A Gene for Anxiety, Depression, and PTSD?

I’ve often wondered why some people are tormented by anxiety and depression while others are not, and how having parents with similar afflictions seems to translate into higher incidence among family members.

Phillip M. Newton, Ph.D., writing in Psychology Today, takes a look at the science behind FK506 binding protein number 5, which might hold the genetic explanation that’s long been assumed.

FKBP5 is part of the body’s stress-sensing system, and this system responds to stress by releasing the hormone cortisol which drives the biological response to stress stimulus. If the FKBP5 gene is slightly altered from person to person, that might explain the hyper-reactive response common to anxiety and PTSD sufferers.

Certainly, slight variations in the FKBP5 gene could account for part of our problem, but what about environmental factors – the other half of the nature vs. nuture formula?

Research around FKBP5 specifically has shown that history of child abuse shows correlation to later development of PTSD. From the article:

Researchers at Emory University, led by Kerry Ressler M.D. Ph.D, have identified four variants of the FKBP5 gene that are more commonly found in people who suffer from posttraumatic stress disorder. Many unfortunate factors contribute toward the development of posttraumatic stress disorder, with a history of child abuse being one of the most significant. Importantly, the genetic variants of FKBP5 are found in PTSD patients with a history of child abuse, but not PTSD patients who do not have a history of child abuse, suggesting a gene- environment interaction during childhood that can predict the development of posttraumatic stress disorder.

As more research develops on the genetic make-up of anxiety disorders, perhaps we’ll see the resulting data used as part of a gene-therapy approach to treatment in the coming years.

Childhood Anxiety Can Start Early

As an adult with anxiety challenges, I’ve often wondered at what point in my life I climbed aboard the anxiety train.

A new study published in the Journal of Child Psychology and Psychiatry posits that up to 15% of preschool children may have “atypically high depression and anxiety levels”, a number that I find statistically significant and somewhat surprising.

What wasn’t surprising was the genetic aspect of childhood anxiety documented. Children with high levels of anxiety and depression are more likely to have mothers who suffer from depression.

The study revealed that children as young as a year old demonstrate indications of higher risk. Given how quickly kids develop in that first year, it makes sense to think that the genetic similarities might come into play, but for me, it raises questions around environmental factors too.

The concept of preventative intervention in very young children with significant risk factors might be a good way to address core issues before they have a chance to lead to atypical behaviors and suffering. It will be interesting to see where the research eventually leads.

Anxiety Insights link

Can Yoga Help Workplace Stress & Anxiety?

With the often relentless pace at work, it’s sometimes difficult to carve out even a half-hour for lunch. Stepping away for 20-30 minutes to have a bite to eat, stretch my legs, and just get away from the workplace energy for a little while can be helpful in reducing those feelings of stress and anxiety that slowly surround me like a misty fog.

So when I read about this study that included guided workplace yoga and meditation to help with stress relief, my first thought was, “Where do I sign up?”, although I’m unsure that anyone wants to see me in full downward facing dog while wearing my Dockers.

I’ve written before about the benefits of mindfulness-based stress reduction therapy, most notably here and here. Conceptually, being able to recognize and be aware of your stressful, anxious state is the first step toward doing something about it. Over time, I learned breathing and relaxation techniques that can be put into use in just about any situation, at any time, the result being a more relaxed, unstressed version of me.

The study, conducted at the Ohio State University here in Columbus, was specifically designed for office worker types wearing business apparel, and involved an hour meeting once a week during lunch, plus 20 minutes per day of yoga and meditation performed at the subject’s desks. The results were impressive:

Mindful attention awareness increased significantly and perceived stress decreased significantly among the intervention group when compared to the control group’s responses. Overall sleep quality increased in both groups, but three of seven components of sleep were more affected in the intervention group.

On average, mindfulness increased by about 9.7 percent and perceived stress decreased by about 11 percent among the group that experienced the intervention. These participants also reported that it took them less time to fall asleep, they had fewer sleep disturbances and they experienced less daytime dysfunction than did members of the non-intervention group.

Two things jump out at me from this study – one, that simply being exposed to the concept of mindfulness, becoming aware of what you are feeling and why, is enormously beneficial. Secondly, there is an amazing sense of empowerment that comes from having effective tools, like yoga and meditation, to help address the stress and anxiety, and feeling better even a little bit can help spur you on, which can lead to even more effective results.

If you would like to know more about the study, you can read the full details at Anxiety Insights. Go forth and unwind those tight muscles and loosen that tense mind!

NY Times: Taking Anxiety to a New Level

The New York Times has a posting in their Fashion and Style section on anxiety. Who knew that my psychological disorder was either stylish, fashionable, or both?

The author experiences some knee-knocking while looking over a cliff at Big Sur and notices that as she gets older, she’s much less inclined to engage in activities that involve elevation. She claims to never have been afraid of heights before, but now, at 47, altitude causes her anxiousness.

From a clinical perspective, as one gets older, we lose some of our mobility, and our confidence in being able to handle some of the physical demands as well as we did in our youth can wane. But is that anxiety?

From the article:

There is a difference between a fear and a phobia, of course. The people at the Anxiety Disorders Association of America will tell you that we all have things that scare us, after all. It’s when fears start limiting our behavior that they become the kind of full-fledged anxiety-producing phobias that afflict more than 19 million people nationwide. That’s more than 8 percent of the adult population, and the only reason I agreed to hike on the headlands trail in the first place was to keep myself from joining them.

So she takes to nature so she doesn’t have to join our ever-growing group of anxiety sufferers? Really?

I think there’s a big difference between fear and anxiety. Standing on the edge of a craggy cliff that juts out over the ocean is the kind of thing humans learned to stay away from, because experience reminded us of the time when Urg the caveman did that and plunged to his death. Our self-survival mechanisms kicked in, and over time it became ingrained in us to avoid doing silly things like that. It reminds me of a cat that sits on a hot stove. He never sits on a hot stove again – but he never sits on a cold one, either.

I’m guessing that the writer was trying to be cute and draw comparisons between loafing at Big Sur and having a panic attack for no discernible reason, but I’m not buying it. We don’t have the choice to avoid our everyday lives like she can avoid Big Sur, or an expensive dinner at a rotating restaurant at the top of some tall building.

Please don’t use anxiety for alliteration purposes, especially if you don’t understand what it is. A couple of quotes tossed in from authoritative anxiety sources doesn’t help explain how crippling anxiety disorders can be, and equating them to being afraid of falling into the ocean do nothing to educate the general public about a very real, very serious illness.

Image via Wikimedia Commons – Dysepsion

It Is What It Is

This may sound completely idiotic coming from an anxiety sufferer, but Murphy’s Law is generally correct. More often than not, things don’t go exactly as planned.

For the anxious control freaks among us, that’s like crack. What better way to get revved up and knee-deep in the drama surrounding something unanticipated than to slap a label on it? If things didn’t turn out like we thought they should, that’s bad. Right?

Or is it?

One of the big challenges I’ve faced over the years has been the struggle to accept things as they are, without assigning a value or judgment to them. Admittedly, that’s a difficult habit to break after 40 years. My natural response to something like stripping a bolt thread or dropping the eggs on the floor has been, “well, that sucks, dammit.” which obviously removes the need for a mind-reader to ascertain what I’m thinking at that moment.

Similarly, whining about how I wished this hadn’t happened, or feeling put upon (this always happens to me at the worst possible time) did nothing to change my situation or act to prevent something from going wrong in the future. The universe doesn’t work that way!

The world is an imperfect place. Screws fall out all the time. Why are we so surprised by this?

If anything, when something goes awry, I should take comfort in the realization that the universe is working exactly as designed. Things are supposed to break down, not work, or turn out poorly now and then. It’s my unrealistic expectation of perfection that’s the problem, not the egg yolks staining my socks.

When I moved into a new job about 18 months ago, it came with a different level of interaction with senior management, one that didn’t always make it easy to be heard or advocate for my programs. After a couple of frustrating weeks of trying to prepare and anticipate where the obstacles would pop up next, I decided to post a handy reminder on the cork board by my Cisco IP phone.

It is what it is.

Sounding like a phrase oft-uttered at the Bada-Bing club by Tony Soprano, it was the perfect cue to draw my focus away from getting caught up in making judgment calls about what was happening, or more importantly, who was causing it to happen. Rather, I began to deal with just the facts of the situation, without worrying if they were good or bad, happy or sad, positive or negative. It all depended on perspective after all – what seemed good to me was bad for someone else, and when we got caught up in trying to convince someone to change their position or outlook, we were missing the main point. It just was – so what do we do next?

Success has been mixed, but it’s important for me to stay engaged and focused, and when events occur, to not lament or wish things are different. They aren’t different. Everything is as it should be.

Image by KaroliK via flickr

Germany Building a Better Anxiety Drug

Via Reuters, German scientists believe they have found a new drug for panic disorders that works effectively without many of the effects of current compounds such as Valium (drowsiness, forgetfulness) and that work much more quickly than SSRIs that can can weeks to build up effective blood levels.

The new drug, termed XBD173, appears to work by targeting a much different “panic button” in the brain than other medicines. It also appears to be both safe and fast-acting. Studies showed XBD173 began to work as quickly as one hour after being administered, which would be ideal for people having acute panic attacks.

Also promising is the discovery that there are no withdrawal symptoms once patients discontinue use of the drug. Valium and other similar compounds are well-known to present dependency challenges and unpleasant withdrawal.

Let’s hope research continues on XBD173 and we see it on the market sometime in the near future.

German research points way to better anxiety drug , via Reuters

Repressing Trauma Not Harmful?

Anxiety Insights has the details of a Geisinger Health Center study that suggests certain people exposed to traumatic events may not suffer harm when they repress memories of those events.

“Going back to the days of Sigmund Freud, psychiatrists and mental health experts have suggested that repression of traumatic memories could lead to health problems,” Dr Boscarino said. “Yet we have found little evidence that repression had an adverse health impact on combat veterans exposed to psychological trauma many years later.”

One thing that leaps out in the article is the view that the use of exposure therapy – where people are asked to relive painful or traumatic events – may actually serve to trigger PTSD symptoms and psychological distress in those who had otherwise been doing just fine, thank you very much.

“While the dominant therapy model for PTSD should not be abandoned at this point, emerging research suggests that it might need to be seriously re-evaluated, at least for some PTSD patients,” Dr Boscarino said. “More research is clearly needed.”

Repressing traumatic memories may not be harmful to some , via Anxiety Insights

Anxiety and Insomnia – Thanks, Mom

US News and World Report has posted an abstract that details the findings of researchers in the U.S. that there might be a genetic link between anxiety, depression and insomnia.

As a result, researchers advise that adolescents who suffer from anxiety and depression should also be screened for insomnia. That seems like an excellent idea.

I’ve often wondered if my occasional (but more frequent as I get older) insomnia and my anxiety are somehow connected, and if so, if my lack of sleep problems in my youth were in any way a signal of impending emotional struggles that didn’t start until later in life.

From the article:

The researchers’ analysis of data from 749 monozygotic twin pairs and 687 dizygotic twin pairs, aged 8 to 17, and their parents revealed that 19.5 percent of the children had insomnia.

The results indicate that, as has been seen in previous studies of insomnia in adults, diagnosable insomnia in children aged 8 to 16 years is moderately likely to be inherited, according to a news release about the study. The shared genetic effects between insomnia, depression and anxiety suggest that these disorders are linked.

Since genetics plays such a key role in so many disorders, it’s not surprising that insomnia might fall into that category, and 19.5% doesn’t seem to be outside of expectations. It’s also not shocking that there’s a link between insomnia and anxiety, but I wonder if this might not qualify as a “which came first – the chicken or the egg?” scenario. Are the teens more prone to anxiety and depression because they are so worn down due to insomnia, or is one of the symptoms of anxiety the inability to exhibit normal sleep patterngens? Or both?

Not much detail in the online article, but it’s an interesting topic nonetheless.

Insomnia and Anxiety May Be Genetically Linked, via US News and World Report

Napping and Anxiety

There’s an old saying that “if you snooze, you lose.” When it comes to anxiety and depression, that might not necessarily be true.

A study conducted on children between the ages of 4-5 (what, 4 1/4, 4 7/8 – that’s how kids count it) found that kids who stopped daytime napping between these ages had parent-reported higher incidence of anxiety, depression, and hyperactivity than kids who continued to take happy naps.

Reported during SLEEP 2009, an annual meeting of sleep professionals (sure wish I qualified for that), the results shed some new light on the benefits of daytime napping. The connection between poor sleep patterns and anxiety or depression are well-documented, but many believed that children could make up for the lack of daytime napping via nighttime sleep.

The quoted study demonstrated the potential for napping to be significantly more beneficial to children’s daytime functioning compared to nighttime sleep only. Any parent can provide anecdotal evidence that kids who nap tend to be less moody and more easily entertained than children who don’t nap.

Not mentioned in the article was any connection or bias on the part of parents whose children stay awake all day. If the study relied on parental reporting of the child’s anxiety or depression, I could easily see a situation where a parents’ own emotional state could impact on the reporting, as parents of kids who don’t nap can be every bit as frazzled as the children.

The article further points out that there’s still no data to suggest an optimal age to stop napping. I’d like to recommend that we never stop napping. In fact, if I had a cot in my office, and support from management, I’d nap every day. But that’s just me.

Napping, hyperactivity, anxiety and depression linked in preschoolers, via Anxiety Insights

Treating the Children of Anxious Parents

Researchers at the Johns Hopkins Children’s Center have found that when one or both parents has an anxiety disorder, therapy involving a family-based program was effecting in reducing anxiety symptoms among the kids and subsequently the risk of these children developing their own anxiety issues later in life.

Newswise has the details of the study, which although small in sample size (40 kids between the ages of 7-12), seems promising. From the study:

Within a year, 30 percent of the children in the no-intervention group had developed an anxiety disorder, compared to none of the children who participated in the family-based therapy. Parents along with researchers who evaluated the children and their parents independently reported a 40-percent drop in anxiety symptoms in the year following the prevention program. There was no reduction of anxiety symptoms among children on the waiting list.

That seems like a statistically significant percentage to me. Not just the children benefit from the therapy, either. Parents were able to develop coping mechanisms and modify their behaviors in several areas, such as “overprotection, excessive criticism and excessive expression of fear and anxiety in front of the children.”

Hopkins is now hoping to expand the study to 100 families. For more information, email CAPS@jhmi.edu .

When Adult Patients Have Anxiety Disorder, Their Children Need Help Too , via Newswise