Common in young . The anxiety center in the brain called the amygdala becomes less active with age . a preceived threatened stimulus is recieved at its lateral ends and output is from its middle to the hypothalamus which releases ACTH which promotes corticosteroid release from the adrenal cortex and this hormone activates the flight and fight ie sympathetic system and other areas of the brain .
Some anxiety is useful eg crossing the road but a prevading sense of apprehension can be disabling and will respond to mild anxiolytics . SSRIs such as Sertaraline upto 200mg daily are very effective especially if there is an obsessive compulsive component . Buspar a 5HT antagonist is an alternative but takes 6 weeks to start working.
Tricycilics like cloimpramine Benzodiazepams inhibit Gaba . Diazepam used to be popular but can be habit forming as can chlordiazepoxide . For severe cases stelazine can be tried . If accompanied by autnomic sympathetic nervous system effects eg clammy palms , fast heart beat , propranolol long acting in those who dont have asthma is quite good
Sudden fast heart beat and breathing rate increase on anticipated event eg going to the shops etc. Cipramil in doses of 20-40mg is effective.
A fairly common condition which can strike out of the blue ie endogenous or due to external factors eg. marital separation , death in the family . Antidepressants are very effective but may take a few weeks to start working and the dose is gradually increased. The most popular ones increase serotonin levels in the brain - sertraline 50-100mg daily or prozac
In moderate drinking ie one or two pints of beer or units of spirits a day , alcohol,has been shown to prolong life due to its beneficial effects on blood fats , prevention of diabetes , and even ward off early dementia , but a few percent- about 10- of people become addicted to it . It then affects the liver ie cirrhosis and brain cerebellum and incordinate gait or the mammillary bodies and forgetfulness or the frontal lobes and long term memory loss and even the heart and lead to an early death.
Alcohol addiction appears to be due to its inhibition of glutamate receptors in the brain which compensates by making more of them , so when alcohol is withdrawn hyperexcitability occurs . Alcohol also lowers inhibition of the brain and lead to rash decisions like fast driving and accidents and in large doses depresses the brain and can lead to coma and death from aspirating vomit . Interestingly the ones who tend to become addicted are the ones who dont get drunk on the same dose that most people would and there may be a genetic reason for it and so it tends to run in families and even races.
For all these reasons it is sensible to stick to the guidelines 14 units ( 7 pints beer ) in women and 21 units in men maximum in a week . The enzyme gamma gt ( GGT) is elevated in alcoholics and signifies liver damage and in early stages the damage can be reversed.
Those who answer yes to 2 of the 4 questions - do you think you need to cut down, have people annoyed you by criticizing your drinking ,have you felt guilty about your drinking , have you had a drink first thing in the morning to steady your drinking - need to seek help . A even better audit test is on Audit test site Very heavy drinkers and those who get violent shakes -delirium tremens need to be started in hospital . Thiamin , chlordiazepoxide or diazepam for a few days may be needed Naltrexone50mg/ day blocks the body's opiates ( endorphins) from being released and is quite succesful .
Antabuse blocks the breakdown of alcohol at an intermediate stage - aldehyde - and this compound causes very unpleasant effects - a flushed red beetroot skin , headach , fear and even worse and so it is very very important to tell the patient not even to try to take a drink while on it .
Antidepressants that increase the brain's serotonin levels eg Sertraline have been used successfuly.
Cognitive therapy ie teaching patients to identify why they drink , setting goals , social skill training , behavioral self control , social clubs , help of spouse , AA meetings all are successful to varying degrees.