Medicinal Plants in the Management of Anxiety Disorders: Clinical Evidence, Mechanisms, and Safety Considerations.

Anxiety disorders are among the most prevalent neuropsychiatric conditions worldwide and represent a major public health burden. Although conventional pharmacological treatments are effective, their long-term use is often limited by adverse effects, including sedation, dependence, and cognitive impairment, prompting growing interest in medicinal plants as alternative or adjunct therapies. This review summarizes current evidence on selected medicinal plants, including Bacopa monnieri, Crocus sativus, Withania somnifera, and Piper methysticum, with emphasis on their pharmacological mechanisms, therapeutic efficacy, and safety profiles in anxiety management. Preclinical and clinical studies suggest that these plants exert anxiolytic effects through modulation of neurotransmitter systems, particularly γ-Aminobutyric Acid (GABA), serotonin, and dopamine pathways, as well as regulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. In addition, antioxidant and anti-inflammatory properties may contribute to neuroprotection and improved stress resilience. Clinical findings indicate that certain herbal preparations may offer benefits comparable to conventional therapies for mild to moderate anxiety, often with fewer adverse effects. However, variability in study design, lack of standardized formulations, and insufficient long-term safety data remain significant limitations. Therefore, well-designed randomized controlled trials and mechanistic investigations are required to establish efficacy, safety, and standardization. Overall, medicinal plants show promising potential as complementary or alternative therapeutic options for anxiety disorders, provided their use is supported by rigorous scientific validation.