A New Treatment For Chronic Anxiety

Far and away, the most common mental illness troubling the human animal is Generalized Anxiety Disorder, which can make life really miserable for almost 25% of women and 15% of men.

When it’s not “chronic”, i.e., with you all the time, a little anxiety is actually useful. You feel a little anxious when you’re deciding (or not) to walk down a dark alley, and sensing potential danger, take another route. If you were to inventory your physical and emotional symptoms at the beginning of that alley (heightened awareness, increased heart and breathing rate), that’s a normal and very brief “fight or flight” response. “Functional fear”, a safety mechanism, probably saved your butt more often than you know. The Flying Wallendas could have used this. Or Evel Knievel.

However, when you go through much of life, good days and bad, experiencing anxiety, worrying thoughts, disturbed sleep, segueing into and out of panic attacks, then you probably need professional help.

Although doctors aren’t positive why some people suffer chronic anxiety and others don’t, the overall numbers have been increasing. People say this is because there’s more to worry about, but the Middle Ages weren’t so great. I think we’re more willing to talk about anxiety, and treatments have improved. Up to the 1940’s, a woman with a panic attack might spend the rest of her life in a state mental hospital. Up to the 1960’s, she’d get a prefrontal lobotomy. I wrote about this, but maybe you’d rather not read it.

We now know the brain chemical serotonin is involved with both depression and anxiety. If you think of serotonin as your ‘factory installed buffer against stress’, you can sort of guess that a lot of the medications and supplements (the SSRI meds like Prozac, Zoloft, Lexapro, St. John’s wort) for anxiety are geared toward boosting serotonin. The female brain has less serotonin than her male counterpart, hence the female susceptibility to both anxiety and depression. Although these medications are widely prescribed, and get good grades from patients, they’re not free from side effects and often take weeks for full effect. When, about three weeks later, the meds work, the response is interesting: “You know doctor, the stuff that was stressing me out is still there. It just isn’t bothering me as much.” That comes from raising your serotonin stress buffer.

By the way, certain personalities are especially prone to anxiety: introverts more than extroverts, especially introverts susceptible to a mental state called neuroticism, which is actually quite common. This is a sense of anxiety in a non-threatening social situation (going to a restaurant, getting on a bus, going shopping <pre-COVID, of course>. I want patients to think of themselves as open wounds and the whole world “out there” is made of salt. Not surprisingly, patients rarely disagree with this assessment of themselves. And if a significant other is in the room, he/she will nod, “That’s you, honey.”

On the plus side, chronically anxious patients are usually highly intuitive and very sensitive to colors, textures, are often artists and even feel the positive and negative ‘energies’ in a place, probably because they’re always on high alert.

To make matters worse for women, serotonin is linked to estrogen, so that during the week before her period, when estrogen takes a nosedive, so will her serotonin stress buffering system. PMS miseries include anxiety, panic, depression. Like an efficient praying mantis, she’ll chew the head off her mate or burst into tears during a Hallmark movie. Relief comes only by her third day of flow when estrogen starts to rise again.

And what happens during your menopause transition? Estrogen declines, serotonin declines, depression and anxiety get worse. Even The Guardian wrote about, ‘Mental Illness During Menopause’.

The second major group of supplements and medications for anxiety are called anxiolytics. These include Valium (diazepam), Xanax (alprazolam), Klonopin (clonazepam), the ‘benzos’, and get a lot of bad press because they can be overprescribed and overused. Natural versions are GABA, L-Theanine and KAVA. If the prescription versions are supervised by an MD or nurse practitioner, an anxiolytic can safely be used every day. I have seen too many instances where a well-meaning family member or friend accuses the patient of being ‘drug dependent’ for using an anxiolytic which she needs literally to get through life.

The newest treatment for anxiety (and depression) is a peptide. Followers of Health Tips know I’ve been writing a lot about peptides, all of which needed to be injected.

Not SELANK. This one is a nasal spray.

Like all peptides, SELANK is a chain of amino acids, but this is easily absorbed through your nasal membranes and the dose is two sprays every morning. It was designed to raise 5-HTP and serotonin but the clinical studies showed results with generalized anxiety, depression, PTSD and even mild ADD as it affected both norepinephrine and dopamine. Study participants reported better focus and attention (called ‘cognitive enhancement’). Here is a research study showing the positive results using SELANK from NIH. Interestingly, unlike the benzo family, there is no tiredness, and no withdrawal, so you can stop at any time. However, SELANK needs to be used every day (not “as needed”). SELANK can be used without discontinuing either your antidepressants or your anti-anxiety medications.

SELANK is prepared by a compounding pharmacy and mailed to your home. One month supply is $100, not covered by insurance but can be paid for with your HSA. Call and schedule an in-person or telemedicine appointment. Your practitioner can discuss SELANK with you and answer your questions. Try it for at least two months. It may bring your anxiety to an end.

Be Well,

David Edelberg, MD