Anxiety and Depression: Separate or Interrelated Illnesses?

Traditionally, psychiatry has diagnosed anxiety and depression based on symptom clusters rather than underlying brain dysfunction. However, ignor­ing brain function limits our diagnostic accuracy and ability to be successful in combating these illnesses. Based on the Amen Clinic's extensive brain im­aging work, we have seen that there are at least five major highly intercon­nected brain circuits that underlie most anxiety and depressive disorders. Problems may arise in individual brain circuits or in a combination of them.

• The basal ganglia (deep brain structures) set the idling level for the body. When they are too active, people feel revved up, anxious, and on edge. When they are underactive, people feel slowed down and unmotivated.
• The deep limbic system (or emotional brain) sets the feeling tone of the mind. When it is overactive, people tend to feel depressed, negative, hopeless, and have appetite and sleep problems.
• The anterior cingulate gyms, in the frontal lobes, helps the brain with cognitive flexibility and shifting attention. When it is overactive, people tend to get stuck on negative thoughts or behaviors (seen commonly in both anxiety and depression).
• The temporal lobes are involved with mood instability, temper control, and memory. When they fire erratically, people may have periods of panic or fear for no reason, they may have dark, evil thoughts, or they may be aggressive toward others or toward themselves (suicidal behavior).

When under active people tend to have trouble focusing and often exhibit poor judgment. When it is overactive, people tend to worry and have trouble letting go of hurts and bad thoughts.
Understanding these brain circuits is critical for proper understanding and diagnosis of anxiety and depressive disorders. Until recently we had no way of looking at the brain function of individual patients.

Through the ad­vent of sophisticated imaging technology, the application of which we have helped pioneer at the Amen Clinics, we can see and evaluate which of these systems work well, work too hard, and/or do not work hard enough. Un­derstanding the role these systems play in the genesis of anxiety and depres­sion has led us to exciting new information in diagnosis and treatment and a new way of classifying these illnesses. Applying this technology while fol­lowing the course of treatment and tracking changes in brain systems has led to more effective treatment. We do not have to rely exclusively on the pa­tient's description of the problem, but rather we can address the underlying physiological issues and improve treatment outcome.



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