Anxiety, Depression & Mixed Anxiety/ Depression

Two Expressions of Similar Problems

Anxiety and depression are becoming some of the most common chronic illnesses; they are now almost twice as common as heart disease.  Of great concern is the frequency of these disorders in adolescents.  The Substance Abuse and Mental Health Services Administration released the 2013 statistics which reported that 2.6 million adolescents were diagnosed with a clinically important depressive episode that year, up from the total of just 1 year earlier.

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From a metabolic viewpoint anxiety and depression can be looked at as 2 different points on a continuum.  In anxiety brain activity is heightened causing increased production of neurotransmitters such as serotonin to “buffer” this effect.  With time the brain will deplete these neurotransmitters and symptoms often switch to a depressive pattern.  Many persons get caught in the middle with over-excitation in the brain expressing anxiety symptoms with intervals of neurotransmitter depletion that mix in symptoms of depression.

As the image above suggests current research is indicating that the neurotransmitter imbalances in these disorders are likely to occur later in the process from other changes in the brain which trigger the symptoms.  As the brain runs “out of balance”, over time the neurons begin to deplete neurotransmitters allowing the disorder to progress.  While drugs that try to increase neurotransmitter signaling may help symptoms some, it is typically only moderately and is unlikely to be addressing the cause of the imbalance.

A key piece of information suggesting that anxiety and depression are caused by the same factors and are just different degrees of the same imbalance is the observation of the heavy overlap of certain symptoms in both disorders as shown below.

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What Metabolic Related Issues Drive Mood Disorders?

Extensive research has found several factors which contribute to the onset of anxiety and depression.  These factors are interrelated and include:

  • Chemical/inflammatory brain stress
  • Mental stress
  • Abnormal cortisol signaling

Inflammatory stress can be generated anywhere in the body by the immune system. Perhaps the most common area of immune inflammatory activation is in the gut. Chronic imbalance of the several trillion bacteria that live in the gut can be either a potent source of anti-inflammatory signaling or a chronic inflammatory generator depending on the relative populations of different bacterial species.

This bacterial population develops based on exposure during early life from maternal transfer during birth and from nursing.  Factors such as caesarean birth, not breast feeding adequate time, maternal antibiotic exposure during pregnancy, early life antibiotic use all can cause long-term alteration of the microbiome population.

Once the immune system increases inflammatory signaling it occurs throughout the body, and the brain is one of the most sensitive tissues to the negative effects of inflammation.  Inflammation has been found to interfere with the function of cells called glial cells that work to keep the neurons adequately nourished and maintained.  When this happens the functioning brain cells, neurons, begin to dysfunction.

A recent study examined all of the research on the use of probiotics to try to re-establish the anti-inflammatory type of gut bacterial population.  The study concluded “These results show that probiotic consumption may have a positive effect on psychological symptoms of depression, anxiety, and perceived stress in healthy human volunteers.”  Study in this area has led to the development of a new term, “psychobiotics” meaning probiotics for psychological effect.

The diversity of chemical imbalances that may affect brain function in addition to inflammation are highlighted in the graphic below.  These stressors may be those of inadequate supply such as inadequate amino acid supply to make neurotransmitters and inadequate nutrient co-factors needed to activate the enzymes used in neurotransmitter production.

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Food sensitivities are common causes of brain inflammation and thus anxiety/depression.  Inflammation activates “danger” signaling pathways in the brain.  While this is helpful in short-term situations where danger is real, chronic activation signaled by inflammation trains the brain into an over alert state in which “normal” things trigger hypervigilance or anxiety.

One of the more common food sensitivities, gluten sensitivity, has been shown to deplete serotonin in the brain which is a factor in the transition from anxiety to depression.  Gluten reaction both interferes with the digestion and absorption of tryptophan, the amino acid that serotonin is made of, but it also causes the brain to use the available tryptophan to make an inflammatory protein kynurenic acid at the expense of making serotonin. Kynurenic acid increases anxiety signaling in the brain while serotonin reduces it.

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Chronic mental stress trains the brain in a similar fashion.  One of the chemical messengers the body uses to prepare all areas to deal with danger or stress is the adrenal hormone cortisol. Chronically excessive cortisol levels train the brain into a sustained state of high attention which causes the brain to “overreact” to normal situations which is the anxiety state.

Cortisol is a multi-tasking hormone which is released in response to several factors:

  • Mental stress
  • Low Blood sugar
  • Inflammation

Each patient with anxiety may have any or all of these factors triggering chronic cortisol activation.  They all may have several causes of the each factor such as a food sensitivity and a chronic gut yeast infection triggering inflammation which activates adrenal cortisol.

 

Treatment

The treatment of anxiety and/or depression first involves thoroughly evaluating all of the potential driving factors mentioned above, it is done with a combined program to address triggers that imbalance the brain activation patterns such as inflammation, and  neurofeedback or “brain training” to rebalance the abnormal brain activation pattern.  Neurofeedback uses a quantitative EEG (QEEG) to examine the patterns of the dominant brainwaves in each area of the brain to look for imbalances.

Anxiety typically activates the front areas of the brain called the frontal attentional network.  This is the network that causes the intense focus during danger.  With time, the brain learns that activation pattern and begins to process normal information as it would danger.  While the frontal attention network is activated, memory processing is inhibited.  This is thought to allow the brain energy resources to be devoted to the attentional areas.  Memory difficulty is common in anxiety and depression.

Another feature of anxiety is that the brain tends to process too much information through the right side which causes a somewhat more emotional perception of the information being processed.  The left side of the brain processes somewhat more analytically and flat.  When both sides are balanced in activation, things are perceived with a good balance of emotional and analytical processing.

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A right processing dominance in anxiety is shown here looking down on top of the brain areas on a QEEG brainmap.   The emotional processing is done more in the right side of the brain.  Chronic stimulus to the emotional areas eventually trains them causing an ongoing over-activity of the right brain.

Anxiety is a disorder classified as “brain too fast” where the brain excessively processes and reacts.  This eventually can begin to use up the neurotransmitters the brain uses to send communications from one cell to the next.  As the brain begins to deplete neurotransmitters, the brain becomes too slow and depressive symptoms begin.  The brain also depletes neurotransmitters in the right side of the brain allowing dominant processing through the left side as shown below.

Often a long intermediate phase exists where at times the brain is too fast and other times too slow as it begins to deplete neurotransmitters resulting in mixed anxiety and depression.  Interestingly, supporting this theory of anxiety and depression being different stages of the same problems is the common observation that the same drugs may benefit either anxiety or depression as well as mixed anxiety/depression.

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Eventually, the neurotransmitter production cannot keep up need, and “slow brain” or depression occurs hallmarked by too excessive left brain processing and altered brain wave activation associated with neurotransmitter depletion.

Often the brain will need to be “re-trained” back into a normal activation pattern with procedures such as neurofeedback which is EEG guided brain biofeedback.  Perhaps the best trait of the brain is it learns.  Anything that is repeated enough will connect circuits in the brain learning and remembering that pattern.  Unfortunately, this learning applies to potentially harmful things such as chronic exposure to stress, inflammation or chemical imbalance.

Once the brainwave imbalance pattern is found with a QEEG brainmap, neurofeedback sessions are done teaching the brain wave pattern to normalize.  This typically “resets” the stressed brain allowing the normal restoration of neurotransmitter levels with time.  Once normalized brain function is re-established, it remains balanced unless the original stressor such as a food sensitivity is activated again.

Neurofeedback is one of the most established and effective non-drug treatments for anxiety and depression.  Combined with nutritional management of the triggering problems, it results in a safe, natural and lasting solution.

 

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