Anxiety and Depression

Affects 38 million Americans each year

According to the National Institutes of Health (NIH), 38 million Americans suffer with anxiety and depressive disorders each year, and 78 million will be afflicted at some point in their lives. Left untreated, anxiety and depression can have serious personal, interpersonal, occupational and social consequences.

The Amen Clinics have been evaluating and successfully treating patients with Anxiety and Depression for 25 years. We have had the clinical advantage of using brain SPECT imaging to study our patients’ brains as part of their evaluations. From nearly 100,000 brain scans in our database, we learned that Anxiety and Depression are not single or simple disorders.

We have found:

  • Anxiety and depression occur together 75% of the time
  • These disorders are, in large part, the result of brain dysfunction
  • There are many forms of anxiety and depression—we’ve identified 7 different types, or patterns, within the brain
  • There are 5 major systems in the brain involved with how we feel (emotions), how we think (cognition) and how we act (behavior):
    1. Basal Ganglia: Sets the body’s idle and anxiety level
    2. The Deep Limbic System: The brain’s emotional center that helps regulate how we feel
    3. The Anterior Cingulate Gyrus: The brain’s gear shifter that allows us to be flexible and adapt to change
    4. The Temporal Lobes: The brain’s memory manager and interpreter of experience
    5. The Prefrontal Cortex: The brain’s CEO

Abnormalities in any of these 5 systems—including combinations—can underlie the symptoms of anxiety and depression.

7 Types of Anxiety and Depression

Type 1: Pure Anxiety

Pure Anxiety results from too much activity in the basal ganglia, setting a person’s “idle” too high.

Common Symptoms in Pure Anxiety:

  • Frequent feelings of nervousness or anxiety
  • Panic attacks
  • Avoidance of people or places, due to a fear of having panic or anxiety attacks
  • Symptoms of heightened muscle tension (headaches, sore muscles, hand tremor)
  • Periods of heart pounding, nausea or dizziness
  • Tendency to predict the worst
  • Multiple persistent fears or phobias (such as dying or doing something crazy)
  • Conflict avoidance
  • Excessive fear of being judged or scrutinized by others
  • Being easily startled or tendency to freeze in anxiety provoking or intense situations
  • Shyness, timidity and getting easily embarrassed
  • Biting fingernails or picking skin

Type 2: Pure Depression

Pure Depression often results from high activity in the deep limbic system—the brain’s emotional center. This type is associated with primary depressive symptoms that range from chronic mild sadness (also known as “dysthymia”) to crippling major depression.

Common symptoms of Pure Depression include:

  • Persistent sad or negative mood
  • Loss of interest in usually pleasurable activities — including sex
  • Restlessness, irritability, or excessive crying
  • Feelings of guilt, worthlessness, helplessness, hopelessness or pessimism
  • Sleeping too much or too little, or early morning awakening
  • Decreased appetite and/or weight loss or overeating and weight gain
  • Decreased energy, fatigue or feeling “slowed down”
  • Thoughts of death or suicide, or suicide attempts
  • Difficulty concentrating, remembering or making decisions
  • Persistent physical symptoms that don’t respond to treatment, such as headaches, digestive problems or chronic pain
  • Chronic low self-esteem
  • Persistent feeling of being dissatisfied or bored

Type 3: Mixed Anxiety/Depression

Imaging studies of Mixed Anxiety and Depression reveal high activity in the brain’s basal ganglia and the deep limbic system.

People with this type have a combination of Pure Anxiety symptoms and Pure Depression symptoms (both listed above). While one type may predominate at any point in time, both symptom clusters are present on a regular basis.

Type 4: Over-Focused Anxiety/Depression

In Over-Focused Anxiety/Depression, there is excessive activity in the brain’s anterior cingulate gyrus, basal ganglia and/or the deep limbic system. Sufferers of this type have trouble shifting attention and tend to get locked into anxious and/or negative thoughts or behaviors.

Common symptoms of Overfocused Anxiety/Depression include 4 symptoms from Pure Anxiety and/or Pure Depression (listed above), plus at least 4 of the following:

  • Excessive or senseless worrying
  • Upset when things are out of place or things don’t go the way you planned
  • Tendency to be oppositional or argumentative
  • Tendency to have repetitive negative or anxious thoughts
  • Tendency toward compulsive or addictive behaviors
  • Intense dislike for change
  • Tendency to hold grudges
  • Difficulty seeing options in situations
  • Tendency to hold onto own opinion and not listen to others
  • Needing to have things done a certain way or you become upset
  • Others complain you worry too much
  • Tendency to say “no” without first thinking about the question

Type 5: Temporal Lobe Anxiety/Depression

Temporal Lobe Anxiety/Depression is related to too little or too much activity in the temporal lobes, in addition to overactivity in the basal ganglia and/or deep limbic system.

Common symptoms of Temporal Lobe Anxiety/Depression include 4 symptoms from Pure Anxiety and/or Pure Depression (listed above), plus at least 4 of the following:

  • Short fuse or periods of extreme irritability
  • Periods of rage with little provocation
  • Often misinterpreting comments as negative when they are not
  • Periods of spaciness or confusion
  • Periods of panic and/or fear for no specific reason
  • Visual or auditory changes, such as seeing shadows or hearing muffled sounds
  • Frequent periods of déjà
  • Sensitivity or mild paranoia
  • Headaches or abdominal pain of uncertain origin
  • History of head injury
  • Family history of violence or explosiveness
  • Dark thoughts that may involve suicidal or homicidal thoughts
  • Periods of forgetfulness or memory problems

Type 6: Cyclic Anxiety/Depression

Cyclic Anxiety/Depression results from very high, focal activity in the brain’s basal ganglia and/or deep limbic system. Cyclical disorders, such as bipolar disorder, cyclothymia, premenstrual tension syndrome and panic attacks are part of this category because they are episodic and unpredictable. The hallmark of Type 6 is its cyclical nature.

Common symptoms of Cyclic Anxiety/Depression include 4 symptoms from Pure Anxiety and/or Pure Depression (listed above) plus periods of time with at least 4 of the following:

  • Abnormally elevated, depressed or anxious
  • Decreased need for sleep, feeling energetic on dramatically less sleep than usual
  • Grandiose notions, ideas or plans
  • Increased talking or pressured speech
  • Racing thoughts
  • Markedly increased energy
  • Poor judgment leading to risk taking behavior (departure from usual behavior)
  • Inappropriate social behavior
  • Irritability or aggression
  • Delusional or psychotic thinking

Type 7: Unfocused Anxiety/Depression

Unfocused Anxiety/Depression results from too little activity in the prefrontal cortex (PFC) in addition to high activity in the basal ganglia and/or deep limbic system. Because of its similarities with ADD, distinguishing between the 2 can be difficult. However, ADD—in its classic form—starts in childhood and can be seen consistently throughout a person’s life. Unfocused Anxiety/Depression may not actually start until later in life.

Symptoms of Unfocused Anxiety/Depression include at least 4 items from the Pure Anxiety and/or Pure Depression symptoms (listed above), plus at least 4 of the following:

  • Trouble staying focused
  • Spaciness or feeling in a fog
  • Overwhelmed by the tasks of daily living
  • Feeling tired, sluggish, or slow moving
  • Procrastination, failure to finish things
  • Chronic boredom
  • Losing things
  • Distractibility
  • Forgetfulness
  • Difficulty expressing feelings
  • Lack of empathy for others

Variant of Unfocused Anxiety/Depression

A variant of Unfocused Anxiety/Depression is caused by overall reduced blood flow and activity in the cortex along with too much activity in the basal ganglia and/or deep limbic system which can be caused by physical illness, drug or alcohol abuse, oxygen deprivation, infections, traumatic brain injury or exposure to toxic substances.

The symptoms of this variant include those listed for Unfocused Anxiety/Depression in addition to frequent feelings of being sick, mental dullness or cognitive impairment.

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