Anxiety can present in many ways. You might feel a constant source of dread that won’t go away. For some, it might be an overreaction to typical life stressors. Sometimes it might be an intense sense of panic and overwhelming doom. Other times, it is just lying in bed at night worrying. Point is, you don’t feel great and would like to get better. You’ve identified a problem, but you are not sure how to fix it.
The first thing you should know is that it is not all in your head. There is a tendency to think that mental health issues are purely with the brain, losing sight of the fact it is connected to a body. There are medical conditions (like an overactive thyroid gland) that can present with symptoms of anxiety. You want to check for those factors and not just focus on the head.
Serotonin:
There is some connection between depression and anxiety with the serotonin neurotransmitter. Everything discuss about serotonin and depression, also applies to anxiety. All of the vitamins and cofactors used to create serotonin applies to anxiety:
Vitamin D
Vitamin B6 (P5P - Pyridoxal-5-phosphate)
Iron
BH4 (Tetrahydrobiopterine)
Accordingly, both SSRIs and and SNRIs are used to treat anxiety symptoms.
Magnesium:
In addition to the vitamins above, being deficient in magnesium can present as anxiety too. It’s an electrolyte that is commonly overlooked in patients dealing with anxiety symptoms. It’s easy enough to replenish with supplements.
Dopamine:
Having dopamine levels that are really high can also be associated with anxiety symptoms. People with elevations in this neurotransmitter tend to be very organized and good at planning. It’s like they have built in adderall.
Dopamine is converted to Norepinephrine by the Dopamine B-Hydroxylase using cofactors:
Vitamin C
B3
Copper
Dopamine is also degraded by the Monoamine Oxidase (MAO) enzyme, utilizing cofactors:
Vitamin B6 (P5P)
B2
B3
Iron
Magnesium
Dopamine is also degraded by the Catechol-O-Methyl-Transferase (COMT) enzyme, utilizing cofactors:
Magnesium
S-Adenosyl Methionine (SAMe)
You could imagine that deficiencies in these cofactors could impact the bodies ability to drop the dopamine levels.
In terms of psychopharmacology, the anxiety related to this condition is best treated with antipsychotic medications that block dopamine receptors.
Histamine:
Having too much histamine can also cause anxiety. This is where diet and genetics can be so important. If you are a person who has trouble breaking down histamine, then you will be prone to having levels that are too high. Supplements can be useful to bring down your histamine and you could also look to go on a low histamine diet to help manage your symptoms. The Diamine Oxidase will break down histamine using cofactors:
Vitamin B6 (P5P)
Vitamin B12
Vitamin C
Iron
Copper
While the Histamine Methyltransferase will breakdown histamine with cofactor:
S-Adenosyl Methionine (SAMe)
SAMe, in turn, is regenerated with the help of the following cofactors:
Vitamin B9 (Folate)
Vitamin B12
Magnesium
You can see how a deficiency in these all of these cofactors might be important.
There are also great antihistamine medications, like hydroxyzine (Atarax or Vistaril)), that can block the histamine and alleviate symptoms of anxiety.
Gamma-AminoButyric Acid (GABA):
GABAa receptors allow chloride to get into the cell and decrease the activity in it. It basically calms down the cell, which in turn calms down the brain. Benzodiazepines and alcohol both impact these receptors. Addiction to either of those products can be a big problem since disrupting the mechanism does not allow the brain to regulate itself properly, hence significant withdrawal risk. This is why using benzodiazepines can be problematic and why mixing them with alcohol can be lethal.
One thing that is really interesting about the body is that this inhibitory neurotransmitter, GABA, is made from glutamate, one of the most excitatory neurotransmitters. The Glutamate Decarboxylase (GAD) enzyme is responsible for that conversion using cofactors:
Vitamin B6 (P5P)
Taurine
Taking it one step further, the Taurine is made from Cysteine with the following cofactors:
Vitamin B6 (P5P)
Iron
Molybdenum
S-Adenosyl Methionine (SAMe)
Cholesterol:
Low levels of pregnenolone is associated with anxiety.
Making sure the body has all of the nutrients it needs to make the different neurotransmitters is the logical first step in addressing psychiatric symptoms. Medications are a shortcut for shifting the biology in a particular direction, but it makes sense to first support the body in its normal functioning. Additionally, you see how there are many different mechanisms connected to the state of anxiety. By having a sense of the underlying mechanisms that are off base, it becomes possible to choose an approach that is more targeted to the underlying problem. The science to support to approach to treatment is still new and not always clearcut. Either way, it is an improvement vs. not gathering molecular data to drive molecular decisions.
