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Anxiety Disorder

Millions of people experience the feeling of anxiety when they are put in uncomfortable situations or fearful of a future event, but some experience these feelings when there is nothing to worry about. These people may be diagnosed with an anxiety disorder. Anxiety disorders are mental illnesses that are can cause feelings of anxiety, nervousness, and panic more often than usual (Barrios). There are many different types of these disorders, including general anxiety disorder (GAD), agoraphobia, and panic disorder.

Some common symptoms of these disorders are frequent panic attacks, which can involve hyperventilation, shaking, and derealization (disconnection from reality), and nervous feelings when there seems to be no imminent danger. In some cases, a person can suffer from two or more disorders at once. Although many people have these disorders, many do not know what causes the development of anxiety disorders, or even how the medicine used to treat them works in the body.

Of course, anyone can have an anxiety attack, or feel differing levels of nervousness at times, but there are a few deciding factors that can tell someone whether he or she is just nervous or if he or she actually has an anxiety disorder. It’s normal to feel scared or worried in a stressful situation, such as flying in a plane for the first time or being late for an important meeting. A person with an anxiety disorder may feel the same feelings in the same situations, but they might also feel anxious for no obvious reason at any time.

There are many other possible causes, but more scientific causes are unknown to many, even those who have been diagnosed with one or more anxiety disorder(s). Chemistry, unknown to some, actually plays a large role in the development of an anxiety disorder. According to an article from Scientific Magazine, anxiety disorders can be caused by “a combination of hormonal fluctuations, brain chemistry, and upbringing (“Anxiety Disorders Are More Common in Women”),” but what exact chemistry is involved?

A lot of the chemistry in the development of these disorders involves serotonin, a chemical used as a neurotransmitter. This means that it is used to communicate between a person’s body and brain. Serotonin (C10H12N2O, see Figure 1) is created by the brain and intestines, and can affect a person’s mood, social behavior, appetite, sleep, and other important functions of the body (McIntosh). As it affects your mood, it can also affect how anxious you feel at any given time. Low serotonin levels in the brain can cause anxiety symptoms, but having anxiety can cause low serotonin levels as well.

Just as serotonin can affect a person’s anxiety, anxiety also affects the chemicals in a person’s brain, which can cause serotonin levels to rise or fall (Ramos). (Figure 1 Serotonin. Digital image. PubChem. N. p. , n. d. Web. 15 May 2016. .) The GABA (Gamma-Aminobutyric acid or C4H9NO2, see Figure 2) receptor of the brain also plays a large role in anxiety disorders. The GABA receptor blocks nerve impulses, which means if it does not work enough, nerve cells “fire too often and too easily” (Schor and Bloom).

The GABA receptor works against glutamate, which encourages these nerve cells to “fire” in the brain, and stops these impulses from occurring by “allowing negatively charged chloride ions into the neuron (Ashton),” which lessen the effects of other neurotransmitters. When the GABA receptor is not able to function properly, the glutamate successfully send more nerve impulses than needed, which makes a person more likely to have a panic attack (Schor and Bloom). (Figure 2. Arnold, Alexander. GABA Receptor. Digital image. Arnold Group.

University of Wisconsin Milwaukee, n. d. Web. 15 May 2016. .) Another variable that can affect the level of anxiety a person experiences is carbon dioxide (CO2). It is common knowledge that inhaling too much carbon dioxide is not good for you in general terms, but it is also not healthy for a person’s brain. A study done by the University of Iowa in 2009 tested the effects of carbon dioxide on normal mice and mice genetically modified to be missing the acid-sensing proteins in the amygdala called ASICs, or acid-sensing ion channels.

These sensors stimulate neurons when acid levels in the brain increase. The study showed that “inhaling elevated concentrations of carbon dioxide triggered strong fear reactions in normal mice, and some of these fear reactions required the presence of the acid-sensing protein in the amygdala (Maddock). ” As mentioned before, one symptom of panic attacks is hyperventilation. This is where a person begins to breathe faster than normal, and it also causes an imbalanced intake of oxygen and carbon dioxide.

Because of this imbalance, carbon dioxide levels in the brain rise, triggering a panicked feeling as it did in the mice in the University of Iowa’s aforementioned experiment. This is why people are advised to attempt to control their breathing when having a panic attack, as breathing properly will eventually balance the levels of oxygen and carbon dioxide in the brain. This will usually help the person suffering from the anxiety attack calm down. There are many ways, including controlling one’s breathing, to stop panic attacks, but there are also ways to prevent them from happening in the first place.

When a person is diagnosed with an anxiety disorder, his or her doctor will usually prescribe a type of treatment, whether it be therapy, medication, or both. Medications can come in different forms, a few of those being benzodiazepines, buspirone, and SSRIs. Many people are aware of different anxiety medicines, such as Xanax, Valium, and Prozac. These medications even appear in various forms of popular culture. One example lies in the hit Broadway musical “Next to Normal,” which is about a woman, her family, and her struggle with multiple mental illnesses.

The song “My Psychopharmacologist and I” includes the following lyrics that list various medications for mental illnesses, including anti-anxiety medications: “Zoloft and Paxil and Buspar and Xanax / Depakote, Klonopin, Ambien, Prozac / Ativan calms me when I see the bills / These are a few of my favorite pills. ” This list includes medications for bipolar disorder and depression, but many on the list are common anxiety medicines that can fall into one of three categories: benzodiazepines, buspirone, or SSRIs.

Some of the more well-known medications that were mentioned earlier, Xanax, Valium, Klonopin, and Ativan, are different, name-brand types of anxiety medications that fall into the class of drugs called benzodiazepines. In the ABC News article “What Are Benzodiazepines (Such As Valium, Xanax), How Do They Work, And How Are They Used To Treat Anxiety Disorders? ”, Dr. Brian Brennan tells us that benzodiazepines “work by binding to a receptor which is located on neurons in the brain called the (GABA) receptor (see Figure 3).

The GABA receptor, as explained before, stops certain impulses in the brain that can lead to anxiety attacks. Benzodiazepines help the GABA receptor to work properly and prevent symptoms of anxiety disorders by allowing even more chloride ions into the neuron, which makes it even more resistant to excitation. (Figure 3. Diagram of Mechanism of Action of the Natural Neurotransmitter GABA (gamma-aminobutyric Acid) and Benzodiazepines on Nerve Cells (neurons) in the Brain. Digital image. Benzo. org. uk : Benzodiazepines: How They Work & How to Withdraw, Prof C H Ashton DM, FRCP, 2002. N. p. Aug. 2002. Web. 15 May 2016. .)

The next type of medication commonly prescribed to people suffering from anxiety disorders is buspirone (see Figure 4). Buspirone works by influencing the neurons in the brain that use serotonin to communicate with the body. It affects one serotonin receptor, specifically the 5HT1A receptor (Schiffman; Brennan, “What is Buspirone? ”). As stated before, low serotonin levels can cause frequent feelings of anxiety, and buspirone helps raise free serotonin levels (Lechin et al. ). The medication Buspar, mentioned earlier, is one type of buspirone. (Figure 4.

Buspirone. Digital image. PubChem. N. p. , n. d. Web. 15 May 2016. ) SSRIs, or selective serotonin reuptake inhibitors, are another type of anti-anxiety medication. Selective serotonin reuptake inhibitors affect the serotonin receptors in the brain as buspirone does, but SSRIs help raise levels of serotonin in all serotonin receptors, whereas buspirone only affects one specific receptor (Mandal). According to Dr. Jason E. Schiffman, SSRIs are the most common anti-anxiety medications prescribed by psychiatrists. Some well-known types of SSRIs are Zoloft (see Figure 5), Paxil, and Prozac.

Selective serotonin reuptake inhibitors can also be used to ease the symptoms of depression, as depression can also be caused by low serotonin levels in the brain (Mandal). (Figure 5. Zoloft. Digital image. RxList. N. p. , n. d. Web. 15 May 2016. .) Two other types of treatment for anxiety disorders are hydroxyzine (name-brand types include Vistaril and Atarax) and Gabapentin (name-brand types include Gralise, Horizant and Neurontin). Hydroxyzine reacts with a subset of serotonin receptors to affect feelings of anxiety, but is not as commonly used as buspirone and SSRIs.

Gabapentin, despite having “gaba” in its name, is not thought to react with the GABA receptors in a person’s brain. It is actually unknown as to how gabapentin has an anti-anxiety effect, which is why it is not used as often for treatment of anxiety disorders (Schiffman). Panic attacks and anxiety disorders can be extremely frightening, not only to those who experience them frequently, but also for people who know someone with an anxiety disorder. Knowing that there are many ways to treat anxiety disorders is, to many, very comforting, as they know that they do not have to constantly suffer from the effects of their disorder.

As the last song in “Next to Normal” states, “There will be light,” and shedding light on the science as to why anxiety disorders can be developed, and the science behind the medications that are used to treat these disorders helps us all understand them. Learning how anxiety disorders, such as general anxiety disorder and panic disorder, are developed, and how the medication used to treat these disorders work may bring new understanding for those who struggle with anxiety disorders daily.

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