Friday, October 8, 2010

Update from the Anxiety Front

I believe I have previously mentioned that I have Generalized Anxiety Disorder (GAD), something I share in common with about 6.8 million Americans.

While Cognitive Behavioral Therapy seems to be the most effective way of dealing with GAD, I've been there, done that (BTDT). Nada. Medications like antidepressants, serotonin-specific reuptake inhibitors (SSRIs) and benzodiazepines are often tried, but they are not very effective and have unwanted side-effects (also BTDT). Meditation is sometimes suggested, and I've BTDT, too: it has little effect soothing my anxiety (but see below); sometimes the underlying cause of anxiety may be biologic (out-of-balance neurotransmitters is presently the leading hypothesis) and one might as well try to meditate away liver disease -- even the Dalai Lama, one of the world's Olympic champions in the field of meditation, is under the care of a doctor for his various physical ailments (he turned 75 years old in July). I've tried exercise (bicycling), which is good for me in many ways, but as anxiolytic therapy, it doesn't make a noticeable difference.

Back in August, my anxiety was exhausting me. I was tired of living with it (read my post here) and decided to attack it directly.

Things have improved markedly. This is an update on that.

I gave up coffee. I miss the taste of coffee but do not regret how coffee jacks my anxiety. It ain't the caffeine, it's something else in coffee because even decafe triggers the anxiety. Green tea and yerba maté are now my friends.

I enlisted the aid of a naturopath (Wendy Weintrob, Glow) who had me provide saliva and urine samples which were sent to a lab for analysis of neurotransmitter levels. I was sceptical about this, having been taught that large molecules like neurotransmitters cannot cross the blood-brain barrier (BBB), but a recent study has shown that neurotransmitters can cross the BBB from the central nervous system into our blood where they are excreted in our urine.

She found elevated levels of cortisol, an adrenal hormone, the stress hormone, and elevated levels of just about every neurotransmitter except DOPAC and epinephrine. Elevated cortisol, the "stress" hormone, is Not A Good Thing: constant stress is associated with cardiovascular and cerebrovascular disease.

(This is bleeding edge stuff: there are no definitive clinical trials that demonstrate the dysregulation of
these neurotransmitters as causative factors of anxiety -- we're working in the land of speculation.)

With this information, she started me on a 5-hydroxy tryptophan (5-HTP) supplement which supports the neurotransmitter GABA, and clinical studies have suggested that increased levels of GABA are associated with lowering anxiety. At the same time, she suggested that I take rhodiola, a supplement derived from the Rhodiola rosea plant, and which has been demonstrated to relieve stress-induced fatigue as well as the symptoms of depression.

Between the rhodiola, the 5-HTP, and giving up coffee, my anxiety has plummeted. Before I started this therapy, my general "background" level of anxiety was a 7 on a scale of 1 to 10. Now it's about a 3. Sometimes a 2.

My insomnia has been reduced, as well, by the addition of rhodiola and 5-HTP.

Placebo? I don't know and I don't care. The psychological and somatic improvements have been dramatic and undeniable.

Last weekend I ran out of the 5-HTP, the GABA-reinforcement supplement. I could have called to get more immediately, but since I was going to see Weintrob on Thursday, decided to just let it go and see if I noticed any change in my overall level of anxiety.

And did I ever. On Wednesday morning, a simple telephone call from a client inquiring about a technical issue spiked my anxiety up to a level that I hadn't felt since I began these therapies. It reminded me of how goddamn unpleasant living with GAD is.

I made arrangements to pick up a new bottle of the 5-HTP supplement later in the day. But in the meantime, I was miserable. "Why don't you meditate?" suggested Mrs Elliott. I explained that I've tried meditation in the past to alleviate the symptoms of anxiety, with little effect. But I was so uncomfortable that I decided to give it a try again.

So around lunchtime, I sat for 30 minutes and afterward, no anxiety.

Why did it help this time, but not the countless number of times I tried it previously? I don't know. I meditate differently now. I used to try to meditate in the "empty your mind" style associated with Zen buddhism. It's a tough row to hoe. A few years ago I was introduced to Dzogchen, a "nondualistic" form of Buddhist meditation (my reader will be interested to know that it's essentially the same as Mahamudra meditation). Once shown how, it's easy-peasy to do, easy as falling off a log, and effortless to maintain.

What can I say? It worked.

I'm on a tear, now. So, apparently, is science. Yesterday I read a new peer-reviewed metastudy in Nutrition Journal which examined the efficacy of herbal supplements and amino acids in the treatment of anxiety (summary here, paper here) in which they reviewed data,
[...] associated with a number of treatments, including St. John's Wort, S-adenosyl-methionine (SAM-e), B vitamins, inositol, choline, kava, omega-3 fatty acids/fish extracts, valerian, lavender, melatonin, passionflower, skullcap, hops, lemon balm, black cohosh, ginkgo biloba, extracts of Magnolia and Phellondendron bark, gamma-aminobutyric acid (GABA), theanine, tryptophan and 5-hydroxytryptophan (5-HTP).

They found, "[...] mixed results -- while passionflower or kava and L-lysine and L-arginine appeared to be effective, St John's Wort and magnesium supplements were not."

I can't take kava, it's not only rough on the liver, but is contraindicated in people who are taking cholesterol-reducing statin medications. But I betcha I can get some of that passionflower, and the amino acids L-lysine and L-arginine at Nature's.


  1. Glad to hear your anxiety has eased, Jack. I'd caution against rushing out to the store and buying supplements and starting to take them without your doctor's approval, though. Some of them might not be appropriate for your condition or appropriate to take in conjunction with the stuff she's already got you on.

  2. Thanks, B-dog.

    As I mentioned, kava is not a good idea for a couple reasons: hammers the liver and interacts badly with cholesterol-reducing statin meds, so that one is off the table for me.

    The two amino acids, L-lysine and L-arginine are found in foods. Large doses of one can cause digestive upset -- I'll see if I experience that -- and amino acids can be a bit tough on kidneys: the more amino acids they have to remove, the harder they work. People who eat low-carb/high-protein diets work their kidneys hard, too, and for the same reason. But I have no history of kidney trouble. There are no interactions with meds I'm taking.

    Passionflower (passiflora incarnata) can cause dizziness in some cases. No drug interactions I could turn up.

    I'll let my MD know when I next see her, but I expect I'm good. is our friend.

  3. interesting. I was looking into St. John's Wort myself, but it is contraindicated for women on birth control, so that's a no-go.

    Any raver will tell you about 5-HTP as some wonder supplement--diligent ravers take it for weeks before doing ecstasy and weeks after, hoping to improve their depleted serotonin levels and otherwise elevate their moods (many swear by it, though I would never mess with my serotonin like that in the first place, not while it is so tenuous).

    The others I have not heard of, though the amino acids sound alright. However, I have started eating meat again, and I do not know how my kidneys are faring as it is with the sudden influx of protein. Ah well. I'll see.

  4. Hi Jack,
    Enjoying your blog.

    How's the meditation going?

  5. Hey Dustin, thanks for reading. I practice now for about 45 minutes every morning.


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