Antidepressant drugs are the most commonly prescribed class of medications in the United States and are used by athletes and non-athletes alike[24]. More than 10% of the American population is taking one or more antidepressant drugs, which represents 27 million individuals taking more than 120 million prescriptions and spending over $80 billion per year. According to a recent survey[25], large numbers of Americans feel an antidepressant drug would be helpful for; dealing with day-to-day stresses (83%); making things easier in relations with family and friends (76%); and helping people feel better about themselves (68%). However, because antidepressant drugs carry the United States Food and Drug Administration’s most stringent “black box” warning (associated with serious life-threatening adverse effects), there is need for safe and effective natural approaches to reducing stress and anxiety.

In addition to a balanced diet, regular physical activity, and various stress management techniques, certain dietary supplements may be effective in naturally maintaining the normal balance between stress, cortisol, and emotional well-being. For example, there are numerous commercial examples of general-purpose “relaxation” and “calming” teas based on traditional herbal blends such as chamomile, fennel, lemon balm and others, while magnolia and phellodendron bark extracts have been specifically demonstrated as natural anxiolytic agents,[7–21, 26]. As such, appropriate dietary supplements may be a safe and effective natural adjunct to diet/exercise/stress management techniques to bring stress response and cortisol levels back to within normal ranges in individuals suffering from chronic stress or in athletes suffering from overtraining syndrome.

Magnolia bark (Magnolia officinalis) and Phellodendron bark (Phellodendron amurense) are traditional herbal medicines used since 100A.D. for treating “stagnation of Qi” in Chinese medicine[7, 8, 17], which is analogous to what we view in Western medicine as reduced psychological vigor or burnout. Magnolia bark extracts are rich in the phenolic compound, honokiol[12], while Phellodendron bark extracts are rich in berberine[14, 15] – each of which contributes to the primary anti-stress, anti-anxiety, and cortisol-lowering effects of the plants[9–19, 26]. Research has shown magnolia and phellodendron extracts and their primary bioactives (honokiol and berberine) to possess powerful “mental acuity” benefits[10, 11, 16] via their actions in modulating the activity of various neurotransmitters and related enzymes in the brain, including brain-derived neurotrophic factor, acetylcholine, choline acetyltransferase, and acetylcholinesterase.

Numerous animal studies have demonstrated that honokiol and berberine act as anxiolytic agents[9–19, 26]. When compared to pharmaceutical agents such as Valium (diazepam), honokiol and berberine appear to be as effective in their anti-anxiety activity yet not nearly as powerful in their sedative ability[9, 12, 13]. These results have been demonstrated in numerous animal studies and suggest that Relora, which is standardized to both honokiol (from magnolia bark) and berberine (from phellodendron), is an effective natural approach for controlling the detrimental effects of everyday stressors, without the tranquilizing side effects of pharmaceutical agents[14–19, 26]. Previous human studies on Relora have shown similar anti-stress and anxiolytic benefits in moderately stressed subjects[20, 21]. The results reported in this study expand on previous findings of simple “relaxation” benefits of Relora to demonstrate specific effects on psychological mood state parameters in moderately-stressed subjects, including benefits for Global Mood State (analogous to an assessment of overall well-being), Tension, Depression, Fatigue, and Vigor (the opposite psychological state from “Burnout”). The magnitude of benefit in stress hormone (cortisol) reduction (18%) and mood state improvement (11%-42%) is meaningful from the perspective of optimal mental and physical performance. For example, the 18% higher Vigor or the 20% lower Depression score observed in the Relora group, could reasonably be associated with subjects reporting “feeling good” (in the case on our moderately-stressed subjects) or “performing well” (in the case of over-stressed or over-trained athletes, which should be the subject of future studies).

Although our study was not conducted in competitive athletes, a number of our moderately stressed healthy subjects were recreational runners and cyclists who commented about feeling more “balanced” in their workouts when their stress levels were balanced. This is a logical individual perception based on a number of studies in elite-level and recreational athletes that have found a direct relationship between overall stress (physical training and psychological stress) and athletic performance, including both mental and physical performance parameters[27–31]. Competitive athletes tend to be characterized by an elevated Vigor score and lower Fatigue score compared to non-athletes[27]. However, in many intervention studies of athletes, a dose–response exists between training stress and mood state[28, 29], so as overall physical “training stress” is elevated beyond a certain tipping point, psychological mood state becomes depressed. In addition, low Vigor scores and overall reduced psychological mood state have been identified as predictors of future athletic injury[30]. The most dramatic changes in psychological mood state are logically the result of intensified periods of training (e.g. increased training intensity and/or duration), which can be modulated positively or negatively by psychological stress (e.g. exams), competitive anxiety, social support network, sleep patterns, and recovery methods[27–31]. Based on the magnitude of the positive changes in cortisol levels and mood state parameters, we would recommend further athlete-specific studies to gauge the possible mental/physical performance benefits of Relora in enhancing post-exercise recovery and preventing over-training syndrome in competitive athletes.

Results from the current study indicate that daily supplementation with a combination of magnolia bark and phellodendron bark (Relora) reduces cortisol exposure and perceived stress, while improving a variety of mood state parameters. Compared to the Placebo group, salivary cortisol exposure was significantly lower (−18%) in the Relora group, while mood state parameters were significantly and meaningfully higher, including an 11% superior Global Mood State and 18% higher Vigor, with 13% lower Tension and 20% lower Depression indices. These results indicate that daily supplementation with a combination of Magnolia and Phellodendron (Relora) is an effective natural approach to the detrimental health effects of chronic stress.