At Florida Detox, we have discovered that many patients self medicate their underlying anxiety disorder with drugs such as OxyContin, Percocet, or alcohol.  These patients usually present to Florida Detox burdened with tremendous shame and guilt.  Incorrectly labeled drug addict or alcoholic at previous rehab centers, these patients in reality are self-medicating a severe anxiety disorder. The diagnosis (drug addict/alcoholic) is a misdiagnosis! Each time these patients relapse following a program, they experience more guilt and shame, exacerbating their depression and anxiety.  Soul pain increases and they feel more hopeless.

Is the anxiety always about low serotonin? When evaluating the anxiety disorder patient, many physicians assume that the anxiety is secondary to serotonin levels. Obsessive compulsive anxiety, which is the most common type of anxiety disorder in the United States, is a product of low serotonin. However, if physicians are focused only on serotonin deficiency, they will misdiagnose over half of the anxiety disorder patients.

Another source of anxiety disorder can be excess production of excitatory brain neurotransmitters such as dopamine, norepinephrine, glutamate, and phenylethylamine. As well, patients can experience anxiety when they suffer from an under-active frontal cortex, otherwise knows as attention deficit disorder (ADD).  Progesterone deficiency is a common etiology of new onset anxiety disorder in middle aged females.  Progesterone naturally breaks down to GABA, a chemical which relaxes the brain. Many females present to Florida Detox describing a chronological pattern of increased anxiety, increased menstrual bleeding and increased uterine cramping. This trio can often be treated with progesterone supplementation. When these biochemical causes of anxiety are diagnosed and treated appropriately, the patient no longer needs to “relax” their brain with alcohol, opiate pain medicine or illicit drugs such as heroin.

Obsessive compulsive anxiety: These patients do suffer from serotonin deficiency.  If the serotonoin deficiency is genetic, it is common to see a pattern in the family tree. These patients typically have mothers, grandmothers, aunts, or uncles who demonstrate excessive negativity. On PET scan or SPECT scan, these patients demonstrate an overactive deep limbic system (emotional brain) and an overactive anterior cingulate gyrus.  The anterior cingulate gyrus is the brain’s gearshifter and it’s function is to promote forward thinking and rumination of the same repetitive and negative thoughts.

 Unfortunately, patients with low serotonin levels and an overactive cingulate, frequently ruminate only on the negative aspects of their life. They obsess on the negative, hold grudges, tend to be perfectionists, and frown upon “change” in their daily routine. These patients, in extreme cases, exhibit social anxiety. The good news is that these patients respond well to serotonin enhancement from such medications as Lexapro, Paxil, or Zoloft.  When treated appropriately, these patients actually demonstrate a more “relaxed” brain on the brain scan. They become much happier and often more successful individuals.

Interestingly, studies of cerebrospinal fluid have proven that patients with obsessive-compulsive disorder typically have 30% to 40% lower levels of tryptophan. Tryptophan is the amino acid from which your body manufactures serotonin.  Patients who suffer magnesium or vitamin B6 deficiency cannot convert tryptophan to serotonin.  Addiction is common with low serotonin patients as these patients frequently self medicate the anxiety with alcohol or OxyContin in their attempt to quiet the increased electrical activity in their brain. Patients will use and often abuse prescribed benzodiazepines (Xanax, Klonopin, Valium) for this problem.  At Florida Detox, we have successfully diagnosed and treated hundreds of patients who no longer require self-medication with OxyContin, alcohol, or Xanax because they no longer need to “turn down the voltage.”

Most recently, we have at Florida Detox diagnosed a small but pertinent subsets of patients who had all the appearance of the typical “excess dopamine producer” and this coinciding anxiety disorder.  These patients, however, did not respond well to medical treatment with a dopamine blocking medication like Geodon or Zyprexa.  In our diligent search to ascertain the true etiology source of this crippling anxiety disorder we began to experiment with the medication Campral.  Campral was just released from the FDA in February 2005 for its blocking affect of glutamate activity in post detox alcoholics.  Glutamate is an excitatory chemical, which increases the electrical voltage of the brain just as dopamine.  When alcoholics take in daily amounts of the GABA drug alcohol constantly turning down the voltage, their brains will up regulate the production of glutamate.  After a patient is taken off the alcohol, the brain requires three to six months to down regulate glutamate activity to normal.  We have assumed that potentially there are subsets of patients who genetically speaking have excess glutamate activity without having ever been an alcoholic.  Our theory has panned out.  The patients who have an anxiety disorder, which present with similar symptomatology such an excess dopamine production will frequently respond to the utility of Campral as a glutamate blocker.  In these patients, it appears they have a deficiency of glutamic acid dehydrogenase, which breaks down glutamate into an inactive state.  When we block their excess glutamate activity with Campral the anxiety goes away and they no longer require alcohol, Xanax, or OxyContin as their self medication to control their anxiety.

As you can see anxiety disorders are multifaceted in etiology, but we are in exciting times.  The industrial revolution while giving us much “progress” has as well been somewhat stressful for our brains.  I believe that God intended for our fight or flight response to go off three or four times a year on the family farm.  Prior to the industrial revolution, most of us would have really had an excess surge of norepinephrine, maybe three to four times per year.  However, in the industrialized world with traffic jams, cell phones, and mothers wearing three hats, the norepinephrine levels are continuously surging throughout the days and week.  This stress chemical, which is released from your locus coeruleus, will cause an ongoing stress on brain.  

The brain, which is under continues excess stress will churn norepinephrine, which has a negative effect on many other brain chemistry neurotransmitters.  The patients under continues stress frequently have very depressed levels of  DHEA.  DHEA is a chemical, which is required to make testosterone, estrogen and other “sense of well being chemicals”.  Obviously lifestyle changes and counseling will decrease stress levels.  It is, however, dogmatic and not pragmatic (practical) to expect patients to undergo major lifestyle changes and career changes in their immediate future, following a detoxification process.  It behooves those of us who pioneer in addiction medicine to intervene immediately after detoxification.  In an effort to reduce the excess norepinephrine floating through patient’s bloodstream at Florida Detox, we work diligently to counter norepinephrine surges through medications (alpha and beta blockers), which counteract the effect of norepinephrine and its receptor as well.  We encourage the utility of outpatient counseling and sometimes cognitive behavioral therapy, which will decrease the patient’s stress response to certain everyday life situations.

As you can see, anxiety is constantly working against our natural well being.  Natural methodologies  to decrease the biochemical cause and effect of anxiety including increasing physical exercise and growing spiritually are extremely important as well.  We are reminded from Philippians, chapter 4, verses 6 and 7, to be anxious for nothing, but in all things to pray and give thanks to God and then we can enjoy the piece and joy that God intended.