ANXIETY AND DEPRESSION
- Generalized anxiety: a chronic sense of unease and fear
- Phobias: fear of certain situations, such as social situations or enclosed spaces
- Panic disorders: acute episodes of high levels of panic, difficulty breathing, and heart racing
- Obsessive-compulsive disorder (OCD): rumination on certain fearful thoughts and compulsive behaviors to relieve anxiety sensations
- Post-traumatic stress disorder (PTSD): high levels of anxiety, hypervigilance, nightmares, and flashbacks related to trauma
MEDICATION AND ANXIETY DISORDERS
Pharmaceutical companies have been at the forefront of developing medications for anxiety, such as the benzodiazepines-clonazepam, alprazolam, and lorazepam. Initially, these medications can have a powerful calming effect by increasing the neurotransmitter gamma-aminobutyric acid (GABA) in the brain. But the medications can come at a cost.
There is ample evidence that the benzodiazepines can cause fatigue and cognitive difficulties. And in short order, the brain adapts to the medications' effects by lowering GABA receptor availability.
When the medication is stopped or the dose lowered, withdrawal symptoms can develop, which may include headaches, dizziness, tremors, and, ironically, increased anxiety.
This often results in the patient's belief that the medications are necessary since stopping them caused an increase in symptoms.
The truth is that the medications cause brain changes that create this Catch-22.
A vicious cycle of medication treatment/withdrawal symptoms can lead to the anxiety disorder becoming worse over time and chronic.
MODERN MEDICINE AND DEPRESSION
In recent decades, an explosion of research on the brain and the neurological basis for anxiety and depression has occurred.
This has led to a subtle shift in the field of psychiatry away from psychological explanations toward a focus on neurotransmitters, inflammation, and genetics to understand these conditions.
It seemed that this research would revolutionize the field.
Yet treatment outcomes have not changed dramatically, despite increased use of medications and procedures, such as electroconvulsive therapy and transcranial magnetic stimulation.
Myth : Depression Is Caused by a Lack of Serotonin
If you ask most doctors what causes depression, they will probably say that it's a chemical imbalance in the brain. As with anxiety, nearly every patient I've seen who has consulted a psychiatrist for depression has come away with that concept.
Many believe it is linked to levels of serotonin in the brain.
Serotonin is a neurotransmitter, a chemical messenger released by nerve cells in the brain and the body that is necessary for a variety of functions, such as sleep, digestion, learning, and memory.
It has been assumed that serotonin must be low in people with depression since the medications that increase serotonin, the serotonin reuptake inhibitors (SRIs), are an effective treatment for depression.
This theory developed simply because these medications were found to help people with depression.
The mechanism behind why they were helpful was unknown.
However, the pharmaceutical companies took that idea and promoted it.
A surprising fact is that there is medication that decreases serotonin in the brain which has also been shown to improve depression
Myth : There Are Minimal Risks to Antidepressants
You will recall that benzodiazepines can alter GABA receptors in the brain and that discontinuing these medications can lead to a rebound in anxiety symptoms.
The same phenomenon can occur with serotonin reuptake inhibitors. In this case, serotonin receptors in the brain downregulate when exposed to this class of medications, meaning that the cells decrease the number or function of receptors for serotonin on the cell surface that controls how much of the chemical gets into the cell to have an effect. This is a compensatory response to higher levels that can overstimulate the cell.
This process creates a new balance of active serotonin in the brain. When the medication is stopped, because those receptors are downregulated, the brain may experience significantly lower levels of serotonin, which can lead to symptoms such as mood swings, dizziness, fatigue, headache, and insomnia.
Withdrawal symptoms such as these occur in approximately 56 percent of people.
These symptoms can lead to the belief that the medication is necessary, that the symptoms are due to underlying depression rather than to the change in the medication.
This often leads to restarting the medication, which makes it more difficult to discontinue in the future.
This boomerang effect occurs with other antidepressants as well.
Some people have developed a protracted withdrawal syndrome, requiring a lengthy time to wean from this class of medications.