焦虑症(专业版)
焦虑症是神经症中最常见的一种,主要表现为无明确客观对象的情绪紧张、恐惧或坐立不安,以及植物神经症状如心悸、手抖和出汗等。
其他名称:焦虑障碍;焦虑性神经症
英文名称:Anxiety Disorders
焦虑症可分为慢性焦虑和急性焦虑发作两类形式:
与焦虑、抑郁等神经症相关的一些病因病理研究机制:
其他可能增加患焦虑症的因素包括:
调整饮食与生活方式
营养与草本综合干预
以下是基于循证医学和循证营养学有关文献综合的结果。
有助于防控焦虑症的营养和草本补充剂,主要包括如下:
1.镁:
镁具有多种功能,有助于缓解压力和焦虑,包括调节肾上腺轴(HPA)活动和降低神经兴奋性1。低镁状态可能与焦虑风险增加有关,尤其是女性。一项针对伊朗受试者的研究发现,与镁摄入量最低的女性相比,镁摄入量最高的女性焦虑风险降低39%2。一项针对126名轻度至中度抑郁症患者的对照试验发现,补充氯化镁,每天提供248mg元素镁,持续六周导致抑郁和焦虑症状量表得分下降3。一项临床试验的系统综述发现,有证据表明,镁单独或与维生素B6或草药提取物联合使用,可以缓解轻度至中度焦虑、经前综合征或高血压患者的焦虑症状4。
一种氨基酸结合形式镁-苏糖酸镁,在焦虑动物模型中被发现对提高脑镁水平、促进神经可塑性和平息恐惧反应特别有效5,6。
2.维生素B族:
B族维生素是全身许多生化途径的关键辅因子,包括神经递质的合成。众所周知,B族维生素水平低会导致神经和心理疾病7,8。在一项针对老年人的研究中,维生素B6水平低与焦虑症状增加有关9。另一项研究发现,因恐慌发作而去急诊室就诊的人比健康志愿者更有可能维生素B6水平较低10。
一项有关对照试验的荟萃分析得出结论,补充维生素和矿物质,尤其是补充维生素B,可以降低感知压力水平,减少轻度焦虑,改善整体情绪11。在健康成年人中,超过16周的每周家庭评估显示,与服用安慰剂的人相比,服用多种维生素的人减轻了压力和焦虑12。一项包括60名抑郁症参与者的安慰剂对照试验发现,服用甲基化维生素B复合物补充剂60天可以减少抑郁和焦虑,并改善生活质量13。
3.欧米伽3脂肪酸:
来自鱼油中的EPA和DHA是大多数细胞膜的成分。DHA可以直接食用,也可以在体内由EPA合成,是神经细胞中主要的多不饱和脂肪酸,对神经系统的正常功能至关重要。欧米伽-3脂肪酸具有抗炎特性,在大脑中,可以抑制应激反应的激活,并有助于缓解焦虑和抑郁症状14。一项对照试验的综述和荟萃分析指出,有证据支持每天2000mg或更多剂量的欧米伽-3脂酸在减轻各种临床疾病患者的焦虑方面发挥作用15。
研究发现,与健康人相比,社交焦虑症患者红细胞膜中的ω-3脂肪酸水平较低16。在一项针对抑郁症患者的研究中,焦虑症患者的血浆EPA和DHA水平低于无焦虑症患者17。多项研究发现,ω-3脂肪酸补充剂可以减轻焦虑症状。在一项包括68名医学生的安慰剂对照试验中,连续12周每天服用2085mg EPA和348mg DHA,焦虑症状减轻了20%,炎症标记物水平也降低了18。在一项针对重度抑郁障碍受试者的安慰剂对照试验中,与服用SSRI加安慰剂的患者相比,在服用SSRI的同时服用ω-3脂肪酸的患者在12周后焦虑敏感性较低,睡眠和情绪调节改善19。其他随机对照试验发现,补充EPA加DHA可以减轻焦虑症状,包括心脏病发作患者20、经前综合征女性21和有药物滥用史的个人22-24。
4. 色氨酸和5-羟色氨酸(5-HTP):
L-色氨酸是肠道和大脑中产生血清素的必需氨基酸和前体25。它被认为在肠道和大脑之间的交流中发挥着重要作用26。在处于急性压力下的健康成年人中,L-色氨酸转化为血清素的效率已被证明较低27。
几十年来,L-色氨酸一直被用来提高血清素水平,以改善情绪和睡眠。290一项对11项对照试验结果的系统综述发现,每天剂量高达3g的L-色氨酸可以减少健康人的焦虑,增加积极情绪28。
5-羟色氨酸(5-HTP)是血清素的直接前体。人们主要研究它的抗抑郁作用29,但一些研究表明,5-HTP也可能对焦虑症有帮助。在一项安慰剂对照试验中,恐慌症患者在服用200mg 5-HTP后对恐慌刺激的反应较少30。还报道了5-HTP对恐慌和其他焦虑症患者的有益作用31,32。此外,每天200-400mg的5-HTP可以减轻纤维肌痛征患者的焦虑症状33,34。在精神疾病背景下对5-HTP的大多数研究质量都值得怀疑,因此有必要进行进一步的严格研究35。
5. N-乙酰半胱氨酸:
已知N-乙酰半胱氨酸(NAC)是半胱氨酸的前体,半胱氨酸是人体主要抗氧化剂之一谷胱甘肽的合成前体。NAC还具有固有的自由基猝灭能力和抗炎特性。
一项针对患有创伤后应激障碍和物质使用障碍的退伍军人的安慰剂对照试验发现,每天服用2400mg NAC,同时进行为期八周的认知行为治疗,可以减轻心理症状和食欲;这些影响中的许多在治疗结束一个月后仍然明显36。多项试验还指出,NAC的使用与强迫症和相关疾病患者的强迫行为减少有关,这些疾病具有严重的焦虑成分37,38。此外,对照试验表明,NAC可以减轻一系列情绪障碍患者的抑郁症状39。
6.褪黑素:
褪黑素参与昼夜节律的调节,并对情绪、疼痛和睡眠产生影响40。临床前研究表明,褪黑激素受体参与焦虑、抑郁和睡眠障碍的机制41,42。
大量确凿的证据表明,褪黑激素有助于促进睡眠,对一系列精神、神经和身体状况都有很大的前景40,43,44。在多个安慰剂对照试验中发现了褪黑激素,可以减轻术前和术后的焦虑45。
7.茶氨酸:
L-茶氨酸是一种存在于绿茶和红茶中的氨基酸,摄入后很容易越过血脑屏障46。L-茶氨有充分的放松作用,被发现可以减轻压力和焦虑症状,改善认知的某些方面46,47。它似乎对大脑化学有复杂的影响,一些研究表明它会增加GABA的水平,调节多巴胺和血清素水平,影响参与神经兴奋的NMDA谷氨酸受体的功能,并增加脑源性神经营养因子的水平,这是一种刺激神经生长和神经元间连接的蛋白质46,48-50。
一项针对30名健康志愿者的对照试验发现,连续四周每天200mg L-茶氨酸可以改善压力引起的焦虑、抑郁和睡眠问题,并提高认知功能51。与安慰剂相比,在挑战前一周和挑战期间10天每天饮用含约15mg L-茶氨酸的低咖啡因绿茶的学生感受到的压力和压力反应的激活更少52。在一项针对46名广泛性焦虑症患者的安慰剂对照试验中,每天450–900mg的剂量,持续8周的抗抑郁治疗,改善了轻度睡眠相关症状患者的睡眠满意度,降低了失眠的严重程度53。L-茶氨酸也被发现可以减轻重度抑郁障碍和精神分裂症患者的焦虑症状54,55。一项对9项对照试验结果的系统综述得出结论,每天200-400mg的剂量,可以帮助减轻压力状况下的人的压力和焦虑56。
8.γ氨基丁酸(GABA):
在神经系统中,GABA是一种神经递质,是神经信号传递的主要抑制剂57。苯二氮卓类药物有时用于治疗焦虑和压力相关疾病,靶向某些GABA受体58。
在一项临床研究中发现,口服GABA补充剂可在一小时内增加健康志愿者大脑中的α波活性并降低β波活性,表明GABA可以诱导放松并减少焦虑59。一项针对63名成年人的安慰剂对照试验发现,在精神任务前30分钟服用100mg GABA可以减少与压力相关的大脑活动变化60。在一项针对10名轻度睡眠问题的健康受试者的随机对照试验中,与安慰剂相比,睡前30分钟服用100mg GABA一周缩短了入睡时间,改善了睡眠质量61。由于睡眠问题、压力和焦虑经常同时发生,GABA可能对治疗这类疾病有益。
9.赖氨酸和精氨酸:
在动物模型中,必需氨基酸L-赖氨酸已被证明与血清素和GABA受体相互作用,单独或与L-精氨酸组合可改善焦虑62,63。赖氨酸抗焦虑特性的另一个潜在作用机制是皮质醇和神经张力的降低64。在一项随机对照研究中,用L-赖氨酸强化小麦可以降低男性的慢性焦虑,降低女性对压力事件的皮质醇反应65。在另一项随机控制试验中,29名患有焦虑性格的健康人分别用3g的L-赖氨素和L-精氨酸治疗10天,然后暴露于社会压力源中。结果应激激素水平有所提高,参与者管理压力的能力也有所提高66。在一项安慰剂对照试验中,招募了107名健康志愿者,每天分别服用2.64g L-赖氨酸和L-精氨酸,持续一周,可以减少男性和女性因压力引发的总体焦虑感;氨基酸组合还降低了生理应激的标志物64。
10.益生菌:
到目前为止研究发现,肠道微生物组对大脑功能有着深远的影响,并在调节情绪方面发挥着重要作用67,68。越来越多的证据支持使用益生菌治疗情绪障碍,导致一些人使用“精神生物制剂(Psychobiotics)”一词来描述这些有益的微生物69,70。几项对照试验表明,含有乳酸杆菌和双歧杆菌菌株的益生菌补充剂可以改善焦虑,包括应激诱导的焦虑71。在一项针对66名健康参与者的安慰剂对照试验中,益生菌组合瑞士乳杆菌 R0052和长双歧杆菌R0175(Lallemand益生菌专有品牌CEREBIOME®),在30天内每天30亿CFU的剂量下,减少了焦虑和抑郁的程度72。对该研究数据的第二次分析显示,这种益生菌配方降低了感知压力以及焦虑和抑郁症状,即使是压力水平最低的人(由尿皮质醇确定),这表明它可能对健康人的心理健康具有保护作用73。
在一项安慰剂对照试验中,补充12周的混合益生菌,每天总共提供1350亿CFU,导致那些具有被认为可能与情绪障碍风险增加有关的遗传模式的人在焦虑测试中得分降低74。具有中等压力水平的健康成年人,在12周内每天服用10亿CFU植物乳杆菌DR7,压力和焦虑减轻,与接受安慰剂的患者相比,炎症细胞因子和应激激素水平降低75。在一项针对健康大学生的随机对照试验中,益生菌可以减轻焦虑症状,对基线痛苦评分较高的学生更有效76。另一项试验发现,在准备检查的医学生中,服用每天提供100亿细菌的热灭活格氏乳杆菌(L.gasseri)补充剂24周,可以比安慰剂更好地减轻焦虑症状和改善睡眠77。
11.薰衣草:
薰衣草以其特有的香味而闻名。薰衣草油在欧洲被批准用作治疗焦虑和压力的植物疗法,其精油也用于芳香疗法。它似乎通过激活副交感神经系统来促进放松,影响血清素信号传导,降低神经兴奋性78,79。薰衣草的芳香疗法应用可能对立即缓解症状更有效,但口服薰衣草制剂在长期治疗中似乎有更好的疗效80。
一项随机对照试验的荟萃分析发现,薰衣草芳香疗法可以减少焦虑,降低收缩压,降低心率,降低唾液皮质醇水平(一种激活应激反应的衡量标准)81。它对焦虑症状的积极影响已经在不同的环境中得到证明,包括在癌症护理期间,在重症监护期间,在牙科或其他手术期间,以及在健康志愿者中。尽管有这些发现,薰衣草治疗焦虑症的质量更好的试验仍然需要82-84。在对四项临床试验的审查中发现,芳香疗法和补充薰衣草制剂都可以改善更年期和老年女性的睡眠困难和其他更年期症状85。在一项有60名老年参与者的对照试验中,连续两周每天喝两次薰衣草茶可以减轻焦虑和抑郁的症状86。使用茶可以结合芳香疗法和薰衣草的内部药物作用。
Silexan(薰衣草口服品牌Silexan™)是一种标准化的薰衣草精油产品,目前在德国被批准用于治疗焦虑相关的烦躁不安。许多临床试验已经调查了Silexan在患有焦虑症、亚临床焦虑症和焦虑相关症状(如睡眠困难)的个体的影响87。一项临床试验的结果表明,它促进睡眠的能力与其抗焦虑作用有关,而非镇静作用88。
一项荟萃分析对645名焦虑症患者进行了为期9-12周的Silexan治疗的5项随机对照试验发现,在减轻症状方面,每天80mgSilexan与标准SSRI(帕罗西汀)一样有效,每天160mg更有效87。另一项荟萃分析包括三项随机对照试验,其中697名焦虑低于焦虑障碍诊断阈值的患者每天服用80mg Silexan治疗10周,结果发现在减少焦虑和改善睡眠方面比安慰剂更有效89。
12.藏红花:
藏红花提取物已在多项临床试验和综述中被报道,可减轻焦虑和抑郁症状,改善心理健康,其疗效与目前使用的抗抑郁药物相当90-93。在一项安慰剂对照试验中,包括60名焦虑和抑郁参与者,在评估焦虑和抑郁症状的测试中,12周内每天50mg藏红花降低了分数94。在另一项试验中,同样有轻度至中度焦虑和抑郁的2型糖尿病患者在8周内每天接受30mg藏红花提取物或安慰剂。试验结束时,服用藏红花的患者症状明显减轻,睡眠改善95。使用藏红花与其他草药提取物(包括红景天和姜黄提取物)的组合进行的试验也报告了有希望的效果96,97。
13.西番莲:
西番莲在欧洲传统上用于治疗焦虑、睡眠障碍和烦躁不安98,99。它具有温和的镇静作用,与增强GABA信号的能力有关100。
在一项随机对照试验中,对36名广泛性焦虑症患者进行了西番莲和苯二氮卓类药物奥西泮(Serax)的比较,发现这两种治疗方法都能减轻焦虑症状;尽管奥西泮的作用开始得更快,但其对工作表现也有更大的负面影响101。西番莲在牙科手术前缓解焦虑方面也被发现与苯二氮卓类药物咪达唑仑(Versed)一样有效102。其他对照试验发现西番莲可以在一些类型的手术前减轻焦虑103-105。一项对照试验发现,睡前西番莲茶在改善轻度失眠受试者睡眠方面比安慰剂更有效106。
14.香蜂草:
作为薄荷科植物家族一员,香蜂草历来用于治疗焦虑、抑郁和认知问题107。在一项公开的临床试验中,20名感知压力水平高、轻度至中度焦虑和睡眠障碍的受试者每天服用两剂300mg香蜂草提取物,持续15天。在研究结束时,70%的参与者经历了焦虑症状的缓解,85%经历了睡眠症状的缓解,70%经历了焦虑和睡眠问题的恢复108。安慰剂对照试验表明,香蜂草可以有效地减少心悸和心绞痛患者的焦虑109,110。另一项包括100名患有经前综合征的青春期女孩的试验发现,连续三个月每天600mg柠檬香蜂草比安慰剂更有效地减少了焦虑和睡眠困难,改善了社交功能111。
15.缬草:
缬草是一种药用植物,长期以来一直作为治疗烦躁不安和焦虑的温和镇静剂。缬草中的活性化合物似乎通过与GABA受体相互作用而发挥放松作用112。
在一项针对31名强迫症患者的安慰剂对照试验中,每天765mg缬草提取物,持续8周,有效改善症状113。单次1500mg缬草提取液也被发现可以减轻即将接受侵入性妇科诊断程序的女性的焦虑114。其他几项临床研究得出结论,缬草在不同的环境中具有适度的抗焦虑和放松作用114-118。
16.卡瓦椒:
卡瓦胡椒几个世纪以来一直被用作松弛剂。卡瓦似乎针对杏仁核和其他与恐惧和担忧有关的大脑区域,并可能通过改变神经递质信号来促进放松119,120。根据对照试验的几项荟萃分析发现,卡瓦提取物使用24周后,可以有效、安全地减轻焦虑症状120-122。一项临床试验综述发现,在广泛性焦虑症患者中,卡瓦提取物每天提供120–280mg的卡瓦内酯(来自卡瓦的生物活性化合物),持续四至八周是安全的,可以减少症状123。
注:在极少数情况下,使用卡瓦会产生严重的副作用,包括皮肤反应、认知问题和肝脏损伤,应仔细监测其使用情况124,125。
17.其他草药:
其他多种草药因其对神经系统的放松作用而受到重视,包括:洋甘菊、啤酒花、加州花菱草、圣洁莓和黑升麻等,可能有助于治疗焦虑及其有关症状126-128。
更多内容可点击其个性化的综合干预方案如下:
焦虑症管理要略:
以及参阅本网如下专文的相关内容:
医疗干预
常规治疗包括如下:
对于严重的焦虑症,医生可能推荐药物如下:
其他疗法
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http://www.adaa.org
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http://www.mentalhealthamerica.net
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免责声明和安全信息
英文名称:Anxiety Disorders
定义
焦虑症是神经症中最常见的一种,主要表现为无明确客观对象的情绪紧张、恐惧或坐立不安,以及植物神经症状如心悸、手抖和出汗等。与正常的焦虑情绪不同,焦虑症患者的焦虑严重程度与客观事实或所处环境明显不符,过度或不合理的担忧,并且干扰到日常生活和工作等。焦虑症可分为慢性焦虑和急性焦虑发作两类形式:
- 慢性焦虑症:又称广泛性焦虑障碍,没有外在因素,经常处于紧张不安、担心忧虑中。
- 急性焦虑发作:即恐慌、恐惧发作,存在诱发因素如事件、场所等,持续时间短、症状表现较严重。
- 广泛性焦虑症(慢性焦虑障碍)
- 恐慌症(急性焦虑发作)
- 社交恐惧症(社交焦虑障碍)
- 恐惧症(恐惧特定物等)
- 广场恐惧症(旷野恐惧)
- 疑病症(慢性健康焦虑)
- 创伤后应激障碍(创伤后应激焦虑)
- 强迫症(强迫思想和行为)
病因
焦虑症病因尚不很明确,可能由基因、环境及身体条件等相互作用而导致脑化学失衡引起。与焦虑、抑郁等神经症相关的一些病因病理研究机制:
- 甲基化反应: 依赖于B族维生素,尤其是B6,B12和叶酸,对于调节情绪的神经递质合成至关重要;参与甲基化循环的另一种化合物是S-腺苷甲硫氨酸(SAMe),其提供甲基进入甲基化循环中,促进神经递质如多巴胺和5-羟色胺的合成。
- 焦虑、抑郁症和下丘脑-垂体-肾上腺(HPA)轴:焦虑与抑郁大多由慢性压力/应激引起,后者长期激活HPA,导致脑神经受损、神经元功能障碍及致脑结构改变等。
- 心境障碍与荷尔蒙水平:研究表明,大多数类固醇激素如孕烯醇酮、雌激素、孕酮、睾酮和DHEA具有神经活性,因为大脑中大量存在这些激素受体。因此,荷尔蒙水平与焦虑、抑郁等情绪障碍密切相关。女性月经周期、妊娠与产后、更年期和绝经后等,都可产生明显变化的神经症或情绪紊乱。
风险因素
女性患焦虑症大约为男性的2倍。其他可能增加患焦虑症的因素包括:
- 家庭成员患焦虑症
- 孩童时代害羞
- 应激性生活事件
- 不良的应对策略
- 身体或心理创伤的历史
- 慢性疾病
- 物质滥用,如酒精、某些处方药和毒品等
- 自残历史,如青少年时期,有或无自杀意图。
症状
焦虑症可表现为心理和身体二大类症状:- 焦虑症心理症状可包括如下:
- 担忧或恐惧
- 侵入或沉思的想法
- 感觉迫在眉睫的危险或灾难
- 恐惧或恐慌
- 躁动
- 烦躁
- 急躁
- 不确定性
- 思维集中困难
- 焦虑症身体症状表现可能包括如下:
- 头痛、感觉头晕或晕厥
- 疲劳
- 胸痛、窒息感
- 气短、心跳加速
- 脸红
- 出汗、口干
- 入睡困难
- 腹部不适或腹泻
- 恶心或呕吐
- 性交困难
- 咬指甲或其他习惯性的行为
并发症
焦虑症可能导致或恶化其他精神和身体状况,包括如下:- 抑郁症(常伴有焦虑症),或其他心理健康障碍
- 物质滥用,包括酗酒、过度吸烟,药物滥用等
- 失眠,睡眠质量差
- 消化道或肠道问题
- 头痛和慢性疼痛
- 社交隔离、独处
- 生活质量差
- 自杀倾向或行为
疗法
有效的治疗通常包括综合的干预措施,选项可包括如下:调整饮食与生活方式
- 戒烟,或不抽烟
- 减少或避免含咖啡因的饮料
- 饮酒适度,过量饮酒可加重焦虑
- 睡眠良好、充足
- 减少暴露在有压力的环境中
- 经常锻炼、参与户外活动
营养与草本综合干预
以下是基于循证医学和循证营养学有关文献综合的结果。
有助于防控焦虑症的营养和草本补充剂,主要包括如下:
1.镁:
镁具有多种功能,有助于缓解压力和焦虑,包括调节肾上腺轴(HPA)活动和降低神经兴奋性1。低镁状态可能与焦虑风险增加有关,尤其是女性。一项针对伊朗受试者的研究发现,与镁摄入量最低的女性相比,镁摄入量最高的女性焦虑风险降低39%2。一项针对126名轻度至中度抑郁症患者的对照试验发现,补充氯化镁,每天提供248mg元素镁,持续六周导致抑郁和焦虑症状量表得分下降3。一项临床试验的系统综述发现,有证据表明,镁单独或与维生素B6或草药提取物联合使用,可以缓解轻度至中度焦虑、经前综合征或高血压患者的焦虑症状4。
一种氨基酸结合形式镁-苏糖酸镁,在焦虑动物模型中被发现对提高脑镁水平、促进神经可塑性和平息恐惧反应特别有效5,6。
2.维生素B族:
B族维生素是全身许多生化途径的关键辅因子,包括神经递质的合成。众所周知,B族维生素水平低会导致神经和心理疾病7,8。在一项针对老年人的研究中,维生素B6水平低与焦虑症状增加有关9。另一项研究发现,因恐慌发作而去急诊室就诊的人比健康志愿者更有可能维生素B6水平较低10。
一项有关对照试验的荟萃分析得出结论,补充维生素和矿物质,尤其是补充维生素B,可以降低感知压力水平,减少轻度焦虑,改善整体情绪11。在健康成年人中,超过16周的每周家庭评估显示,与服用安慰剂的人相比,服用多种维生素的人减轻了压力和焦虑12。一项包括60名抑郁症参与者的安慰剂对照试验发现,服用甲基化维生素B复合物补充剂60天可以减少抑郁和焦虑,并改善生活质量13。
3.欧米伽3脂肪酸:
来自鱼油中的EPA和DHA是大多数细胞膜的成分。DHA可以直接食用,也可以在体内由EPA合成,是神经细胞中主要的多不饱和脂肪酸,对神经系统的正常功能至关重要。欧米伽-3脂肪酸具有抗炎特性,在大脑中,可以抑制应激反应的激活,并有助于缓解焦虑和抑郁症状14。一项对照试验的综述和荟萃分析指出,有证据支持每天2000mg或更多剂量的欧米伽-3脂酸在减轻各种临床疾病患者的焦虑方面发挥作用15。
研究发现,与健康人相比,社交焦虑症患者红细胞膜中的ω-3脂肪酸水平较低16。在一项针对抑郁症患者的研究中,焦虑症患者的血浆EPA和DHA水平低于无焦虑症患者17。多项研究发现,ω-3脂肪酸补充剂可以减轻焦虑症状。在一项包括68名医学生的安慰剂对照试验中,连续12周每天服用2085mg EPA和348mg DHA,焦虑症状减轻了20%,炎症标记物水平也降低了18。在一项针对重度抑郁障碍受试者的安慰剂对照试验中,与服用SSRI加安慰剂的患者相比,在服用SSRI的同时服用ω-3脂肪酸的患者在12周后焦虑敏感性较低,睡眠和情绪调节改善19。其他随机对照试验发现,补充EPA加DHA可以减轻焦虑症状,包括心脏病发作患者20、经前综合征女性21和有药物滥用史的个人22-24。
4. 色氨酸和5-羟色氨酸(5-HTP):
L-色氨酸是肠道和大脑中产生血清素的必需氨基酸和前体25。它被认为在肠道和大脑之间的交流中发挥着重要作用26。在处于急性压力下的健康成年人中,L-色氨酸转化为血清素的效率已被证明较低27。
几十年来,L-色氨酸一直被用来提高血清素水平,以改善情绪和睡眠。290一项对11项对照试验结果的系统综述发现,每天剂量高达3g的L-色氨酸可以减少健康人的焦虑,增加积极情绪28。
5-羟色氨酸(5-HTP)是血清素的直接前体。人们主要研究它的抗抑郁作用29,但一些研究表明,5-HTP也可能对焦虑症有帮助。在一项安慰剂对照试验中,恐慌症患者在服用200mg 5-HTP后对恐慌刺激的反应较少30。还报道了5-HTP对恐慌和其他焦虑症患者的有益作用31,32。此外,每天200-400mg的5-HTP可以减轻纤维肌痛征患者的焦虑症状33,34。在精神疾病背景下对5-HTP的大多数研究质量都值得怀疑,因此有必要进行进一步的严格研究35。
5. N-乙酰半胱氨酸:
已知N-乙酰半胱氨酸(NAC)是半胱氨酸的前体,半胱氨酸是人体主要抗氧化剂之一谷胱甘肽的合成前体。NAC还具有固有的自由基猝灭能力和抗炎特性。
一项针对患有创伤后应激障碍和物质使用障碍的退伍军人的安慰剂对照试验发现,每天服用2400mg NAC,同时进行为期八周的认知行为治疗,可以减轻心理症状和食欲;这些影响中的许多在治疗结束一个月后仍然明显36。多项试验还指出,NAC的使用与强迫症和相关疾病患者的强迫行为减少有关,这些疾病具有严重的焦虑成分37,38。此外,对照试验表明,NAC可以减轻一系列情绪障碍患者的抑郁症状39。
6.褪黑素:
褪黑素参与昼夜节律的调节,并对情绪、疼痛和睡眠产生影响40。临床前研究表明,褪黑激素受体参与焦虑、抑郁和睡眠障碍的机制41,42。
大量确凿的证据表明,褪黑激素有助于促进睡眠,对一系列精神、神经和身体状况都有很大的前景40,43,44。在多个安慰剂对照试验中发现了褪黑激素,可以减轻术前和术后的焦虑45。
7.茶氨酸:
L-茶氨酸是一种存在于绿茶和红茶中的氨基酸,摄入后很容易越过血脑屏障46。L-茶氨有充分的放松作用,被发现可以减轻压力和焦虑症状,改善认知的某些方面46,47。它似乎对大脑化学有复杂的影响,一些研究表明它会增加GABA的水平,调节多巴胺和血清素水平,影响参与神经兴奋的NMDA谷氨酸受体的功能,并增加脑源性神经营养因子的水平,这是一种刺激神经生长和神经元间连接的蛋白质46,48-50。
一项针对30名健康志愿者的对照试验发现,连续四周每天200mg L-茶氨酸可以改善压力引起的焦虑、抑郁和睡眠问题,并提高认知功能51。与安慰剂相比,在挑战前一周和挑战期间10天每天饮用含约15mg L-茶氨酸的低咖啡因绿茶的学生感受到的压力和压力反应的激活更少52。在一项针对46名广泛性焦虑症患者的安慰剂对照试验中,每天450–900mg的剂量,持续8周的抗抑郁治疗,改善了轻度睡眠相关症状患者的睡眠满意度,降低了失眠的严重程度53。L-茶氨酸也被发现可以减轻重度抑郁障碍和精神分裂症患者的焦虑症状54,55。一项对9项对照试验结果的系统综述得出结论,每天200-400mg的剂量,可以帮助减轻压力状况下的人的压力和焦虑56。
8.γ氨基丁酸(GABA):
在神经系统中,GABA是一种神经递质,是神经信号传递的主要抑制剂57。苯二氮卓类药物有时用于治疗焦虑和压力相关疾病,靶向某些GABA受体58。
在一项临床研究中发现,口服GABA补充剂可在一小时内增加健康志愿者大脑中的α波活性并降低β波活性,表明GABA可以诱导放松并减少焦虑59。一项针对63名成年人的安慰剂对照试验发现,在精神任务前30分钟服用100mg GABA可以减少与压力相关的大脑活动变化60。在一项针对10名轻度睡眠问题的健康受试者的随机对照试验中,与安慰剂相比,睡前30分钟服用100mg GABA一周缩短了入睡时间,改善了睡眠质量61。由于睡眠问题、压力和焦虑经常同时发生,GABA可能对治疗这类疾病有益。
9.赖氨酸和精氨酸:
在动物模型中,必需氨基酸L-赖氨酸已被证明与血清素和GABA受体相互作用,单独或与L-精氨酸组合可改善焦虑62,63。赖氨酸抗焦虑特性的另一个潜在作用机制是皮质醇和神经张力的降低64。在一项随机对照研究中,用L-赖氨酸强化小麦可以降低男性的慢性焦虑,降低女性对压力事件的皮质醇反应65。在另一项随机控制试验中,29名患有焦虑性格的健康人分别用3g的L-赖氨素和L-精氨酸治疗10天,然后暴露于社会压力源中。结果应激激素水平有所提高,参与者管理压力的能力也有所提高66。在一项安慰剂对照试验中,招募了107名健康志愿者,每天分别服用2.64g L-赖氨酸和L-精氨酸,持续一周,可以减少男性和女性因压力引发的总体焦虑感;氨基酸组合还降低了生理应激的标志物64。
10.益生菌:
到目前为止研究发现,肠道微生物组对大脑功能有着深远的影响,并在调节情绪方面发挥着重要作用67,68。越来越多的证据支持使用益生菌治疗情绪障碍,导致一些人使用“精神生物制剂(Psychobiotics)”一词来描述这些有益的微生物69,70。几项对照试验表明,含有乳酸杆菌和双歧杆菌菌株的益生菌补充剂可以改善焦虑,包括应激诱导的焦虑71。在一项针对66名健康参与者的安慰剂对照试验中,益生菌组合瑞士乳杆菌 R0052和长双歧杆菌R0175(Lallemand益生菌专有品牌CEREBIOME®),在30天内每天30亿CFU的剂量下,减少了焦虑和抑郁的程度72。对该研究数据的第二次分析显示,这种益生菌配方降低了感知压力以及焦虑和抑郁症状,即使是压力水平最低的人(由尿皮质醇确定),这表明它可能对健康人的心理健康具有保护作用73。
在一项安慰剂对照试验中,补充12周的混合益生菌,每天总共提供1350亿CFU,导致那些具有被认为可能与情绪障碍风险增加有关的遗传模式的人在焦虑测试中得分降低74。具有中等压力水平的健康成年人,在12周内每天服用10亿CFU植物乳杆菌DR7,压力和焦虑减轻,与接受安慰剂的患者相比,炎症细胞因子和应激激素水平降低75。在一项针对健康大学生的随机对照试验中,益生菌可以减轻焦虑症状,对基线痛苦评分较高的学生更有效76。另一项试验发现,在准备检查的医学生中,服用每天提供100亿细菌的热灭活格氏乳杆菌(L.gasseri)补充剂24周,可以比安慰剂更好地减轻焦虑症状和改善睡眠77。
11.薰衣草:
薰衣草以其特有的香味而闻名。薰衣草油在欧洲被批准用作治疗焦虑和压力的植物疗法,其精油也用于芳香疗法。它似乎通过激活副交感神经系统来促进放松,影响血清素信号传导,降低神经兴奋性78,79。薰衣草的芳香疗法应用可能对立即缓解症状更有效,但口服薰衣草制剂在长期治疗中似乎有更好的疗效80。
一项随机对照试验的荟萃分析发现,薰衣草芳香疗法可以减少焦虑,降低收缩压,降低心率,降低唾液皮质醇水平(一种激活应激反应的衡量标准)81。它对焦虑症状的积极影响已经在不同的环境中得到证明,包括在癌症护理期间,在重症监护期间,在牙科或其他手术期间,以及在健康志愿者中。尽管有这些发现,薰衣草治疗焦虑症的质量更好的试验仍然需要82-84。在对四项临床试验的审查中发现,芳香疗法和补充薰衣草制剂都可以改善更年期和老年女性的睡眠困难和其他更年期症状85。在一项有60名老年参与者的对照试验中,连续两周每天喝两次薰衣草茶可以减轻焦虑和抑郁的症状86。使用茶可以结合芳香疗法和薰衣草的内部药物作用。
Silexan(薰衣草口服品牌Silexan™)是一种标准化的薰衣草精油产品,目前在德国被批准用于治疗焦虑相关的烦躁不安。许多临床试验已经调查了Silexan在患有焦虑症、亚临床焦虑症和焦虑相关症状(如睡眠困难)的个体的影响87。一项临床试验的结果表明,它促进睡眠的能力与其抗焦虑作用有关,而非镇静作用88。
一项荟萃分析对645名焦虑症患者进行了为期9-12周的Silexan治疗的5项随机对照试验发现,在减轻症状方面,每天80mgSilexan与标准SSRI(帕罗西汀)一样有效,每天160mg更有效87。另一项荟萃分析包括三项随机对照试验,其中697名焦虑低于焦虑障碍诊断阈值的患者每天服用80mg Silexan治疗10周,结果发现在减少焦虑和改善睡眠方面比安慰剂更有效89。
12.藏红花:
藏红花提取物已在多项临床试验和综述中被报道,可减轻焦虑和抑郁症状,改善心理健康,其疗效与目前使用的抗抑郁药物相当90-93。在一项安慰剂对照试验中,包括60名焦虑和抑郁参与者,在评估焦虑和抑郁症状的测试中,12周内每天50mg藏红花降低了分数94。在另一项试验中,同样有轻度至中度焦虑和抑郁的2型糖尿病患者在8周内每天接受30mg藏红花提取物或安慰剂。试验结束时,服用藏红花的患者症状明显减轻,睡眠改善95。使用藏红花与其他草药提取物(包括红景天和姜黄提取物)的组合进行的试验也报告了有希望的效果96,97。
13.西番莲:
西番莲在欧洲传统上用于治疗焦虑、睡眠障碍和烦躁不安98,99。它具有温和的镇静作用,与增强GABA信号的能力有关100。
在一项随机对照试验中,对36名广泛性焦虑症患者进行了西番莲和苯二氮卓类药物奥西泮(Serax)的比较,发现这两种治疗方法都能减轻焦虑症状;尽管奥西泮的作用开始得更快,但其对工作表现也有更大的负面影响101。西番莲在牙科手术前缓解焦虑方面也被发现与苯二氮卓类药物咪达唑仑(Versed)一样有效102。其他对照试验发现西番莲可以在一些类型的手术前减轻焦虑103-105。一项对照试验发现,睡前西番莲茶在改善轻度失眠受试者睡眠方面比安慰剂更有效106。
14.香蜂草:
作为薄荷科植物家族一员,香蜂草历来用于治疗焦虑、抑郁和认知问题107。在一项公开的临床试验中,20名感知压力水平高、轻度至中度焦虑和睡眠障碍的受试者每天服用两剂300mg香蜂草提取物,持续15天。在研究结束时,70%的参与者经历了焦虑症状的缓解,85%经历了睡眠症状的缓解,70%经历了焦虑和睡眠问题的恢复108。安慰剂对照试验表明,香蜂草可以有效地减少心悸和心绞痛患者的焦虑109,110。另一项包括100名患有经前综合征的青春期女孩的试验发现,连续三个月每天600mg柠檬香蜂草比安慰剂更有效地减少了焦虑和睡眠困难,改善了社交功能111。
15.缬草:
缬草是一种药用植物,长期以来一直作为治疗烦躁不安和焦虑的温和镇静剂。缬草中的活性化合物似乎通过与GABA受体相互作用而发挥放松作用112。
在一项针对31名强迫症患者的安慰剂对照试验中,每天765mg缬草提取物,持续8周,有效改善症状113。单次1500mg缬草提取液也被发现可以减轻即将接受侵入性妇科诊断程序的女性的焦虑114。其他几项临床研究得出结论,缬草在不同的环境中具有适度的抗焦虑和放松作用114-118。
16.卡瓦椒:
卡瓦胡椒几个世纪以来一直被用作松弛剂。卡瓦似乎针对杏仁核和其他与恐惧和担忧有关的大脑区域,并可能通过改变神经递质信号来促进放松119,120。根据对照试验的几项荟萃分析发现,卡瓦提取物使用24周后,可以有效、安全地减轻焦虑症状120-122。一项临床试验综述发现,在广泛性焦虑症患者中,卡瓦提取物每天提供120–280mg的卡瓦内酯(来自卡瓦的生物活性化合物),持续四至八周是安全的,可以减少症状123。
注:在极少数情况下,使用卡瓦会产生严重的副作用,包括皮肤反应、认知问题和肝脏损伤,应仔细监测其使用情况124,125。
17.其他草药:
其他多种草药因其对神经系统的放松作用而受到重视,包括:洋甘菊、啤酒花、加州花菱草、圣洁莓和黑升麻等,可能有助于治疗焦虑及其有关症状126-128。
更多内容可点击其个性化的综合干预方案如下:
焦虑症管理要略:
以及参阅本网如下专文的相关内容:
医疗干预
常规治疗包括如下:
对于严重的焦虑症,医生可能推荐药物如下:
- 抗抑郁剂,如选择性5-羟色胺再摄取抑制剂(SSRIs),或三环类抗抑郁药等
- 丁螺环酮
- 苯二氮卓类
- 抗惊厥药
其他疗法
- 家庭和社会关系支持包括:
- 获得家庭和朋友的支持
- 家庭疗法可改善应对技能
- 加入病友俱乐部
- 心理咨询与认知行为疗法:
- 心理疗法:可介入思想、感情和行为,缓解焦虑症状,有助于摆脱心理创伤和矛盾。
- 认知行为疗法(CBT) :可识别消极思维模式和行为,可以训练思维、以应对压力和焦虑恐惧。认知行为疗法已证明,在儿童和青少年很有效。
- 学习掌握缓解压力的技巧如下:
- 练习深呼吸和冥想
- 学会做渐进式肌肉放松
- 按摩
- 从事愉快的活动
- 做瑜伽
预防
有助于预防焦虑症的方法,包括如下:- 要明白可能引起焦虑因素,如职业、环境,以及那些可带来压力的人际关系。
- 如果不可避免的,则面对和克服那些引起焦虑的不利因素。
- 找到放松的方法,并经常使用。
- 建立和维护一个强大的社会支持关系。
- 当情绪发生时候,要适当发泄出来。
- 挑战对自己不合理的信任和想法。
- 纠正误解,询问别人对自己的看法。
- 与治疗师合作。
- 避免使用尼古丁或其他毒品。
- 如果喝酒,要适可而止。
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参考来源:
美国梅奥诊所
www.mayoclinic.org
美国焦虑与抑郁症协会
http://www.adaa.org
美国心理健康网
http://www.mentalhealthamerica.net
美国国立卫生研究院公众健康网
www.medlineplus.gov
加拿大精神病学协会
http://www.cpa-apc.org
加拿大心理学协会
http://cpa.ca
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