Polynesian Pepper may help Anxiety
Alternative Approach, Daily Herald, 2/21/04

By Patrick Massey MD, PhD

Can a Polynesian pepper help control anxiety?

The answer might be a resounding yes, as long as the pepper is kava-kava.

Kava-kava (Piper methysticum) is indigenous to Polynesia. Historically it has been used in ceremonies and to reduce anxiety and tension at peace talks between warring tribes. Today, it is used to reduce general anxiety...but does it really work?

A recent German medical study compared kava to two prescription anti-anxiety medications, Buspirone and Opipramol (not available in the United States). This study compared the effects of these products on symptoms of general anxiety disorder.

General anxiety disorder is a serious medical condition. It is characterized by unrealistic or excessive anxiety or worry and often is associated with other anxiety disorders and depression. Patients suffering from general anxiety disorder most commonly are treated by primary-care physicians, not psychiatrists, and misdiagnosis and inadequate treatment are major problems. Patients' frustration might be one reason for kava's popularity.

Participants in this study took either kava, Buspirone or Opipramol daily for eight weeks. Measures of anxiety were done before and after the eight weeks. At the end of the study, all of the treatment groups had significant improvements in anxiety measurements. There were no significant differences in outcomes in any of the treatment groups, suggesting that kava was as effective as the prescription medications in reducing general anxiety.

In each group, about 75 percent of the participants responded positively and about 60 percent had full remission of symptoms. The author's conclusions were that kava is effective in treating general anxiety disorder. Since some people prefer using herbs over prescription medications, kava should be considered as a viable therapeutic approach.

Kava does not seem to have as many side effects as traditional medications, but it is not recommended for children or for women who are pregnant or breastfeeding.

As good as kava seems to be, it is not 100 percent safe. Over the past two years, a small number of cases of liver failure and death have been associated with kava. For that reason, a number of European countries and Canada have limited the sale of kava.

Most of the cases of liver failure were associated with one specific European manufacturer (an international drug manufacturer). This manufacturer no longer sells kava. Since millions of people use kava every day, the chance of having liver damage is very small.

In contrast, acetaminophen, in the United States alone, is responsible for 56,000 visits to the emergency room, annually, and results in hundreds of cases of acute liver failure and about 200 deaths/annually. Interestingly, the anxiety medication Buspirone also is associated with liver failure.

My patients have used kava, 400 mg per day, with significant success. I recommend checking with a physician who is knowledgeable about herbs before considering kava. It can react with antidepressants, levodopa, alcohol, sedatives and sleeping aids.

Patrick B. Massey MD, PhD
Medical Director
Complementary and Alternative Medicine
Alexian Brothers Hospital Network

President
ALT-MED Medical and Physical Therapy Program

1544 Nerge Rd.
Elk Grove Village IL 60007
www.alt-med.org