Recent research advances allow neurochemical hypotheses for each of the different anxiety disorders.
Generalized Anxiety Disorder
Ø Neurochemical abnormalities
o Suppressed serotonergic mediation
§ SSRIs increase serotonin
o Decrease in GABA, the brain’s predominant inhibitory neurotransmitter
§ Benzodiazepines improve GABA effects
§ Depakote increases GABA concentrations
o Activation of the locus coeruleus-norepinephrine-sympathetic system
§ Effexor modulates
Obsessive-Compulsive Disorder = the tenth most disabling of all medical conditions worldwide
Ø Increased activity in the ventromedial-cortico-striatal-thalamic-cortical circuit
Ø Neurochemical abnormalities
o Region specific serotonergic abnormality
§ Only 50% of OCD patients respond to SSRIs alone
o Abnormal dopamine striatal circuits
§ Augment SSRIs with antipsychotics
o Decreased GABA and increased glutamate
§ Add Depakote (calms by increasing GABA) and/or Lamictal (calms by suppressing glutamate)
Panic Disorder
Ø The amygdala plays a central role in conditioned fear sending out efferents to:
o The lateral nucleus of the amygdala—autonomic arousal
o Hypothalamus —increases adrenocorticoid release
o Locus coeruleus—increases norepinephrine release
o Parabrachial nucleus—increases respiratory rate
Ø Treatment—there is no integrated treatment for the neurochemical complexity of panic. Currently the treatment for panic remains SSRIs and benzodiazepines
Posttraumatic Stress Disorder
Ø The amygdala and limbic regions play a particularly important role in the final common pathway of chronic hypersensitivity to post traumatic events
Ø The hypothalamic-pituitary-adrenal system results in decreased cortisol and increased glucocorticoid receptor responsiveness found in chronic stress and in neuronal damage of the hippocampus that could account for some of the cognitive impairments found in PTSD
Ø Treatment—multiple medication combinations can help relieve specific symptom complexes
October 1, 2008 I will begin a position at Carilion New River Valley Medical Center, Virginia. You can find Psychopharmacology Update on the Blog, Relationship Solutions: LifeWorks or you can receive a hard copy by sending $12 to cover printing/postage for one year to Wende Whitus, 2820 Huckleberry Hill Dr, Fort Mill, SC 29715.
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