>The test examines biomarkers that can help them objectively determine someone's risk for developing anxiety, the severity of their current anxiety and which therapies would likely treat their anxiety the best.
It actually sounds more interesting than the headline suggests.
I do research in this area and I sort of bristle whenever an article talks about "objective measures" of some psychological phenomenon, as if the subjective experience isn't really what it's about. So the framing of this article really rubbed me the wrong way.
Having said that, I thought this was still interesting just in terms of the biochemistry and molecular biology of systems involved in anxiety.
I think the most practical utility of this might be in drug treatment planning although that tends to not work out in the real world as well as it does in theory and research.
Another angle on this kinda mentioned in various places is that people come into the clinic claiming extreme anxiety when they just want drugs to resell or abuse. But even that could get tricky because lots of times people abusing drugs also feel anxiety.
One elephant in the room with this paper is they didn't really measure anything else. So it has some predictive utility in "anxiety versus not" in a select group of people, but what if other mood state issues are also moving around with it? It's kind of like saying "hey our model predicts cats in images" in some database where you've removed all the dogs and foxes and otters and so forth and so on. Or maybe it's like having a database where all the images with cats also have a 80% chance of having a dog, fox, etc.?
If there is a possibility for a simple test that gives a quick and precise answer, it could be better than someone asking someone and interpreting an answer.
It's common for a patient with a chronic mystery symptom to be dismissed with "You seem very anxious. Anxiety can cause blah blab blah." plus a useless-to-harmful prescription. A legible-to-doctors test for 'anxiety', which doctors are expected to use, might help reduce this kind of stupidity.
I’m not trying to be flippant, but why do we need a blood test for this when we have a test already, eg “Do you have anxiety? Do you have any of these symptoms?”
Not everyone can identify anxiety symptoms in themselves, especially if they have been experiencing them for so long it's become 'normal'. There's also those that won't report what they are actually feeling, even when asked explicitly, for a range of reasons.
This. I've always been aware of every sign of executive dysfunction but never reported it because I thought it was normal. I was 100% aware of it and depressed over it but I thought that it was something that normal people are supposed to be able to just get over but I felt like I just didn't have the willpower and it was my fault.
I'm so lucky I talked about "not being able to do the things that I want to do" and someone in the thread noticed and brought up ADHD.
I'm on ADHD meds now and it fixes nearly every issue.
I wonder if this has to do with methylation status? From what I remember there are different metabolic processes that enable shifting between sympathetic and parasympathetic modes, specifically the glutamate/glutamine cycle. People have different ways of handling the nutrients that support this process (e.g. various B vitamins). Switching back and forth between alert and resting states isn't free, and people who have to do it a lot, for whatever reason, can get exhausted in the process. For some people taking vitamin B12 can be a relief, whereas for other people it can worsen anxiety.
FYI, most of the time when you read an article that reduces complex functions to “methylation status”, it’s pseudoscience.
Methylation is a real biological function, but it has been co-opted by alternative medicine peddlers as a convenient (though incorrect) explanation for everything. It’s part of a new wave of alternative medicine that takes real scientific concepts (methylation, glutamate/glutamine cycles) and tries to work backwards from symptoms to assume the status of various cycles in the body.
One key feature of this pseudoscience is that it often has dual explanations for everything such that everyone will identify with it. For example, when they say that Vitamin B12 can make some people feel better but some people feel worse, they’re setting up an explanation that everyone will identify with: If you give someone a supplement and ask them to see if they feel better or worse over the coming hours, days, and weeks, eventually they’ll have a good or bad day and assign it to the supplement. The methylation pseudoscience people capitalize on this effect by claiming that all of their interventions will either worsen or improve people’s symptoms, which creates confirmation bias everywhere.
One of the easiest ways to debunk the methylation alternative medicine pushers is to examine how almost nobody claims to actually recover from their treatments. It’s always a back and forth of thinking they’re taking too much B12 or folate or other supplements because they’ve been conditioned to believe that all of their symptoms are traceable back to methylation.
To be clear, B12 and/or folate deficiencies are real and measurable conditions that should be treated if present. However, the idea that you can modulate all of the body’s processes up and down by taking varying levels of B12 and folate supplements is pseudoscience.
You argue to debunk requires no one to claim recovery then go on to say B12 deficiencies are real and can be treated. B12 deficiencies often need to be continuously treated which means you can debunk them. But they are real.. just not when a group I dislike says so? Being anti pseudoscience puts you in the same category as someone who is pro pseudoscience; both groups misuse facts to present their side and justify their position as the correct side in a holywar
> You argue to debunk requires no one to claim recovery then go on to say B12 deficiencies are real and can be treated
B12 deficiencies are real and can be measured. Everyone who has a B12 deficiency and supplements B12 back into normal ranges will improve. This is an example of real science.
Using B12 and Folate to treat pseudoscientific “methylation” issues that are presumed (rather than measured) based on vague symptom reports that go in both directions (e.g. some people feel better, some people feel worse) is the pseudoscience.
> Being anti pseudoscience puts you in the same category as someone who is pro pseudoscience;
What?
> both groups misuse facts to present their side and justify their position as the correct side in a holywar
No, one side uses real science and the other side uses pseudoscience. That’s literally the definition of the word.
Measurable B12 deficiencies are real and supported by the science. Explaining everything, including anxiety, as caused by “methylation status” is not.
You missed my point and took a side in a tribal war. Then try to discredit the other side by putting in a qualifier of 'real' to change the meaning of science to something you can control by limiting who fits into this new group to whoever you decide.
> Methylation is a real biological function, but it has been co-opted by alternative medicine peddlers as a convenient (though incorrect) explanation for everything. It’s part of a new wave of alternative medicine that takes real scientific concepts (methylation, glutamate/glutamine cycles) and tries to work backwards from symptoms to assume the status of various cycles in the body.
I'm not gonna say you are wrong about this, but methylation is also a super hot topic right now among legitimate researchers and biotech companies. It's completely possible that anxiety-response is modulated by methylation of specific sites that produce cortisol and other biomarkers. Agree that it's not driven by methylation per se, but the biological response could be tested and proven by analysis for specific methylation patterns.
> In most situations medical professionals can just ask someone if they’re feeling anxious.
Except they literally refuse to believe your answer. You can swear up and down "I was not anxious, I actually felt great" and they fire back with "many people don't know when they're anxious. You can be anxious without realizing it." It's completely unfalsifiable, like the old asylums where everything you could ever say is just more confirmation of whatever mental illness they already decided you have.
If they don't know what's wrong with you and you don't have symptoms that very specifically fit their pre-determined list of the 100 things that might ever be wrong with anyone, then some use "anxiety" as a catch-all, regardless of whether you claim to have it or not. Everyone feels stressed occasionally, so there's no objective way to self-report it. My "very anxious" might be your "normal Tuesday night". They capitalize on this to make it completely impossible to argue with their "diagnosis" so they can get you out the door with a magic pill to fix all your woes, while they move on to the next patient they can give 3 minutes to out of their overbooked 12-hour workday. I would do the same if I were completely overworked in a trainwreck of a system run by incompetent hospital administrators and faceless insurance companies.
> Except they literally refuse to believe your answer. You can swear up and down "I was not anxious, I actually felt great" and they fire back with "many people don't know when they're anxious. You can be anxious without realizing it." It's completely unfalsifiable, like the old asylums where everything you could ever say is just more confirmation of whatever mental illness they already decided you have.
My doctor did this with depression. If you question it then you just don't know you have it. If you insist that you don't have it you're just in denial. I just had to take the antidepressant until it started causing sudden emotional breakdowns and then nope the fuck out of there and tell my doctor that's not the problem.
Guess what, the real problem was indeed exactly what I came to him claiming I needed treatment for. It was ADHD. Stimulant medication fixed every issue. But he didn't believe me the first time, and led me down a path I knew was wrong for a whole month.
Weed's healthier. Alcohol can help with a lot of the same things, but the side-effects of terrible sleep and hangovers can make the problem worse the next day. I understand weed is also supposed to harm sleep quality, but IME it's not even close to as bad as even a light-buzz amount of alcohol, and weed's never given me a hangover. And it doesn't make you gain weight (directly—munchies, LOL, but then again I get those on alcohol, too, personally).
Alcohol has maybe given me a hangover once. I also don't typically have more than two drinks in a day, and if I am having a bad enough day to want to use alcohol then that's going to be closer to 2pm than bedtime. Cannabis use is pretty continual these days, being locally legal, but I don't find it very effective for anxiety. But actually one of the main things I'm using for mood regulation these days is programming. It's hard to think about code simultaneously with anything else, and learning coding was among other things a process of learning emotional regulation with regards to coding, because it's not like the computer cares if you find a bug challenging.
It doesn't exacerbate it, though it doesn't cure it either per-say. For example you still feel your skin crawling while high, but it transforms the interpretation of the sensation from super-annoying to mildly amusing and completely ignore-able.
I don't have any problems sleeping with low-to-moderate amounts of alcohol and I certainly don't get hangovers unless I'm really getting drunk. Then again, we all handle different substances differently. For me, weed usually causes anxiety, sometimes acute, severe anxiety. And paranoia. Indica strains seem to do this much less, but also make me incredibly sleepy. High CBD strains seem to be best but are not easy to find.
Alcohol temporarily helps but you pay it back with interest over time.
It sounds trite but exercise and sleeping/eating better is really the only thing we have proof that works. (zoloft can help kickstart the changes but it won't reduce anxiety long term)
I think I have more of an acute issue with anxiety, at the moment mostly driven by financial insecurity combined with unexpected medical expenses. Like what I really need right now is a few thousand dollars in travel expenses and for this precertification to go through, but failing that I just need to make it from one day to the next.
Alcohol works so well for me that I'm sort of scared of it. Often even after just one or two drinks I become the happiest and most sociable person on the planet.
Alcohol is borrowing happiness today from tomorrow. If you self-medicate with alcohol it will be worse in the longterm. Don't fall down that rabbit hole.
Therapy has worked for me in the past as well as some medications (very low doses of psychiatrist prescribed benzodiazepines). Mostly I find that exposure to what makes me anxious makes it lessen, but I've yet to find a way to deal with my generalized anxiety as it'll often go hunting for something else to be anxious about. I cope with the generalized anxiety by trying to be as structured in my life to reduce the chaos and noise.
Yeah, and it doesn't have to be "exercise" exercise either, just exertion. Go work in the yard. Repair your house. Reorganize your stuff. Build some shelves. Change your own oil and rotate your own tires. Just do things that involve moving your body.
I don't have the source at hand, but I read somewhere that in many hunter-gatherer societies, pretty much all people walk 15-20 kilometers every day. Coincidentally, this is approximately equivalent to the the amount of exercising I need to do calm my anxiety down.
Maybe anxiety is just some kind of exercise-deficiency. After all, we were made to move around, it's entirely plausible that many biological processes in our bodies just don't work well while sedentary and our anxiety is trying to tell us that.
> After all, we were made to move around, it's entirely plausible that many biological processes in our bodies just don't work well while sedentary and our anxiety is trying to tell us that.
Muscle contractions function as the heart for our second circulatory system.
I promote exercise as an excellent way to combat and prevent anxiety/depression/etc., but calling it a silver bullet is just wrong. Some people can do all the right things and still feel like absolute shit at the end of the day. There are wars that cannot be won.
Thank you for this. There are multiple comments in this thread saying exercise is the "silver bullet," but if you have a severe anxiety disorder, it often isn't.
I am much less anxious on the days I don't exercise. I still do it nearly every day because I want to stay healthy.
What works for me? Good old SSRIs. They are my silver bullet.
I've found valerian root extract can be helpful sometimes but it doesn't seem to work for particularly long, whatever the underlying compound is it must have a short half-life.
My psychiatrist says in her experience lavender takes 6-8 weeks to show any effect, and it only gets you a 10-20% improvement. She prescribes it as an add-on when the existing treatment regimen is mostly working.
Heavy exercising, especially aerobic exercising. Something light like half an hour walk isn't enough, I have to properly exhaust myself calm the fuck down. Some different workouts that are usually enough are: one hour of heavy barbell training at the gym, 45 minutes of running, two hours of brisk walking.
Also interacting people in a non-bullshit way works but is often more difficult to do. Keeping up appearances and roles works the opposite, but if I tell people what I actually think and let myself be more emotional and less reserved around them, I actually feel more connected, which alleviates anxiety.
I think that at the hear, anxiety is born out of insecurity. Being connected (in a real, non-pretentious/bullshit way) with people raises my security. However, this is often easier said than done. I guess exercising works as a sort of a patch by reducing my energy levels so much that I don't any left for my anxiety.
> Heavy exercising, especially aerobic exercising.
Possibly all this activity means hour(s) of not-stressor focus is calming you down. All your "free" time is exercise instead of stewing.
To rule out the time, swap these high time consumption activities for 4 minutes of HIIT (high intensity interval training) bookended by 2 mins warmup and 2 mins cooldown, which is proven to have even better metabolic benefits due to the 4 minutes of anaerobic intervals (sprints).
It's a shame more people don't know "this one trick". Few of us have extra hours a day to gambol about. Most people can find 8 minutes.
> I think that at the heart, anxiety is born out of insecurity
Maybe exactly at the heart.
As noted in a discussion here last week, there's a heart-brain link for anxiety, heart can cause the brain to feel anxious. HIIT improves heart better than, say, beta blockers, so it could be the mechanism is something like exercise is improving heart which signals less anxiety to brain.
I've had enough lifestyle variation to say with quite good confidence that it's the aerobic exercising that helps me. Before I learned to manage my anxiety I tried to calm down by just, you know, lying down and trying to relax, but it never worked very well. My mind would just generate more anxious thoughts and it would often get worse, not better by just relaxing.
I've also don HIIT and I can confirm that 15-20 minutes of HIIT (maybe 5-7 intervals with a bit of warmup) provides the same results as one hour of more moderate form of aerobic exercising. However, HIIT, when done properly, is fucking horrible (several times I've been very close to puking afterwards). I still do it maybe once every two weeks, but I think I would die if I tried to do a proper HIIT workout every day.
That's exactly what prevented VersaClimber (a 95% muscle recruitment machine that gets it done in 4 intervals of 40 seconds on 20 seconds off) from getting popular. It made people puke. Apparently this is disconcerting in a sports club or gym.
Martial arts was always my natural medicine. Have not been training much the last year or so, hoping to get it back on track but it worries me as I can't do that forever as I get old.
I am convinced that lack of exercise is exacerbating a lot of peoples mental issues (not claiming it is the cause, however).
Think about dogs. Anyone who has owned a larger, high energy dog knows exactly what happens when they do not get regular and intense exercise - they become an anxious mess and often become destructive or even self destructive.
Cutting out alcohol was probably the biggest one. The effects of alcohol on anxiety can last days for me. Low carbohydrate diets seem to really help as well for me. Minimizes highs and lows.
This is interesting because I've only been able to get over my anxiety after being prescribed memantine for sensory/audio processing disorder (SPD/APD).
Looking back I was constantly in a state of hyper-awareness that was so intense I couldn’t understand speech in real-time or move smoothly (keeping a beat took 100% concentration so I couldn’t learn an instrument) without total concentration. I also had hyper-sensitivity to touch. All this was from severe CPTSD growing up.
Memantine is an NMDA uptake inhibitor (probably). But I don’t really know anything about what role NMDA plays.
Memantine slows the amount of calcium that enters the NMDA receptor in a way similar to magneisum. Zicn also inhibits NMDA but by a different mechanism
It is the calcium in the cell that triggers nerve excitement and oxidative stress that triggers the anxiety. I am over simplfying all of this.
I have the opposite problem. I have slow NMDA receptor function but my Anxiety is caused by issues inside the neuron (NOS1). Magnesium gives me anxiety.It may be that my porr NMDA receptor function helps me a bit.
Really the root cause is low Cyclic Adenosine Monophosphate (cAMP) signaling in the neuron stemming from low Nitric Oxide or slow NMDA receptor function.
Thank you for clarifying. I know a bit about the brain and brain chemistry, but I was unfamiliar with NMDA receptors.
Unfortunately the rest of your explanation was too technical and I didn’t follow any of it. Can you explain what NMDA receptors are for and what the link to anxiety, in either direction, is?
My anxiety wasn’t caused by this, but I was able to treat it because of the memantine. I just stopped memanitine a month ago after about 5 years and all the symptoms seem resolved now.
You are saying that your anxiety was not casued my NMDA receptor changes, but it was. Traumatic events change the function and density of these receptors.
NMDA receptors allow calcium into the neurons. The more calcium in a neuron the more excitable it is, like in hyper-arousal.
By taking the memantine you allowed you possible grow more healthy neural pathways, away from the hypervigilance and towards calmness. I am assuning you have been in therapy?
Sure, on a technical level, but the cause of it, globally, was several layers up the abstraction stack. It feels like blaming the add and multiply instructions for poorly written firmware/software, especially since it resolved itself once I addressed the issues I listed below.
Thank you for the paper. That's just the kind of thing I was hoping to find.
The experience of going on memantine for the first time was like becoming in sync with my body for the first time that I could remember. My body, mind, and thoughts stopped being out of sync, like a video that wasn't streaming well. That allowed me to slow down (and not try to anticipate the ten different ways a conversation could go), stop rambling, and listen to what people were saying to me instead of what I expected them to say.
I'm only seriously pursuing therapy now; hyper-independence is another symptom of my CPTSD. I learned all this by trial and error and reading ungodly amounts of self-help books (moving to psychology books lately), helping my wife through losing her parents at 21, and teaching my wife to work through her PTSD.
What allowed me to be calm was learning to trust, at least to some extent, people again (which I didn't even realize was an issue) and learning to express my emotions (I had nearly total blocks on sadness and fear). Then slowly processing the traumatic events from my childhood. After I forced myself to cry about one event (the last time I cried as a child) and allowed myself to feel fear about things I couldn't control, my chronic anxiety faded, and now it is situational. I continue to work on the underlying causes of these distinct reactions.
It is very difficult because fear of being like my dad or being poor drove me so hard for 20+ years to become a software engineer and make it into a top-tier company. Without that desperation, I have to relearn (learn?) how to live and do things.
I'm definitely curious as to how you got to such a nuanced diagnosis / underlying mechanism for your anxiety. After an overnight sudden change, I'm told I've been stuck in 'fight or flight', constantly, for about 20 years. I've gone from MRI to many medication trials to genetic testing / perfunctory bloodwork, to therapy to yoga to sriracha enemas (kidding), but never got anywhere beyond feeling like the science overall is nascent at best, and a total load of snake-oil quackery at worst.
Your miles seemed to have played out differently. How did you go about arriving at the underlying pathology, so to speak, and how confident are you that it is 'the right answer'? Are you under the care of a doc / neuro / psych? And if so, do they take your NOS1 explanation into account when treating you?
This is important, you need to look at your total environment to see what changed. It could be anything from air pollution, diet, EMFs. Anxiety always has a trigger and it is not always psychological.
> I'm definitely curious as to how you got to such a nuanced diagnosis / underlying mechanism for your anxiety.
I went through everything you did, but once I noticed so many people were doing the woo woo route and nothing helped, so I decided to learn about neurobiology, genetics and nutrition. Almost everything you will read about anxiety and mood is wrong. (For example, low serotonin is the result of high GABA, and it is the high GABA that causes depression, not the low serotonin or dopmaine, that is just a result of the low GABA. https://www.nature.com/articles/s41380-022-01730-4)
I was anxious as a child, and had OCD, so I knew it was genetics. My mother had mental health issues as well all up her side of the family. 20 years ago I ended up on disability and doctors were of little help, just felt drugged all the time, so I set off to research neurobiology since I had the spare time and lived next to a university research hospital.
Then when 23andMe appeared I jumped on it and it was all right there. But it took years for more research to come out which narrowed in on my problem. First it was genes like CACNA1C and SLC6A4, but when I saw many immune genes linking to my Ankylosing Spondylitis (ERAP1) it became a bit more confusing. I kept seeing so many genes that needed zinc flagging in my genome. High does zinc fixed my autoimmune issues, as did long chain omega 3 (FADS1, FADS2 also linked to mood). But the studies I began to read about NOS1AP matched my genetics so I dove head first into that pathway at it ll became clear how glutamate was casueing my anxiety and paranoina and psychosis.
I also have changes in GCH1 that controls the amount of serotoin and dopmaine we make. I am in a study at Stanford as they feel it is linked to ME/CFS. I was diagnosed with CFS years ago but I only have infrequent symptoms now.
I have one doctor who knows I know what I am talking about and gets me some tests that might help me see what is going on but this is all research level stuff, nothing and doctor will see for years if ever. I am on Medicare, fully disabled, so it is hard for her to get some weird tests but she tries. She also helps me get meds I feel might help that might not be her first thought. But meds are no answer, they work until they do not.
Glutamate/GABA imbalance and nitric oxide will soon be recognized as the drivers of mood disorders.
I am confidant I am right because all my friends have see the change in me. Plus I no longer needs meds.
If I had you genetics I could probably see what is going on with you. Let me know if you want me to take a look: followingthedao@fastmail.com
I was first diagnosed with ADHD in 2016 then a year later with ASD. Adderall helped a lot, but there were other symptoms that continued bothering me.
Between me reading and learning more about my problems and working with my psychiatrist we tried many things. Having someone so reflective and motivated led him to be more experimental with treatments for me. Also, he was an ADHD specialist who started researching autism because he suspected his son was autistic too.
That's how we tried memantine. It seems to help in a small percentage of APD/SPD cases, but no one knows how or why.
This thread was how I found a hypothesis for why it worked for me. Six years after I first started memantine.
Having an engaged healthcare / mentalcare provider makes a huge difference! I'm going to run memantine past my son's doctor, who is also quite engaged.
Yes, I have. But yiou will really need your genetics to figure it out. There are many pathwyas that when slw or fast that can lead to anxiety.
I have my genome and found that I carry a change in a gene called NOS1AP. This means I do not produce enough NOS1 (Neuronal Nitric Oxide Synthase, nNOS, CAPON) which leads to an influx of calcium through the NMDA receptor.
So basically I have low NOS1 and typically higher amounts of glutamate and there for I am very excitable.
Klonopin as needed helps in emergencies but I rely on a few dietary changes to limit bio-active compounds from inhibiting NOS1. These include limiting a large range of phenol's that inhibit NOS1 and avoiding air pollution (air purifier with activated carbon).
P5P (B6) helps as well because I have issues truing glutmate to GABA via the GAD1 enzyme. I also eat lower protein and zero MSG like flavorings (Pea Protein Extract)
Doing these things has lead me off of all my meds, which is huge.
I also have latent CMV which at times effects me since it increases NMDA receptor function. CMV also gave me ankylosing spondylitis and lung nodules.
When I have anxiety spells, I force myself to do something creative like draw or paint. It helps, but this is not exactly available if you have a panic attack in the middle of a work meeting or something.
Cognitive behavioural therapy, specifically for this: evidence vs assumption.
Making assumptions is part of life, but it is important to verify a lot of them. The system responsible for keeping you out of danger fires in a "better safe than sorry" manner. If you never train this response then it'll be inaccurate and it'll fire off all the time and you get anxiety. Likewise if the system has been trained by an entire school career of bullying or negativity it'll need recalibrating (are you going to get bullied as an adult for standing out? At least it's much less likely)
For example I wasn't going to go to a meet-up because I thought I wouldn't like it, or fit in, or whatever other reason - I was feeling anxious.
Looking back at actual times I've gone beyond my comfort zone in this way I realised that most times I end up a better person, with a new friend, or at least enjoyed doing it. Worst case I didn't get harmed in any way. Evidence overrules the assumption.
You don't want zero assumption of course, feel free to assume jumping off a cliff without anything to stop you hitting the floor at high speed will be a bad time, but for things other people are able to do without harming themselves or others at least give it a quick pros and cons check before bottling it.
Unfortunately it needs it real world experience. Think of it like working out; you won't get ripped just because you know how to use the machines, you've gotta use them too. On the positive side every time you push yourself successfully - and these don't need to be massive, the snowball effect works here - it's more evidence for next time. I now write down my thoughts and feelings before and after so I can actually go back and look at them in future if needed.
I'd highly recommend nerdy types try out CBT if it's a possibility, especially if they don't feel like the "how does that make you feel?" type of therapy is worth doing (I need ideas and solutions, not a soap box!). It works really well for me anyway, it's like debugging my brain.
Standard disclaimers: Don't use this comment as an alternative to medical advice. What I know may not be what the therapist taught me, this is my interpretation of that information. This isn't the only thing I've learned in CBT but it is pretty foundational for it to work well. As far as I know so far. Works on my machine.
I've only recently realised I think I have a problem. Last week had horrendous migraines and anxiety which I couldn't shift. I had to go to the doctors (UK) and beg them to help. I generally live healthy, don't really know what else to do.
I'm now noticing my WFH job is starting to get to me so looking to go into the office once a week or more.
I picked up a few useful tricks from Cognitive Behavioral Therapy that I use to this day, but the best lessons came from eastern philosophy.
Anxiety isn't a disease - you don't 'have' it. Everyone experiences anxiety. It's a temporary signal, like stomach butterflies or being starstruck. What happens next after experiencing these signals is up to you. You can let your ego take control, or acknowledge the experience and let it pass. Sometimes it's a useful signal to act on. Many times it's not. Think of your body like a tuning fork, the anxiety is you vibrating in reaction to a new experience. There's nothing inherently good or bad about new experiences, it depends experience to experience. Therefore the anxiety reaction should be taken under advisement but confers no knowledge about what's to come, and shouldn't be treated like a warning indicator.
Therapy, Ativan, Running, Meditation in roughly that order.
Therapy helped defuse the worst of it quickly and gave me the tools to manage it moving forward. Easily some of the best time and money I've ever spent, though I consider myself incredibly lucky to have found such a compatible therapist.
Ativan was always more of a placebo for me. I never took it more than a few times per week and I haven't taken any in years. But I still carry one in my wallet at all times, and knowing I have that option puts me at ease.
Running for me is a very efficient way of generating that after-workout high that tends to eclipse anxiety, at least temporarily.
Mediation may be the best tool of the bunch, but I've never been able to adhere to a regular schedule. But even on an intermittent basis it can be helpful. I believe the form of mediation I've practiced would be called mindfulness.
As an OTC supplement, I occasionally use Sceletium Tortuosum extract, which is marketed under the trademark Zembrin. Sceletium Tortuosum is a South African succulent plant that has been chewed by the San tribe people for thousands of years under the name Kanna. (recall N!xau ?Toma in "The Gods Must Be Crazy")
There have been recent peer reviewed studies showing it both safe and effective, and placebo or not, I have noted relief of my symptoms. It's also rather inexpensive compared to a lot of other supplements, at around $0.30 for a daily dose.
These are mostly for managing your baseline anxiety levels:
Valerian capsules help, but get a good brand like Oregon's Wild Havest, valerian tends to pick up lead in the ground. Valerian helps a lot with panic attacks, too.
Make a habit of drinking rooibos tea. After it builds up in your system it counters cortisol (in my experience, very effectively). Mountain Rose Herbs sells quality rooibos.
Cut out caffeine, or try to limit it to green tea. Green tea has L-theanine in it, which helps with anxiety. I'd like to point out that caffeine doesn't leave your system completely for quite a while and reduces your quality of sleep leading to cognitive decline over time.
Eat well, sleep well and go outside more, preferably involving vigorous exercise.
(I have no affiliation with the brands mentioned above but if you're going the herbal route, quality is an important factor and those brands have worked quite well for me)
If you talk to yourself a lot I'd recommend a pet to talk to instead. Externalize your self-talk and try to make it nicer. Use the pet to rubber duck solutions to life's problems.
ADHD medication. My ADHD was so bad that I couldn't get out of bed consistently without having the blanket forcefully ripped away from my body. Didn't have a 24 hour schedule either because I'd randomly just become unable to get out of bed and fall asleep early even if I wasn't actually tired.
Obviously don't look into this unless you actually have ADHD. However, if you haven't actually done research on ADHD in adults, you shouldn't rule it out until you have.
Cutting out gluten, oddly enough. I found this out while going on a keto diet and eating some bread on a cheat day. I later found online that gluten can digest into opioids so it made sense why I felt tired often as well.
My therapist gives me a neutral, third-party perspective. I do talk therapy, but I have tried CBT and it wasn't a good fit for me. CBT felt very linear and goals based, where talk therapy feels more exploratory and relaxed.
Lexapro was a struggle in the beginning. The biggest hurdle to overcome was feeling like I was being "controlled" by a pill.
Meditation has done wonders. I aim for 5 minutes before I go to bed. Helps to clear the mind, process emotions and feelings, and let's me check in with my body to feel out stress and pain.
I don't have it anymore. I think that anxiety is just a symptom of being disconnected from the body - just not having proper body awareness. I think that many people get pulled into anxiety (at least those visiting this site) through their work (and as for the general population, ever-present infinite scroll feeds have the same effect). When you spend a lot of time in front of a computer, you don't have to use your body at all, you get sucked more and more into the intellectual world and the body awareness you were born with gradually erodes. Now you have no control of your body, which means your emotional control is lower as well. You are more prone to the effect of random thoughts that create anxiety and don't know how to pull yourself out.
That was me in my teenage years and early 20s. At some point I started doing Zen meditation (and not just like 20 min / day, way more). The basics of Zen practice are basically body awareness, being mindful of the surroundings and dismissing thoughts / calming down the mind - in other words, learning naked attention. My problem with anxiety was that I was sometimes hyperventilating when walking alone outside. What did that look like internally? Drowning in my own thoughts, no awareness of the body, hyperventilating, poor, fog-like awareness of the outside. Pursuing Zen aggressively allowed me to fix everything about that internal imbalance, it took some time and effort though. Maybe I have just learned to ignore it (by refocusing on the practice) and the negative pathways in the forest of the brain grew over, that surely is at least part of what happened, but I also do experience slight anxiety comeback from time to time (but nothing near hyperventilating) and I am able to defuse it in 20 minutes - and it always follows the realization that, oh I'm just too much in my head, I don't have proper body awareness, so I just focus on that again, to focus on the outside, to bring my centre of attention to hara, I start to feel much more control of my body and anxiety cannot co-exist in that state.
The gist of it is that, Zen practice or not, anxiety is a physiological state and you can exert a lot of control on your physiological and emotional state through regular practice in the long term.
I can only speak from my own experience, but I'm pretty confident that this would work for the majority of cases but the most severe perhaps. Of course, we would never ever see this is as the mainstream cure for anxiety - it's too much effort (10000x ?) vs. a quick-fix med. But if you are really really determined to fix this and put a lot of time into it, you probably can. To me, my day to day internal state is just as important as general health, I have long term goals but I live for the moment and cannot envision going through negative mental states on a daily basis, I would just do everything to fix it, and having it done (and continuing to do it - practicing Zen, use it or lose it), I would say without a doubt that was one of the best time investments in my entire life (past and future).
Of the genes they note in the study (GAD1, NTRK3, ADRA2A, FZD10, GRK4, and SLC6A4), I have significant polymorphisms in GAD1, NTRK3, and SLC6A4, But I also carry NOS1AP and GRIN2B changes which also are more highly correlated with anxiety.
The NTRK3 was a new one for me.
I have Aspergers, Schizoaffective Bipolar Disorder and a panic/anxiety disorder.
I would have loved this. I had been fine my entire life until one day I started feeling panic and subsequently had several panic attacks that week and developed the related agoraphobia. It would have been great to see what biomarkers had changed and ideas on where this suddenly came from. The current treatment doesn’t care about the underline reasons as much as immediately giving you a SSRI.
I was taking a lot of supplements - basics like magnesium and fish oil, all the way to choline, some mushrooms, amino acids, EGCG etc. Nothing crazy or illegal but certainly more than the average person takes. Unfortunately even after stopping for months the panic disorder didn’t go away. Otherwise at that time work was easy and my life was not stressful. It’s a mystery.
Almost like messing with your own biochemistry caused a change in your biochemistry. I'm glad you moved away from it; nobody needs supplements if they don't have an underlying medical condition and eat normally, no matter what the supplement pushers try to tell you.
Also, you mention mushrooms, is that the magic kind? That'll mess with your brain chemistry for sure.
Yeah taking random psychoactive chemicals in untested combinations can do that to you, lol. It always amazes me how uncritical people are of "natural" drugs, as if they're somehow implicitly safe and exempt from interactions, unlike "synthetic" drugs.
> The current treatment doesn’t care about the underline reasons as much as immediately giving you a SSRI.
I had panic and anxiety a lot, it turned out to be ADHD. My brain wasn't getting enough stimulation from reward and good feelings so it apparently supplemented it with anxiety and bad feelings. It's also where my OCD came from.
Once I started on ADHD meds, all my depression, anxiety, and a lot of OCD just... went away.
So yeah, I also wish more doctors would consider things other than SSRIs.
can I ask what you take for this? I'm taking ADHD meds and they were working for maybe a month or two (long-acting) and now only the short-acting meds work, but there's national shortages and I can't find it anymore. Simply sucks!
Can’t speak for OP, but I can say a few years in that med tolerance builds up. Before the shortages I had a pretty good routine with my dr switching every 3-6 months. Even for almost identical meds, the slight chemical or metabolic change has been helpful. With shortages? Idk good luck :(
I take dextroamphetamine sulfate XR, but I've only been taking it for around 3 weeks so I can't say anything about making it past the 1-2 month mark yet.
I can say however that the brand matters, because accidentally taking the wrong brand put me in a hypertensive crisis for 2 days straight until I realized what was going on.
(I would have posted this reply around 10 minutes after yours, but I got hit by "You're posting too fast. Please slow down. Thanks.". Apparently this means a moderator reviewed my posting history and thought I was spamming)
I also discovered that treating my ADHD roughly solved my (chronic) depression, and made anxiety manageable. My anxiety was far past debilitating by this point, my life had basically collapsed.
Kind of amusingly, my executive function improvements aren’t nearly as pronounced as most earlier diagnosees tend to report. I’m pretty much the same functioning-superhero-or-hyperfocused-trainwreck I always was. I just get a whole lot less anxiety from existing as that.
Anyway, diagnosis and meds to treat it saved my life. Didn’t make me a lick more productive or better at controlling focus. They just let me be kind of at home in my body and brain and environment.
I've been on stimulants for a year now, and I'm noticing it's the baseline that has lowered (so when I'm calm I really am calm), but the threshold to anxiety is lower as well, so I need less to reach an anxious stage.
So sometimes it's hard to say if it is a net positive.
That said, my life is a little upside down at the moment, so perhaps I should not blame everything on the meds.
That's strange, but the article talks about 5HT2A receptors, and not about Ashwagandha. I know you mean that there could be a link in theory though. I'll do some research on this, thanks. Personally I only take a capsule when I'm stressed and it does the trick. I don't take it habitually.
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