Erica Ryke

Ridgefield, CT, USA

Generalized Anxiety Disorder and Depression: My personal experience

Wake up in the morning

Hear the sirens of an emergency vehicle

Walk up a steep hill Fly in an airplane

Watch medical shows like Grey’s Anatomy or ER

Go on carnival or amusement park rides

Attempt to fall asleep

How do you feel when you do the following?

Struggling to breathe

Feeling the world closing in on you

Your heart is racing

Throat closing

Getting dizzy

Twitching uncontrollably

Waking up crying

Overwhelming fear of death and the unknown

Anticipation

Heavy chest

Now imagine…

Diagnosis: General anxiety disorder (GAD) and depression Pre-diagnosis: full EKG, multiple trips to ER and

doctor’s office

Predisposition: Mother also suffers from both

Cause: Imbalance of brain chemicals – serotonin and GABA

Experiences: Effected closely by 9/11, the blackout of 2002, family deaths and illness

Triggers: Sirens, thoughts of death, medical television and hospitals, anticipation, loss of control

Medication: Lexapro (escitalopram oxalate) - selective serotonin reuptake inhibitor, Xanax when needed

This was my world at age 16

GAD includes excessive anxiety and worry that is difficult to control and pertains to several events or activities; it must occur more often than not for a period of at least 6 months and be accompanied by 3 or more for the following symptoms: restlessness, easy fatigability, difficulty concentrating, irritability, muscle tension, and sleep disturbances.

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Depression is an illness that involves the body, mood, and thoughts. It interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her.

So what is GAD and depression?

Thalamus – breaks down incoming auditory and visual stimulus and sends it to cortex

Cortex – gives meaning to thalamus signals; prefrontal cortex may be vital in turning off the anxiety response

Amygdala – emotional core, responding to fear (bursts of fear)

Bed nucleus of the stria terminalis – perpetual fear, causing longer-term unease

Locus ceruleus – receives signals from the amygdala, initiating classic anxiety responses (increased blood pressure, rapid heartbeat, sweating, pupil dilation)

Hippocampus – memory center used for storing in-coming information from senses

GAD: The Brain’s Role

Figure 1. The innervation of the parasympathetic nervous system from limbic structures is thought to mediate visceral symptoms associated with anxiety (Drevets

& Charney, 2002)

Depression: where does it occur?

Amygdala: activated when a person recalls emotionally charged memories, such as a frightening situation. Activity in the amygdala is higher when a person is sad or clinically depressed. This increased activity continues even after recovery from depression.

Thalamus: receives most sensory information and relays it to the appropriate part of the cerebral cortex, which directs high-level functions such as speech, behavioral reactions, movement, thinking, and learning.

Hippocampus: central role in processing long-term memory and recollection. Registers fear when you are confronted by a barking, aggressive dog, and the memory of such an experience may make you wary of dogs you come across later in life. The hippocampus is smaller in some depressed people.

Prefrontal Cortex: mediates pain, aggression, sexual functioning, and eating behaviours’; executive function

Anterior Cingulated Cortex: cognitive/executive and emotional/motivational information; behavior and cognition

DepressionGAD

Serotonin: helps regulate sleep, appetite, and mood and inhibits pain; some depressed people have reduced serotonin transmission

Norepinephrine: constricts blood vessels, raising blood pressure; helps determine motivation and reward

Gamma-aminobutyric acid (GABA): amino acid that researchers believe acts as an inhibitory neurotransmitter

Acetylcholine: enhances memory and is involved in learning and recall

Serotonin: helps regulate sleep, appetite, and mood and inhibits pain; some depressed people have reduced serotonin transmission

Norepinephrine: constricts blood vessels, raising blood pressure; helps determine motivation and reward

Dopamine: essential to movement; influences motivation and plays a role in how a person perceives reality; involved in the brain’s reward system

Glutamate: small molecule believed to act as an excitatory neurotransmitter and to play a role in bipolar disorder and schizophrenia

Gamma-aminobutyric acid (GABA): amino acid that researchers believe acts as an inhibitory neurotransmitter

Neurotransmitters

SSRIs (Serotonin Reuptake Inhibitor): • block the reuptake of serotonin, meaning more serotonin than

usual remains available in the synaptic space

Lexapro Specific: • highly selective SSRI with minimal effects on norepinephrine

and dopamine neuronal reuptake

• linked to potentiation of serotonergic activity in the CNS resulting from its inhibition of CNS neuronal reuptake of serotonin (5-HT)

• Serotonin receptor, 5HT1A is present most the time

• 5HT2A is affected and some other 5HT-serotonin receptors, but to a lesser extent than other SSRIs

• 5HT2A inhibits dopamine

• If SSRI causes too much serotonin around 5HT2A receptors, side effects occur

How do I fix this? Lexapro!

• Still on Lexapro

• Fully functioning, no panic attacks, very rare to have any anxiety

• No bad thoughts

• Suffer from minor skin picking disorder, especially when stressed

• Grey’s Anatomy is one of my favorite shows (ambulances don’t bother me)

• I’ve traveled the world (lot’s of flying!)

• Have my master’s and work at Yale University

• HAPPY!

This is my world now at age 25…

Y

• I better understand the steps the body goes through in a panic attack, allowing me to better rationalize fear and the body’s reaction to its overreaction - the disconnect with the brain and body is amazing

• The topic of thermoregulation was really eye opening, especially as I watch my mom go through hot flashes and I told her, “sorry, there’s nothing you can do!”

• The auditory section was something I had previously known about, but not in such a detailed way. Knowing I am destroying my hearing every day has made me rethink my sound levels (sometimes!).

• Why University of Chicago is on top of my list of schools for PhD programs! Dr. Mason is amazing! One of the most relatable and entertaining teachers for such a complex subject.

Phenomena around you all the time!Class taught me specifically…

GAD

• GAD affects 6.8 million adults, or 3.1% of the U.S. population, in any given year. Women are twice as likely to be affected.

• Anxiety disorders are the most common mental illness in the U.S., affecting 40 million adults in the United States age 18 and older (18% of U.S. population).

• Anxiety disorders cost the U.S. more than $42 billion a year, almost one-third of the country's $148 billion total mental health bill.

Depression

• At any point in time, 3 to 5 percent of people suffer from major depression; the lifetime risk is about 17 percent.

• Of the estimated 17.5 million Americans who are affected by some form of depression, 9.2 million have major or clinical depression.

• The leading cause of disability in the U.S. for ages 15 to 44.3

Facts about GAD and Depression

• Drevets, W. C., & Charney, D. S. (2002). NEUROBIOLOGICAL BASIS OF ANXIETY DISORDERS. In Neuropsychopharmacology: The Fifth Generation of Progress (pp. 901–930).

• Martin, E., Ressler, K., Binder, E., & Nemeroff, C. (2009). The Neurobiology of Anxiety Disorders: Brain Imaging, Genetics, and Psychoneuroendocrinology. Psychiatr Clin North Am., 32(3), 549–575. doi:10.1016/j.psc.2009.05.004.The

• Mason, P. (2011). Medical Neurobiology (pp. 1–688). New York: Oxford University Press.

• Stein, M. B. (2009). Neurobiology of generalized anxiety disorder. The Journal of Clinical Psychiatry, 70 Suppl 2(suppl 2), 15–9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19371502

References