Everyone at one time or another has experienced the debilitating symptoms of anxiety. The anxiety response is a warning adaptation initiated by the nervous system to prepare us for eminent danger. As people, in general, no longer live in a state of constant danger, it is thought that the overactivity of these fear responses are responsible for the symptoms of anxiety. According to a 2002 Canadian Community Health Survey (CCHS) just over 2 million Canadians, aged 15 or older, reported having an anxiety disorder. Unfortunately, it is thought that most people suffering from anxiety do not seek professional advice for there fears, making anxiety disorders actually much more prevalent than currently reported. Although the causes of anxiety are diverse and likely individual, there are many great ways to evaluate and treat both the symptoms and causes of anxiety disorders.
Anxiety has a myriad of presentations and labels that can be attached to it. Some of the more general presentations to be aware of are disturbances in sleep, concentration, and social or occupational functioning. Anxiety can also mimic other serious conditions such as a heart attack, angina, indigestion, hyperthyroidism, asthma and low blood sugar. Severe anxiety or “panic” attacks can present with a sense of impending doom, and symptoms of chest pain, dizziness, and shortness of breath, among others listed.
|Box 1: DSM IV-TR Criteria for an Anxiety or Panic Attack|
|A panic attack is a period of intense fear or discomfort, developing abruptly and peaking within 10 minutes, and requiring at least four of the following:|
|Chest pain or discomfort||Feeling dizzy, light-headed, or faint|
|Chills or hot flushes||Feeling of choking|
|Derealization (feelings of unreality)||Changes in Heart Rate or Rhythm|
|Fear of losing control||Paresthesias (Loss of feeling)|
|Depersonalization (detached from oneself)||Nausea or abdominal distress|
|Sweating||Shortness of breath|
|Trembling or shaking||Sense of impending doom|
Data from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text rev. Washington, DC, American Psychiatric Association, 2000.
Nurture versus nature? The endless debate of medical science certainly doesn’t stop when characterizing anxiety disorders. In almost all cases of anxiety presenting at my clinic, people are aware of a time in there life when there symptoms first developed. Understanding the trigger that overstimmulated the nervous system, whether it was a life event or medical illness, is one of the key components to reversing the anxiety condition. In psychiatric medicine the true cause of anxiety in unknown however it is thought to involve an imbalance in the neurotransmitters serotonin, noradrenaline and or gamma-aminobutyric acid (GABA). Anxiety may also be experienced when excessive amounts of the adrenal hormone cortisol are excreted or derivatives of cortisol are taken as anti-inflammatory medication. More in women, but also in men, anxiety can also be caused from sex hormone imbalances of estrogen, progesterone and testosterone.
When biochemically characterizing anxiety disorders there are several different potential imbalances which can occur and need to be evaluated properly. Firstly, it is thought that up to 60% of the population has an impairment in there ability to methylate folic acid. Blood testing for folate, vitamin B12, homocysteine, methymalonic acid (MMA) and a 24 hour urine test for Vanillylmandelic acid (VMA) should be performed. Secondly, a inherited deficiency in the enzymes that make the antioxidant glutathione may exist. A erythrocyte glutathione test may be performed to evaluate for glutathione deficiencies. Deficiencies in the methylated form of folic acid and glutathione can lead to an impairment in the production of serotonin, dopamine and noradrenaline. Imbalances in these neurotransmitters can have a huge impact on subjective feelings of well-being. If excessive stress is likely to be the cause of the anxiety, a serum or salivary cortisol should be assessed between 8 and 10 am and again between 3 and 4 pm. If sex hormone disturbances are a likely cause for anxiety, salivary hormone testing can be a very helpful way to determine sex hormone imbalances. Sex hormone evaluations should rarely be performed on a single day and should ideally be evaluated in relation to Cortisol and DHEA-S for more accurate interpretations. Blood sugar evaluations, multiple times during the day, may also be helpful to determine if a pattern of hypoglycemia exists. Other specialized tests which may also be considered in the evaluation of the biochemical causes of anxiety are an organic acid profile and a pyroluria. These tests may be performed by private laboratories in the United States.
After a thorough intake and evaluation by your medical professional, the treatment of anxiety can become much more comprehensive. There are many nutrients that can be helpful in supporting anxiety, but without properly assessing for deficiencies or imbalances, improper treatment will likely occur. Although there are certainly biochemical markers which are helpful in determining the imbalances in the body, addressing the underlying mind-body disturbance is very important as well. I strongly encourage all people suffering from anxiety to practice some form of deep breathing exercises for relaxation and to avoid blood sugar abnormalities with dietary support. Exercise can also be a very helpful way to improve anxiety symptoms.