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Are Hops Effective for Treating Anxiety?
An Herbals Poster By: Tyler Jewkes, Paige Spriggs and Derek Young
Background:
“Hops” is a term used for portions of a vine called Humulus lupulus. Other names include “vigne du Nord ” or simply “common hops”. Historically, hops has been used as a main ingredient for beer brewing, as well as a treatment for things like poor digestion, GI upset, leprosy, and even tuberculosis. More recently, studies have been performed to associate the effectiveness of hops to treat anxiety and stress. We aim, through this poster, to provide insight into the results of these studies and bring to light the potential use of hops for these conditions.
Mechanism of Action:
The currently proposed mechanism of action on anxiety for this product is agonism/antagonism of GABA-a receptors in the CNS, which causes a benzodiazepine-like sedation, thereby relieving anxiety symptoms.
Side Effects:
The common side effects for this product are dizziness and sedation, but there have been some reports of post menopausal bleeding.
Interactions:
No major drug interactions have been found with hops, however due to the mechanism of action, care should be taken when using in combination with alcohol or other CNS depressants.
Clinical evidence:
A randomized, placebo-controlled, double-blind, crossover study conducted by Kyrou et al. recruited young adults that were enrolled as graduate or undergraduate students at a specific university in Greece. Each participant completed the Depression Anxiety Stress Scale (DASS-21) to determine if they had any of those three mental illnesses – none of the participants had ever formally been diagnosed. Once that was determined, students spent either four weeks in the treatment group (two 0.2g capsules a day of a hops extract) or in the placebo group; they then had a two week washout followed by a four week period of the opposite intervention. After each intervention, participants again took the DASS-21 survey. The results showed a significant decrease in the DASS-21 scores for both the hops and placebo interventions – specifically for anxiety, the decrease in the hops groups was 9.2+/-7.3 while the placebo was only 8.3+/-7.1. While both groups showed a decrease in anxiety, the effect in the hops group was significantly greater. This led the authors to conclude that in otherwise young, healthy adults, daily supplementation of hops for a short amount of time can help decrease symptoms of anxiety as well as depression and stress.
Franco et al. conducted a longitudinal study that used participants as their own control. Participants included 17 female nurses that worked rotating and/or night shifts in high stress areas of the hospital. Treatment was 330mL of non-alcoholic beer that contained hops with dinner vs. not drinking hops with dinner. Interventions lasted for 14 days then were compared to a 14 day treatment with the other intervention. Results were determined to be an increase in overall quality of sleep (specifically noting an improvement in sleep latency, sleep efficiency and activity during sleep). Authors also measured state and trait anxiety before and after treatment through the State-Trait Anxiety Intervention (STAI). They found that state anxiety (anxiety at that specific time) also decreased to 18.09+/-3.8 compared to placebo 20.69+/-2.14. Authors concluded that by consuming a moderate amount of nonalcoholic beer, the hops content (through its sedative properties) helped to improve quality of sleep and through that also helped improve state anxiety.
Conclusion:
Hops is a generally well tolerated supplement that has been demonstrated to have minimal amounts of side effects and interactions while showing a potential for anxiolytic activity. The most common side effects are dizziness, sedation and menstrual disturbances while showing no real major drug interactions. Research has shown that hops have the potential to be effective in treating anxiety as well as depression and stress and it can improve quality of sleep in an otherwise healthy population. Because of this, hops is a supplement that could be considered in treating certain disease states such as anxiety.
References
- Kyrou, I., Christou, A., Panagiotakos, D. et al. Effects of a hops (Humulus lupulus L.) dry extract supplement on self-reported depression, anxiety and stress levels in apparently healthy young adults: a randomized, placebo-controlled, double-blind, crossover pilot study. Hormones 16, 171–180 (2017). https://doi.org/10.14310/horm.2002.1738
- Franco, Lourdes, et al. “The Sedative Effect of Non-Alcoholic Beer in Healthy Female Nurses.” PLoS ONE, vol. 7, no. 7, 2012, doi:10.1371/journal.pone.0037290.
- Western New York Urology Associates; accessed on 29 July 2021 (https://www.wnyurology.com/content.aspx?chunkiid=21755)
- Natural Medicines. (2021, July 21). Hops [monograph]. https://naturalmedicines.therapeuticresearch.com/databases/food,-herbs-supplements/professional.aspx?productid=856
- Ceremuga TE, Johnson LA, Adams-Henderson JM, Mccall S, Johnson D. Investigation of the Anxiolytic Effects of Xanthohumol, a Component of Humulus lupulus (Hops), in the Male Sprague-Dawley Rat.
Responses
Hello Derek, Paige, and Tyler – what are the two main things you learned from preparing and developing this topic?
Hello, something I learned is that hops can increase levels of GABA and interact with serotonin and melatonin receptor subtypes. These interactions could definitely help to explain the effects it has on anxiety as well as depression and stress and help increase the quality of sleep. I also learned that even though it has these qualities, the adverse events and interactions are relatively minimal, which is quite fascinating to me.
The two main things I learned from completing this project were as follows: one, that presenting this much information in a poster format is not my preferred way of displaying scientific information. And two, that working with my classmates on such an interesting topic, such as hops treatment of anxiety, was very enjoyable and that our leadership traits such as “execute”, “examine”, and “excite”, were utilized in the best ways possible. We coordinated well together and delegated the portions of work in advance so that we had ample time to prepare and put the poster together. It was great being a member of this team!
Nice poster! In the first study – did the authors address response and remission scores? In the second study were statistics used to determine significance? Would you recommend this product to patients?
Regarding the first question, the authors tested not only the DASS-21 score but also went further into testing morning cortisol levels to determine if there was a true response to hops regarding depression stress, and anxiety. While there was a decrease in participants’ DASS-21 score, there were no significant changes in cortisol levels. This could further indicate a possible placebo effect that is present in the study. They did not further explain any remission scores.
In the second study, statistics authors used included the Kolmogorov-Smirnov test. This looked at the distribution of the results. After this was completed, t-tests were also run. The p-value they set was p<0.05.
Given the results from these studies, and since there are minimal side effects and interactions with hops, taking hops for a limited amount of time should be safe and may have the potential to help anxiety. However, most individuals in these studies had never formally been diagnosed with anxiety or any other form of mental illness. These are serious issues and hops should not be a long-term solution to these, individuals should contact their personal care provider and discuss this for further treatment recommendations.
Interesting topic. Your summary of the evidence was well-written. It was stated that there was a significant difference between the groups. Did the studies report a p-value? It appears based on the standard deviations presented that the difference is generally small. Can you comment on this? Also, if statistically significant, was the difference clinically relevant?
Hello Dr. Malone, both studies did report a p-value of p<0.05. I would agree that the difference is small, and in my opinion, I would be hesitant to say that this is clinically significant. All individuals involved had self-reported anxiety and had not been clinically diagnosed. I would recommend that patients who feel as though they may be suffering from anxiety visit their PCP and discuss what treatment option would be best for their situation.
Great information! What kinds of potential confounding bias did your studies address other than the lack of generalizability?
Hello James, I would say that both studies included patients that had self-reported anxiety. These individuals could be seeking out treatment to reduce their feelings of stress and anxiety which could create a form of unconscious or implicit bias that could influence the results away from the null hypothesis.
This is such an interesting topic, makes me wonder if I started drinking it might help my anxiety. In all seriousness though I find alternative treatments for anxiety super fascinating, did the authors mention if they were examining specific types of anxiety-related disorders, anxiety symptoms, or singularly generalized anxiety disorder?
Hello Michael, in the study conducted by Franco et al., the authors did look at two types of anxiety: state and trait anxiety. They found a decrease in state anxiety which is the anxiety that individuals were feeling at the specific instance. However, they did not find a decrease in trait anxiety which is a relative propensity to anxiety. In the study conducted by Kyrou et al. they did not specify the type of anxiety or its symptoms. I think it is important to note that the individuals included in both studies had never been diagnosed with any type of anxiety, so the effects that hops has on anxiety is solely self-reported.
That’s a fantastic question there Michael. The study by Kyrou et al. included patients who scored at least a “mild” category of depression, anxiety, and stress via the DASS-21 survey. It did mention that those with clinically diagnosed anxiety, depression, or other psychiatric disorders were excluded from the pool.
Michael, it appears that the amount of hops that you get from a single beer is so small compared to the amount of alcohol, that it would be impossible to see any anxiolytic effect from the hops alone when consuming beer. You would have to consume far too many beers and would suffer from alcohol poisoning long before you saw the anxiolytic effects from hops alone, but I had similar thoughts.
I’m super surprised more people don’t use this over St. John’s Wort. In your searching did you happen across any studies comparing the two?
Hi Laura, that is a FANTASTIC question! In the study conducted by Kyrou et al., they do mention that the use of herbals is increasing due to people’s desire to take a more holistic approach to medicine and their dislike of conventional medicines. Studies for hops in the past have typically been in combination with valerian and authors wanted to determine what effect hops had on its own. I think most people associate hops with beer and thus do not consider using it as a supplement for their anxiety. St. John’s Wort is pretty well known and I think that is easier for the consumer to obtain. This could be a great oppertunity for pharmacists to step in and educate patients purchasing SJW that that supplement has some major adverse events and interactions associated with it and hops may potentially be a safer alternative.
Dr. Shane-McWhorter,
I think that two of the major and or most interesting things that I learned from this poster are that hops potentially interact with GABA-a receptors and that hops can be taken orally as a supplement drug in general. Whenever I think of hops, the first thing that I think of is beer. It was really interesting to me that hops are used as an oral supplement, and not just a flavor ingredient in beer production. There are a large number of people that take it, and there has been serious studies to try and identify its utility in anxiety and depression treatment which is extremely interesting to me. I also was fascinated to learn that its potential mechanism of action is by acting on GABA-a receptors. This is so interesting to me, because these are the same receptors that benzodiazepines and alcohol target. If this is its main mechanism of action, it would make a lot of sense as to why we see sedative and anxiolytic effects. I hope there are more studies looking into hops and I enjoyed learning about it as a potential treatment.
This is an interesting topic. Did you see any studies that compared hops to prescription anxiety treatments?
In my research, there were no comparisons to prescription medication. I think most studies only included populations that were self-diagnosed and thus had never been prescribed anything for their anxiety.
Hello Derek, Paige, and Tyler!
In the first study you included, there was data to suggest hops lowered symptoms of depression, anxiety, and stress. Did your group happen to find any studies for the use of hops in patients being treated solely for depression?
Hello Ryley, from the studies that I found, it would seem that all of these disorders were included and hops was never studied for a singular illness.
Hi Derek, Paige and Tyler
Nice work on your poster! I learned much about hops!! I grow them in my garden and love the vines and flowers. I was not aware of the many side effects of hops exposure…I guess if you work in a factory and handle them on a continuous basis. Poster was well balanced and full of great information!! Thank you for sharing your expertise!
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