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The Dangers (and Benefits) of Yohimbe Niacinamide as Treatment for Anxiety

Men and women often look for natural ways to control anxiety. That's because the idea of taking some type of prescription medication can be frightening - these are chemicals that affect your brain, and as such, there is a component to them that many people want to avoid.

But natural supplements are often either ineffective or have side effects of their own. This article we explore one such supplement - Yohimbe Niacinamide - and see whether or not it is a useful tool for controlling anxiety symptoms.

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Introduction to Yohimbe Niacinamide

All-natural and made from relatively user-friendly components, Yohimbe Niacinamide at first glance appears to have potential as an alternative anti-anxiety medication. However, a closer examination of its component ingredients reveals some potential problems for anxiety sufferers who choose to use it.

A primarily plant-derived medication, Yohimbe Niacinamide is made from a combination of yohimbine, an extract from the bark of the African Yohimbe tree ( Pausinystalia yohimbe), and niacinamide, the water-soluble form of niacin, a vitamin more commonly known as Vitamin B3.

Yohimbine: Mild Anxiety Inhibitor, Stronger Stimulant

On the one hand, a high dosage of yohimbine (a mild MAOI or Monoamine Oxidase Inhibitor) blocks specific adrenaline receptors in the body, which has the effect of minor corpus cavernosum smooth muscle relaxation. This slight body relaxation effect represents a potential benefit: however, there is more to consider.

High doses of yohimbine have been linked to lowering blood pressure to a dangerous degree. Furthermore, the margin for error when it comes to yohimbine dosage is very slim-- too much (100+ mg), and your heart slows to a potentially dangerous rate; too little, and it has precisely the opposite effect someone suffering from an anxiety attack would want: namely, stimulation rather than relaxation.

The Dangers of Yohimbe Stimulation

In Africa, Yohimbe bark is traditionally used as a stimulant specifically, a sexual stimulant. It is used most widely within the U.S. and other countries for this purpose at doses of about 15-30 mg, due to its propensity to raise the blood pressure at this dosage.

For the same reason, it has been used in the treatment of PTSD (Post-Traumatic Stress Disorder) to trigger the resurfacing of traumatic memories. It is advised that persons with PTSD not use Yohimbe outside a therapeutic setting. Furthermore, it is as an inadvisable supplement for anyone who knows or suspects that they have a psychological disorder.

Yohimbe bark is on the FDA list of dangerous supplements due to the risks connected to its use as a stimulant, including panic disorder type reactions: rapid heart rate, hallucinations, heart attack, and in rare cases even death.

To summarize:

Positive Effects

  • Muscle relaxation at (supervised) higher doses

Negative Effects (high risk)

  • High doses (100 mg+) can lead to dangerously low blood pressure
  • Low doses promote high blood pressure and can cause panic attacks

The bottom line regarding the Yohimbe aspect of Yohimbe Niacinamide is that professional guidance and supervision are preferable when using it, which makes it less than ideal as a treatment for a person suffering from anxiety in their daily life.

Niacinamide: Better then Benzodiazepines?

In contrast, niacinamide or Vitamin B3 is widely regarded as an effective anxiety inhibitor. User reports indicate that B3 supplements are equally and possibly more effective than benzodiazepines, which are standard anti-anxiety meds. While there is little research supporting this theory, those that use natural supplements tend to support the results.

Unlike B3, benzodiazepines have addictive properties that result in dependence if used for over four consecutive weeks (after which point they can exacerbate the anxiety problems they are intended to treat), or if inappropriately high doses are taken.

B3 rarely causes side effects and is considered safe to use as a medication, in food, and even in cosmetic products according to the "Final report of the safety assessment of niacinamide and niacin" by the Cosmetic Ingredient Review Expert Panel (2005).

Scientific evidence on the effectiveness of Niacin on anxiety is lacking, however. There have been few controlled studies that have compared Niacin to benzodiazepines, and it is possible that the effects of Niacin are simply placebo. Nevertheless, there is a small portion of the natural medicine community that reports strong effects of niacin on anxiety, making it possible that the scientific community has simply not researched this vitamin thoroughly yet.

Positive Effects vs. Possible Complications

Niacinamide is believed to lower blood pressure. For this reason, using it with other medications that can lower blood pressure (including yohimbine at higher doses) is inadvisable. This indicates that Yohimbe Niacinamide is probably a drug to avoid.

Used alone, however, niacinamide is considered to improve central nervous system impairments, and its ability to trigger the body's benzodiazepine receptors results in a calmative effect.

Possible side effects associated with niacinamide supplements include dizziness, skin flushing, and stomach upset. Taking the supplement with food is advisable as a preventative measure. Additionally, niacinamide results in increased histamine production, which can make allergies worse.

While the chemistry of niacinamide is said to prevent the facial flushing caused by pure Niacin, a flushing effect (facial redness, itching) has been reported by some users with anxiety who find that this temporary side effect makes them more anxious. Preventative measures for facial flushing include taking a single plain (not enteric coated) NSAID such as aspirin or ibuprofen 30 minutes before taking niacinamide. Talk to your doctor before taking any medication or herb.

In summary:

Potential Positive Effects

  • Lowers blood pressure
  • Improves nervous system functionality
  • Calmative

Potential Negative Effects (preventable)

  • Should not be taken with medication that can also lower blood pressure (Yohimbine)
  • Users who experience facial flushing should take aspirin/ibuprofen 30 minutes beforehand as a preventative measure
  • Take with food to help prevent other possible side effects (dizziness, stomach upset)
  • Can increase allergies due to causing an increase in the body's histamine production

Because of the potential for side effects and interactions with medications, the supervision of a knowledgeable health care provider is important when deciding if you should take dietary supplements.

The medications listed below should NOT be taken in combination with Yohimbe Niacinamide, or either Niacinamide or Yohimbine.

Do Not Combine With:

  • MAOIs (Monoamine Oxidase Inhibitors): If you are undergoing MAOI therapy, you should wait at least 14 days before taking Yohimbe Niacinamide (or either component).
  • NRIs (Norepinephrine Reuptake Inhibitors): Avoid taking NRIs such as dextromethorphan, tramadol, antidepressants than contain NRIs or central nervous system stimulants for treatment of ADHD simultaneously with Yohimbine Niacinamide to prevent hypertensive crisis.

Do Not Take If You Have:

  • Liver problems
  • Kidney problems
  • Stomach ulcers
  • Diabetes or gallbladder disease (permissible only under medical supervision)

Summary of Findings

Yohimbe Niacinamide combines yohimbine, an unwieldy substance with a known possible side effect of panic attacks, with niacinamide, a more stable substance whose side effects are less severe and more preventable. For anxiety sufferers, Yohimbine Niacinamide is probably not worth the risk. However, niacinamide or B3 is a potentially safer (and more effective) alternative.

Still, all herbal and natural supplements - especially Yohimbe Niacinamide - have little research supporting them. There is a strong chance that any effects that you experience from either ingredient are the result of the placebo effect.

That's why it's important that you always partner any natural supplement with a behavioral/cognitive treatment as well. It's the only way to make sure that you are doing everything you can to make sure that your anxiety goes away. Make sure that you also never take any herbal supplement before first discussing it with your doctor.

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De Smet, P. A., and O. S. Smeets. Potential risks of health food products containing yohimbe extracts. BMJ: British Medical Journal 309.6959 (1994): 958.

Prousky, Jonathan E. Niacinamide's potent role in alleviating anxiety with its benzodiazepine-like properties: a case report . J Orthomol Med 19.2 (2004): 104-110.

Author: Micah Abraham, BSc Psychology, last updated Jan 03, 2018.

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