Anxiety is a common human experience characterized by feelings of worry, nervousness, or unease. These feelings become a concern when they are persistent, severe, and interfere with daily life. For many people seeking immediate, easily accessible solutions, over-the-counter (OTC) options—products sold directly to the public without a prescription—appear as a first step. This has led to a market filled with various non-prescription items, from herbal remedies to traditional drugs, used to manage symptoms of stress and anxiety.
Dietary Supplements Popular for Anxiety Relief
Many individuals turn to widely available dietary supplements for their perceived calming effects on the nervous system. Among the most popular is the amino acid L-Theanine, naturally found in green and black tea leaves. This compound promotes relaxation without causing drowsiness by increasing alpha brain waves, which are associated with “wakeful relaxation.” Typical doses range from 100 to 200 milligrams and are often taken to manage stressful situations or daily tension.
Magnesium is another frequently used supplement, often recommended due to its role as a cofactor in hundreds of bodily reactions, including those that regulate mood and stress responses. The mineral is thought to help modulate the release of stress hormones and bind to GABA receptors, which have a calming effect on the central nervous system. Magnesium glycinate is a form often suggested for anxiety because it is generally well-tolerated and less likely to cause gastrointestinal upset than other forms.
Certain botanicals have a long history of traditional use for promoting tranquility and sleep. Valerian root is one such herb, with some research suggesting that compounds within it may interact with the brain’s GABA (gamma-aminobutyric acid) system, similar to how certain prescription anti-anxiety medications function. Similarly, Chamomile, commonly consumed as a tea, contains the compound apigenin, which can bind to benzodiazepine receptors in the brain, inducing mild sedative and calming effects.
Kava, derived from the roots of a pepper plant, has shown substantial evidence for its anxiolytic properties. Its active ingredients, kavalactones, are psychoactive and affect several neurotransmitter systems, including GABA, dopamine, and norepinephrine. Due to historical concerns about liver toxicity, kava should only be sourced from reputable suppliers and used with caution. Ashwagandha, an adaptogenic herb, is often used to help the body manage stress by potentially lowering elevated levels of the stress hormone cortisol.
Off-Label Use of Traditional OTC Medications
Beyond supplements, regulated pharmaceutical products are available over the counter that people sometimes use to manage anxiety. This is considered an off-label application, as these medications are not FDA-approved for treating anxiety disorders. Their use for anxiety stems solely from a common side effect of their primary purpose: sedation.
The most common examples are first-generation antihistamines, such as Diphenhydramine (often sold as an allergy medication) and Doxylamine (frequently marketed as a sleep aid). These drugs are FDA-approved for treating allergies or temporary insomnia, respectively, by blocking histamine H1 receptors in the body and brain. The resulting drowsiness is the effect that some people seek to quiet their anxiety or to help with anxiety-related sleeplessness.
Because these drugs rely on sedation rather than a specific anti-anxiety mechanism, they can cause unwanted next-day effects. Due to their relatively long duration of action, especially Doxylamine, side effects include grogginess, impaired concentration, and mental slowness. Furthermore, their anticholinergic properties pose risks, particularly for older adults, including confusion and memory issues with prolonged use.
Evaluating Scientific Evidence and Regulatory Differences
The fundamental difference in how OTC products are regulated in the United States impacts the scientific evidence available for their use in anxiety. Traditional OTC drugs, like Diphenhydramine, are regulated by the FDA and must demonstrate safety and efficacy for their labeled use before public sale. Manufacturers must conduct rigorous clinical trials to support their approved indications.
Dietary supplements, including most herbal and amino acid remedies, are regulated under the Dietary Supplement Health and Education Act (DSHEA) of 1994. Under this framework, supplements are treated more like food products, and manufacturers do not need FDA approval to market them. The FDA’s role is largely reactive, stepping in only if a product is proven unsafe or mislabeled after it is already being sold.
This difference explains the general lack of large-scale, placebo-controlled clinical trials for most supplements regarding their efficacy in treating diagnosed anxiety disorders. While some supplements, like Kava or L-Theanine, have promising small-scale data, this evidence does not meet the rigorous standards required for an FDA-approved drug claim. Supplements are therefore not permitted to claim they treat, cure, or prevent a disease, but only to support the structure or function of the body, such as promoting relaxation or managing stress.
Safety Warnings and Consulting a Healthcare Professional
Even though these products are available without a prescription, they are not without risks, especially when managing a complex condition like anxiety. Both herbal supplements and sedating OTC drugs can cause side effects, including drowsiness, dizziness, and gastrointestinal distress. Because first-generation antihistamines and many herbal supplements act as central nervous system depressants, combining them with other sedating substances, such as alcohol, can be dangerous and lead to excessive sedation or respiratory depression.
Serious drug interactions are a concern, as some supplements can interfere with prescription medications. For example, St. John’s Wort interacts with a wide variety of drugs, including certain antidepressants and blood thinners, by altering how the body metabolizes them. Chamomile has also been reported to interact with blood-thinning medications. It is imperative to review all supplements and OTC drugs with a healthcare provider to check for potential negative interactions before starting a new regimen.
Relying on non-prescription options carries the risk of delaying professional diagnosis and treatment for a severe, underlying mental health condition. Persistent or debilitating anxiety often requires a comprehensive approach that includes psychotherapy, such as cognitive-behavioral therapy, or prescription medication. OTC products should never replace professional care, especially if anxiety is severe, leads to panic attacks, or significantly impairs daily functioning.