This has been called the age of anxiety – and with good reason.
Tranquilizers have become almost as commonplace as aspirin in the typical medicine cabinet, and each day doctors hear a multitude of physical complaints that were triggered by anxiety attacks.
This undercurrent of everyday anxiousness tends to obscure a widespread psychiatric problem. It is known by various names, of which anxiety neurosis is the most common. Although it affects an estimated 10 million people, making it the most prevalent single medical ailment, its causes and cure are unknown.
Recently, Dr. Feris Pitts and Dr. James N. McClure of Washington University, St. Louis, took the first step toward unraveling this mystery. They showed that anxiety neurotics produce excessive amounts of a key chemical which is a normal product of metabolism.
When this chemical – lactic acid – is injected into patients it predictably and reliably produces anxiety symptoms. Thus, a new area of research has been opened in chemical psychiatry.
Dr. Pitts describes how anxiety neuroses effects an estimated 5 per cent of the population of this country. “These people, although they are constantly nervous and have anxiety attacks, seem to be conscientious and manage to carry on their work,” he says.
One of Dr Pitts’ patients, describes his anxiety symptoms this way (they began 22 years ago when he was living with his wife and two small children in San Francisco):
“I started to get ready for bed one evening and the first thing I was aware of was a pain in the center of my chest. It spread around my chest and got worse. Next I felt palpitations and then I had difficulty breathing. I started walking around, trying to get my breath. I became frightened and thought I was having a heart attack. Then I got panicky.
“Finally, I had some coffee, and after an hour or so I found it easier to breathe and my chest pains were not quite so severe. But I didn’t go back to bed again. I sat up all night.
“The symptoms kept recurring every week. I went from one doctor to another and it was always the same. They listened to my heart, took my blood pressure, and they all gave me the same answer: There was nothing wrong with me.
“I came to the conclusion that I had an incurable heart disease and the doctors just didn’t want to upset me by telling me.
“One night I came home from work and told my wife that, if I had to die, I wanted to die among friends and relatives in my home town. So in three days I had sold everything and we moved back to St. Louis.
“The attacks continued and 1 started the round of doctors again. I got the same answer.
“One night at home, I jumped up and ran six blocks to a hospital. I didn’t think about it, of course, but that was a dandy thing to do if you were having a heart attack. I ran up to the front desk at the hospital and asked for the nearest doctor. 1 told him, “I’m having a heart attack!” I can laugh now but I wasn’t laughing then.
“The doctor checked me over, and eased me into the idea that 1 should see a psychiatrist. He was the first doctor who suggested this.
“I took his advice. Later on, I was referred to Dr. Pitts.”
That was eight years ago. Now 50 years old, he says: “If 1 knew then what I know now, I’m sure my attacks would have been milder because of the very knowledge of what they really were.”
Dr. Pitts points out that making a diagnosis of anxiety neurosis is a complex matter. Some of the symptoms exist to a degree in normal people who are under stress; for example, in soldiers in combat or in students under the strain of exams.
Using guidelines established in earlier studies and from his own experiences, professor Pitts uses the following criteria for diagnosis:
Frequent episodes of extreme fearfulness, such as a feeling of impending doom, fear of insanity, fear of haying a heart attack or other serious affliction. In addition, the attacks include at least two of the following: dizziness or giddiness, faintness, or getting a full breath, choking or struggling to breathe, sighing, chest pain and a lump in the throat; plus at least three of the following: dizziness or giddiness, faintness, weakness, fatigue, inward shakiness, tremor tingling sensation in the skin, vascular throbbing, and palpitation.
Severe feelings of tenseness nearly daily for at least two years immediately before the interview for the tests.
On occasion, at least 10 of the following symptoms: headache, dizziness, blurred vision chest pain, palpitations, difficulty in breathing, sighing, fatigue tingling sensation in the skin depressed mood, trembling, shakiness weakness, fears and insomnia.
No other psychiatric disease or serious medical disorder affecting heart, lungs, liver, kidney, or neuromuscular function. It is extremely rare to find a patient in whom the onset of these symptoms occur after the age of 35.
The results of four independent studies in four nations prompted Dr. Pitts to conduct a chemical test which showed that anxiety neurotics, after performing standard exercises, produced excessive amounts of lactic acid. Also, their anxiety symptoms often appeared with an increase of the substance in the body.
Lactic acid is normally produced in sugar metabolism in body tissue. People with serious organic disease develop high blood lactate levels after exercise. In investigations, the anxiety neurotics produced the same high blood levels of the substance.
During exercise muscle tissue produces lactic acid, which then is carried to the liver by the bloodstream. The liver, in turn, removes the lactic acid and rebuilds sugar molecules which are returned to the blood stream. In patients with liver disease this clearing process of the liver is defective and excessive lactic acid is produced. Liver [unction was found to be normal in anxiety neurotics, however.
Dr. Pitts decided to find whether lactate injected directly into a patient would produce symptoms of anxiety neurosis. The response was dramatic. All anxiety neurotics experienced the symptoms of an anxiety attack.
“Very nervous and chest tight,” said one patient. “Breathing uncomfortable, vision not well focused, very unpleasant. Had this kind of attack once at work and they had to take me to the doctor – just like this, only I’m not as scared this time because you’re here and you wouldn’t let that fluid in my vein harm me.”
Thus the first step has been taken toward understanding the complex chemistry which underlies symptoms of anxiety neurosis. Drs. Pitts and McClure’s work strongly indicates that a specific physical process triggers the increased levels of lactic acid. Should the steps in this biochemical process become known in detail, it may be possible to control the symptoms of anxiety attacks or even prevent them althogether.
Anxiety Attack Coping Strategies
