Anxiety Disorders

Paul L. Reller L.Ac. / Last Updated: August 03, 2017

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Anxiety Disorders are now recognized as the most prevalent psychological problem in the United States, with the National Institute of Mental Health estimating that 40 million Americans today suffer from some type of anxiety disorder. Although we all experience anxiety naturally, the mechanism of persistent unresolved anxiety is a problem that must be addressed therapeutically, and Complementary Medicine, especially in the form of Traditional Chinese Medicine, has much to offer in a safe, holistic package of care that involves the patient in a proactive approach to achieve natural control of this difficult psychoemotional syndrome. Scientific study has found that Anxiety Mood Disorders have a complex mind-body pathology, are highly associated with a Depressive Mood Disorder, and may occur secondary to another disease. Early treatment intervention, a multidisciplinary holistic approach to treatment, and an individualized assessment and treatment protocol are essential. One key to any mental health issue is to first understand that a majority of the population suffers from these health issues and that there is no stigma attached. A second key to resolving the psychoemotional health problem is to first achieve understanding and objectivity in order to reclaim the innate control of our emotional balance and of the mind-body physical responses that get in the way of a healthy and productive life. Emotional responses are very subjective and hard to control, and time spent understanding that these responses are sometimes tied to tangible concrete physical problems, as well as behavioral and cognitive habits that are under your control, helps one to reestablish normal patterns of anxiety resolution.

Anxiety disorder is a combination of learned behavior and cognitive habits coupled with physiological problems in specific areas of the brain and metabolic concerns. It is a mind-body health problem that requires a holistic and thorough approach to fully restore healthy balance. The specialty of Traditional Chinese Medicine offers an array of individualized treatment protocols to integrate into the overall care.

Much research has revealed that the basic problem in Anxiety Disorders is hyperexcitability in a part of the brain called the amygdala, which is located in the limbic system, in the temporal lobe. This limbic part of the brain is well known as a coordinating center tied to emotional responses and memory, as well as the hypothalamic regulation of the neuroendocrine system, and has direct connections to the thalamus and hypothalamus in the midbrain. When persistent hyperexcitation occurs here this may lead to symptoms associated with the autonomic nervous system or the hormonal responses, and in the same way, when there is hormonal imbalance or autonomic pathology, the emotional excitation in the limbic system may be imbalanced and stressed. Today, doctors refer to this as the mind-body aspect of pathology, and it has been the chief cause of concern in the science of Traditional Chinese Medicine for many centuries. TCM has developed a holistic approach to restoring this mind-body coordination, and this approach has expanded greatly with greater access to research in herbal/nutrient chemistry and functional MRI studies with acupuncture stimulation, which have shown how specific acupuncture and electroacupuncture stimulations modify anxiety-related biological functions at the amygdala and other areas of the brain involved in anxiety syndromes. Combining specific anxiolytic herbs and nutrients with these acupuncture protocols helps achieve a more significant response. Some of this scientific study is available below in Additional Information with links to the study summaries.

Normally, our brain regulates excitation and inhibition shifts, which are often sudden with emotional stimulation, or an instinctual response to threat memory, with a complex response of neurotransmitter production, especially with the neurotransmitter GABA (gamma-Aminobutyric acid). When the brain is not efficient in regulation of mood shifts, overwhelming symptoms of anxiety will occur, sometimes inexplicably. This is different from the normal fear or fright response, because the anxiety is often not a response to an event, and our coping mechanism is not effective in dealing with the anxiety response. Normal anxiety is directed outward to an object or event that we fear, but unhealthy anxiety is directed inward and tied to persistent worries and insecurities. In these cases, triggering of common anxiety will also trigger a persistent anxious reponse that requires a more complex coping response in our brains. We may have adopted bad habits with this coping mechanism that perpetuates anxiety, in much the same way that we adopt bad postural habits that perpetuate muscle strain and chronic pain. We often must both correct imbalances in the nervous system and correct improper behavior and cognitive habits to fully correct chronic anxiety disorder. This is an example of a mind-body approach to therapy.

Scientists that study Anxiety Disorder have found that anxiety may occur at three levels, the brain, the behavior, and the subjective experience or cognitive level. Resolution of Anxiety Disorder must occur at all three levels, which means that a holistic approach must be taken to therapy. Understanding of the problem and integration of Complementary Medicine is essential to success.

Stimulation of the nervous system with acupuncture, and the taking of key herbal chemicals and nutrient building blocks to facilitate effective neurotransmitters, are proven therapies to effect the brain, but time spent discussing behavior and resolving cognitive problems is also important. The Licensed Acupuncturist often has both the skills to perform therapy and prescribe effective herbal and nutrient medicines, as well as to spend the time to discuss effective strategies to correct behavioral responses and examine the subjective experiences associated with confusing anxiety responses.

Emotional balance has always been an important point of study in TCM, and understanding how we use our various emotions to control and balance emotional response also helps us to exert conscious control over cognitive mechanisms that are usually subconscious. The foundation text of TCM, the Nei Jing de Huang Di, discusses the belief that emotional constraint is the chief underlying cause of internal disease, and discusses many strategies for restoring emotional homeostasis. This text extensively outlines the specific emotional ties to various physical organ systems in the body, matching emotional excesses to symptoms, and explaining how one emotion is generated to control another in the 5-element cycle. The TCM physician may utilize all of this knowledge and various treatment skills to provide a comprehensive package of treatment that balances appropriate aspects of body physiology and cognitive emotional mechanisms. Modern research has also identified restraint as a key aspect in the pathophysiology of anxiety disorder. Physical restraint triggers a response that heightens the physiological responses measured in anxiety states, and similarly, psychological constraints are found to mimic this response, and create a sense of poor control of anxiety. Acupuncture stimulation has been proven to reduce these physiological dysfunctions in the anxiety state, and repeated acupuncture stimulation has been found to nurture a better learned response to these triggers.

While modern medicine has scoffed at the holistic explanation for emotional imbalance seen in ancient Daoist texts of TCM, their own medical institutions have now confirmed that emotional responses are indeed holistic and individualized, not specific to certain neurons, parts of the brain, or specific neurotransmitters, and indeed varied in their complexity from one individual to the next, and from one set of circumstances to the next. There is no possibility that an allopathic approach will cure emotional problems. Dr. Lisa Feldman Barrett, a leading expert in the study of biological emotional responses as a Professor of Psychology and director of the Interdisciplinary Affective Science Laboratory at Northeastern University, has found in numerous studies, that our modern belief that specific emotional responses reside in specific areas of the brain are indeed wrong. Her varied studies, including distinct mapping of small sections of the brain in numerous subjects and mapping biochemical and neuroelectric responses to specific emotions, shows that emotions are indeed a complex and holistic set of reactions in a quantum field of related data and environmental triggers.

Typical symptoms of anxiety include heart racing and palpitation, shortness of breath, feeling of dread, sweat in the palms, irritability, restless sleep, stomach upset, discomfort with swallowing, dizziness, headache, muscle tension, frequent urination, and occasional loose stool. Each patient may experience some but not all of these symptoms. Often, anxiety disorder accompanies chronic depression, but not always. Sometimes, the mild anxiety disorder suddenly becomes a more severe episodic panic attack. Related symptoms, such as visual disturbances, unusual sensitivity to smell and taste, and even tinnitus, may be caused by heightened sensitivity in sensory perception and autonomic nervous responses and adrenal stimulation. Often, there is no actual health problem in these sensory systems, but the unusual symptoms themselves contribute to the anxiety and anticipation of anxiety, and may become triggers of heightened anxiety and panic states. In like manner, the autonomic responses of heart racing and increased force of contraction, and respiratory responses, may be poorly controlled autonomic reactions and not signify actual problems with the heart or lungs, but these reactions often contribute to heightened fears and anxiety. By understanding the mechanisms of anxiety, taking an objective look at the problem, the patient is able to exert more control and is able to understand what specific therapies are needed to cure this disorder. The typical medical treatment utilizes benzodiazepines, such as Lorazepam or Ativan, sometimes with anti-depressant selective serotonin and norepinephrine reuptake inhibitors (SSNRIs), and since anxiety usually leads to problematic insomnia, a hypnotic medication such as Zolpidem (Ambien). This type of treatment is often effective in the short term, but long-term use of benzodiazepines often creates a decreased effectiveness and an alarming withdrawal syndrome when the patient and doctor decides that they are no longer effective or that the side effects outweigh the benefit. In addition, more an more experts in this field are becoming alarmed at the research revealing long-term adverse effects of these medications, and with the combination of these medications.

The Trouble with Standard Therapy and New Strategies

A March 19, 2014 article in the esteemed British Medical Journal (BMJ), entitled Effect of Anxiolytic and Hypnotic Drug Prescriptions on Mortality Hazards: Restrospective Cohort Study, following nearly 35,000 patients prescribed anxiolytic drugs such as benzodiazepines, and over 69,000 matching patients not prescribed these drugs, found that prescription of an anxiolytic drug such as a benzodiazepine combined with a sleeping pill in the form of a hypnotic, such as Ambien (Zolpidem), which has been a common combination, increased the risk of death by any cause by twice as much over the next 8 years. These researchers noted that another study of this type reported an increased risk of death of 4.56 times over a 2.5 year period. These researchers, mainly professors from the University of Warwick, in Coventry, UK, Keele University, and St. George's Hospital Academic Psychiatry Unit, in Staffordshire, UK, noted that evidence of a wide array of adverse effects of these drugs included risk of dementia, psychomotor impairments (extrapyramidal symptoms), cancer, pneumonia, and risk of increased infections (neurohormonal immune dysfunction), which could account for the statistical association (see link to the study below in Additional Information). Obviously, such concern indicates the need for safer treatment protocol, and a less ready jump to prescribe these drugs, especially in patients without a proven need. These researchers noted that in 2011-12 more than 16 million prescriptions of these drugs were written in England alone. (BMJ 2014;348:g1996)

Both benzodiazepine withdrawal and problems with stopping SSNRI medications have become a major concern with physicians around the world, and many books have now been written on these subjects, yet the evidence of adverse effects and risks, as well as the well known risk of serious withdrawal syndromes has not slowed the prescription for these drugs to treat anxiety. Obviously, the first line of therapy with the start of a mild anxiety mood disorder should be to try a conservative treatment protocol that individually addresses the underlying causes, and treats the trinity of aspects the are the core of such disorders, altered biochemical homeostasis in the central nervous system, cognitive disorder, and behaviors that contribute to the disease that are not apparent. Integration of Complementary Medicine has been slowly accepted with these proven concerns. Patients and doctors are turning to Complementary and Integrative Medicine to help correct the underlying health problems as well as to facilitate a smooth withdrawal and alleviate side effects, but this medical specialty is still largely unsupported in standard medicine, which considers it an alternative and competing science. We are seeing an increasing concern with the standard treatment protocol, though. Since uncontrolled anxiety, with physical manifestations of racing heart, high blood pressure, etc., is a key symptom of withdrawal from benzodiazepines and SSNRI medications, this presents a problem of drug dependancy for many patients and prescribing physicians (see the article on this website entitled Withdrawal from Benzodiazepines and SSRIs).

Acupuncture, herbal and nutrient medicine, and behavioral and cognitive stress reduction techniques are now acknowledged as effective parts of the integrative medical strategy for these withdrawal syndromes, for which there is no effective therapy in standard medicine. In addition, Complementary Medicine provides effective and proven therapy to treat anxiety both at its core, and its manifestations, with proof of efficacy with acupuncture, herbal and nutrient medicine. Such therapy should be started at an early stage of Anxiety Mood Disorder. Much evidence has been presented to prove that some herbal chemicals do have a benzodiazepine-like effect, and that these herbal chemicals are safe and without side effects or dependancy. Herbal and nutrient medicine also provides an improved bioavailability of natural production of neurotransmitters, allowing the patient to correct metabolic deficiencies without taking synthetic substitutes for these chemicals in our brains. Anxyolitic, or anxiety-reducing, chemicals in herbs have been well documented, and the mechanisms of these various herbal chemicals have now been well studied to afford the patient and physician more information to effectively prescribe herbs and dosage. While our media, and especially the internet media, has given us a belief that we must look to specific herbs and nutrient medicines to relieve our health problems, the truth of the matter is that the patient and their physicians must come to understand the array of herbal and nutrient chemicals, paired with acupuncture, that should be individualized to achieve a complete protocol of care in Complementary Medicine. Added to this is the integration of Cognitive Behavioral protocols to fully correct Anxiety Mood Disorders and their related health problems.

Obviously, underlying health problems with chronic Depressive Mood Disorder and Sleep Disturbance contribute to the heightening of the Anxiety Mood Disorder. These health problems are often ignored or tolerated for too long, leading to increased biochemical and neurological imbalance, as well as being objective causes for anxiousness. Many patients are understandably reluctant to consent to taking antidepressant and sleep medication that comes with a chronic dependency, and instead try to cope with these underlying problems without treatment. A host of studies in recent years show that sleep disturbance and poor quality sleep are significantly linked to Depressive Mood Disorders, as well as Anxiety Mood Disorder. In the past, a number of experts dismissed this association as primarily a problem of phenotypic genetic expression. We now know that there is no clear differentiation between genetic expression and environmental causes, with a wide array of controls affecting phenotypic genetic expressions of protein messengers in the body, including epigenetic changes, environmental toxins, viral and microbial antigens, and oxidant stress. Many patients see this medical advice, that their problems are genetic, as a declaration of Fate, rather than a helpful tool to create an effective treatment protocol. Studies have also noted the relationship of health problems such as childhood asthma with anxiety and depression, showing the need for a more holistic approach to therapy in treating Anxiety Mood Disorders. Overlooked health problems, such as the onset of Anxiety and Depressive Mood Disorder in mothers of children with asthma, sleep disturbance, and anxiety have also been elucidated (Respiratory Medicine 101(12): p2550-54; 9/17/2007).

Scientific study in 2009, at the University of California, San Francisco, conclusively found that elevated anxiety symptoms are associated with poor sleep quality, factoring out contributions to the Anxiety Mood Disorder from other causes, such as use of anxiety medications, other medical conditions that could cause anxiety, and significant Depressive Mood Disorders (PMID: 19155746). All of these studies indicate that an array of health problems should be addressed holistically, with a comprehensive treatment strategy, when an Anxiety Mood Disorder is recognized. Our strategy of belief in a quick fix with problematic anti-anxiety, antidepressant, and sleep medication has been proven to be a mistake, yet a more comprehensive approach, integrating Complementary Medicine and a holistic treatment protocol, has not been widely supported. Often, the mistaken belief in the quick fix carries over to the treatment in Complementary Medicine as well, with patients finally coming to the Licensed Acupuncturist after standard therapy has failed them, but again expecting a quick fix, and disappointed when one or two treatments do not resolve their anxiety disorder. By realizing the need for a step-by-step comprehensive approach to this health problem, becoming educated to the physiological, cognitive and behavioral aspects, and taking a persistent proactive approach, the patient is able to regain control of their life. This proactive mind-body approach is perhaps the most important aspect of effective therapy to resolve Anxiety Mood Disorder. It starts with patient education and understanding.