Anxiety is a multisystem response to a perceived threat or danger. It reflects biochemical changes in the body, the patient's personal history and memory, and the social situation. It is important to distinguish between anxiety as a feeling or experience, and an anxiety disorder as a psychiatric diagnosis. A person may feel anxious without having an anxiety disorder. In addition, a person facing a clear and present danger or a realistic fear is not usually considered to be in a state of anxiety. Generalised anxiety disorder (GAD) is defined as a person who feels anxious on most days, worrying about a variety of things, extending for a period of six months or more.
The ‘emotional’ brain regions (the hippocampus and amygdala) both have a role in anxiety. The hippocampus exerts a calming effect, while the amygdala activates the stress response system and is responsible for the expression of fear, aggression and defensive behaviour. The Hypothalamus Pituitary Adrenal axis (HPA axis) is affected by this calming and activating pattern. The hyper-sensitivity or heightened activation of this HPA axis in anxiety, induces adrenalin, noradrenalin and cortisol to mount an unremitting ‘flight or fight’ response. And in the brain, glutamate (an excitatory neurotransmitter) stimulates more activity. Whilst this glutamate signalling is increasing focus and speed of brain activity, which has obvious benefits for the stress response, if left unchecked it contributes to symptoms of stress, noise intolerance and irritability.
One in six Australian's will experience a major depressive disorder at some time in their life. Depression can be defined by experiences of loss, anger, sadness, or frustration outweighing a person's ability to effectively cope with daily experiences. A diagnosis of unipolar depression is made with the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) when 5 of more symptoms below are present (without mania) and last for at least 2 weeks:
- Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). (In children and adolescents, this may be characterised as an irritable mood);
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day;
- Significant weight loss when not dieting or weight gain (e.g., a change of more than 5kg of body weight in a month), or decrease or increase in appetite nearly every day;
- Insomnia or hypersomnia nearly every day;
- Psychomotor agitation or retardation nearly every day;
- Fatigue or loss of energy nearly every day;
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day;
- Diminished ability to think or concentrate, or indecisiveness, nearly every day;
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Depression is very common and frequently undiagnosed. The causes of depression may be multifactorial, driven by psychological, biological factors, and also by neuroplasticity (changes to brain tissue). Chronic stress, likewise play a role, especially early childhood loss or deprivation. Similar to anxiety (see above) HPA dysfunction and other biologic factors, such as alteration of neurotransmitters, leads to excessive neurotoxic levels of glutamate. This excessive stimulation damages the vulnerable hippocampus and prefrontal cortex neurons changing the inflammatory tone of the brain.
Other aspects contributing to this mood disorder include amount of light exposure, sleep disturbances, degree of social isolation, and nutritional deficiencies, notably folate and omega-3 fatty acids. Many depressed patients report a precipitating stressful life event preceding their symptoms, which may have an immediate or delayed onset following a trauma such as loss of a loved one, abuse, or a natural disaster. Depression can also be precipitated and linked to other medical conditions such as irritable bowel syndrome (IBS), cardiovascular disease, diabetes, metabolic syndrome and pain syndromes. Additionally, certain medications (e.g. blood pressure, cholesterol and heart medications) can also contribute to symptoms.
Risk factors for Anxiety and Depression
- Genetic vulnerability
- Traumatic early life experiences
- Anxious mother
- Stress, depression, other psychiatric conditions
- Inflammatory illnesses and infections (see stealth pathogens)
- Obesity; Visceral adipose tissue releases hormones and cytokines that may contribute to SNS activation
- Digestive disorders, gut dysbiosis and SIBO.
- Prior episodes of depression, family history of depression, prior suicide gesture(s)
- Aged between 25 and 44: this is when the rate of occurrence is highest. The elderly are also at particular risk due to death of loved ones, physical illness, impaired function, and loss of independence
- Postpartum period
- Medical or psychological comorbidity: including autoimmune conditions, systemic cancers, heart disease, thyroid disorders, chronic headaches or pain, IBS, concurrent anxiety that also increases risk of suicide, obsessive-compulsive disorder, and borderline personality disorder
- Stressful life events, especially loss (e.g., death of spouse, divorce, miscarriage), particularly loss at a young age (e.g., death of a parent or sibling)
- History of abuse, lack of social support system
- Current or past alcohol or drug abuse: 25% of those who abuse substances actually have depressive disorder.
Note: Microbial imbalances (gut dysbiosis) are shown to have an impact on neurobiology, thereby affecting anxiety and depression.
Signs and Symptoms of Anxiety and Depression
Anxiety: Muscle tension - Tachycardia - Hypervigilance - Dyspnoea - Dizziness/near-syncope - Palpitations - Trembling - Sweating - Feelings of unreality - Fatigue - Impaired concentration - Irritability - Excessive worry/sense of impending doom - Sleep disturbances
- Insomnia (especially early morning awakening) or hypersomnia. Sleep disturbance is experienced by at least 90% of depressed patients; some data suggest that early treatment of sleep disorders prevents later development of depression
- Significant change in appetite and/or either weight loss or weight gain (appetite is generally not affected in dysthymia)
- Fatigue and loss of energy
- Feelings of worthlessness, self-reproach, inappropriate guilt
- Extremely poor concentration
- Either feelings of agitation, restlessness, and irritability or near complete inactivity and withdrawal
- Recurrent thoughts of death or suicide
- Feelings of hopelessness.
Supporting the HPA axis and the ‘emotional’ brain regions (the hippocampus and amygdala) are the core focus of treatment. This is achieved by correcting nutritional deficiencies (very common in stressed individuals), herbal medicine to support GABA activity and numerous other strategies as relevant to the individual.
Key factors to address in treatment include:
- Enhancing GABA activity and reducing glutamate stimulation
- Promoting neurogenesis (repair of neural tissue), reducing inflammation and supporting mitochondrial function (energy production)
- Nutritional support for the Hypothalamic-pituitary-adrenal (HPA) axis to regulate stress hormone synthesis, activity and receptor sensitivity
- Elimination of toxins (including endotoxins from dysbiosis and mycotoxins)
- Balancing blood sugar levels (low blood sugar exacerbates anxiety)
- Restore healthy sleeping patterns
- Correct any other underlying drivers of the individuals condition
The following are examples of treatments used:
- Herbal Medicines: Passion flower, Skullcap, Lemon Balm, St John's Wort, Kava, Bacopa, Withania, Licorice, Rhodiola, Berberine herbs ( e.g. Barberry, Phellodendrin for gut dysbiosis), Turmeric, Rosemary, Ginkgo and others
- Nutrients: Magnesium, CoQ10, GABA, Activated B Vitamins, Zinc, N-Acetylcysteine and others
- Probiotics: Lactobacillus rhamnosus GG (LGG), L. plantarum (299v), Bifidobacterium lactis (BB-12) and others
- Diet: Anti-inflammatory diet, Identify food intolerances, low alcohol and caffeine, minimise processed foods
- Lifestyle factors: practice relaxation or meditation techniques, support from a qualified psychologist or counsellor if relevant, address sleep hygiene, regular exercise, talk with supportive family and friends.
This information is not intended to replace medical advice. Please do not self-treat with the above herbal medicines - seek professional advice specific to your condition.