Dr. Amy Nett: I’m not entirely sure if you mean, like, how you would support someone actually during a panic attack. I don’t handle emergencies or even urgent situations. Even if someone is having a more acute illness, I don’t see someone for about 48 hours. I just don’t have room to fit them in that day. So I don’t actually walk people through panic attacks. I’m not sure if that’s what you’re asking, if it’s panic attacks, or if you’re saying just more general anxiety. If it’s more general anxiety, I think there’s a lot that you have to look at, what are the sort of comorbidities, and use your clinical judgment in terms of what’s going on. Do you think there’s inflammation in the body? Probably, if we think about the model of depression and anxiety as being related to some degree of neural inflammation. You could think about doing things like curcumin or boswellia or cod liver oil, things to help decrease inflammation.
Again, I honestly don’t start supplements, though, until I’ve seen test results. The way we do our process is we do an initial consult, and I don’t make any treatment recommendations at that time. That’s also partly because I need to see someone in person before I make specific treatment recommendations based on California medical law. I would say you kind of need to have some tests to make useful recommendations. It’s going to depend on the situation, but some of the things I would think about using are Kavinace; for some people, 5-HTP; Calm CP, especially in the evening, if sleep is an issue with anxiety; CBD oil; Relora; theanine. Those are probably the places I would start. Again, it would depend a little bit on the situation, and also if it is someone who has acute anxiety, make sure they’re not on a prescription medication. I had a patient yesterday who saw me. She’s on Zoloft. It’s an SSRI. She wanted additional supplements, herbal ones, for depression and anxiety, but I’m always reluctant, especially when someone’s on an SSRI. Think about serotonin syndrome. That’s something I would never, never want to contribute to happening in someone, so be cautious about 5-HTP. Or if you use St. John’s wort—I don’t, but some people might. St. John’s wort might be associated with serotonin syndrome, as well, so I might not mix it with an SSRI.
Think about those options, decreasing inflammation. Then if there’s a depression component, you might want things to build up serotonin. If there’s a cortisol component, you might want to use some of the adaptogenic herbs. See what the whole picture looks like, and then try to use that.
I’m not sure if you’re asking what advice you would give, if you mean supplements. Well, yeah, you said, “Is there a supplement you would suggest?” Yeah, that’s where I would go in terms of thinking about supplements, but look at the context so you get the whole picture there, and see if it’s more of a depression, more of an anxiety, and then decide.