Posted by Anxiety. I’m sure you’ve felt it. Racing heart. Sweating. Nausea. Trouble swallowing. Chest pain. Dizziness. Numbness in your extremities. Weakness. Dry mouth. Shortness of breath. Racing thoughts. This may even be a panic attack. If you’ve never had one, count yourself lucky. They’re so miserable, people think they’re having a heart attack or even a stroke. And this is a fair concern— some people feel like they’re dying. Have one of these once or even five times in your life? It’s likely situational. Maybe you’ve just heard terrible, life-altering news. Maybe your marriage is spiraling. Maybe you just wrecked your car. Regardless, a panic attack is certainly justified in these situations. Have one of these several times a month with no known trigger? You likely have generalized anxiety disorder and/or panic disorder.
According to the DSM-V (the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders) and psychiatry.org, anxiety disorder is defined as “persistent and excessive worry that interferes with daily activities.” Panic disorder is defined as having “recurrent panic attacks—an overwhelming combination of physical and psychological distress.”
Let’s back up and explain the neurochemical reason behind a panic attack. Your brain is telling you to choose “fight or flight.” You’ve heard of this…picture Jamie Lee Curtis in Halloween. Picture a shark circling you in the ocean. Even reading those two scenarios may make your heart race a few more beats per minute. Why does the heart speed up? It’s responding to the brain’s message—a message in the form of stress hormones. There are several hormones involved, and they set off a cascade of events outside of the brain (hormones like GABA, serotonin, norepinephrine, cholecystokinin). This all happens in a few specific parts of the brain— one you may have heard of is the amygdala. Lots of your cranial nerves then get involved to tell the body to, again, fight or flee (cortisol and adrenaline are two stress hormones outside the brain that cause us to feel physical reactions to stress). So, to review— brain hormones tell body hormones to amp up and turn you into a superhuman of strength, speed, and hyperawareness. There’s a faulty system in the brain in those who suffer from anxiety/panic disorder—it’s one that tells your body to kick into high gear when there is no serious threat around you. These panic attacks even wake people in the middle of the night. Has that happened to you? Miserable, for sure. My patients who’ve told me that ask, “How can I have anxiety when I’m sleeping?!” Their brain has imbalances in the hormones that tell the body to panic—randomly. Okay, but what causes these imbalances? I’m glad you asked.
There are oodles of studies that explain the initiation of generalized anxiety disorder and panic disorder. Many, many, many studies show that trauma or some kind of substantial life event can change you, change your personality, and change your brain (think of our brave soldiers with PTSD). Simple “chronic stress” can cause an anxious state of mind. Genetics also play a role. Panic disorder is especially passed on genetically—a child is SEVEN times more likely to have panic disorder if one of their parents does (Hettema et al, 2001). Something important to note, though, is it’s not nature versus nurture, here. It’s nature AND nurture. Both affect the chance that your children will suffer from this fate if you happen to. Your behaviors, if characterized by excessive and sometimes baseless worry, can be learned and emulated in your children. Key word: CAN. If they see it enough and think this is a natural reaction to life stressors, they’ll likely act the same way. Nurture affecting nature (your experiences affecting your genes) is called epigenetics. It’s super cool, but also super complex and another topic for another day. But I will mention this: chronic elevations in stress hormones (cortisol in this study) actually CHANGED how genes acted in mice in a 2010 Johns Hopkins University study (Lee et al). The gene they studied is the Kfbp5 gene, one that’s associated with PTSD and mood disorders.
Anyway, sometimes patients have no idea why they’re anxious. They state that crowds suddenly make them uneasy or driving on highways causes them to hyperventilate. I wish I had all the answers for them. What we do know is this: the brain is a powerful motherboard. It can cause us to act in ways we never thought possible and to think thoughts we never have before. Sure, anxiety can be a momentary feeling; count to ten, practice grounding techniques, or take deep breaths and it will usually pass. As I said, you’re lucky if it only happens to you a handful of times in your life. And having appropriately placed anxiety is just that— appropriate. I have had a couple of these myself. But having these feelings daily or several times a day when life is otherwise “fine” is not appropriate, and you should speak to a healthcare professional. In a time of increased mental health awareness and acceptance (thank goodness), I will tell you that certain medications ARE necessary if you wish to remedy the neurochemical imbalances of which I speak. Therapy IS helpful if you wish to learn coping mechanisms for stress. Cognitive behavioral therapy, or CBT, was shown in one study to be especially helpful in Iraqi war veterans with PTSD. Functional MRIs on these patients showed that their brains literally calmed down after CBT sessions (Dickie et al, 2008). Medications, as you’ve probably guessed by now, target those aforementioned hormones in the brain to regain a sense of balance and proper functioning. Stigmas about psychiatric medications are thankfully waning. And no, clinicians don’t want to make you a zombie while treating your anxiety. We want you to regain your sense of self— to feel your “normal” again. We want you to be able to go to Kroger without breaking down in the freezer section, or go to a social gathering without having to hide in the back room. Sometimes medication takes a year to balance you, sometimes a couple of years. It depends on your depth of anxiety and if it’s based in traumatic, life-altering experiences. The brain is stubborn. Life keeps happening and stress is always presenting itself. But with the marriage of medication and effective cognitive behavioral therapy, patients with anxiety disorder can regain their normalcy—even in this crazy, fast-paced world.
AS AN ASIDE: I hope your understanding of anxiety is deepened by what you’ve just read. Today’s post is a little lengthy and I hope you stuck with me. I will expand on various blurbs I’ve mentioned in this post at a later date. There are several anxiety diagnoses, and we can explore those more extensively later.
References:
Dickie EW, Brunet A, Akerib V, Armony JL. An fMRI investigation of memory encoding in PTSD: influence of symptom severity. Neuropsychologia. 2008 Apr; 46(5):1522-31.
Hettema JM, Neale MC, Kendler KS. A review and meta-analysis of the genetic epidemiology of anxiety disorders. Am J Psychiatry. 2001 Oct; 158(10):1568-78.
Lee RS, Tamashiro KL, Yang X, et al. Chronic corticosterone exposure increases expression and decreases deoxyribonucleic acid methylation of Fkbp5 in mice. Endocrinology. 2010;151(9):4332–4343. doi:10.1210/en.2010-0225
Martin EI, Ressler KJ, Binder E, Nemeroff CB. The neurobiology of anxiety disorders: brain imaging, genetics, and psychoneuroendocrinology. Psychiatr Clin North Am. 2009;32(3):549–575. doi:10.1016/j.psc.2009.05.004
Psychiatry.org. What are anxiety disorders? Retrieved October 25, 2019 from https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
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