Evidence-Based Herbal Support for Anxiety and Insomnia
Chronic stress and anxiety are increasingly common in today’s fast-paced, 24-hour society. One in four Australians will experience an anxiety disorder at some point in their lives, which is often accompanied by sleep disturbance.1 Medications and talk therapy are the main recommended treatments for diagnosed anxiety disorders;1 however herbal medicines including Chamomilla recutita (Chamomile), Passiflora incarnata (Passion Flower), Melissa officinalis (Lemon Balm) and Ziziphus jujuba var. spinosa (Ziziphus) may offer an effective alternative or adjunct treatment for anxiety and sleep disturbances.
Chamomile
The effect of oral chamomile on anxiety: a systematic review of clinical trials2
Design: Systematic Review
Number of studies: Ten randomised controlled trials
Population: Total of 844 participants, aged 19 to 69 years, with generalised anxiety disorder, primary insomnia, or anxiety symptoms.
Key findings: Chamomile supplementation significantly reduced symptoms of anxiety in nine out of ten studies. Benefits were seen in a range of populations, including patients diagnosed with generalised anxiety disorder, women with premenstrual anxiety, postmenopausal women with anxiety symptoms, people suffering from insomnia and anxiety, and patients in the recovery phase of their psychological disorder. No adverse effects were reported.
Effects of chamomile (Matricaria chamomilla L.) on sleep: A systematic review and meta-analysis of clinical trials3
Design: Systematic review and meta analysis
Number of studies: Ten randomised controlled trials
Population: Total of 772 participants, aged 17 to >70 years, with primary insomnia, sleep disturbance, or healthy populations
Key findings: Meta analysis of selected studies found that Chamomile supplementation significantly improved Pittsburgh Sleep Quality Index (PSQI) scores by 1.88 points (p<0.001). Sleep onset latency and number of wakes also improved. No adverse effects were reported.
Passion Flower
Passiflora incarnata as an adjunctive treatment for anxiety and sleep disorders4
Design: Systematic review
Number of studies: Total of 23 studies, including thirteen clinical trials, six preclinical trials and four observational studies
Population: Individuals with diagnosed anxiety disorders, depression, sleep disturbances, and healthy volunteers.
Key findings: Seven clinical trials reported a significant reduction in anxiety scores with Passion Flower supplementation. One trial reported that Passion Flower was equally as effective as benzodiazepines in patients with generalised anxiety disorder, while another reported significant anxiolytic effects in patients undergoing benzodiazepine withdrawal. Five studies reported improvements in depression scores, and six studies reported improved sleep quality. No serious adverse effects were reported.
Lemon Balm
The effects of lemon balm (Melissa officinalis L.) on depression and anxiety in clinical trials: A systematic review and meta-analysis5
Design: Systematic review and meta analysis
Number of studies: Ten randomised controlled trials
Population: Total of 632 participants, with acute or chronic symptoms of anxiety or depression
Key findings: Five studies demonstrated a significant reduction in anxiety scores with Lemon Balm supplementation (p=0.003). Three studies reported a significant reduction in depression scores (p=0.0005), with one study finding that Lemon Balm was equally as effective as the antidepressant fluoxetine.
Ziziphus
The herbal medicine Suanzaoren (Ziziphi Spinosae Semen) for sleep quality improvements: a systematic review and meta-analysis6
Design: Systematic review
Number of studies: Nine randomised controlled trials
Population: A total of 905 participants with primary insomnia or sleep disturbance
Key findings: Ziziphus supplementation led to significant improvements in subjective sleep quality when compared to placebo (p<0.01). It also led to a significant reduction in insomnia severity when compared to benzodiazepines or cognitive behaviour therapy at four weeks (p<0.03).
Evidence-Based Support
A substantial amount of human clinical evidence supports the use of Chamomile, Passion Flower, Lemon Balm and Ziziphus for anxiety and insomnia.
References
1 Beyond Blue. Anxiety [Internet]. 2024 [cited 2025 Apr 10]. Available from: https://www.beyondblue.org.au/get-support/anxiety
2 Saadatmand S, Zohroudi F, Tangestani H. The effect of oral chamomile on anxiety: a systematic review of clinical trials. Clin Nutr Res. 2024;13(2):139. DOI:10.7762/cnr.2024.13.2.139
3 Kazemi A, Shojaei-Zarghani S, Eskandarzadeh P, Hashempur MH. Effects of chamomile (Matricaria chamomilla L.) on sleep: A systematic review and meta-analysis of clinical trials. Complementary Therapies in Medicine. 2024 Sep;84:103071. DOI:10.1016/j.ctim.2024.103071
4 Kaźmierczyk I, Bychowski M, Kwaśna J, Załęska A, Lenart K, Górski M, et al. Passiflora incarnata as an Adjunctive Treatment for Anxiety and Sleep Disorders. Qual Sport. 2024 Dec 16;35:56361. DOI:10.12775/QS.2024.35.56361
5 Ghazizadeh J, Sadigh‐Eteghad S, Marx W, Fakhari A, Hamedeyazdan S, Torbati M, et al. The effects of lemon balm (Melissa officinalis L.) on depression and anxiety in clinical trials: A systematic review and meta‐analysis. Phytotherapy Research. 2021 Dec;35(12):6690-705. DOI:10.1002/ptr.7252
6 Yang M, Wang H, Zhang YL, Zhang F, Li X, Kim S, et al. The Herbal Medicine Suanzaoren (Ziziphi Spinosae Semen) for Sleep Quality Improvements: A Systematic Review and Meta-analysis. Integr Cancer Ther. 2023 Jan;22:1-11. DOI:10.1177/15347354231162080