On Bears and the Limbic System

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I have seen over the years, and in all jurisdictions, not a small number of folks with generalized anxiety disorders often with panic attacks and agoraphobia.

Many are young women age 20-40 with a history of trauma, others with a genetic substrate. Some have classic PTSD with panic anxiety, hypervigilance, startle reactions and dissociation. A few have experienced actual combat. Some grew up in similar conditions with chaotic dysfunctional families.

I describe to my patients a model that explains the protean manifestations of panic: rapid heart rate, dizziness, tingling, tremor etc associated with intense fear of death or medical catastrophe.

To explain this I begin again with post traumatic stress. Growing up in a chaotic abusive family is much like living in a war zone. Whether Afghanistan or suburbia the end result is a highly charged central nervous system. Many have found the thermostat paradigm that I use to describe what happens to the nervous system under such conditions to be helpful. This model also applies to those with no trauma history but a strong genetic input.
And what I refer to specifically is the locus coeruleus. This is a neuronal bundle just north of the reticular formation….

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It has the highest concentration of norepinephrine in the brain and regulates stress response. It receives data from the relay station (reticular formation) and fires it up to the limbic system for a fight or flight response.

If you are hiking in the forest and come upon a bear your body will quickly react with panic symptoms to prime the body for action. Fight or flight. Preferably the latter. The heart races and the muscles tense up. This is no time to have the frontal lobe kick in and think about the adverse conditions bears face and offer up a snack or to ponder the meaning of life or contemplate John 11:25.

The thing about spontaneous panic attacks however is that they are bear encounters without a bear. You could be asleep, sitting in the living room reading or be in a social setting, when it hits without much warning. A panic attack can last > 20 minutes and end with exhaustion. The end result is often a phobia of public places or secondary depression or demoralization.

What happens is that the locus is firing off signals when not required. The locus is the thermostat that regulates the level of tension in the body. It is there for safety and protection. In anxious panic patients  the thermostat is set too high leaving no room for variation. The end result is existential dread. These patients are more in touch with the fragility of the body and what could be called ultimate concern-the tenous state of being. They often worry about body sensations with catastrophic interpretations.They ponder philosophical and theological issues often obsessively. They are in tune with the human condition more than average and suffer accordingly.

Alongside supportive therapy and use of cognitive behavioural techniques, the locus ceruleus can be clamped medically with  drugs of the SSRI class such as Zoloft or benzos like Clonazepam which chemically inhibit the locus and calm it down. However upon discontinuation the chances of recurrence are high. And many people do not want a chemical solution. I have discussed mindfulness CBT meditation before and in cases of panic anxiety this therapy that has great utility. With repeated yoga meditation the mind is put at ease, the concerns around bodily decompensation diminish and with repeated practice the thermostat is permanently  reset to normal levels.

Existential dread diminishes and the bear goes into permanent hibernation. After all the locus ceruleus is a bear of very little brain.

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