Dramatic reversal in research on anxiety — (The Age)

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The Age

By STEVE DOW

Sunday 14 May 2000

Startling and unexpected findings on panic disorder patients could fundamentally change the way anxiety and anxiety-related depression are treated.  The findings by Melbourne’s Baker Medical Research Institute, presented to a recent scientific meeting and soon to be submitted to the medical journal The Lancet, have unsettled scientists and turned upside down
their ideas on brain chemistry among the anxious. But the evidence from the work by cardiologist Professor Murray Esler and colleagues is so strong that it is being taken seriously.

The scientists tested the levels of the mood-regulating chemical serotonin in 20 patients who suffer panic attacks and found that, even on a good day, the average levels of the chemical in the brains of at least 15 of the patients were eight times higher than normal. Until now, the theory has been that anxiety, panic and anxiety-related depression are caused by a lack or underactivity of serotonin in the brain. Based on this theory, the selective serotonin re-uptake inhibitor (SSRI) wonder drugs that emerged in the ’90s – marketed as Prozac,
Aropax and Zoloft – are intended to increase serotonin around the brain neurons involved in anxiety. Professor Esler emphasised that the SSRIs were “great drugs” and should remain worldwide bestsellers. However, there were two important implications of the new research, he said. First, the conventional view of how SSRIs operate has been challenged.

It would appear that the drugs are effective because, over time, they somehow decrease, rather than increase, serotonin as originally thought. Second, the new findings could spark drug companies to create drugs that stop serotonin directly. Such a response might stop the common problem of “serotonin agitation” experienced by many patients on SSRIs. These
patients experience increased anxiety in their first weeks of treatment on drugs such as Prozac, Aropax and Zoloft; the drugs making the problem “worse before they make it better”, Professor Esler said.  He said there was now compelling evidence that panic disorder and depression were on a par with high blood pressure and smoking as risk factors for heart disease. A study of several panic disorder patients had shown a spasm of coronary arteries was common after an attack. One patient, a woman of 40, suffered a clot and subsequent heart attack
because of her panic disorder. The Baker Institute wishes to recruit patients who suffer panic disorders and depression for future studies. Contact the institute on 95224212.