Chamomile for Anxiety: Effective or Nah?

Chamomile is the common name for various daisy-like plants of the Asteraceae/Compositae family.

The 2 most common chamomile varieties (species) include: (1) German chamomile (Matricaria recutita) and (2) Roman chamomile (Anthemis nobilis).

Chamomile has long been considered a medicinal herb, with many claiming it helps alleviate stress and treat anxiety.

Because (A) I enjoy chamomile tea and find it induces relaxation and (B) others allege that it helps with anxiety/stress – I decided to investigate whether there’s any evidence supporting the idea that chamomile reduces anxiety.

Chamomile for Anxiety (Research)

Included below are studies/papers that discuss the effect of chamomile on anxiety.

Systematic reviews & meta-analyses

Therapeutic efficacy & safety of chamomile for anxiety & insomnia (2019) (R)

Hieu et al.: “Chamomile appears to be a relatively safe herb for the improvement of sleep quality and generalized anxiety disorder (GAD) in the short-term.”

Aim: Evaluate the efficacy and safety of chamomile for state anxiety, generalized anxiety disorder (GAD), sleep quality, and insomnia in humans.

Methods: 11 databases were searched for relevant studies that assessed the effect of chamomile on anxiety and sleep.

12 randomized controlled trials were included in the analysis – but only 6 trials evaluated “anxiety” as either a primary or secondary outcome measure.

What were the results?

• A meta-analysis of 3 studies (Jenabi et al. 2010; Jornet et al. 2016; Zick et al. 2011) with a fixed effect model, using anxiety questionnaires, HADS, and PRIME-MD – showed zero significant effect of chamomile on state anxiety reduction after 4 weeks.
• 3 studies (2 RCTs) indicate that chamomile is effective in treating generalized anxiety disorder (GAD) (Amsterdam et al. 2009; Keefe et al. 2016; Mao et al. 2016) – as evidenced by significantly reduced HAM-A scores after 2 and 4 weeks of treatment.
• Hieu et al. state that there was no significant anxiety reduction after 8 weeks.
• There was a significant reduction in anxiety symptoms after 26 weeks and a nonsignificant decline in relapse of generalized anxiety disorder (GAD) in the study by Mao et al. (2016).
• Amsterdam et al. found no significant effect of chamomile on BAI, PGWB index, CGI-S rating.
• Chamomile was classified as “relatively safe” by Hieu et al. following the meta-analysis.

What can we learn here?

Chamomile appears effective as a short-term treatment for generalized anxiety disorder particularly after 2-4+ weeks of treatment – with a less significant impact when used for a long-term (8 or 26 weeks).

There’s no evidence that chamomile significantly reduces state anxiety.

The quality of evidence of chamomile for anxiety, generalized anxiety disorder (GAD), sleep quality, and insomnia ranged from very low to low (due to the Level 3 evidence included in this study).

Limitations: Low number of studies (can affect conclusion); potential publication bias; small sample sizes in studies; heterogeneity of medical conditions; heterogeneity of specific outcome measures; high risk of bias; low quality of evidence.

Randomized controlled trials (RCTs)

Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: A randomized clinical trial (2016) (R)

To date, this is the highest-quality study of chamomile for the treatment of anxiety.

Favorable aspects of this study: long-term; placebo-controlled; randomization; patients with anxiety disorders (GAD); etc.

Mao et al.: “Long-term chamomile was safe and significantly reduced moderate-to-severe GAD symptoms, but did not significantly reduce rate of relapse.”

• Aim: Evaluate long-term administration of chamomile (Matricaria chamomilla L.) for the prevention of relapse in generalized anxiety disorder (GAD).
• 179 patients with generalized anxiety disorder (GAD) participated in a randomized, double-blind, placebo-controlled trial (2010-2015).
• The mean duration of GAD prior to chamomile treatment was ~9.3 years with severity ranging from: moderate (86%) to moderately severe-to-severe (14%).
• Phase 1: Eligible participants received 12 weeks of open-label therapy with chamomile pharmaceutical grade extract 1500 mg (500 mg capsule, 3x daily).
• Phase 2: Treatment responders were randomized to either: (A) 26 weeks of chamomile therapy (N = 46) OR (B) placebo (N = 47) – in a double-blind, placebo-substitution design.
• Outcome: (1) Time to relapse during continuation therapy, analyzed with Cox proportional hazards and (2) proportion who relapsed; treatment-emergent adverse events; and vital sign changes.

What were the results?

• 93/179 participants (51.9%) were classified as “responders” to chamomile in the open-label Phase 1 of the study.
• A greater number of placebo-switched (i.e. chamomile swapped for placebo) (N = 12/47; 25.5%) vs. chamomile-continuation (N = 7/46; 15.2%) relapsed during Phase 2 follow-up.
• Mean times to relapse were: ~11.4 (+/- 8.4) weeks for chamomile ~6.3 (+/- 3.9) weeks for placebo – indicating that relapse occurred quicker in placebo recipients by ~5 weeks.
• Hazard of relapse was lower for chamomile (HR = 0.52) but this was not significant.
• During follow-up, chamomile users maintained significantly lower symptoms of generalized anxiety disorder (GAD) placebo – with significant reductions in body weight and mean arterial blood pressure.
• Rates of adverse events were similar between groups (17.4% for chamomile vs. 19.1% for placebo) – suggesting that chamomile is unlikely to cause significant side effects/adverse reactions. (All adverse events were mild and did not require medical treatment.)

What can we learn here?

Chamomile extract (1500 mg) appears effective for a subset of patients with longstanding generalized anxiety disorder (GAD) – as evidenced by ~50% “responding” to chamomile (whether it be through an actual effect, a placebo effect, or some combination thereof) over an initial 12-week period.

Chamomile use was associated with significantly: (A) fewer symptoms of generalized anxiety disorder (GAD) and (B) improved psychological well-being – relative to placebo – in the double-blind, placebo-controlled, randomized phase of the study (Phase 2).

• This suggests that chamomile is an effective anxiolytic and that the effect does not significantly diminish over a 38-week period.

Chamomile use was associated with significant reductions in body weight and mean arterial blood pressure (both of which are considered beneficial) with rates of adverse events roughly equivalent to the placebo.

• This indicates that chamomile may provide health benefits beyond anxiety reduction in some cases.

Chamomile appears to prevent GAD relapse in a majority of users (39/46; 84.78%) over a 26-week period – which is a relatively high figure.

• There was technically no “statistically significant” difference in GAD relapse rate between chamomile and placebo in Phase 2 (26-week period), but this may have been due to an atypically high placebo response (35/47; 74.46% avoided GAD relapse).

Specific chamomile product used…

500 mg extract (dry extract) of Matricaria chamomilla L. flowers (equivalent to 2 grams of German chamomile flowers) corresponding to 6 mg total apigenin-7-glycosides (Api-7Glc)

This was pharmaceutical-grade German chamomile dry extract SHC-1 (DER 4:1) standardized to the following:

• 2% Api-7Glc
• 2-0.6% teracoumaroyl spermine (TCS)
• Matricariae flower genuine extract (65%)

Note: Extraction solvents were ethanol 70%, V/V, and water (second extraction).

Limitations: Low rate of placebo relapse (relative to the norm in literature); participants removed from trial after meeting relapse criteria (disproportionate distribution of missing data in the 2 groups for long-term follow-up); possible bias in estimating effects; single-institution study (limits generalizability of findings); only one dosing increment (1500 mg/day); GAD patients only; sample size (could be larger); 1/3 of patients had history of a major depressive episode; etc.

A trial of oral Matricaria Recutita (Chamomile) Extract therapy for generalized anxiety disorder (2013) (R)

Amsterdam et al.: “Results suggest that chamomile may have modest anxiolytic activity in patients with mild to moderate GAD.”

• Aim: Evaluate the efficacy and tolerability of chamomile (German chamomile extract w/ ~1.2% apigenin) vs. a placebo (lactose monohydrate) in the treatment of GAD.
• 57 patients with mild-to-moderate GAD were randomized to receive either: (1) 220 mg chamomile extract capsules (N = 28); OR (2) placebo (N = 29) for 8 weeks.
• Measures: HAM-A scores; BAI scores; Psychological Well Being score; CGI-S score; proportion of patients with >50% reduction in baseline HAM-A scores.

What were the results?

• Chamomile (220 mg capsules) taken “as needed” reduced HAM-A scores to a significantly greater extent than placebo.
• Positive changes in all secondary outcomes (e.g. BAI scores; psychological wellbeing scores; CGI-S scores; proportion of patients with 50% reduction in baseline HAM-A scores) were observed for chamomile relative to placebo.
• However, changes in secondary outcome measures lacked statistical significance [likely] due to underpowering associated with the small sample size.
• There were no significant differences between chamomile and the placebo in side effect/adverse events burden – and chamomile was “exceedingly well tolerated.”

Limitations: Small sample size (underpowering risk); GAD patients only; mild-to-moderate GAD only; dosing (may have been under-dosed); dosing not standardized (patients administered chamomile “as needed” during times of anxiety symptoms); specific chamomile extract from Matricaria Recutita with apigenin (results may have differed with a different species/no apigenin); no verification of the blinded conditions (possible bias).

What can we learn here?

Chamomile extract “as needed” seems to significantly reduce anxiety in patients with mild-to-moderate generalized anxiety disorder (GAD) and is well-tolerated (analogous tolerability to placebo).

Researchers: “The demonstration of chamomile’s efficacy and tolerability in patients with milder GAD may provide a wider acceptability of anxiolytic treatment in the general medical community.”

Other relevant analyses…

The research of chamomile for anxiety is riddled with adjunctive “analyses” of the study by Mao et al.

These are not “separate studies” as some might think but analyses of specific: (A) phases of the study; (B) subgroups within the study; or (C) participant “expectations.”

Keefe et al. (2016): “Patients entering chamomile treatment for GAD with more favorable self-generated expectancies for the treatment experience greater improvement and fewer adverse events.” (R)

• This was Keefe et al. specifically evaluating the effect of “expectation” on responses to chamomile and side effect burden.
• Individuals with higher expectancy of positive outcomes with chamomile – experience greater reduction of anxiety symptoms and are more likely to achieve clinically-significant responses than others.
• Individuals who expect to experience more side effects with chamomile end up experiencing a greater number of side effects during treatment (on average) than others.
• Researchers think that outcome expectancies (e.g. expecting chamomile to be effective for anxiety) may influence whether and how people capitalize on the treatment they receive by building on the functional gains produced by the drug.
• However, we must consider that the “expectancy” for chamomile to be effective could yield a placebo-like effect (wherein a person experiences favorable physiological changes as a result of positive expectation).
• We must also consider that the “expectancy” of chamomile to cause side effects and/or be ineffective could be mediated by a nocebo-like effect (wherein a person experiences deleterious physiological changes as a result of negative expectation).

Keefe et al. (2016): “Chamomile extract produced a clinically meaningful reduction in GAD symptoms over 8 weeks, with a response rate comparable to those observed during conventional anxiolytic drug therapy and a favorable adverse event profile.” (R)

• This was Keefe et al. specifically reflecting upon the 8-week “open-label” phase of the 38-week chamomile extract trial published by Mao et al.

Amsterdam et al. (2020): “M. chamomilla L. may produce clinically meaningful antidepressant effects in addition to its anxiolytic activity in subjects with GAD and comorbid depression.” (R)

• This was Amsterdam et al. specifically reflecting upon patient subgroups (comorbid anxiety & depression) in the 38-week chamomile extract trial published by Mao et al.

Amsterdam et al. (2012): “Chamomile may have clinically meaningful antidepressant activity that occurs in addition to its previously observed anxiolytic activity.” (R)

• This was a specific analysis of a patient subgroup (depression & anxiety) within Amsterdam et al.’s 2009 chamomile extract trial with 57 participants.

In sum, what does the research suggest re: chamomile and anxiety?

At this time, there’s Level 3 (low quality) evidence to suggest that chamomile (Matricaria Recutita) is safe, well-tolerated, and effective for the treatment of generalized anxiety disorder (GAD) – at least in a subset of individuals.

Hieu et al. (2019) conducted a systematic review and meta-analysis of RCTs that evaluated chamomile for the treatment of state anxiety, anxiety disorders, and insomnia/sleep disturbances.

• 6/12 (50%) of trials included in the meta-analysis measured anxiety.
  • 3 trials evaluated “state anxiety” secondary to specific medical conditions (e.g. dysmenorrhea, lichen planus, cancer, pregnancy, etc.)
  • 3 studies (from 2 RCTs) evaluated “generalized anxiety disorder” (GAD) – a chronic psychiatric condition.

State anxiety: Hieu et al. reported that there was no significant effect of chamomile on “state anxiety” associated with various medical conditions.

Generalized anxiety disorder: Hieu et al. reported that there was a significant effect of chamomile on generalized anxiety disorder (GAD) over a short-term (2-4 weeks).

• It was unclear as to whether anxiety reduction is sustained beyond 4 weeks – as Hieu et al.’s analysis found no significant reduction in GAD at 8 weeks.
• Hieu et al. acknowledged that there was a significant reduction in GAD symptoms at 26 weeks of chamomile treatment – which seems contradictory to the lack of reduction in symptoms at 8 weeks.
• Hieu et al. stated that there was a nonsignificant decline in GAD symptom relapse associated with chamomile relative to placebo.

Mao et al. (2016): Evaluated chamomile extract (500 mg, t.i.d.) in 179 patients with moderate-to-severe generalized anxiety disorder (GAD) (mean GAD duration: ~9.3 years) for 38 weeks.

• About 51.9% of the sample responded to treatment in an 8-week open-label phase.
• Among initial responders (8-week Phase 1): Significant reductions in anxiety were documented after 26 weeks of treatment (Phase 2) relative to placebo recipients.
• GAD relapse rates did not significantly differ between chamomile and placebo recipients at 26 weeks – but both were favorable.
  • Relapse rates favored chamomile: 15.2% for chamomile vs. 25.5% for placebo).
  • Time to relapse was longer in chamomile users: ~11.4 weeks (chamomile) vs. ~6.3 weeks (placebo).
  • Authors noted that placebo responses were atypically high – such that it may have explained the lack of significance in GAD relapse.
• Chamomile also significantly improved well-being, reduced arterial blood pressure, and decreased body weight.
• Side effect burden associated with chamomile was indistinguishable from placebo – all side effects were mild and none required medical treatment.

Amsterdam et al. (2013):  Evaluated chamomile extract (220 mg, p.r.n.) in 57 patients with mild-to-moderate generalized anxiety disorder (GAD) for 8 weeks.

• The primary outcome measure (HAM-A scores) indicated that chamomile treatment significantly decreased anxiety after 8 weeks relative to a placebo.
• Chamomile was well-tolerated with side effect burden equivalent to the placebo.

To recap: research suggests that chamomile extract is a safe, tolerable, and effective treatment for anxiety associated with generalized anxiety disorder (GAD) – at least in a subset of patients.

There are no data to suggest chamomile is effective for the treatment of “state anxiety” associated with various medical conditions – or other forms of anxiety (e.g. social anxiety).

Chamomile for Anxiety (Mechanism of action)

Below is the hypothesized mechanism by which chamomile may be effective for anxiety.

Understand that there may be differences between chamomile species in mechanisms of action due to disparities in phytochemical composition.

Bioactive constituents of chamomile (R)

• 120 secondary metabolites
• 28 terpenoids
• 36 flavonoids

Apigenin, quercetin, patuletin, luteolin and their glucosides are the chief constituents. (R)

A majority of the anxiolytic effects derived from chamomile are thought to be from the phenolic compound “apigenin” which effectively penetrates the blood-brain-barrier (BBB).

Hieu et al. state that the mechanism(s) of how chamomile elicits an anxiolytic effect remains elusive – and mechanistic investigations (such as for components like apigenin) have generated contradictory results.

Mao et al. (2014) speculate that chamomile may generate an anxiolytic effect: (R)

• Primarily via interactions with: GABA; 5-HT (serotonin); NA (norepinephrine); and DA (dopamine) systems.
• Indirectly via interactions with the: HPA axis and vasomotor systems.

Jia et al. (2021) investigated pharmacological mechanisms by which chamomile exerts an anxiolytic (anti-anxiety) effect. (R)

The researchers employed network pharmacology and gene expression data mining to clarify and predict potential protein targets and its relationship on pathways related to chamomile and anxiety disorder – analyzing a total of 669 chamomile targets and 712 anxiety disorder targets.

Researchers believe that, based on their analysis, Roman chamomile interacts with the following targets to elicit an anxiolytic effect in humans:

• Neuroactive ligand-receptors
• Serotonin synapses
• cAMP signaling pathway
• Calcium signaling pathway
• Neurotransmitter binding pathways
• LRRK2 gene protein modulator

Mechanisms for anxiolysis in non-humans

Various mechanisms by which chamomile and its chief bioactive compound, apigenin, have been discovered in animal models and cell line studies.

It’s possible that some of chamomile’s anxiolytic mechanisms in non-humans are similar and/or overlap with those in humans.  That said, we should NOT assume that mechanisms for non-humans/cell lines are identical to those occurring in humans.

GABA modulation

Apigenin and other phytochemicals within chamomile may interact with the neurotransmission of GABA and GABA-A receptors – but the specific interactions remain unknown.

Zanoli et al. (2000) claim that the anxiolytic activity of chamomile (Matricaria chamomilla) is best explained by the presence of benzodiazepine-like compounds. (R)

Viola et al. (1995) claimed that apigenin is a ligand for the central benzodiazepine receptors (GABA-A). (R)

Campbell et al. (2004) reported that apigenin acts as a GABA-A antagonist while simultaneously enhancing the GABAergic effects of diazepam. (R)

Goutman et al. (2003) noted that apigenin acted as an antagonist at alpha-1-beta-2-gamma-2s GABA-A receptors. (R)

Avallone et al. (2000) reported that apigenin reduced GABA-activated negatively-charged chloride channels in a dose-dependent manner – which might indicate an anxiogenic effect (rather than anxiolytic effect). (R)

Modulation of GABA receptor activity and/or GABA neurotransmission could be a mechanism by which chamomile decreases anxiety.

5-HT2A serotonin receptor downregulation

Roman chamomile effectively reduced the expression of 5-HT2A in the hippocampus of rats. (R)

Expression of 5-HT2A is located primarily in hippocampal glutamate neurons – and its activation increases anxiety behavior in response to environmental changes.

It’s possible that chamomile’s interaction with 5-HT2A receptors (such as via hippocampal downregulation) could generate an anxiolytic effect.

Monoamine oxidase inhibition

Apigenin appears to inhibit both MAO-A (monoamine oxidase A) and MAO-B (monoamine oxidase B) simultaneously – with greater selectivity at MAO-A. (R1, R2)

• MAO-A primarily metabolizes serotonin, melatonin, epinephrine, and norepinephrine.
• MAO-B primarily metabolizes phenethylamine and trace amines.
• Both MAO-A and MAO-B metabolize dopamine to an equal extent.

Inhibition of MAO-A and MAO-B increases various concentrations of neurotransmitters in the brain, which in turn can generate an anxiolytic effect in some individuals.

Norepinephrine (NA) modulation

Apigenin reduced the uptake of norepinephrine (by ~60%) and norepinephrine metabolites; increased unmetabolized norepinephrine from 11% to 45%; and O-methylated metabolites decreased from 33% to 14%. (R)

Apigenin appears to reduce norepinephrine uptake and monoamine oxidase activity simultaneously.

There’s evidence that norepinephrine modulation may help some cases of anxiety. (R)

HPA axis modulation (Cortisol & ACTH reduction)

Neuroendocrine stress responses are mediated by the HPA (hypothalamic-pituitary-adrenal) axis – which promotes the secretion of stress hormones (e.g. cortisol, ACTH, etc.).

Chamomile may alleviate anxiety by modulating hypothalamic-pituitary-adrenocortical (HPA) axis function.

In mice, apigenin reversed stress-related increases in HPA axis activity. (R)

In cattle, chamomile (Matricaria chamomilla) was associated with significant reductions in circulating cortisol (~38.4%). (R)

In human adreno-cortical H295R cells, chamomile decreased cortisol production by about ~47.5%. (R)

Increased L-Tyrosine Uptake

Alterations in the availability of L-tyrosine in the brain can influence the synthesis of both dopamine and norepinephrine in experimental animal models and probably humans. (R)

Apigenin appears to stimulate the uptake of L-tyrosine (precursor to norepinephrine and dopamine) in cultured bovine cells. (R)

Soranzo & Aquili (2019) found that L-tyrosine abolishes fear expression compared to a placebo. (R)

Glutamate reduction

Apigenin appears to presynaptically inhibit the release of glutamate in the hippocampus of rats – likely via reducing voltage-gated ion channels. (R)

Apigenin has an antagonistic effect on GABA and NMDA channels – which may protect against glutamatergic neurotoxicity. (R)

Anti-inflammatory effects

Apigenin appears to attenuate production of pro-inflammatory cytokines: interleukin-1B (IL-1B) and tumor necrosis factor-alpha (TNF-a) in mice following LPS administration (a pro-inflammatory substance). (R)

Apigenin also appears to suppress inducible nitric oxide synthase (iNOS) and cyclooxygenase-2 (COX-2) expression – both of which reduce inflammation.

Xie et al. (2019) note that apigenin may slow aging and prevent cancer via suppressing the inflammation response. (R)

A subset of patients with anxiety tend to have high inflammation – such that reversing/lowering this inflammation may help treat the anxiety. (R)

Which mechanisms are most important for anxiety reduction?

It’s unclear which specific mechanisms associated with chamomile (and its bioactive compounds like apigenin) in non-human studies are most important for anxiety reduction in humans.

It’s possible that there’s one or two critical mechanisms that account for a majority of the anxiolytic effect generated by chamomile – but it’s also possible that there are a variety of mechanisms and cascade effects that facilitate anxiety reduction.

Nakazawa et al. (2003) noted that, in mice under stress, apigenin: (1) reduced dopamine in the striatum and hippocampus; (2) reduced serotonin in the hypothalamus; (3) increased dopamine in the thalamus and hypothalamus; and (4) increased norepinephrine in the amygdala, frontal cortex, hypothalamus, and midbrain. (R)

Indirect ways chamomile might help anxiety

There are a variety of indirect ways in which chamomile might help reduce anxiety.

• Sleep enhancement: For some individuals, chamomile significantly enhances sleep quality and/or increases sleep duration. Suboptimal sleep quality and/or inadequate total sleep time can cause anxiety in some cases – such that reversing sleep abnormalities could be a mechanism by which it lowers anxiety.
• Antioxidant effect: A subset of anxiety disorders are associated with abnormally high levels of oxidative/nitrosative stress in the brain. Chamomile may elicit an antioxidant effect whereby reductions in oxidative/nitrosative stress decreases anxiety.
• Brain waves: Alpha brain waves (8-10 Hz) significantly changed after chamomile inhalation. (R) This might account for some of its anxiolytic effect (but could just be a “reaction” to neurochemically-mediated anxiolysis rather than a “cause”).
• Gut microbiome modulation: Evidence suggests that apigenin, a component of chamomile, affects the growth and gene expression of gut bacteria like: E. caccae and B. galacturonicus. It also reduced Firmicutes/Bacteroidetes (F/B) ratios and promotes production of SCFAs (short-chain fatty acids) like butyrate which is associated with health. (R) Because gut composition may affect anxiety – this should be considered another potential mechanism.
• Hormone modulation: Chamomile has been reported to decrease concentrations of various stress hormones (e.g. ACTH & cortisol) via modulation of the HPA axis. It’s possible that chamomile may interact with other (non-stress) hormones to reduce anxiety.
• Antidepressant effect: Some individuals with comorbid depression and anxiety find that a decrease in depression significantly reduces anxiety (and vice-versa). For this reason, it’s possible that an antidepressant effect derived from chamomile helps to lower anxiety. (R)

Chamomile for anxiety (Anecdotes)

Included below are paraphrased/summarized anecdotes from individuals that have tried chamomile for anxiety.

Keep in mind that anecdotes are NOT a reliable way to gauge the anxiolytic efficacy of chamomile.

Anecdote #1: I find it hard to escape my obsessive thoughts and am very stressed. A few days ago I sat down with a cup of chamomile tea and realized how calm it makes me feel. It magically puts a hold on my thinking. I don’t even have to try to relax – it makes me relax.

Anecdote #2: Chamomile doesn’t do anything for my social anxiety but does make me sleepy.

Anecdote #3: Chamomile tea seems to calm me down when I’m feeling anxious and sometimes helps with my mood.

Anecdote #4: I was part of a study at the University of Pennsylvania (testing chamomile for anxiety). I’ve taken chamomile extract every day for the past 5 years because of it. My life is way better and my anxiety is dramatically reduced.

Anecdote #5: I started drinking chamomile tea a few days ago and I feel more relaxed and calm.

Anecdote #6: Just tried chamomile tea for the first time and it really calmed me down – it was incredible. I was alone so not sure how well it would work in a social situation. Slept like a baby and woke up like one too.

Anecdote #7: Chamomile tea improved my quality of life and reduced my anxiety as a substitute for coffee. I was better able to deal with the “anxiety of being a programmer” and being hooked on social media.

Anecdote #8: Chamomile tea combined with L-theanine “drops my anxiety like a bad habit” along with relaxing my muscles and clearing my head.

Anecdote #9: Started drinking chamomile like a month ago and sleep so deeply now that I sometimes wake up lethargic – but super relaxed!

Using Chamomile for anxiety (Recommendations)

Included below are various recommendations that you may want to consider prior to trying chamomile as an anxiolytic.

1. Confirm safety with a medical doctor (MD) & pharmacist

Before trialing chamomile for anxiety, it is recommended to consult a medical doctor and/or pharmacist and verify that chamomile is safe to take based on: current medical conditions; general health status; medication/supplement regimen; etc.

Allergies: Individuals with a ragweed allergy (also in the daisy family) may be allergic to chamomile as a result of immune cross-reactivity.

Interactions: Chamomile has potential to interact with many drugs and supplements – so anyone considering chamomile for anxiety should confirm its safety with a medical doctor and/or pharmacist.

Contraindications: Chamomile ingestion is contraindicated in persons with allergies to ragweed and those who are pregnant/breastfeeding. Chamomile can cause uterine contractions that induce miscarriage and it is unclear as to whether it is safe during breastfeeding.

2. Chamomile extract

I recommend using Chamomile extract as opposed to tea is because the contents are effectively “standardized” such that you know the exact dosage you’re getting within each capsule.

Consuming something like Chamomile tea might result in slightly different effects each time ingested due to: (A) intra-batch/inter-batch variability (same supplier); (B) variability in composition (between suppliers); (C) differences in brew temperature/time.

It’s unknown how much “tea” would be required from any specific vendor to match the potency of a single 500 mg chamomile extract capsule.

Moreover, all of the research evaluating the efficacy of chamomile for the treatment of anxiety utilized chamomile extract – not chamomile tea.

3. German chamomile (Matricaria recutica)

Both of the large-scale clinical trials evaluating the effect of chamomile in the treatment of generalized anxiety disorder (GAD) utilized Matricaria recutita – or “German chamomile.”

This isn’t to imply that Roman chamomile (Anthemis nobilis or Chamaemelum nobile) is somehow ineffective and/or less effective for anxiety – it just hasn’t been subject to extensive testing like German chamomile and thus might differ in effect.

Therefore, it’s tougher to currently recommend Roman chamomile – although Jie et al. believe there are likely multiple mechanisms by which Roman chamomile specifically alleviates anxiety.

4. Dosage of chamomile for anxiety (220 mg to 1500 mg)

Assuming you find chamomile helpful for anxiety, it is generally recommended to utilize the “lowest effective dose” – as this will help decrease likelihood of adverse reactions/side effects relative to using an unnecessarily higher dose.

In the largest study reporting benefit from chamomile extract for anxiety – a dosage of 1500 mg per day, in 3 doses of 500 mg, was administered (e.g. 500 mg in morning; 500 mg in afternoon; 500 mg in evening).

In another study reporting benefit from chamomile extract for anxiety, a dosage of 220 mg administered “as needed” (with a maximum daily dose of 1100 mg) seemed to work well.

Researchers acknowledge that the optimal dose of chamomile for anxiety remains unknown due to the lack of dose range and tolerability studies in humans. (Interestingly one study reported fewer adverse events from higher doses than lower doses.)

The ideal dose may be contingent upon the specific strain (German vs. Roman); format (extract vs. tea vs. apigenin); body size/BMI; genetics (implicated in metabolism); anxiety subtype; and/or whether administered in isolation vs. with other substances.

5. Administration specifics

Frequency: It is recommended to take chamomile either “as needed” or in divided doses throughout the day rather than a large dose at once.

Duration: Chamomile might not provide anxiety relief after the very first dose. Consistent, longer-term administration (over a period of weeks) may be necessary to derive a noticeable anxiolytic effect.

Note: It is recommended to avoid operating heavy machinery/motor vehicles after administering chamomile until you know how you’re affected – as it might increase sedation/drowsiness which lead to an accident.

6. Choose a quality supplement

Not all chamomile supplements necessarily contain what’s listed on the packaging (e.g. dosage, ingredients, etc.).

Additionally, some supplements could contain other herbs that may impact the effect of chamomile extract on anxiety (either via amplification or interference).

That said, in my experience, most brands of chamomile extract are comparable. I’ve tried 3 distinct chamomile extract brands and 1 chamomile tea for comparison – and subjectively, the effects were similar.

Note: You could technically conduct a placebo-controlled self-experiment wherein you have 2 unmarked bottles (one with placebo vs. one with chamomile) – and mark one on the bottom or have a friend give you a specific pill and record it, etc. (Might be somewhat challenging to pull this off considering chamomile has a potent aroma and noticeable coloration – but a drop of chamomile oil on the placebo might be useful vs. a drop of neutral oil on chamomile).

Can Chamomile cause anxiety or worsen preexisting anxiety?

Yes – but this is subject to significant inter-individual variation.  Chamomile may: (1) work great for some in managing anxiety; (2) have no effect for some; and (3) worsen anxiety in others.

In the largest study by Mao et al. – chamomile was found to be ineffective in ~48% of patients with generalized anxiety disorder (GAD).

Therefore, you should NOT automatically assume: because your friend or gym buddy found chamomile helpful for his anxiety – that chamomile will work for your anxiety.

Not everyone has the same: physiological underpinnings associated with anxiety – such that modulation of neurochemistry; the autonomic nervous system (ANS); hormones with Chamomile might actually cause anxiety in persons without preexisting anxiety OR worsen anxiety in those with preexisting anxiety.

Will you build tolerance to Chamomile for anxiety?

Possibly. There’s technically no scientific evidence to substantiate the idea that chamomile can cause physiological tolerance characterized by diminished effect over time.

However, many substances that modulate neurochemistry and physiology in specific ways to generate a therapeutic effect like anxiolysis (anxiety reduction) cause one’s physiology to adjust in specific ways in response to pharmacokinetics and pharmacodynamics.

It’s possible that a person could develop pharmacokinetic tolerance (associated with changes in the metabolism of chamomile compounds) and/or pharmacodynamic tolerance (associated with changes in the brain/CNS) – which might cause the substance to be less effective over time.

Will Chamomile cause withdrawal symptoms?

It’s possible. Chamomile can have withdrawal symptoms following cessation – especially after long-term, high-dose, daily administration. (Read: Chamomile withdrawal)

The severity of chamomile withdrawal will likely be contingent upon a combination of: (1) frequency of use (e.g. daily vs. infrequently); (2) dosage (high vs. low); (3) duration of use (e.g. weeks vs. years); and/or (4) specific chamomile species.

Unless you use chamomile daily for a long-term at a high dose – withdrawals are unlikely to be noticeable, significant, or clinically relevant.

However, if you use chamomile daily or multiple times per day, at a high dose, for a long-term – sudden cessation may cause withdrawal symptoms.

Withdrawal symptoms that might occur following cessation of chamomile include: rebound anxiety; insomnia; sleep disturbances; restlessness; agitation; and irritability.

To reduce the likelihood of chamomile withdrawal – it is generally recommended to gradually taper your dosage down before completely stopping. If you want to be ultra-conservative, taper the dosage by 10% per week if a long-term user (go even slower if necessary).

Withdrawal symptoms can likely be reduced with a combination of: (A) stress reduction (e.g. meditation, relaxation, etc.); (B) physical activity (e.g. aerobic exercise, resistance training, etc.); and/or (C) dietary supplements (e.g. magnesium threonate).

That said, withdrawal from chamomile – assuming it actually happens – should be significantly milder than withdrawal from potent neuropsychiatric medications like benzodiazepines and serotonergic modulators.

My experience with chamomile for anxiety…

In my experience, both chamomile tea (2-3 bags) and chamomile extract (500 mg) work equally as well for anxiety/stress reduction.

On occasion I’ll combine them such as by taking one extract capsule (500 mg) and having chamomile tea thereafter.

• The favorable aspect of chamomile extract is that I know the approximate dosage I’m ingesting and can easily titrate if necessary.
• With tea brewing, dosages likely become less precise due to a combination of factors (e.g. specific batch/product, brewing times/temperatures, etc.) – so it’s more difficult to know the dosage I’m receiving. Nonetheless, I usually have 2-3 tea bags when I have chamomile tea.

I enjoy the experience of consuming chamomile tea far more than popping a chamomile extract capsule – mostly because I can: (A) savor the pleasant aroma and flavors and (B) alter the rate of delivery and subsequent pharmacokinetics (such as by slowly sipping it).

As someone who’s tried nearly every supplement and medication for anxiety – I can safely say that chamomile packs a noticeable punch.

Sometimes the effect feels similar to that of alprazolam (Xanax) or alcohol if I administer a high enough dosage – but the drowsiness and cognitive impairment is less significant than both of the aforementioned substances for me.

When chamomile kicks in, I feel significantly more physically and mentally relaxed relative to pre-chamomile – but also way too spaced out (with “brain fog”) to remain productive.

I have the urge to sit around, watch TV, and zone out. My conversational skills, verbal recall, etc. seem to take a negative hit – but I haven’t experienced any significant side effects other than slightly increased acid reflux (likely due to modulation of esophageal sphincters).

I should mention that I’ve never tried administering chamomile more than once per day – and have never really used it on a daily basis for an extended period.

It’s possible that some of the initial sedation and cognitive deficits would “wear off” following an adaptation period.

Chamomile products I recommend for anxiety…

Included below are chamomile products that I personally have used/tested for anxiety and they seem to work well for me.

(These contain affiliate links – and although I’d appreciate it if you bought through my link because it’s the same price either way, it’s cool if you don’t.)

I cannot guarantee that they’ll work for you OR that they’ll work for all types of anxiety. Moreover, you might find a different product to be more effective than the one’s I find useful.

Chamomile extract (Swanson)

I like chamomile extract because you know exactly what you’re getting in terms of dosing/potency.

This is the brand that I’ve personally used… it’s cheap and I find that it works just as well as any other. Plus it contains German chamomile (1.2% apigenin) – consistent with what the research suggests should help.

Chamomile tea

I actually prefer consuming chamomile tea over taking chamomile extract, but chamomile tea can be problematic if the aim is to provide a standardized dose.

• Specific tea manufacturers, intra-batch variance, inter-batch variance, steeping temperatures, steeping times, etc. will influence tea composition.
• As a result, it’s difficult to verify that the tea you brew today (even with the same brand) will match the tea you brew tomorrow in terms of composition and anxiolytic effect.
• Still, I hypothesize that sticking with: the same chamomile manufacturer, the same amount of tea leaves, and consistent brew times/temperatures – should yield a similar tea composition and anxiolytic effect.

Apigenin (ND)

Some experts believe that a majority of the anxiolytic effect derived from chamomile extract is attributable to its bioactive compound “apigenin.”  This is the highest-quality brand of apigenin.

Note: I’ve personally found chamomile extract to be subjectively more effective for anxiety than apigenin. Apigenin may work well for others though and might have distinct health benefits when used in isolation.

Who would be an ideal candidate to try chamomile for anxiety?

Generalized anxiety (disorder): Research suggests that chamomile is effective for a subset of patients with generalized anxiety disorder – even when used over a long-term (~38 weeks).

Expecting chamomile to help: An analysis by Keefe et al. found that individuals with high expectancy of effect (i.e. expecting chamomile to reduce anxiety) had the most significant anxiety reduction from chamomile relative to those with lower expectancy of effect.

Fearful of pharmaceuticals: Chamomile extract has a side effect profile that is indistinguishable from a placebo – meaning it’s unlikely to cause serious side effects (e.g. sexual dysfunction, cognitive impairment, etc.) that make people fearful of conventional pharmaceutical anxiolytics.

No pregnancy/breastfeeding: Chamomile should not be used by pregnant women or those who are nursing/breastfeeding – as it could have adverse effects on the fetus/baby.

No ragweed allergy: Individuals with ragweed allergy may react adversely to chamomile as a result of immune cross-reactivity (chamomile is in the ragweed family).

No other medications/health conditions: Chamomile may interact with other medications and/or be contraindicated with certain health conditions. Verify with a doctor that chamomile is safe for anxiety before use.

Have you tried chamomile for anxiety?

If you’ve experimented with chamomile for anxiety,

• Did you find chamomile effective for anxiety? (Yes vs. no effect vs. worsening of anxiety)
• If you found chamomile to be effective, what would you rate its efficacy? (Scale of 1-10 with 1 = ineffective & 10 = maximally effective).
• What type of anxiety are/were you dealing with? (Generalized, social, health, etc.)
• Have you been officially diagnosed with an anxiety disorder? (If so, what’s the diagnosis?)
• How long have you been battling anxiety? (Weeks, months, years, etc.)
• Do you use any other substances with chamomile? (If so, how do you know the chamomile is providing benefit?)
• How long have you used chamomile for anxiety? (If long-term, have you noticed any change in its efficacy over time?)
• What format of chamomile do you use? (Tea, extract, etc.)
• Which species of chamomile do you use?
• What dose of chamomile do you administer?