Posted by linkadge on January 6, 2019, at 15:27:05
In reply to How can ADs increasing norepinephrine help anxiety, posted by mtom on January 5, 2019, at 20:40:48
This question is often asked, and I don't think there is single conclusive answer to it. However, having read a bit on this topic here's what I've found...
Most of these medications are primarily antidepressants (and their impact on anxiety was a secondary effect). Improving depression itself, has an ability to reduce anxiety for some people, regardless of the mechanism of the treatment.
The anti-anxiety effect of SNRIs can take some time to develop fully. In the short term, increasing norepinephrine can actually aggravate anxiety, as you mention. The key is the way that the medication (if it works) changes your outlook or behavior so that there is an adaptation to either resolve issues that are causing stress, respond in a more adaptive way, or avoid the stressor altogether.
Not everybody with anxiety responds to S/NRIs for anxiety.
However, consider somebody with a mixed depression / anxiety who gets trapped in a cycle of low self esteem / confidence, low energy, bad choices, avoidance etc. who ends up making their anxiety worse long term because they may let problems pile up, they have difficulty thinking longer term etc. Poor concentration and low energy are typical problems with depressed people, which understandably could lead to worse anxiety. Increasing serotonin and norepinephrine together tends to improve mood and increase energy. If the med works, the improved mood and energy allows the individual to tackle the issues that are causing anxiety and to learn a more adaptive response. For example, taking action (i.e. norepinephrine boost) to build an emergency fund, which provides a financial buffer against future stressors.
Another thing I gather is that it is more regulation of the system than the increasing action per se. Some research suggeests that while NRIs increase norepinephrine in the short term, there are compensatory effects which work to offset this. People with anxiety, typically have abnormal norepinephrine release patterns (i.e surges and then dropoffs). Many antiderepssants seem to normalize the firing patterns.
One could say the same with ritalin for ADHD. Why would a 'stimulant' calm a person with hyperactivity? The answer lies in the fact that, for individuals with ADHD, the stimulant (in the right dose) actually normalizes dopamine release patterns. People with ADHD typically have low dopamine firing, and then surges (i.e. hyperfocus) etc.
Linkadge
poster:linkadge
thread:1102698
URL: http://www.dr-bob.org/babble/20181024/msgs/1102702.html