Anxiety and Panic Disorders

30% of the American population experiences clinically diagnosed chronic anxiety. About 70% of its patients who walk into our office experience anxiety. Anxiety is defined as an excessive fear response and/or worry that interferes with functioning or causes significant distress. This is – according to the Diagnostic Statistical Manual, Volume 5 – the gold standard text book for psychiatrists. In their world it’s a psychiatric disorder. But Dr. Ted Carrick, the developer of the discipline of functional neurology feels it’s more important to emphasize the role of the abnormal functioning of the basal ganglia as the underlying functional causal mechanism as the personality disorder diagnosis label of “anxiety”.

The basal ganglia is a processing unit deep in the brain that decided whether we can have an action-like movement. It decides whether we can move our eyes, it decides whether we can have an emotion. The basal is, in effect, the gas pedal and the brake, for all neurological brain functions.

When the basal ganglion is functioning well, technically, we are calm. However, when the basal ganglia starts to break down due to one of a variety of causes, tremors of the hand, or restless leg syndrome, or Tourette’s syndrome can occur. Anxiety is really the result of some neurological phenomenon except that it a different part of the basal ganglion is involved creating the disorder.

There are two types of anxiety – productive anxiety responses and non-productive anxiety responses. An example of a productive anxiety response would be the frail grandmother who sees her grandchild trapped in a dangerous situation – i.e., the child pinned under a car. Without thinking, she runs over to the car, lifts the car off her granddaughter and saves the day. Obviously a productive action. But how does that happen? Grandma’s fear-based response flooded her system with stress hormones that allowed her to produce a maximum muscular contraction effort far beyond what would be expected by a senior citizen under normal circumstances.

Chronic fear-based anxiety responses are not productive. Again the literature tells us that approximately 30% of the American population experiences chronic (daily) fear based responses. This is the person who has nothing fearful impending and they don’t have a tiger two feet away preparing to attack, yet they’re in fear as though they do. They’re constantly worrying about the future and what might happen. These are maladaptive fear based responses and are not productive.

Panic attacks are neurologically similar in nature to anxiety. They too are not psychological but are in fact fear based physiological problems. In panic attacks the most debilitating feature of them is that they happen when you’re not expecting them (making it kind of difficult to legitimately classify it as a psychological disorder). This unexpected panic reaction in turn creates more fear. You get hit with a sudden “panic attack” and your heart races above 100, you feel like someone is sitting on your chest, you have chest pain, and you’re worried you’ve just had a heart attack. You’re sweating and you don’t know why. The reason these symptoms occur is that there are imbalances in the fear processing circuits in the brain and there is excessive activation of the amygdala.

The amygdala is called the fear center of the brain. When you’re presented with a fearful circumstance, the amygdala fires off like a fire cracker and sends different signals through the rest of your brain activating your fight/flight response. A response that is primarily intended to be a “survival” mechanism. This response is the real igniting and causative factor of both anxiety and panic disorders. It’s an over-firing fear center in the brain that in the panic attack/anxiety sufferer is more hyperactive and more sensitive to normal stimuli that is the average person’s brain. These igniting stimuli can be light, sounds, over exercise, auto-immune response, surgeries, traumas (both emotional and physical), overwhelming infections, and more. If your amygdala is over-reactive, these stimuli can set up a sensitive amygdala and once it is stimulated by an emotional response, the fear based attacks become chronic.

What make the amygdala oversensitive? Chronic physical, verbal, or sexual abuse, long standing stressors like alcoholic parents, combative divorce, the long slow lingering death of a loved one, war, and most any abnormal trauma (having someone put a gun to your head). These severe emotional traumas not only powerfully chemically stimulate your amygdala but make it GROW!! Thus increasing its ability to create fight/flight response at the drop of a hat.

Back to the basal ganglion and its relationship to anxiety and panic attacks. Your frontal lobe (think forehead part of the brain) has many functions. One of its most prominent functions is associated with thoughts and emotions. These can be positive emotions or fear based emotions (psychological counseling affects this area of the brain). To have these emotions, the frontal lobe must get its command from the basal ganglia (remember? It starts and stops things). One of the neurological pathways of the basal ganglion shuts off unwanted thoughts and is dependent on frontal lobe functions as well. In anxiety and panic disorders this frontal lobe function becomes abnormal and it then loses its ability to help the basal ganglion put the brakes on the amygdalal fear based response. The frontal lobe itself becomes overactive and there we are – we have anxiety and panic attacks – better known in the functional neurological and functional metabolic world as an over firing frontal lobe. Period.

So in summation, you have a brain whose ability to withstand normal daily stimulation (stress) has been set up to be over reactive due to past emotional traumas enlarging your amygdala, is then set off by one of the many triggers mentioned above that then overstimulate an already vulnerable amygdala, all of which overwhelms your frontal lobe which, along with the basal ganglion loses its ability to “put the brakes” the amygdala – and now you have anxiety and panic attack “disorders”. This same mechanism plays into generalized anxiety disorders, social anxiety, obsessive compulsive disorders, and phobias.

The standard approach in today’s world is drugs. But what the functional neurologists realized is that if you go deep down into the brain and exercise and strengthen the different weakened structures (frontal lobe, basal ganglion) of the brain and make them stronger that they become far more able to shut down these fight/flight responses (overactive amygdala) before they ever occur. Functional medicine came to realize that by dealing with the major metabolic components of brain chemistry and normalizing them (blood sugar, hashimoto’s, inflammation from leaky gut, food sensitivities, and more) you could also decrease the above outlined neurological mechanisms and chemical responses to fear-based stimuli and reduce panic attacks and anxiety. At Power Health we’ve found that combining both approaches seems to work the best. So though counseling and drugs can be good short or long term solutions to both it would appear that the functional approach of getting the brain to work better on its own without medication is a superior long term approach relative to not creating many of the side effects associated with “psych” drugs and allows the person suffering from “anxiety” or “panic disorders” to also get out from under the stigma of being labeled with psychological “problems”.