99). In people with diagnosed depression the SMD was -0.35, and in people with depressive symptoms it was -0.17 (95% CI -0.61 to 0.26) [25]. A 2026 meta-analysis of 19 RCTs found lower scores in people with depression (SMD -0.76, 95% CI -1.22 to -0.30, 8 studies) and in people with depressive symptoms (SMD -0.53, 95% CI -0.97 to -0.09, 11 studies) [26]. Another, of 26 RCTs (1,491 participants), reported larger drops in depression (SMD -1.53, 95% CI -2.05 to -1.02), anxiety (SMD -1.67) and stress (SMD -1.71) against placebo [27]. In 15 RCTs (1,123 adults with chronic diseases), depressive symptoms (SMD -0.65) and anxiety (SMD -0.22, 95% CI -0.40 to -0.05, I² 0%) fell [28].
Population: Patients with depression or depressive symptoms [25][26]; adults with depression, anxiety or stress symptoms [27]; adults with type 2 diabetes, obesity, arthritis and other chronic diseases [28].
Sources: [25], [26], [27], [28]
Caveats: Evidence quality was rated low [25]. Pooled depression effects ranged from SMD -0.32 to -1.53 across reviews [25][27]. Heterogeneity reached 94.5% and the effect was fragile in sensitivity analysis [26]. Certainty was moderate to low [27].

BacopaLimited

Anxiety and stress

Small trials found bacopa lowered anxiety and self-reported stress scores against placebo in older and middle-aged adults.

The numbers and sources

Effect: In the 12-week trial of older adults, depression and anxiety scores fell on bacopa and rose on placebo, and mood scale scores did not differ [6]. In a crossover of 17 healthy volunteers, single 320 mg and 640 mg doses produced some positive mood effects and lower cortisol during multitasking stress [9]. In adults aged 40 to 70, 12 weeks of 300 mg a day reduced self-reported stress reactivity more than placebo (p = 0.03), along with fatigue and stress after a demanding computer task [5].
Population: 54 older adults [6]. 17 healthy volunteers [9]. 87 adults with self-reported memory problems [5].
Sources: [6], [9], [5]
Caveats: Small trials. The authors of [9] call for replication in a larger sample.

KratomGrey marketLimited

Mood and anxiety

Linked to small drops in momentary anxiety and, less consistently, sadness in the hours after use among regular users tracked by phone. No randomized trial was located.

The numbers and sources

Effect: In 357 US adults who used kratom at least 3 days a week, tracked by smartphone prompts for 15 days, kratom use in the prior 3 hours was linked to lower momentary anxiety than no use, and single use events to lower sadness. Use of prescribed anxiety or depression medicines did not change these links [23]. In the same sample, people named managing psychiatric and substance use problems as overall reasons for use [24]. In an online survey, 67% used kratom for anxiety and 65% for depression, and respondents gave it high ratings for these uses [21].
Population: 357 regular US kratom users [23][24]. 2,798 self-selected survey respondents [21].
Sources: [23], [21], [24]
Caveats: Observational studies of people who already use kratom and chose to take part. The authors describe the reductions in anxiety as small and call for randomized trials [23]. Self-ratings may reflect relief of withdrawal between doses.

L-TheanineLimited

Symptoms of mental disorders

Limited evidence: a review of 11 trials reported fewer symptoms in schizophrenia, anxiety disorders and ADHD, often alongside medication. One anxiety trial found no effect.

The numbers and sources

Effect: A systematic review of 11 RCTs from six countries reported that theanine reduced psychiatric symptoms more than control in schizophrenia, anxiety disorders and ADHD [8].
Population: Patients with schizophrenia, ADHD, OCD, major depression, sleep disorders, GAD or Tourette syndrome, often taking it alongside their medication [8].
Sources: [8]
Caveats: No pooled effect sizes are given in the abstract. Results differ by disorder, and an adjunctive GAD trial found no anxiety effect [9].

Lion's ManeLimitedStudied in women

Mood, depression and anxiety

One trial found depression scores fell from baseline in 30 women over 4 weeks, but most comparisons were not against placebo.

The numbers and sources

Effect: In 30 women given lion's mane cookies or placebo cookies for 4 weeks, depression (CES-D) and indefinite complaint scores fell from baseline in the mushroom group. Two complaint items were lower than placebo, and concentration, irritability and anxiety tended to be lower [7].
Population: 30 women [7].
Sources: [7]
Caveats: One small 4-week trial. Most comparisons were against baseline, not placebo [7].

ReishiLimitedStudied in women

Stress and fitness

One small trial found better VO2 max, grip strength and mood scores than placebo in sedentary female students over 30 days.

The numbers and sources

Effect: In 78 female college students in India, 1,000 mg a day for 30 days improved heart rate, VO2 max, physical work capacity and right-hand grip strength against placebo, and anxiety, depression and well-being scores improved. The 500 mg dose differed from the 1,000 mg dose on VO2 max and work capacity [6].
Population: 78 sedentary female students, mean age 20.6 [6].
Sources: [6]
Caveats: One small trial. The abstract does not report effect sizes or funding.

Vitamin B6Limited

Depression symptoms

One trial found lower depression scores over 1 month only in adults with mild or worse symptoms at baseline. Anxiety and stress did not change.

The numbers and sources

Effect: Over 1 month, 100 mg of pyridoxine a day lowered depression scores more than placebo or 1,000 µg of B12 only in participants with mild or worse depression symptoms at baseline (partial η² 0.20). Anxiety and stress scores did not change [5].
Population: 267 adults from the general population, 215 of them female. 58 had mild or worse depression symptoms at baseline [5].
Sources: [5]
Caveats: One trial, and the effect appeared in a subgroup defined by baseline scores. Participants were not patients with diagnosed depression [5].

AshwagandhaModerate

Stress and anxiety

Mixed results: most reviews found lower stress and anxiety than placebo in adults, with very high variation, while one review found no change in perceived stress.

The numbers and sources

Effect: Across 12 RCTs (1,002 participants aged 25 to 48), ashwagandha lowered anxiety (SMD -1.55, 95% CI -2.37 to -0.74, I² 93.8%) and stress (SMD -1.75, 95% CI -2.29 to -1.22, I² 83.1%) compared with placebo [1]. In 14 trials in people with mental disorders, mostly anxiety disorders, anxiety fell (outlier-corrected SMD -1.13, 95% CI -1.65 to -0.60) and so did stress (SMD -0.95, 95% CI -1.46 to -0.43) [2]. A 2026 analysis of 22 trials reported lower stress (SMD -5.88, 95% CI -8.15 to -3.60) and anxiety (SMD -6.87, 95% CI -8.77 to -4.97), with stress falling further as dose rose [3]. A 2025 analysis of 6 trials found no change in Perceived Stress Scale scores (SMD -0.355, 95% CI -1.188 to 0.47) [4].
Population: Adults in 12 RCTs [1]. 360 people with mental disorders on ashwagandha and 353 controls [2]. Adults in 22 RCTs [3]. 488 participants in 7 cortisol and 6 stress trials [4].
Sources: [1], [2], [3], [4]
Caveats: Certainty was rated low for both outcomes in [1], and heterogeneity was very high. The mental disorders review was limited by few studies, substantial heterogeneity and outliers [2]. The effect sizes in [3] are several times those in the other reviews. The abstracts do not report funding of the included trials.

KavaModerate

Anxiety symptoms

Mixed results: a Cochrane review found anxiety scores fell 5 points more than placebo, while a later 4-week trial found no added drop.

The numbers and sources

Effect: In 11 trials (645 participants), 6 studies pooled on the Hamilton Anxiety scale showed a 5.0-point greater reduction with kava extract than placebo (95% CI 1.1 to 8.8, n 345) [1]. In an internet-based trial of 391 adults with anxiety and insomnia, anxiety scores fell 14.4 points on placebo, and the drop on kava was 2.7 points smaller (95% CI -0.8 to 6.2) [2].
Population: Adults with anxiety in trials of 1 to 24 weeks [1]. 391 US adults over 4 weeks [2].
Sources: [1], [2]
Caveats: The Cochrane trials were short, and the review sought data from kava manufacturers [1]. The two sources differ in direction.

KavaLimited

Generalized anxiety disorder

Small trials found mixed results: a 6-week trial found less anxiety than placebo, and a larger 16-week trial found no difference.

The numbers and sources

Effect: In 58 analyzed participants with generalized anxiety disorder, 6 weeks of an aqueous extract (120 to 240 mg kavalactones a day) lowered anxiety more than placebo (Cohen d 0.62), and 26% against 6% were in remission [3]. In a 16-week phase III trial of 171 people with the same diagnosis, 120 mg of kavalactones twice a day did not differ from placebo (1.37 points favoring placebo, p 0.25), and remission was 17.4% on kava and 23.8% on placebo [4].
Population: Adults with generalized anxiety disorder in Australia [3][4].
Sources: [3], [4]
Caveats: The two trials, from the same research group, disagree. The larger, longer trial was funded by Australia's National Health and Medical Research Council [4].

L-TheanineLimited

Stress and anxiety

Limited evidence: acute stress fell modestly, mostly in high-bias studies, and a 28-day trial found perceived stress fell equally on placebo.

The numbers and sources

Effect: The reduction in acute stress after a single dose was modest (SMD 0.31) and largely influenced by high-risk-of-bias studies. Anxiety effects were inconsistent and not significant, except one study in psychotic anxiety at 400 mg a day for 8 weeks (SMD 0.54) [1]. A systematic review of 9 trials of pure theanine described possible stress and anxiety reduction at 200 to 400 mg a day in people under stressful conditions [4]. In 30 adults with moderate stress given 400 mg a day for 28 days, perceived stress fell 17.98% with theanine and 17.88% with placebo, and salivary cortisol did not differ between groups [5].
Population: Healthy adults and clinical groups [1][4]. 30 adults with moderate stress [5].
Sources: [1], [4], [5]
Caveats: The 28-day trial was funded by Ethical Naturals, which sells the extract tested, and one author was its employee [5].

InositolModerate

Depression and anxiety

Not shown to change depression, anxiety or obsessive-compulsive symptoms. One small trial found fewer panic attacks on 12 g a day.

The numbers and sources

Effect: Inositol did not significantly change depressive, anxiety or obsessive-compulsive symptoms against placebo. Responders in depression were marginally more common (P = 0.06) [12]. In a 4-week crossover trial, panic attack frequency and severity fell more on 12 g a day than placebo [13].
Population: 242 people in 7 depression trials and 70 in 4 anxiety trials [12]; 21 people with panic disorder [13].
Sources: [12], [13]
Caveats: Trials were few and small [12]. The panic trial is one of four pooled anxiety trials [12][13].

ValerianLimited

Anxiety

One small trial found anxiety scores did not differ from placebo or diazepam in people with generalized anxiety disorder.

The numbers and sources

Effect: A Cochrane review found one eligible RCT, a 4-week pilot in 36 patients with generalized anxiety disorder. HAM-A scores did not differ between valerian and placebo, or between valerian and diazepam [6]. A 2020 meta-analysis pooled 8 studies (535 participants) on anxiety [3].
Population: 36 patients with GAD [6]. Mixed populations [3].
Sources: [3], [6]
Caveats: The 2020 abstract does not report a pooled anxiety effect size [3]. The Cochrane authors found the evidence too thin for conclusions [6].

Therapies

Cognitive behavioral therapyStrong

Anxiety disorders, compared with placebo

Shown to ease anxiety disorder symptoms moderately against pill or psychological placebo, with nearly three times the odds of responding.

Compared with psychological placebo [6][7]; pill placebo [6][7]; waiting list [7]

The numbers and sources

Effect: Against psychological or pill placebo, CBT reduced target disorder symptoms (Hedges' g 0.56), other anxiety symptoms (g 0.38), depression (g 0.31) and improved quality of life (g 0.30). The odds of responding were 2.97 times those on placebo. Effects were large for obsessive compulsive disorder, generalized anxiety disorder and acute stress disorder, and small to moderate for PTSD, social anxiety and panic disorder [6]. In a second analysis, individual CBT outperformed waiting list, psychological placebo and pill placebo [7].
Population: 2,843 patients in 41 placebo-controlled trials [6]. 37,333 patients in 234 trials of panic disorder, generalized anxiety disorder and social phobia [7].
Sources: [6], [7]
Caveats: Effects were larger in completers than in intention-to-treat samples [6]. Patients know they are receiving therapy, which a pill placebo cannot match.

Cognitive behavioral therapyStrong

Depression and anxiety, online or computer CBT

Shown to lower depression and anxiety disorder symptoms against control conditions, with guided programs ahead of unguided ones right after treatment.

Compared with control treatments [13]; care as usual, waiting list, information control, psychological placebo or pill placebo [14]; face-to-face CBT [14]

The numbers and sources

Effect: In individual data from 39 trials, guided and unguided internet CBT lowered depression scores more than control treatments in the short and long term. Guided programs were ahead of unguided ones after treatment (PHQ-9 mean difference -0.8, 95% CI -1.4 to -0.2) and not at 6 or 12 months [13]. Across 64 trials in major depression, panic disorder, social anxiety and generalized anxiety, computer or internet CBT outperformed control groups (g 0.80, number needed to treat 2.34). Nine trials comparing it with face-to-face CBT found them equally beneficial [14].
Population: 9,751 people with depression in 39 trials [13]. 64 trials in adults meeting diagnostic criteria [14].
Sources: [13], [14]
Caveats: Few trials compared online CBT with medication [14].

ReflexologyStrong

Anxiety, compared with usual care or no intervention

Shown to lower anxiety around heart procedures and in other adults in pooled trials, mostly against usual care or no intervention, with large and varied effects.

Compared with control groups the source abstracts do not describe [8][9]; nonactive controls: sham intervention, usual care, waiting list or psychoeducation [10]

The numbers and sources

Effect: In 10 trials of patients having cardiovascular procedures, reflexology lowered anxiety more than control [8]. In patients having coronary angiography, anxiety fell immediately after reflexology (Hedges' g -1.78, 95% CI -2.94 to -0.63) and 30 minutes later (g -1.16) [9]. Across adults with a range of conditions, anxiety fell (g -1.237, 95% CI -1.682 to -0.791) and depression fell (g -0.921, 95% CI -1.246 to -0.595) [10].
Population: 760 patients with a mean age of 59 in 10 trials [8]. 913 patients in 10 studies [9]. 2,366 adults in 26 trials [10].
Sources: [8], [9], [10]
Caveats: Most control groups had no touch, so attention and touch are part of the effect. Two of the angiography studies were not randomized [9]. The sham-controlled results are in the blocks above.

Biofeedback and neurofeedbackModerate

Anxiety and stress, heart rate variability biofeedback

Shown to reduce self-reported stress and anxiety with a large effect (Hedges' g 0.83) against control conditions, in a meta-analysis of 24 studies.

Compared with control conditions the source abstract does not describe [9]

The numbers and sources

Effect: Heart rate variability biofeedback reduced stress and anxiety within groups (g 0.81) and against control conditions (g 0.83). The effect did not depend on study year, risk of bias, share of women, number of sessions or whether people had an anxiety disorder [9].
Population: 484 participants in 24 studies [9].
Sources: [9]
Caveats: Small studies, and outcomes were self-reported. The authors call for more well-controlled trials [9].

Cognitive behavioral therapyModerate

Anxiety disorders, long-term

Shown to keep anxiety lower than control conditions for up to 12 months, and past 12 months for generalized anxiety, social anxiety and PTSD, in mostly low-quality trials.

Compared with care as usual, relaxation, psychoeducation, pill placebo, supportive therapy or waiting list [8]

The numbers and sources

Effect: CBT was associated with better outcomes at treatment end and at 1 to 6 and 6 to 12 months for generalized anxiety disorder (g 0.07 to 0.40), panic disorder (g 0.22 to 0.35), social anxiety disorder (g 0.34 to 0.60), specific phobia (g 0.49 to 0.72), PTSD (g 0.59 to 0.72) and OCD (g 0.70 to 0.85). At 12 months or more, effects remained for generalized anxiety (g 0.22), social anxiety (g 0.42) and PTSD (g 0.84), and not for panic disorder [8].
Population: 4,118 adult outpatients in 69 trials [8].
Sources: [8]
Caveats: Trials were mainly of low quality, and relapse rates of 0% to 14% came from only 6 trials [8].

Hypnotherapy and clinical hypnosisModerate

Anxiety

Shown to reduce anxiety more than control conditions, with the average treated person improving more than 79% of controls, and more when combined with other psychological treatment.

Compared with control conditions the source abstract does not describe [18]

The numbers and sources

Effect: At the end of treatment, 17 trials gave a mean weighted effect size of 0.79, and at the longest follow-up 7 trials gave 0.99. Hypnosis reduced anxiety more when combined with other psychological interventions than when used alone [18].
Population: 17 trials in 15 studies [18].
Sources: [18]
Caveats: The abstract does not describe the control conditions or the populations [18].

Massage therapyModerate

Anxiety

Shown to lower anxiety in pooled trials, including state anxiety after a single session and trait anxiety after a course of treatment.

Compared with control conditions in randomized studies the source abstract does not describe [12]; active treatments [2]

The numbers and sources

Effect: A meta-analysis of 37 randomized studies found single sessions reduced state anxiety, and a course of treatment reduced trait anxiety and depression, its largest effects, by amounts the authors likened to psychotherapy [12]. Against active comparators in pain populations, anxiety was lower with massage (SMD -0.57) [2].
Population: 37 randomized studies [12]. Trials in people with pain [2].
Sources: [12], [2]
Caveats: The older meta-analysis predates many current trials and its abstract gives no effect sizes [12]. Participants cannot be blinded to massage.

ReflexologyModerateStudied in pregnancy

Pain and anxiety in labor

Shown to lower labor pain by about 1.9 points on a 0 to 10 scale and reduce anxiety, against placebo, usual care or no intervention.

Compared with placebo, usual care or no intervention [13]

The numbers and sources

Effect: Foot reflexology lowered pain (mean difference -1.89 on a 0 to 10 scale, 95% CI -2.34 to -1.45) and anxiety (SMD -0.88, 95% CI -1.41 to -0.34), shortened the stages of labor and raised birth satisfaction. It lowered pulse and breathing rate and did not change blood pressure. The reviewers rated the evidence moderate for pain [13].
Population: 1,189 pregnant women in 13 trials [13].
Sources: [13]
Caveats: Heterogeneity was very high (I² 92% for pain). Some trials had high risk of bias in how women were assigned to groups [13].

Reiki and therapeutic touchModerate

Anxiety, compared with placebo or no treatment pooled together

Shown to lower anxiety (SMD -0.82) in pooled trials that mixed placebo and no-treatment comparisons, with very high heterogeneity.

Compared with a placebo group or blank control, pooled together [4]

The numbers and sources

Effect: Across 13 studies, Reiki lowered anxiety (SMD -0.82, 95% CI -1.29 to -0.36), with heterogeneity of 88.5%. Effects were less consistent for anxiety before surgery and death-related anxiety in cancer patients [4].
Population: 824 adults in 13 studies, including people with chronic illness and healthy adults [4].
Sources: [4]
Caveats: The review included quasi-experimental studies and did not separate sham Reiki from no treatment [4].

Cognitive behavioral therapyModerate

Anxiety disorders, compared with medication

Mixed results: head-to-head trials found psychotherapy and antidepressants similar overall, while a broader analysis found larger before-and-after improvements with medication.

Compared with antidepressant medication in head-to-head trials [5]; medication arms in separate trials, before and after treatment in the same people [7]

The numbers and sources

Effect: In 67 head-to-head trials, psychotherapy and antidepressants did not differ overall (g 0.02). Psychotherapy outperformed medication for obsessive compulsive disorder (g 0.64) [5]. Across 234 trials, average improvement from before to after treatment was larger with medication (d 2.02) than with psychotherapy (d 1.22), with individual CBT at d 1.30 and pill placebo at d 1.29 [7].
Population: 27 head-to-head trials in anxiety disorders, among 5,993 patients [5]. 37,333 patients in 234 trials [7].
Sources: [5], [7]
Caveats: The before-and-after comparison sets arms of different trials side by side, which is weaker than a head-to-head trial [7]. The head-to-head analysis covers all psychotherapies [5].

Reiki and therapeutic touchModerate

Anxiety, stress and depression, compared with sham Reiki by untrained people

Mixed results: a review of 14 sham-controlled trials found Reiki ahead of sham on some mental health symptoms, and a chemotherapy trial found comfort rose equally with sham.

Compared with sham Reiki, usually given by an untrained person taught to copy the Reiki practitioner's hand positions [2]; a sham Reiki placebo, and standard care [3]

The numbers and sources

Effect: In 14 trials with a placebo-Reiki group, Reiki showed a greater effect than placebo for some mental health symptoms. The reviewers rated the evidence high for clinically relevant stress and depression, moderate to high for clinically relevant anxiety, and low for anxiety and depression at normal levels [2]. In 189 people having chemotherapy, comfort and well-being rose after Reiki and also after sham Reiki, and did not change with standard care [3].
Population: 14 randomized placebo-controlled trials in adults [2]. 189 adults at an outpatient chemotherapy center [3].
Sources: [2], [3]
Caveats: The reviewers found few trials in each area and called the findings inconclusive, with most trials at some risk of bias [2]. The chemotherapy authors attributed the gain to one-on-one presence of a nurse [3].

Massage therapyLimited

Generalized anxiety disorder

Small trials disagree: one found Swedish massage lowered anxiety more than light touch, and another found massage did not differ from a relaxing room or heat therapy.

Compared with light touch [13]; thermotherapy [14]; a relaxing room [14]

The numbers and sources

Effect: In 47 untreated adults with generalized anxiety disorder, twice-weekly Swedish massage for 6 weeks lowered Hamilton Anxiety scores by 11.67 points against 8.41 with light touch (difference 3.26, P = .030) [13]. In 68 adults with the disorder, massage, thermotherapy and a relaxing room all lowered anxiety scores by 10 to 13 points, with no difference between groups (P = .39), and gains held at 26 weeks [14].
Population: 47 adults, 40 analyzed [13]. 68 adults [14].
Sources: [13], [14]
Caveats: Two small trials. The authors of [14] attributed the improvement in every group to a general relaxation response.

Reiki and therapeutic touchModerate

Any condition, systematic reviews

Not shown to treat any condition in a review of nine trials. A Cochrane review found too few data to judge Reiki for anxiety or depression.

Compared with sham Reiki and conventional care [5]; control conditions in three trials, which the source abstract does not describe [6]

The numbers and sources

Effect: Of nine trials, two suggested benefit over sham for depression and one did not report group differences. There was no difference from sham for stroke recovery, for anxiety in women having amniocentesis, or for pain in diabetic nerve pain, and no effect on anxiety or depression against conventional care in women having breast biopsy. The reviewers found the evidence insufficient for any condition [5]. A Cochrane review found three trials with only 25 people with anxiety and 17 with depression, and no evidence that Reiki is either beneficial or harmful for them [6]. NCCIH states that "Reiki hasn't been clearly shown to be effective for any health-related purpose" [1].
Population: 9 randomized trials [5]. 3 trials in adults aged 16 or over [6].
Sources: [5], [6], [1]
Caveats: Trials were small, rarely replicated and often poorly reported [5][6].

HomeopathyLimited

Anxiety

Limited evidence: one trial in generalized anxiety disorder found anxiety fell as much on placebo as on individualized homeopathy, and a review found contradictory, underpowered trials.

Compared with placebo [15]; control conditions in eight randomized trials, which the review abstract does not describe [16]

The numbers and sources

Effect: In 44 people with generalized anxiety disorder, Hamilton anxiety scores improved significantly in both the homeopathy and placebo groups over 10 weeks, with no difference between groups [15]. A systematic review found eight randomized trials in test anxiety, generalized anxiety disorder and anxiety around cancer or surgery, with contradictory results and too little power or detail to draw conclusions [16].
Population: 44 adults with generalized anxiety disorder, 39 completing [15]. 8 randomized trials and many case reports and uncontrolled studies [16].
Sources: [15], [16]
Caveats: Small trials. The trial authors note that the size of improvement on placebo could explain belief in homeopathy [15].

ReflexologyLimitedStudied in women

Anxiety and mood, compared with plain foot massage

Limited evidence: two trials in women found anxiety and depression fell as much with plain foot massage or lay foot manipulation as with reflexology.

Compared with nonspecific foot massage [7]; lay foot manipulation, and conventional care [6]

The numbers and sources

Effect: In 76 women with menopausal symptoms, anxiety scores fell from 0.43 to 0.22 with reflexology and from 0.37 to 0.27 with foot massage, and depression scores fell from 0.37 to 0.20 and from 0.36 to 0.20, with no difference between groups. Hot flushes and night sweats changed similarly [7]. In 385 women with advanced breast cancer, state anxiety and depressive symptoms did not differ between groups [6].
Population: 76 women aged 45 to 60 [7]. 385 women with advanced breast cancer [6].
Sources: [7], [6]
Caveats: In the menopause trial, 14 of 37 women given foot massage believed they had not received true reflexology [7].

Practices

MeditationStrong

Symptoms of psychiatric disorders

Shown to ease disorder-specific symptoms more than no treatment and other active controls in pooled trials, and no differently from established treatments such as CBT or medication.

Compared with no treatment, minimal treatment, nonspecific and specific active controls, and evidence-based treatments [5]; waiting list, other active treatments, CBT and medication [6]

The numbers and sources

Effect: Across 142 samples, mindfulness programs were superior at the end of treatment to no treatment (d = 0.55), minimal treatment (d = 0.37), nonspecific active controls (d = 0.35) and specific active controls (d = 0.23), and did not differ from evidence-based treatments (d = -0.004). The most consistent evidence was for depression, pain conditions, smoking and addictive disorders [5]. Across 209 studies, effects were g = 0.53 against waiting list and g = 0.33 against other active treatments, with no difference from traditional CBT or behavioral therapies (g = -0.07) or medication (g = 0.13, 3 studies) [6].
Population: 12,005 participants with psychiatric disorders [5]. 12,145 participants in 209 studies [6].
Sources: [5], [6]
Caveats: The two reviews overlap in the trials they pool. The equivalence with medication rests on 3 studies [6]. Effects shrink as the comparison becomes more active [5].

Slow breathing and breathworkStrong

Anxiety and depression symptoms

Shown to lower self-rated anxiety and depression symptoms in two meta-analyses, by small amounts for breathwork in general and larger amounts for heart rate variability biofeedback.

Compared with non-breathwork controls, active and inactive [2]; control conditions the source abstract does not describe [5]; inactive and active controls [3]

The numbers and sources

Effect: Breathwork lowered self-rated anxiety (g = -0.32, 20 trials, p < 0.0001) and depressive symptoms (g = -0.40, 18 trials, p < 0.0001) against non-breathwork controls, with moderate, significant heterogeneity [2]. Across 24 studies, heart rate variability biofeedback reduced self-reported stress and anxiety against control conditions by g = 0.83, an effect not changed by whether participants had an anxiety disorder [5]. A wider meta-analysis of the same technique found its largest effects for anxiety, depression and anger, from few studies each [3].
Population: Adults in 20 and 18 randomized trials [2]. 484 participants in 24 studies [5]. 58 randomized trials [3].
Sources: [2], [5], [3]
Caveats: Symptoms were self-rated and nobody can be blinded to breathing training. The biofeedback analysis pooled stress and anxiety together and included some studies without control groups in its within-group estimate [5].

MeditationModerate

Anxiety

Shown to ease anxiety in adults with health conditions against time-matched control programs, and an 8-week course matched escitalopram in one trial of anxiety disorders.

Compared with active control programs matched for time and attention [3]; escitalopram 10 to 20 mg [4]

The numbers and sources

Effect: In trials with active controls, mindfulness programs improved anxiety by an effect size of 0.38 (95% CI 0.12 to 0.64) at 8 weeks and 0.22 (95% CI 0.02 to 0.43) at 3 to 6 months, rated moderate evidence [3]. In 208 adults with a diagnosed anxiety disorder, anxiety severity fell 1.35 points with mindfulness-based stress reduction and 1.43 with escitalopram on a 7-point clinician scale. The difference of -0.07 (95% CI -0.38 to 0.23) met the trial's noninferiority margin [4].
Population: 3,515 participants in 47 trials of adults with clinical conditions [3]. 208 adults with a diagnosed anxiety disorder, 75% women, mean age 33, at 3 US academic centers [4].
Sources: [3], [4]
Caveats: The escitalopram trial had no placebo or waiting list arm, so it shows the two did not differ, not how much either did beyond time and expectation [4]. The effect against active controls was small and smaller at follow-up [3].

Tai chi and qigongModerate

Stress, anxiety and depression

Shown to lower stress, anxiety and depression in pooled trials of tai chi and of qigong, against waiting list and varied controls, in trials with methodological limits.

Compared with varied control groups, including some nonrandomized studies [12]; waiting list [13]; lectures and structured movement alone [13]

The numbers and sources

Effect: Tai chi reduced stress (effect size 0.66, 95% CI 0.23 to 1.09), anxiety (0.66, 95% CI 0.29 to 1.03) and depression (0.56, 95% CI 0.31 to 0.80) and improved mood (0.45) [12]. In healthy adults, 1 to 3 months of qigong lowered anxiety (SMD -0.75, 95% CI -1.11 to -0.40, 4 trials) and stress (SMD -0.88, 95% CI -1.22 to -0.55, 3 trials) against waiting list [13].
Population: 3,817 participants in 40 studies, healthy and with chronic conditions [12]. Healthy adults in 7 trials [13].
Sources: [12], [13]
Caveats: The tai chi review pooled randomized and nonrandomized trials and noted inadequate controls [12]. The qigong review had few trials with methodological flaws [13].

YogaModerate

Anxiety, against no treatment

Shown to ease anxiety slightly against no treatment in one meta-analysis of 8 small trials, in people with raised anxiety. No effect appeared in diagnosed anxiety disorders.

Compared with no treatment [4]

The numbers and sources

Effect: Against no treatment, anxiety fell in the short term (SMD -0.43, 95% CI -0.74 to -0.11) and depression fell (SMD -0.35, 95% CI -0.66 to -0.04). No effects were found for people with anxiety disorders diagnosed by DSM criteria, only for those diagnosed by other methods and those with elevated anxiety without a formal diagnosis [4].
Population: 319 participants, mean age 30 to 38.5, in 8 trials [4].
Sources: [4]
Caveats: Few small trials with unclear risk of selection bias [4].

YogaModerate

Anxiety, against active comparisons

Shown to ease anxiety more than active comparisons in small pooled trials. In one trial of generalized anxiety disorder, Kundalini yoga beat stress education but fell short of CBT.

Compared with active comparators the source abstract does not describe [4]; stress education [5]; cognitive behavioral therapy [5]

The numbers and sources

Effect: Against active comparators, anxiety fell more with yoga (SMD -0.86, 95% CI -1.56 to -0.15) [4]. In 226 adults with generalized anxiety disorder, 54.2% responded to Kundalini yoga against 33.0% to stress education (odds ratio 2.46, 95% CI 1.12 to 5.42, number needed to treat 4.59) and 70.8% to CBT. Yoga did not meet the noninferiority test against CBT [5].
Population: Participants in the active-comparison trials of 8 [4]. 226 adults with a primary diagnosis of generalized anxiety disorder, mean age 33, 70% women [5].
Sources: [4], [5]
Caveats: The pooled active comparison rests on few trials with a wide interval [4]. Only 68.6% completed the post-treatment assessment in the anxiety disorder trial [5].

Slow breathing and breathworkLimited

Asthma, against asthma education

One trial of 183 adults found physiotherapist breathing training improved asthma quality of life and anxiety more than nurse asthma education at 6 months, not at 1 month.

Compared with nurse-delivered asthma education, to control for clinician attention [16]

The numbers and sources

Effect: At 6 months, breathing training improved asthma quality of life by 0.38 units more than education (95% CI 0.08 to 0.68), with differences in anxiety (1.1 points), depression (0.8) and hyperventilation scores (3.2). No differences were seen at 1 month. Airway physiology, inflammation and hyper-responsiveness did not change [16]. The Cochrane review pooled this comparison from the same single trial [15].
Population: 183 adults with asthma and impaired health status in UK primary care [16].
Sources: [16], [15]
Caveats: Three sessions, one trial, single-blind [16].

GroundingLimited

Mood

Mixed results: one sham-controlled study of 40 adults found 1 hour grounded lifted mood, while a 12-week pilot found anxiety and depression did not differ from sham.

Compared with sham grounding [7][1]; weeks without grounding, in the same people [3]

The numbers and sources

Effect: In a double-blind pilot, pleasant and positive mood improved after 1 hour of grounding in a recliner and did not improve with sham grounding [7]. Massage therapists reported less depressed mood while grounded [3]. In patients with mild Alzheimer's disease, Beck Anxiety and Beck Depression scores did not change significantly with grounding compared with sham [1].
Population: 40 adults [7]. 16 massage therapists [3]. 15 patients with mild Alzheimer's disease [1].
Sources: [7], [1], [3]
Caveats: Very small studies with short exposures. The 40-person study was by a researcher who has worked as a contractor for the sponsoring company [7][4].

Daily life

Physical activityStrong

Depression and anxiety symptoms in trials

Shown to lower depression and anxiety symptoms by a medium amount in trials across many groups, including people with major depression, in reviews rated low in quality.

Compared with usual care [13]; active controls such as usual care or a placebo tablet [14]

The numbers and sources

Effect: Across 97 reviews, physical activity had medium effects on depression (median effect size -0.43), anxiety (-0.42) and psychological distress (-0.60, 95% CI -0.78 to -0.42), with larger effects at higher intensity [13]. In major depression, walking or jogging (g -0.62, 95% credible interval -0.80 to -0.45) and mixed aerobic exercise (g -0.43) reduced symptoms, with effects in proportion to the intensity prescribed [14].
Population: 128,119 participants in 1,039 trials within 97 reviews [13]. 14,170 people with major depression in 218 trials [14].
Sources: [13], [14]
Caveats: Most reviews were rated critically low in quality [13]. Only one depression trial was at low risk of bias, and participants could not be blinded [14].

Strength trainingStrong

Depression and anxiety symptoms

Shown to lower depressive symptoms by a moderate amount and anxiety by a small amount in pooled trials, with smaller effects in trials with blinded assessment.

Compared with nonactive control conditions [17][18]; active controls such as usual care or a placebo tablet [19]

The numbers and sources

Effect: Resistance training reduced depressive symptoms (effect size 0.66, 95% CI 0.48 to 0.83), a number needed to treat of 4, regardless of health status or training volume [17]. It reduced anxiety symptoms (effect size 0.31, 95% CI 0.17 to 0.44), more in healthy people (0.50) [18]. In major depression, strength training reduced symptoms (g -0.49, 95% credible interval -0.69 to -0.29) and was among the options people tolerated most [19].
Population: 1,877 participants in 33 trials [17]. 922 participants in 16 trials [18]. 643 people with major depression in 22 strength training arms [19].
Sources: [17], [18], [19]
Caveats: Trials with blinded allocation or assessment found smaller effects [17]. Confidence in the depression network results was rated very low for strength training [19].

Time in natureStrong

Mood, anxiety and depressive feelings

Shown to ease negative mood, anxiety and depressive feelings and raise positive mood after time in nature, in several meta-analyses rating study quality mostly low.

Compared with control conditions, mostly passive [7]; control groups [8]; built environments [9]; before the forest bathing, in the same people [6]; a 90-minute walk in an urban setting [10]

The numbers and sources

Effect: Across 30 reviews, nature-based programs lowered anxiety (SMD -0.83, 95% CI -1.19 to -0.47), depressive symptoms (SMD -0.72) and negative affect (SMD -0.61), and raised positive affect (SMD 0.52). Physiological measures did not rise significantly (SMD 0.24, 95% CI -0.19 to 0.67) [7]. An umbrella review found lower tension (SMD -0.87) and negative affect (SMD -0.51) and higher positive affect (SMD 0.98) and wellbeing (SMD 0.40), at moderate credibility [8]. Short visits to natural settings had a small effect on depressive mood (mean g -0.29) [9]. After forest bathing, tension-anxiety and depression-dejection scores fell [6]. A 90-minute nature walk lowered rumination and activity in a brain region tied to it, and an urban walk did not [10].
Population: 3,870 primary studies in 30 reviews [7]. 344 studies in 28 reviews [8]. 33 studies [9]. 11 studies [6]. Healthy adults in one trial [10].
Sources: [7], [8], [9], [6], [10]
Caveats: Most primary studies used passive controls, short follow-up and self-report, and were rated at high risk of bias [7][9]. Only 10 of 91 associations had moderate credibility [8]. Heterogeneity was large [9].

Volunteering and purposeStrong

Purpose in life and depression

Linked to fewer depressive and anxiety symptoms in people with a stronger sense of purpose in life, in two meta-analyses, moderate correlations.

Compared with people with a lower sense of purpose in life [13][14]

The numbers and sources

Effect: Purpose in life correlated with lower depression (r -0.49, 95% CI -0.52 to -0.45) and lower anxiety (r -0.36) [13]. In 71 of 72 samples, purpose was linked to fewer depressive symptoms (estimate -0.32, 95% CI -0.35 to -0.30), and each standard deviation more purpose to lower odds of severe distress (OR 0.53) [14].
Population: 66,468 people in 99 samples [13]. 531,038 participants in 72 samples across six world regions [14].
Sources: [13], [14]
Caveats: Mostly measured at one time, so depression lowering purpose is as likely as the reverse. The two concepts overlap in how they are asked about.

GardeningModerate

Stress and anxiety

Shown to lower self-rated stress with horticultural therapy in one meta-analysis, without changing physiological measures. A community gardening trial found larger falls in stress and anxiety.

Compared with a control group the abstract does not describe [6]; a waiting list for a community garden plot [7]

The numbers and sources

Effect: Horticultural therapy improved psychological stress measures against control, with no significant effect on physiological measures. A total of 100 to 500 minutes gave larger effects [6]. People given a community garden plot had greater reductions in perceived stress and anxiety from spring to autumn than those kept on the waiting list [7].
Population: Trials of horticultural therapy in varied populations [6]. 291 adults new to gardening in Denver and Aurora, Colorado, 82% women [7].
Sources: [6], [7]
Caveats: The meta-analysis abstract gives no pooled sizes [6]. Stress and anxiety were secondary outcomes in the trial and were self-rated [7].

SmokingModerate

Mood after quitting

Linked to small improvements in depression, anxiety and stress after quitting, in a Cochrane review of mostly cohort data rated very low to moderate in certainty.

Compared with people who continued to smoke [19]

The numbers and sources

Effect: Against continuing to smoke, quitting was linked to lower anxiety (SMD -0.28, 95% CI -0.43 to -0.13), depression (SMD -0.30, 95% CI -0.39 to -0.21), mixed anxiety and depression (SMD -0.31) and stress (SMD -0.19), and more positive affect (SMD 0.22). New mixed anxiety and depression was less common in quitters (OR 0.76, 95% CI 0.66 to 0.86). Results were similar in people with mental illness [19].
Population: 102 studies with over 169,500 adults who smoked, followed at least 6 weeks [19].
Sources: [19]
Caveats: All studies were judged at serious risk of bias from confounding that changes over time, and there was some sign of publication bias [19]. People whose mood improves may find it easier to quit, which is reverse causation.

Pet ownershipStrong

Depression

Not linked to depression in pet owners in a meta-analysis of 21 studies, or in older dog owners in a systematic review.

Compared with people without pets [10]; older adults without a dog [11]

The numbers and sources

Effect: Pet ownership was not linked to depression (OR 1.03, 95% CI 0.995 to 1.07). Dog ownership was not linked (OR 0.93, 95% CI 0.789 to 1.10), and cat ownership was linked to slightly higher risk (OR 1.06, 95% CI 1.02 to 1.09) [10]. In community-dwelling adults aged 70 and over, having a dog was not linked to depressive symptoms, and regular contact with a dog was linked to fewer anxiety symptoms [11].
Population: 159,322 participants in 21 studies [10]. 25,138 older adults in 5 cross-sectional studies and 1 controlled before-and-after study [11].
Sources: [10], [11]
Caveats: Observational and mostly cross-sectional. People may get a pet for support when already low, which can hide or reverse a link.

Food and drink

Dark chocolateModerate

Mood and anxiety

Shown to ease depressive and anxiety symptoms in the short term, in one meta-analysis of 9 small studies of cocoa-rich products.

Compared with control conditions the abstract does not describe [7]

The numbers and sources

Effect: Cocoa-rich products lowered depressive symptoms (Hedges' g -0.42, 95% CI -0.67 to -0.17) and anxiety symptoms (g -0.49), and improved positive (g 0.41) and negative affect (g -0.47) [7].
Population: 9 studies, 5 of a single dose, 2 of 3 days and 2 of more than a week [7].
Sources: [7]
Caveats: Few participants and short studies, so the results do not cover regular intake over months [7].