Experience Life - November 2009

“GlaxoSmithKline spent almost $100 million promoting social anxiety disorder in what they called a public awareness campaign just two or three months after they got FDA approval for Paxil — then, the only pharmaceutical treatment available,” Lane explains. “Meanwhile, the psychiatric community went straight for medication and largely overlooked other forms of viable treatment.”

While medication can provide immediate relief from anxiety (although at the risk of side effects), long-term pharmaceutical treatment rests on the controversial 1950s-era theory that mental illness is caused by a “ chemical imbalance” that can be corrected with medications. When the brain functions normally, it sends what can be thought of as a chemical code from one cell to the next using substances called neurotransmitters. When a person is depressed or anxious, levels of some of these neurotransmitters drop; thus, the notion that correcting the chemical balance corrects the condition.

Although the metaphor of an imbalanced brain persists, we now know that it’s a biological oversimplification. Neurotransmitters like serotonin and dopamine may

be present in higher or lower levels during various emotional states — but that doesn’t necessarily mean they are the primary cause of those states. In fact, they can just as easily be seen as the result or biochemical product of emotional experiences.

Moreover, depression and anxiety are normal, predictable responses to certain life events, so any change in brain chemistry during these states can’t accurately or always be described as an “imbalance.” Neurotransmitters often play more than just one role in the brain and can act broadly to influence all sorts of body functions (serotonin, for example, has been shown to play a role in both mood and appetite), so interfering with their transmission can affect more than just mood — sometimes in unpredictable ways.

Drug interactions with brain chemistry are similarly broad: Any drug, whether cocaine or Prozac, affects our mental state by broadly repressing or enhancing our ability to manufacture, release or transfer certain neurotransmitters. Which is to say that increasing or suppressing the transmission of a selected neurotransmitter increases or suppresses all the roles that neurotransmitter plays in the brain, not just its one role in, say, anxiety. (For a look at how nutrition affects neurotransmitters and moods, see “Comfort Food for Your Brain,” page 62.)

But perhaps the most damaging aspect of the chemical imbalance theory is that it treats the brain in isolation from the rest of the body.

In fact, they’re one highly integrated system.

Research has shown that our mental and emotional states are a complicated mix of brain chemistry and biology, as well as genetic, environmental and physical factors. Instead of thinking of the brain as some kind of isolated chemical lab that sends directions to the body, scientists now understand that our bodily experiences and our environments directly affect the functioning of the brain. Increasingly, doctors are recognizing this connection as an essential element in effectively treating disorders like anxiety.

Instead of thinking of the brain as some kind of isolated chemical lab that sends directions to the body, scientists now understand that our bodily experiences and our environments directly affect the functioning of the brain.

MIND-BODY CONNECTIONS

The biological processes triggered by anxiety — sweaty hands, shallow breathing, increased heart rate, dizziness — are hardwired human responses to stressful situations. Most of these responses serve some biological purpose, such as preparing our bodies to react (fight or flee), or they are the byproduct of the chemicals, such as cortisol and adrenaline, that such a reaction might require. It’s when we perceive a major threat in situations where, objectively speaking, there is little or none — for example, in a crowded elevator (claustrophobia), crossing a bridge (fear of heights), leaving the house (agoraphobia) or at an office mixer (social anxiety) — that anxiety is classified as a disorder.