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Anxiety Disorders

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

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Information Resources and Additional Information with Links to Scientific Studies

  1. The World Council of Anxiety, and the Harvard University School of Medicine, Department of Psychiatry, recommends against long-term use of benzodiazepine treatment for anxiety disorders: http://www.ncbi.nlm.nih.gov/pubmed/14767398
  2. As far back as 1995, research showed that almost half of patients seeking medical treatment for anxiety, panic, and phobia, were diagnosed as caused by chronic use of benzodiazepines or chronic alcohol use: http://www.ncbi.nlm.nih.gov/pubmed/7769598
  3. As far back as 1982, medical authorities warned of benzodiazepine withdrawal syndrome, which has now been widely recognized as a prevalent problem: http://www.ncbi.nlm.nih.gov/pubmed/6133446
  4. A large cohort study in the United Kingdom, by professors at the University of Warwick and Keele University, followed the health records of nearly 35,000 patients prescribed benzodiazepines for anxiety, often combined with a hypnotic sleeping aid such as Ambien, and compared these records to over 69,000 matching controls who did not take these drugs, and found that this common combination of medications was associated with the doubling of risk of overall mortality: http://www.bmj.com/content/348/bmj.g1996
  5. A 2004 study by experts at the Sleep Research Laboratory and the Department of Psychiatry at the University of Toronto, Ontario, Canada, showed that acupuncture stimulation reduces anxiety and insomnia, with measurable increases in nocturnal melatonin, and presents a potential solution to the health risks associated with the most widely prescribed treatment for anxiety and insomnia, benzodiazepines: http://www.sunshineih.com/Health/wp-content/uploads/2010/11/Nocturnal-Melatonin.pdf
  6. A 2015 randomized controlled human clinical study at the University Aix-Marseilles and the University Montpelier, in France, found that taking a benzodiazepine prior to surgery produced worst outcomes and did not appear to signficantly benefit patients. The cognitive recovery after surgery was significantly impaired compared to the placebo and non-medicated patients: http://www.ncbi.nlm.nih.gov/pubmed/25734733
  7. A 2015 study at the New York University School of Medicine, found that acute intervention with benzodiazepines for the elderly with anxiety and behavioral problems showed few significant therapeutic benefits, and adverse effects of reduced recall and psychomotor slowing. These experts noted that widespread use of benzodiazepines for the elderly, especially in nursing homes, have shown adverse effects on cognitive function and memory in numerous studies, although there is still a paucity of studies of the long-term effects: http://www.ncbi.nlm.nih.gov/pubmed/25195839
  8. Manipulation of research and publication by pharmaceutical companies has been found to be particularly egregious in the field of psychiatry. This 2010 NY Times article revealed that the U.S. Senate committee investigating this manipulation found that GlaxoKlineSmith went so far as to develop and publish a textbook for medical schools to teach young family practice doctors how to prescribe psychiatric medication. One of the ghost writers for this textbook was chairman of the department of psychiatry at Stanford University until 2009, Alan Schatzberg, who was given a preliminary draft of the book by GlaxoKlineSmith, and the writing company in charge was proven to have developed the concept, wrote the original outline, and worked on all content. A bioethicist at California State University, Leemon McHenry, states that this evidence is only the tip of the iceberg in findings of illegal manipulation of published scientific work. These findings have come up in a lawsuit against Paxil: http://www.nytimes.com/2010/11/30/business/30drug.html?src=me&ref=business
  9. Research in 2010 at the National Institute for Longevity Sciences, Section of Oriental Medicine, in Aichi, Japan, found that aging and repeated stress makes us physiologically hyperresponsive to acute stressors, with more extreme elevation of cortisone in circulation, and decreased cellular responses in areas of the brain related to emotional and mood control, particularly with c-Fos expression, which is also related to immune and hormonal stress and dysfunction: http://www.ncbi.nlm.nih.gov/pubmed/20307586
  10. Research as far back as 1995, at the University of Cambridge in England, found that acute stress evoked a host of responses in the brain via c-Fos expression, with autonomic reactions such as a rapid heart rate and temperature dysregulation, as well as cortisone responses. This research indicated that learned adaptive responses to repeated stress impacted a wide variety of endocrine and neurological responses in the body: http://www.ncbi.nlm.nih.gov/pubmed/7715780
  11. Research in 2009, at the University of California in San Francisco (UCSF), found that Anxiety Mood Disorders in older women are highly associated with poor sleep quality, independent of other contributing factors, such as anti-anxiety medications (which ironically cause a considerable percentage of these disorders with chronic use), other medical conditions, or significant depressive symptoms. This study implies that sleep quality may be a significant part of the multifactorial underlying cause of Anxiety Mood Disorder, and that restoring sleep quality, not just taking a sleep medication, is very important in the holistic treatment protocol, especially with aging: http://www.ncbi.nlm.nih.gov/pubmed/19155746
  12. Research in 2004 at the University of Cambridge in England, found that estrogen deficiencies related to menopause or hysterectomy increased stress-induced anxiety responses, and diminished the normal physiological reactions, such as the cortisone response. Treatment with 17beta-estradiol, an active estrogen metabolite that converts from estrone, significantly reduced stress-induced anxiety behavior. The most abundant form of estrogen in the body is estriol, which converts to estrone and estradiol as needed. Proper estriol supplementation will be a useful protocol in aging and estrogen deficient states to provide bioavailability of 17beta-estradiol in the brain: http://www.ncbi.nlm.nih.gov/pubmed/15344916
  13. A 2007 paper on the experience of emotion, headed by the esteemed Lisa Feldman Barrett. of Boston College, Harvard Medical School, and the Massachusetts General Hospital, is very revealing of how we have formed our current ideas of emotion in modern medicine, and the mistaken assumptions that we operate on. Since 2007, Dr. Feldman Barrett has delved more extensively into the biological measures of emotions at her Interdisciplinary Affective Science Laboratory at Northeastern University, and found that emotions cannot be simplified to specific specialized areas of the brain, specific neurotransmitters, or even specific external manifestations of affect and response, but must be seen in a larger context within a quantum field of neurohormonal events: http://dept.psych.columbia.edu/~kochsner/pdf/Barrett_AR_2006.pdf
  14. A 2013 meta-review of published studies of herbal medicine to treat anxiety, at the University of Melbourne, Australia, Department of Psychiatry, found that clinical evidence supported 21 herbs, including Kava, chamomile, Gingko biloba, skullcap, milk thistle, Passiflora, Withania somnifera (Ashwaghanda), Galphimia glauca, Centella asiatica (Ji Xue Cao, or Gotu Kola), Rhodiola rosea, Echinacea, Melissa officianalis (lemonbalm), and Echium amoenum, and acute anxiolytic activity was proven for Salvia, Passiflora, Melissa, Centella asiatica, and Citrus aurantium. Obviously, the scientific studies published in China were omitted: http://www.ncbi.nlm.nih.gov/pubmed/23653088
  15. A 2013 meta-review of scientific evidence for herbal and nutrient medicines for the treatment of anxiety, by experts at New York Medical College, in Valhalla, New York, U.S.A. found that evidence supports integration of this Complementary Medicine in the treatment of anxiety, insomnia, fatigue, cognitive enhancement, mental focus and sexual function in these disorders. A call for more funding of sound research into Complementary Medicine and herbal extracts was made: http://www.ncbi.nlm.nih.gov/pubmed/23538075
  16. A 2016 meta-review of scientific studies of acupuncture as part of the treatment for anxiety, by the University of Sao Paolo, in Brazil, found 11 studies with strong evidence levels, with 5 randomized controlled human clinical trials of high quality. The evidence supported acupuncture as an adjunct treatment for anxiety mood disorders and recommended more high quality studies: http://www.ncbi.nlm.nih.gov/pu...http://www.ncbi.nlm.nih.gov/pubmed/27355312
  17. A 2015 study of the herb Withania somnifera (Ashwaghanda), by experts at California State University in Los Angeles, California, U.S.A. and the University of California at Irvine, found that active chemicals in the herb exert significant GABAergic activity on GABA type A and p receptors in the brain, and could play a role in treatment of anxiety, insomnia, muscle spasms, restless leg syndromes, and seizures: http://www.ncbi.nlm.nih.gov/pubmed/26068424
  18. Research in 2007 concludes that the Chinese herb Ganoderma lucidum, or Ling zhi, called Reishi mushroom, has a significant benzodiazepine-like effect, without side effects or withdrawal: http://www.ncbi.nlm.nih.gov/pubmed/17383716
  19. Research in Japan has confirmed that the chemicals magnolol and honokiol from the bark of medicinal magnolia (Hou Pou) have significant anxiolytic, or anxiety reducing effects. These chemicals may be found in greater concentration in alcohol extract rather than water extract: http://www.ncbi.nlm.nih.gov/pubmed/11186252
  20. Research in 1999 confirmed that the chemicals in magnolia bark have an effect of increasing potentiation of GABA neuroinhibition to treat anxiety disorder, by increasing GABA receptor health, and increasing the number of binding sites in the forebrain: http://www.ncbi.nlm.nih.gov/pubmed/10591411
  21. Further research in 2002 found that the chemicals in medicinal magnolia bark, honokiol and magnolol had selectivity on different GABA receptor sites, creating a positive modulating effect in treatment of anxiety: http://www.ncbi.nlm.nih.gov/pubmed/11408830
  22. Research in 2012, at the University of South Carolina, U.S.A. found that the chemicals magnolol and honokiol, in the magnolia bark herbal extract (Hou Pou), modulate the GABA receptor type A in a way that enhances the receptor activity and biological effects, and thus would be effective as anxiolytics: http://www.ncbi.nlm.nih.gov/pubmed/22445602
  23. The NIH and USDA Agricultural Research Service of the United States government has recorded that California Poppy extract, or Escholzia californica, does exbibit anxiolytic effects and has an affinity for the benzodiazepine receptor, although its full mechanism of modulatory effect is not fully understood: http://grande.nal.usda.gov/ibids/
  24. A French study, double-blind placebo controlled, in 2008, found significant benefits from a combination of California poppy, hawthorn flower (Craetagus oxycantha), and magnesium, on anxiety disorder. As usual in studies of anxiety disorder, the placebo response was high, but the herb supplement combination was much greater: http://www.liebertonline.com/doi/abs/10.1089%2Fact.2004.10.309
  25. A Meta-review of scientific human clinical studies of the herbs Hypericum (St. John's Wort) and Kava kava (Piper methysticum), by the University of Queensland School of Medicine in Brisbane, Australia, in 2009, found that current evidence supported Hypericum for moderate depressive disorders, and Kava for generalized anxiety disorder: http://www.ncbi.nlm.nih.gov/pubmed/19614563
  26. A 2013 meta-review of scientific human clinical studies of the herb Hypericum (St. John's Wort), by the University of Melbourne, Australia, found that while evidence may not strongly support this herbal extract for the treatment of depression, the large number of scientific studies of the herb shows that evidence supports a wide variety of clinical uses for somatization disorders, social phobia, obsessive compulsive disorder, attention deficit hyperactivity disorder, and bipolar depression, as well as major depressive disorder, all of which are associated with anxiety mood disorders. Such review of scientific study shows the emerging realization that single herbs provide a source of contribution to a larger integrated protocol, not a monotherapy that should by itself compete with specific pharmaceuticals: http://www.ncbi.nlm.nih.gov/pubmed/23538077
  27. A 2012 study at the Chinese University of Hong Kong, found that one mechanism of effect in St. John's Wort, or Hypericum perforatum, involves the chemical constituent myricetin, which is shown to modulate the GABA receptor type A via calcium channel and MK enzyme regulation: http://www.ncbi.nlm.nih.gov/pubmed/23258999
  28. A 2012 review of the pharmacodynamics of Kava kava (Piper methysticum) at South Dakota State University College of Pharmacology, Brookings, South Dakota, U.S.A. found that the kavalactones in this herb have been shown to enhance GABA receptor functions, diminish excitatory neurotransmitter release via calcium ion channel inhibition, reduce reuptake of norepinephrine, reversibly inhibit monoamine oxidase B (MOA-B) and suppress synthesis of an antagonist of GABA receptors, eicosanoid thromboxane A2. Studies have shown the ability of Kava to effectively treat anxiety at subclinical and clinical levels, menopausal anxiety, and anxiety due to various disorders, at a low dose. Reported interactions with other drugs are shown to be rare, and only reported with prolonged use of Kava at a high dose, which rarely occurs in herbal therapy, and is easily reversed with lowering the dose or stopping Kava. In the last decade, the researchers found, about 35 cases of suspected liver damage from prolonged use of a high dosage of Kava were reported, but no direct causal relationship was found in any of these cases. Of course, all researchers in standard medicine continue to caution that further research is necessary to fully rule out potential adverse effects of Kava, but this type of criticism has become negligible by 2013, as no proof of adverse effects has been produced (widespread reporting of the potential adverse effects of Kava and St. John's Wort effectively eliminated them from standard herbal medicine around 2002 - too bad for many patients): http://www.ncbi.nlm.nih.gov/pubmed/12383029
  29. A 2013 randomized controlled study of Kava (Piper methysticum) water extract, at the University of Melbourne, in Melbourne, Australia, found that this simple herbal medicine significantly reduced anxiety in patients diagnosed with generalized anxiety disorder, and that there were no adverse effects and no adverse effect on the liver function. The herbal chemicals appeared to work by modifying the GABA metabolism: http://www.ncbi.nlm.nih.gov/pubmed/23635869
  30. A study in 2010 at the JB Roy State Ayurvedic Medical College in Kolkata, India, found that Centella asiatica (Gotu kola), which is called Brahmi, and related to Bacopa monieri, was effective to relieve anxiety. An alcohol tincture of the herb was used, and human subjects were evaluated with standard tests: http://www.ncbi.nlm.nih.gov/pubmed/20677602
  31. A randomized clinical study in 2008 at Justin-Liebig University Geissen, Germany, of the effects of a low dose of valerian and hops showed significant benefit to relieve insomnia over placebo. The study used EEG to evaluate the sleep cycle and brain activity, noting improved sleep cycle: http://www.ncbi.nlm.nih.gov/pubmed/18559301
  32. A 204 study at Ewha Women's University Medical School, in Seoul, South Korea, found that the Chinese herb Albizzia julibrissin (He huan pi) exerted significant anxiolytic effects via the serotonergic system: http://www.ncbi.nlm.nih.gov/pubmed/15464830
  33. A 2013 study at Jeju National University, Jeju-si, South Korea, found that an alcohol extract of the Chinese herb Morus alba leaves (Sang zhi, or Mulberry leaf) exert significant anxiolytic effects via the histaminergic system, increasing the histidine carboxylase expression in the amygdala: http://www.ncbi.nlm.nih.gov/pubmed/23965748
  34. A 2015 study of the herbal extract of Albizia adianthifolia, analogous to the Chinese herb He huan pi and He huan hua, by the University of Yaounde' School of Medicine, in Yaounde', Cameroon, showed that an aqueous extract of this herb, helped relieved anxiety and depression by attenuating oxidative stress in the amygdala of study animals. This is just one specific measured benefit of this herb, traditionally used to treat mood disorders in Chinese herbal formulas: http://www.ncbi.nlm.nih.gov/pubmed/26481946
  35. A 2011 metareview of scientific studies of herbal remedies for anxiety, depression and insomnia by the University of Melbourne Department of Psychiatry, Australia, shows that although there is a paucity of large studies and human clinical trials, evidence does support the efficacy of a number of herbal medicines to treat these disorders: http://www.ncbi.nlm.nih.gov/pubmed/21601431
  36. While reluctant to acknowledge effectiveness of herbal medicine, a number of psychiatric clinics now have recognized that there is proof that a variety of herbs and supplements have promising effects: http://www.gatewaypsychiatric.com/Book Lists/Herbs and Supplements and Anxiety.htm
  37. A 2012 survey of patients with anxiety disorders by the University of California Los Angeles (UCLA) Department of Psychiatry and Biobehavioral Science, found that about 43 percent of these patients in California utilized Complementary Medicine in treatment. The more typical patient was older, more educated, suffered from Generalized Anxiety Disorder, and had two or more chronic comorbid medical conditions. The survey found that these patients that reported a 50 percent improvement in anxiety were less likely to need continued use of Complementary Medicine therapy: http:/www.ncbi.nlm.nih.gov/pubmed/22304968
  38. Research in 2009 at the University of Columbia in Vancouver found that chronic adrenal stress could desensitize serotonergic 5HT receptors in the hypothalamus and cause endocrine suppression. Such findings may implicate adrenal stress in the suppression of dopamine receptors as well.: http://www.sciencedirect.com/science
  39. Research in 2011 at the Zhejiang Chinese Medical University, in Huangzhou, China, showed that electroacupuncture at the point ST36 both cleared lactate from circulation, and modulated 5-HT in the hypothalamus, which would not only relieve chronic fatigue, but would benefit patients with Panic Disorder: http://www.ncbi.nlm.nih.gov/pubmed/22256648
  40. Research in 2008, at Kyung Hee University, in Seoul, South Korea, found that electroacupuncture at the points HT7 and ST36 exerted its anxiety reducing, or anxiolytic, effects in study animals via modulation of corticotropin-releasing hormone at the amygdala: http://www.ncbi.nlm.nih.gov/pubmed/18060697
  41. Research in 2010, at the Catholic University of Korea, in Seoul, South Korea, with a controlled randomized study of laboratory animals, found that 2 Hz 2 mA electric stimulation at the acupuncture point ST36 effectively ameliorated anxiety stress reponses, with a decrease in the excess corticosterone in circulation induced by anxiety, and a decrease in tyrosine hydroxylase immunoreactivity: http://www.ncbi.nlm.nih.gov/pubmed/20034458
  42. Research in 2013, at Mudanjiang Medical University, in Mudanjiang, China, also found in laboratory studies that electroacupuncture at HT7 and ST37 mediates anxiety by modulation of corticotropin-releasing factor in the amygdala: http://www.ncbi.nlm.nih.gov/pubmed/24139460
  43. Research in 2014 at the Fluminense Federal University Community Health Institute, in Rio de Janeiro, Brazil, involving a randomized controlled human clinical trial with medical students, found that electroacupuncture significantly benefited patients with stress-related anxiety and sleep disturbance as measured by 5 standard assessment guides. The controls in this study included a sham TENS stimulation at the acupuncture points, and a control group on a waiting list, with significant benefits seen in the electroacupuncture group not seen in these other two groups. The group receiving the TENS stimulation at the acupuncture points did receive some measurable benefits attributed to a placebo effect, but not the benefits measured with electroacupuncture: http://www.ncbi.nlm.nih.gov/pubmed/24113152
  44. A 2015 randomized controlled human clinical trial in China of electroacupuncture to treat PTSD found that significant symptom improvement related to improved connectivity between the parietal lobe, hippocampus, and amygdala occurred with 3 treatments per week for 12 weeks, using the points DU20, DU24, Sishencong, and GB20, with electrical stimulation at DU20 and DU24 for 30 minutes each session. Functional MRI was used to determine effects on specific areas of the brain: http://www.ncbi.nlm.nih.gov/pubmed/26255522
  45. Research in 2013 at the University of Pennsylvania, in Philadelphia, Pennsylvania, U.S.A. tested a variety of common acupuncture points to measure the effects of patients consenting to hypnosis before dental or minor surgery to induce calming. The point DU24 aided hypnotic induction the best, while P6 was best for reducing tension, and LI4 for muscle relaxation: http://www.ncbi.nlm.nih.gov/pubmed/23679111
  46. A 2015 study at the Heilongjiang University of Chinese Medicine in Harbin, China, found with functional MRI study that the acupuncture point KI4, or Da zhong, traditionally used to treat agoraphobia and other anxiety disorders, does affect primalrily the right insula, frontal cortex, frontal gyrus and most importantly the right thalamus, which coordinates communication between the right and left brain centers. These areas of the brain are associated with emotional activities, social behavior and governing executive functions: http://www.ncbi.nlm.nih.gov/pubmed/26059879
  47. A 2012 meta-review of all published scientific study of acupuncture to relieve anxiety, at the Bor Cerwyn Centre, Hwyel Dda University, United Kingdom, Department of Physiology, found that a wide variety of research variables are seen, generally in small studies, but that the overwhelming positive outcomes and study of both humans in randomized trials and animal studies measuring parameters indicate that while definitive conclusions are hard to find, it appears that acupuncture for the treatment of anxiety presents a very promising type of effective therapy: http://www.ncbi.nlm.nih.gov/pubmed/22070429
  48. A meta-review of acupuncture in treating premenstrual dysphoric disorder (PDD), a significant cause of anxiety mood disorders, by experts at Meiji University of Integrative Medicine, in Kyoto, Japan, found that this treatment was proven effective, while many patients have not responded to standard therapies for PDD: http://www.ncbi.nlm.nih.gov/pubmed/19326136
  49. The University of Pittsburgh Medical Center brings over 20 hospitals and research facilities together, and provides this standard assessment of the efficacy and safety of kava: http://www.upmc.com/HEALTHATOZ/Pages/HealthLibrary.aspx?chunkiid=21785
  50. An April 2010 article in the New York Times Magazine by a prominent psychiatrist, Daniel Carlat, shows that many medical professionals are regretting the widespread denial of care outside of pharmacological treatment to patients for psychological disorders, and are now calling for a search for an approach that integrates with other specialties to provide a more effective course of care: http://www.nytimes.com/2010/04/25/magazine/25Memoir-t.html?scp=1&sq=mind over med&st=cse
  51. A clinical study in 2008, at Chengdu University in Sichun, China, found that combining electroacupuncture with cognitive and behavioral therapy increased the effective outcomes considerably: http://www.ncbi.nlm.nih.gov/pubmed/18767577
  52. A clinical study in 2010, at the Catholic University of Korea, Department of Integrative Medicine, found that a 2 Hz 2mA electrical stimulation for just 10 minutes at a single acupuncture point, ST36, ameliorated physiological dysfunctions in anxiety triggered by restraint stress, such as cortisone spikes and immunoreactive expression affecting neurotransmitters, as well as decreasing anxiety-related behavioral responses: http://www.ncbi.nlm.nih.gov/pubmed/20034458
  53. An article cited by the American Academy of Orthopaedic Surgeons in 2011 reveals that research confirms that 20-51 percent of patients suffering significant orthopaedic injury experience post-traumatic stress disorders: http://www6.aaos.org/news/pemr/releases/release.cfm?releasenum=999
  54. A 2013 recommendation by Dr. Judith Herman, of the Harvard University School of Medicine, was that the varied and complex diagnosis of Post-Traumatic Stress Disorder be expanded to a term such as Complex PTSD / Disorders of Extreme Stress to describe patients suffering from a chronic stress disorder, especially one involving prolonged trauma, physical and emotional, and a feeling of lack of control: http://www.ptsd.va.gov/professional/PTSD-overview/complex-ptsd.asp
  55. A guide to treatment options for Complex Post Traumatic Stress Disorder is available here from Wordpress, the publishers of books by Dr. Judith Herman: https://traumainform.wordpress.com/treatment-2/
  56. A 1999 article on acupuncture and the limbic system outlines some of the early scientific observations after fMRI studies revealed how directly acupuncture stimulation affected the limbic system, and how science explains these effects: http://www.acampbell.ukfsn.org/acupuncture/articles/limbic.html
  57. A study in 2003 in Seoul, South Korea, at Kyung Hee University, found that acupuncture stimulation significantly modulated the hippocampus and neuropeptide Y, restoring functional activities. The hippocampus and neuropeptide Y have been observed to have decreased activity in patients with stress disorders, causing physical symptoms: http://www.ncbi.nlm.nih.gov/pubmed/12749995
  58. A follow-up study in South Korea to the one mentioned above found that neuropeptide Y is involved in the regulation of various physiological functions related to anxiety, and that specific acupuncture stimulations signficantly modulated the expression of both neuropeptide Y (NPY) in the amygdala, as well as the expression of NPY-immunoreactive cells. The researchers found that this may be one way that the acupuncture stimulation reduced anxiety-related symptoms in study animals following traumatic stress. http://www.ncbi.nlm.nih.gov/pubmed/15755522
  59. A 2008 study at Kyung Hee University then found that acupuncture stimulation also modulated corticotropin-releasing factor (CRF), as well as neuropeptide Y, in the limbic system, to improve physical manifestations of anxiety induced by chemical stimulation. http://www.ncbi.nlm.nih.gov/pubmed/18060697
  60. A 2008 study by Donald F. Klein M.D. and Maurice Peter M.D. outlines an integrative theory of cause of Panic Disorder, showing that excess plasma CO2 and lactate in the brain is involved, as well as a lack of response by the hypothalamic-pituitary axis. Opioid neurotransmitters regulate responses to excess CO2, as well as neurohormonal responses in separation anxiety, and a deficiency in these endorphins and dynorphins is proposed as a central mechanism. Further imbalances with the digestive hormonal responses (cholecystokinin) and the effects of steroid hormones on neural receptors need to be more fully researched as well: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2325919/
  61. As far back as 1985 it was known that successful treatment of panic disorder involves normalization of pCO2 (blood plasma carbon dioxide), as well as pH (acid base balance), and bicarbonate levels (HCO3-), which is largely regulated by electrolyte balance and kidney function, and helps buffer excess lactic acid, or lactate, in the brain: http://www.ncbi.nlm.nih.gov/pubmed/3921997
  62. A study of hyperventilation in panic was conducted at the University of Oxford, Department of Psychiatry, in 1989, and proved that hyperventilation was not a cause of panic attacks, but a consequence, and that patients that reflexively hyperventilated in response to panic and anxiety had lowered anxiety ratings, not increased. In 2013, there is still misinformation concerning breathing in panic, and the physiology of this reflexive response to panic, which is pitiful. The tendency to oversimplify such topics is the cause of this confusion: http://www.ncbi.nlm.nih.gov/pubmed/2515911
  63. A thorough informative article on the effects of controlled breathing, especially in yoga practices, is offered by the University of New Mexico: http://www.unm.edu/~lkravitz/Article%20folder/Breathing.html
  64. A 2003 study at the esteemed Max Planck Institute in Munich, Germany, found that deficiency of types of progesterone with concurrent increases in a functional antagonistic isomer of progesterone accompanied dysfunction in GABA receptor types in the brain during induced panic attacks (induced by cholecystokinin and sodium lactate increases). Overexpression of GABA type A receptor induced by chronic anxiety may play a role in this complex pathophysiology. Hormonal imbalances, gastric hypofunction, irritable bowel syndrome, adrenal stress syndromes, and other factors may all play a role in a complex set of causative factors, affecting cholecystokine production, cortisol levels, etc.: http://www.ncbi.nlm.nih.gov/pubmed/12578433
  65. A 2012 study at the Federal University of Rio de Janeiro, Brazil, Laboratory of Panic and Respiration, found that cannabidiol, a constituent chemical of marijuana, exerts significant anxiolytic effects and reduces anxiety and panic in both animal and human subjects. Cannabidiol is an inactive cannabinoid does not get the patient "high", and research is finding that this chemical also exerts significant anti-inflammatory, antioxidant, and neuroprotective effects. Nutrient supplement cannabidiol is being developed, and presently, alcohol extracts even of cannabis seeds may provide some effect. The long suppression of research related to cannabis in the United States has hindered the therapeutic applications: http:/www.ncbi.nlm.nih.gov/pubmed/22729452
  66. A 2012 study at Boston University in Massachusetts showed that a brief course of cognitive behavioral therapy in panic disorders was associated with a clinically meaningful symptom improvement and should be incorporated into an integrative protocol in treatment: http://www.ncbi.nlm.nih.gov/pubmed/22730311
  67. A 2012 study at Istanbul University, in Turkey, Department of Psychiatry, found that there is indeed a relationship between immune dysfunction and panic disorder, with significant differences in the levels of proinflammatory immune cytokines IL-12 and interferon gamma between subject and control groups. Low levels of interferon gamma (IFN) were especially predictive of susceptibility to panic disorder. This demonstrates how a holistic approach is needed in homeostatic restoration to resolve this complex pathology: http://www.ncbi.nlm.nih.gov/pubmed/22691562
  68. A 2006 study at Ludwig Maximillian University in Munich, Germany, found that neuroactive steroid hormones are integral to modulation of mood disorders, and that neuroactive steroids may modulate anxiety and depressive disorders, panic disorder, and improve the effects of therapeutic pharmaceuticals. Initial studies with the administration of DHEA, a natural androgen precursor, revealed promising effects in the treatment of depression. Neuroactive steroid hormone composition in the brain was found to be opposite in panic attacks and depression, implying that depression may be a physiological response to stop panic attacks. The implication is that we should continue to search in Complementary Medicine for new therapeutic agents that affect neuroactive hormone levels, and integrate these with standard pharmacological medicine: http://www.ncbi.nlm.nih.gov/pubmed/16247651
  69. A 2011 study at the US Army Brooke Army Medical Center, in San Houston, Texas, found that a chemical in the Chinese herb Yan hu suo (Corydalis), tetrahydropalmatine, exerted significant anxiolytic, or anxiety reducing, effects, in studies comparing pharmaceutical agents: http:/www.ncbi.nlm.nih.gov/pubmed/22403971
  70. A 2011 article by Sabine Wilhelms of Massachusetts General Hospital and Harvard Medical School outlines a modular set of therapies to treat Body Dysmorphic Syndrome with Cognitive-Behavioral therapy. Severe and chronic anxiety disorders, often associated with chronic complex post-traumatic stress disorder, often include a body dysmorphic disorder, yet this is rarely diagnosed and little treatment protocol is offered: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320734/
  71. A 2015 study of Body Dysmorphic Syndrome, often associated with anxiety disorders and post-traumatic stress syndrome, published in the medical journal Australian Family Physician, notes that studies show that this disorder is seen clinically about equally in men and women, although often discounted and ignored in med. The tendency to be anxious about muscle appearance and strength occurs more often in men, and more and more guidelines for therapy are being devised: http://www.ncbi.nlm.nih.gov/pubmed/26590618