In the past 5 years, science research has shifted perspective in understanding long term anxiety and what it means for treatment. Latest science research is clearly less about “finding a stronger SSRI or another new medication” but instead, a more complete understanding of why the nervous system stays stuck in the loop of fight flight, always under threat or fear.
This long awaited and exciting research tells us that anxiety needs to be seen as a multi-systemic state, rather than simply a hormone imbalance that needs fixing. The old model told us that anxiety was simply due to serotonin imbalance, and while serotonin plays an obvious role, the research goes deeper. More evidence mounts revealing relative shortfalls in the old approach often labeling anxiety as treatment resistant.
This so-called ‘treatment resistant anxiety’ can be due to a number of factors including unprocessed emotional patterns or trauma, GABA inhibition (where the nervous system has difficulty in down regulating the stress response, so it stays switched on), glutamate dysregulation, where the brain is over stimulated by repeated signalling, the HPA axis dysregulation, with stress hormones stuck on high alert in the background, and a general autonomic nervous system imbalance through nutrient and mineral depletion from inadequate dietary intake, prompting low vagal tone and keeping the loop spiraling.
The research helps explain why medications targeting serotonin alone cannot completely resolve symptoms.
There is also an increasing body research showing that chronic anxiety is also linked with low grade chronic inflammation throughout the nervous system and body. Where there are elevated inflammation markers such as CRP and IL-6, we tend to see anxiety symptoms, and this in turn reduces neuroplasticity - meaning that people will be less likely to respond to medical protocols and SSRIs and even talk therapies.
One of the strongest emerging areas of research is on the gut-brain axis. The fast growing body of research (essentially looking at the vagus nerve pathway between the gut and brain), provides more of the complete picture of anxiety. We now are beginning to understand and recognise more about the role of gut microbiome and its interaction with hormones and other nutrients produced in the gut, including GABA, tryptophan, serotonin, vitamin B12 and short chain fatty acids.
Most importantly from a naturopathic perspective is the fast growing body of research on anxiety as a 'learned pattern' within the nervous system, which essentially is primed for our survival. This is at the core of the cutting edge research. If anxiety is a learned pattern for survival then it calls into question the old idea that anxiety is merely a chemical imbalance. And, as a learned pattern, it becomes foreseeable that a new pattern can be learned. We know this is possible due to the research into neuroplasticity.
In individuals who have experienced anxiety for many years, have tried multiple medications or other treatments without satisfactory resolution, and also who have had a history of chronic stress or past trauma, this new approach offers hope and is particularly significant.
From brain scans in those diagnosed with anxiety, we see overactivity in the amygdala (the area of the brain which essentially scans for threats) alongside under activity in the prefrontal cortex (the thinking area of the brain) we also see reduced blood circulation to the prefrontal cortex in anxious individuals. This makes sense when we consider that in a state of fight flight, or survival mode, we need to act quickly (from the amygdala) rather than stopping to think it through (from the prefrontal cortex) and so we need a boost in circulation to the hind brain. In a survival situation, the response needs to be fast, so our hind brain and subconscious will take over. This is a well known innate survival mechanism.
In anxious individuals, the constant looping in fight-flight or sympathetic nervous system dominance leads to further shut down of circulation to the prefrontal cortex leading to poor decision making quality and inability to extinguish fear responses. Decisions made while experiencing anxiety tend not to be well thought out, and often regretted. In turn, this elevated stress hormone production leads to further mineral and nutritional depletion, which if unaddressed further compounds the anxiety symptoms, and the cycle continues.
Interestingly, the new research on long-term SSRI use, has actually revealed an increase in common anxiety symptoms and sleep problems, possibly resulting from gut dysregulation (a common side effect of most medications). It’s of paramount importance to discuss this new research paradigm with the treating medical doctor or specialist to find possible alternative treatment options to maximise resolution of anxiety symptoms and increase in quality of life. You may need to take this research with you to an appointent to be specific in your questions so that you get the answers you need. If you’re unhappy with your mainstream treatment options, there is always the option of seeking a second opinion, or a third. Having good rapport with your treating physician is important in order to discuss your plan for recovery openly.
In terms of a scientific holistic and naturopathic approach, it is beneficial to first address the root cause, the mental and emotion load, the patterns leading to production of hormones and metabolites which contribute to the looping thoughts and emotional responses.
At the outset, one way of addressing the root cause is by the use of cutting edge mindset coaching tools to rewire the old patterns, along with multisystemic repair of gut health (stress hormones are only synthesised well in a healthy gut), repair of sleep patterns (to allow for glymphatic drainage, and for restoring mental wellbeing), and by addressing the impact of environmental and lifestyle factors and continuing stressors, with awareness of nutrients required to promote healing and also facilitate ongoing sustainable wellbeing.
Research now suggests that this approach is actually foundational rather than simply supportive. The resolution of anxiety symptoms is at hand. Speak to your naturopathic practitioner about the options available either to sit alongside your current treatment plan if that is your aim, or as an alternative for sustainable and optimal mental health and wellness into the future for a life you love.
