Brain Differences in Severe Anxiety Sufferers and Pros and Cons of Various Medications

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There has now been a very significant amount of research undertaken by neuroscientists and other professionals connected to the study of psychology into whether those of us who are severely afflicted by anxiety conditions have differences in our brains in comparison to those lucky enough to have normal anxiety responses (when the anxiety response is normal, it is an adaptive, self-protecting and helpful mechanism eg deterring individuals from taking unnecessary risks).

Researchers have, in particular, focused upon:

1) differences in the brain’s biochemistry

2) differences in brain structures.

Let’s look at these two important areas of research:

1) DIFFERENCES IN THE BRAIN’S BIOCHEMISTRY:

a) Research has shown that individuals who suffer from anxiety are often likely to have insufficient quantities of the brain chemical (or neurotransmitter) called SEROTONIN. Serotonin is intimately related to the human functions of appetite, mood, sleep and memory (all of which are often affected by anxiety eg the mind ‘going blank’ when experiencing high stress, losing one’s appetite, insomnia, becoming irritable/aggressive etc).

b) Research has also focused on an AMINO ACID in the brain abbreviated to GABA (gamma-aminobutyric acid, for those who are interested). As with serotonin, studies suggest that those who suffer anxiety are deficient, too, in this. Abnormally low quantities of GABA in the brain are believed to be associated with:

– racing thoughts
– restlessness
– agitation
– insomnia

Because of these findings, it has been theorized that medications which help resolve these biological abnormalities will, in turn, alleviate the anxiety with which they are associated (I’ll turn to look at the pros and cons of medications in the next but one paragraph).

2) DIFFERENCES IN BRAIN STRUCTURE:

Cutting-edge brain imaging techniques have revealed that the brain structure known as the HIPPOCAMPUS, which is associated with processing memories and emotions, CAN BE UP TO 25% SMALLER in individuals who have undergone extreme . It has been theorized that this is why those who have experienced such trauma find it extremely difficult to REGULATE (control) POWERFUL AND OVERWHELMING EMOTIONS, and, also, why they often experience FLASHBACKS and FRAGMENTED MEMORIES.

GIVEN THE ABOVE, IS MEDICATION USEFUL IN TREATING ANXIETY?

Many different types of drugs are used in an attempt to treat anxiety and people’s subjective responses to their effectiveness (or otherwise) vary dramatically. Different medications are given for different types of anxiety disorder.

Below are listed the main drugs prescribed for the treatment ofanxiety, together with the most commonly reported pros and cons of each:

A) SSRI (selective serotonin reuptake inhibitors) ANTIDEPRESSANTS: eg Prozac, Zoloft, Luvox

PROS: – reported effectivess by many (but see my post on the placebo effect)
– not addictive

CONS: – take 2-6 weeks to work
– can, at first, WORSEN ANXIETY
– can produce initial side-effects eg headache, insomnia, sweating, headache, loss of sex drive, impotence (temporary but sometimes ongoing for as long as the drugs are taken).

B) BENZODIAZEPINES: eg Valium, Librium, Ativan

PROS: – immediate effect
– initial help with insomnia

CONS: – can lead to subjective feelings of over-medication or ‘mental fogginess’
– danger of addiction (psychological and physiological)
– some of the benzodiazepines (those that are ‘short-term acting’) can lead to withdrawal effects (eg seizure) if stopped suddenly after several months; very rarely, this can be life-threatening

C) BETA-BLOCKERS: eg Inderal

PROS: – good for reducing the physiological effects of anxiety, eg racing heart, sweating, hyperventilation, shaking. They have also been found useful for those who suffer from performance anxiety, such as fear of public speaking

CONS: – effects very short lived
– if the heart rate is slowed too much this can be problematic

D) BUSPAR:

PROS: – not addictive
– can help to counteract any adverse effects antidepressants have had upon sexual functioning

CONS: – fewer people report a positive effect in comparison with those who take benzodiazepines
– can take 3 to 4 weeks to work

E) ANTIHISTAMINES: -eg Vistaril

PROS: – these can have a sedative effect
– non-addictive

CONS: – less effective, reportedly, than other anti-anxiety medications
– side-effects( which include dry mouth and urinary retention).

F) ANTICONVULSANTS: -Neurontin

PROS: – reported to have calming effect
– reported to improve sleep

CONS: – side-effects (including feelings of sleepiness, dizziness and ‘mental fogginess’).

It is, of course, imperarative to seek medical advice for anyone considering taking such medications.

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Best wishes, David Hosier BSc Hons; MSc; PGDE(FAHE).

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