Condition
    Moderate Evidence
    Effectiveness 4/5

    Chamomile for Anxiety

    Chamomile extract at 500-1,500 mg/day produced clinically meaningful reductions in Hamilton Anxiety scores in randomised trials of diagnosed generalised anxiety disorder. It is not sedating at daytime doses and shows no dependence signal, though the total trial base remains small.

    Overview

    Chamomile is usually thought of as a bedtime tea, but the clinical evidence rests on something much more concentrated: standardised Matricaria recutita extract at 220-1500 mg per day, roughly equivalent to many cups of tea. The 2009 Journal of Clinical Psychopharmacology randomised double-blind placebo-controlled trial in generalized anxiety disorder found a significant reduction in Hamilton Anxiety scores against placebo, and the 2016 Phytomedicine long-term trial confirmed the effect persisted over extended treatment with good tolerability. The 2019 Phytotherapy Research meta-analysis pooled randomised and quasi-randomised trials across state anxiety, generalized anxiety disorder, insomnia and sleep quality, supporting benefit for anxiety symptoms while noting the small evidence base. Expect a modest, gradual reduction in anxiety over two to eight weeks — worth trying for mild to moderate symptoms, not a substitute for treatment of severe anxiety.

    Verdict

    Likely effective

    A meta-analysis and two randomised placebo-controlled trials show standardised chamomile extract reduces anxiety scores in generalized anxiety disorder at 220-1500 mg/day over 2-8 weeks.

    How It Works

    Apigenin is the compound doing most of the work. It is a flavonoid that binds benzodiazepine binding sites on the GABA-A receptor as a partial agonist — enough to reduce neuronal excitability and produce anxiolysis, but with far weaker receptor activity than a benzodiazepine, which explains both the milder effect and the absence of dependence, tolerance and withdrawal. Secondary routes probably contribute. Chamomile constituents modulate serotonin and noradrenaline signalling in preclinical models, consistent with the mood improvements reported alongside anxiety reductions in trials. There is also evidence of HPA axis effects, with reduced morning cortisol in some studies, which fits the observed improvement in the physical side of anxiety — tension, restlessness and poor sleep. The practical implication is that apigenin content matters more than the plant. Standardised extracts specify apigenin concentration; tea delivers a small and highly variable amount, which is why the trials that found effects used extract capsules rather than infusions.

    Pathways involved

    Apigenin partial agonism at GABA-A benzodiazepine sites
    Reduced neuronal excitability
    Serotonin and noradrenaline modulation
    HPA axis and cortisol
    Sleep quality
    No dependence or withdrawal profile

    Dosing & Protocol

    The generalized anxiety disorder trials used standardised Matricaria recutita extract at 220-1500 mg per day, most commonly 500 mg three times daily, standardised to around 1.2% apigenin. The long-term trial titrated up over the first weeks and maintained higher doses over extended treatment without loss of tolerability. Start at 220-500 mg once daily and increase over one to two weeks. Daytime drowsiness is the commonest reason to slow down, and it usually settles or resolves by shifting more of the dose to the evening. Take it with food to limit nausea. If the primary complaint is sleep rather than daytime anxiety, a single evening dose is a reasonable simplification. Tea is not equivalent. One to three cups daily is pleasant, safe and may help wind-down behaviourally, but the apigenin dose is a small fraction of what the trials delivered and the content varies widely between products. Expect an early signal within two weeks and judge properly at eight.
    ScenarioDoseFormTiming
    Trial standard500 mg three times daily (1500 mg/day)Standardised extract, ~1.2% apigeninWith food
    Starting dose220-500 mg once dailyStandardised extractWith food, week 1
    Sleep-focused use400-500 mg once dailyStandardised extract1 hour before bed
    Long-term trial range220-1500 mg/dayStandardised extractTitrated upwards over weeks
    Tea1-3 cups dailyInfusionFar below trial apigenin doses
    Assessment2 weeks for early signal, 8 weeks to judge-Effects build gradually
    1. 1

      Check for an allergy risk· Before starting

      Chamomile is an Asteraceae plant. Known allergy to ragweed, chrysanthemums, marigolds or daisies means a real risk of cross-reaction, including anaphylaxis in rare cases.

    2. 2

      Match the tool to the severity· Before starting

      Mild to moderate anxiety is where the evidence sits. Panic attacks, disabling anxiety or any self-harm thoughts need clinical care.

    3. 3

      Start 220-500 mg once daily with food· Week 1

      Standardised extract specifying apigenin content, not a tea or an unstandardised powder.

    4. 4

      Titrate towards 500 mg three times daily· Weeks 2-8

      Increase gradually over one to two weeks; ease back if daytime drowsiness interferes.

    5. 5

      Score anxiety weekly· Weekly

      A repeatable measure such as the GAD-7 gives you something reliable to judge a modest effect against.

    6. 6

      Review at 8 weeks· Week 8

      Meaningful improvement justifies continuing; the long-term trial supports extended use. No change means stop.

    Evidence

    The 2009 Journal of Clinical Psychopharmacology randomised double-blind placebo-controlled trial of oral Matricaria recutita extract in generalized anxiety disorder is the foundation: over eight weeks, participants on standardised extract showed a significantly greater reduction in Hamilton Anxiety scores than placebo, with adverse events comparable between groups. It is small, but it is a properly diagnosed clinical population with a validated primary outcome. The 2016 Phytomedicine long-term randomised clinical trial addressed the obvious follow-up question of durability, finding that extended chamomile treatment in generalized anxiety disorder maintained symptom reductions with continued good tolerability — a substantive point, since few botanical anxiolytics have any long-term data at all. The 2019 Phytotherapy Research systematic review and meta-analysis pooled randomised and quasi-randomised trials across state anxiety, generalized anxiety disorder, insomnia and sleep quality. It supported efficacy for anxiety while flagging the real weaknesses: few trials, small samples, heterogeneous preparations and doses, and a concentration of the strongest evidence in a small number of research groups. The direction of effect is consistent; the evidence base is thin.
    Best available evidence
    One meta-analysis plus two randomised placebo-controlled trials
    Typical effect
    Modest reduction in anxiety scale scores; improved sleep quality
    Studied dose
    220-1500 mg/day standardised extract, ~1.2% apigenin
    Time to effect
    2-8 weeks
    Population studied
    Adults with diagnosed generalized anxiety disorder
    Certainty of evidence
    Moderate; few and small trials, heterogeneous preparations

    A meta-analysis of chamomile for anxiety, generalized anxiety disorder and sleep, a long-term randomised clinical trial in generalized anxiety disorder, and the original randomised placebo-controlled trial of oral chamomile extract.

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

    Score: 7/10
    2016
    rct
    n=93

    Mao JJ, Xie SX, Keefe JR +3 more

    Long-term chamomile treatment was well tolerated and reduced anxiety symptoms, but did not significantly prevent relapse of generalized anxiety disorder compared with placebo.

    View source

    Therapeutic efficacy and safety of chamomile for state anxiety, generalized anxiety disorder, insomnia, and sleep quality: A systematic review and meta-analysis of randomized trials and quasi-randomized trials

    Score: 7/10
    2019
    meta_analysis
    n=1550

    Hieu TH, Dibas M, Surya Dila KA +1 more

    Chamomile significantly improved generalized anxiety disorder symptoms and sleep quality versus control, while effects on state anxiety and insomnia severity were not statistically significant.

    View source

    A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder

    Score: 6/10
    2009
    rct
    n=57

    Amsterdam JD, Li Y, Soeller I +3 more

    Chamomile extract produced a significantly greater reduction in Hamilton Anxiety Rating Scale scores than placebo in patients with mild to moderate generalized anxiety disorder.

    View source

    Safety

    Chamomile is among the better-tolerated botanical anxiolytics, with trial adverse event rates close to placebo. Mild drowsiness, nausea and occasional dizziness are the usual reports, and drowsiness typically settles or responds to weighting the dose towards the evening. Allergy is the exception that matters. Chamomile belongs to the Asteraceae family alongside ragweed, chrysanthemums, marigolds and daisies, and cross-reactivity is well documented — including rare cases of anaphylaxis, most often associated with Roman rather than German chamomile. Anyone with a known Asteraceae allergy should avoid it, and everyone else should stop immediately for rash, facial swelling, wheeze or throat tightness. Anticoagulation deserves specific caution: chamomile contains coumarin derivatives and case reports describe raised INR when combined with warfarin. Avoid in pregnancy, where uterine-stimulating effects have been suggested, and be cautious while breastfeeding. Because it acts on GABA-A benzodiazepine sites, sedation is additive with alcohol, benzodiazepines and Z-drugs. Stop two weeks before surgery.

    Tea is not the trial dose

    The randomised trials used 220-1500 mg per day of standardised extract, equivalent to far more apigenin than a few cups of tea provide. Chamomile tea is safe and pleasant, but do not expect it to reproduce the trial results.

    Interactions & Conflicts

    Interacts withSeverityMechanismAction
    Asteraceae allergy (ragweed, chrysanthemum, marigold, daisy)
    high
    		Cross-reactivity; rare anaphylaxisAvoid entirely
    Warfarin and anticoagulants
    high
    		Coumarin derivatives; case reports of raised INRAvoid or monitor INR closely
    Benzodiazepines, Z-drugs and sedatives
    moderate
    		Additive GABA-A activityAvoid combining without prescriber advice
    Alcohol
    moderate
    		Additive sedationLimit intake
    Ciclosporin and CYP3A4 substrates
    moderate
    		Possible inhibition of hepatic metabolismDiscuss with your pharmacist
    Pregnancy
    high
    		Possible uterine-stimulating effectsAvoid
    Breastfeeding
    moderate
    		Limited safety dataDiscuss with your clinician
    Surgery
    moderate
    		Additive sedation and bleeding riskStop 2 weeks beforehand

    References

    1. Hieu TH et al. Therapeutic efficacy and safety of chamomile for state anxiety, generalized anxiety disorder, insomnia, and sleep quality: a systematic review and meta-analysis. Phytother Res. 2019
    2. Mao JJ et al. Long-term chamomile (Matricaria chamomilla L.) treatment for generalized anxiety disorder: a randomized clinical trial. Phytomedicine. 2016
    3. Amsterdam JD et al. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. J Clin Psychopharmacol. 2009

    Frequently Asked Questions

    Medical Disclaimer

    The information provided on this website is for educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or before starting any supplement regimen.

    Individual results may vary. The statements on this website have not been evaluated by the Food and Drug Administration. Products and information are not intended to diagnose, treat, cure, or prevent any disease.