About Anxiety

Anxiety is a hot topic among social media. This is not surprising considering anxiety disorders affect 40 million adults in the United States each year. Sadly, less than 40% receive treatment, according to the ADAA (Anxiety and Depression Association of America).

There is also a strikingly high number of children (ages 13-18) suffering from anxiety disorders, from 25-32%, depending on various credible resources. (see “More Resources” below)

The term “anxiety disorders” actually includes a number of well known illnesses like; GAD (generalized anxiety disorder), PD (panic disorder), SAD (social anxiety disorder), OCD (obsessive compulsive disorder), PTSD (posttraumatic stress disorder) and more. The bottom line is anxiety may range from mild to severe and interfere with activities of daily life, even trapping some at home.

What Happens When We Are Anxious?

An anxiety response is familiar to many as the “fight or flight” phenomenon. We experience rapid heart rate, faster breathing, and heightened awareness. Our body is increasing oxygen and blood flow to our peripheral muscles, away from some of our internal organs like the GI system, in preparation to run. Thus, anxiety is inherently good and helped our ancestors to survive attacks from wild animals. It helps us today to flee dangerous situations like jumping out of the way of a moving vehicle.

The anxiety response originates in two small areas of the brain, the hippocampus and the amygdala. Together they manage emotionality, memory, stress and depression. A review paper by Barkus, et al delves into this connection. They explain that anxiety is the response to a potential threat and works to help us avoid dangerous situations. Also, fear is response to a present threat and works to remove us from dangerous situations. When our brain experiences situations of conflict or uncertainty it responds with anxiety. The hippocampus tries to resolve this by increasing attention and arousal and slowing our motor actions. Imagine walking through the woods at dusk and you hear a low growl. You become acutely aware of the surroundings, your heart pounds and you may feel short of breath. You slow your pace as your brain gathers more information to resolve this new “conflict”. Your brain is screaming to avoid what may or may not be danger. Of course, it may quickly respond with fear and send you running in the other direction to remove you from the danger. Your anxiety response allowed you to make a quick getaway.

How Do We Treat Anxiety?

Anxiety that persists outside of a clear danger or stressful situations is treatable. A mental health care provider or your primary physician can direct you to a course of treatment. One popular approach is talk therapy, which can be individual, in a group, in person and/or online via texting or video chats. With modern technology one does not even have to leave the house to get help. Cognitive behavioral therapy and psychotherapy are common formal options offered by mental health professionals.

Medications are often an adjunct to therapy. Major categories include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), benzodiazepines, tricyclic antidepressants (TCAs), and ketamine.

Complementary and alternative medicine (CAM) works to include more options to treat anxiety, such as meditation, acupuncture and relaxation techniques.

What if We Don’t Treat Anxiety?

The long term physical effects from being in a “fight or flight” mode hurts our body and may lead to disease. Harvard Women’s Health Watch posted an article on anxiety and physical illness. They refer to research connecting anxiety with chronic disease. Irritable bowel syndrome (IBS), which includes symptoms of diarrhea or constipation, abdominal pain and bloating, is one such example. Anxiety may also have significant impact on chronic respiratory disorders, such as chronic obstructive pulmonary disease (COPD), and lead to more frequent hospitalizations. Perhaps the most alarming connection is with heart disease. Both the development of heart disease and worsening of coronary events in people who already have the disease may result. Suffering both anxiety and heart disease may double or triple the risk of heart attack or stroke. And, this risk increases with the severity of the anxiety disease.

Why Choose Ketamine Treatments?

Ketamine therapy will often not pop up on someone’s radar unless they are struggling with traditional treatments for anxiety. Side effects from medications may be intolerable, or they have hit a roadblock with therapy. In this situation, ketamine is a logical choice to investigate. The response will be relatively rapid (from days to a couple weeks) versus weeks to months of changing oral medications and therapy. The results from a short series of ketamine treatments may last weeks to months. It can lead to breakthroughs that advance the success of a patient’s psychotherapy. It may also provide relief of symptoms long enough for oral medications to take effect. Ketamine is an effective tool to add to tool kit for anxiety. People can resume their lives in work and relationships. Therefore, resolving anxiety helps the individual and society in general.

How Ketamine Treats Anxiety

The science of how ketamine works in the brain to reduce anxiety is fascinating, and not entirely yet known. We do know anxiety shares the same pathways in the brain as depression, which are well studied related to ketamine. There is evidence ketamine has a positive impact on neuroplasticity, or synaptogenesis. This is the formation of new connections between brain nerve cells that leads to relief of symptoms.

Scientists have also zeroed in on a specific part of the hippocampus that has a collection of NMDA receptors that when disabled in the science lab, reduces anxiety.(Barkus et al) These same receptors, when blocked by ketamine, also result in decreased anxiety. There is now evidence from a variety of studies that supports this connection.

Ketamine Providers Report High Success Rates

Dr. Keith Ablow, a leading American psychiatrist and Assistant Clinical Professor of Psychiatry, Tufts Medical School states:

“Over two thirds of my [anxiety] patients have experienced dramatic recoveries. Their profoundly low mood, lack of energy, decreased self-esteem and even suicidal thinking very frequently yields entirely to the Ketamine infusions.”

If you suspect anxiety in you or a loved one, initial steps may include education, seeking help, getting a proper diagnosis and starting treatment. For further reading, visit the websites listed below.
Dr. Van Praag

More Resources:
Anxiety and Depression Association of America https://adaa.org/
National Institute of Mental Health http://bit.ly/2H0XMdj
The ADAA has an easy to understand infographic about myths vs reality found at: http://bit.ly/2L77Wvf

References:

  1. Barkus C, McHugh SB, et al. Hippocampal NMDA receptors and anxiety: At the interface between cognition and emotion. European Journal of Pharmacology (2010) 626; 49-56 http://bit.ly/2KYoCJb
  2. Anxiety and Physical Illness, published online by Harvard Health Publishing. http://bit.ly/2KQ1Tj9