Why can anxiety be so hard to treat?

Anxiety disorders are the most common mental illness in the United States, affecting almost 20 percent of the adult population, according to the Anxiety and Depression Association of America.

“Anxiety is a disease that is characterized by excessive and uncontrollable worrying,” says Dr. Stasia Kahn, an internal medicine physician and member of Advocate Physician Partners. And while doctors understand what physiologically causes anxiety and how it affects our hormones, finding the best treatment for each individual remains challenging. But thanks to a new study, more focused treatment options may soon be a reality.

When an individual feels anxious, cortisol, the stress hormone, is released from the body. Today’s anti-anxiety medications typically target cortisol levels in the brain. However, doctors have recently discovered that even though cortisol is the hormone that is released when one is anxious or stressed, targeting cortisol alone may not be completely effective. And many medications that target cortisol are too broad.

They may reduce cortisol levels in some parts of the brain while elevating it in other parts, said Joseph Majzoub, the lead author of the study, so the two effects may cancel each other out.

The research, published in the journal Molecular Psychiatry, found that a set of neurons in the hypothalamus are crucial to the anxiety response. Researchers genetically engineered mice to be missing a gene that controls the release of cortisol in these neurons. They found that the mice without the gene were more relaxed and more adventurous compared to the control mice whose cortisol levels were not regulated.

“By locating the specific nerves in the brain that lead to anxiety, the hope for humans is that someday researchers may be able to develop more effective treatments for anxiety,” says Dr. Kahn.

If you have symptoms of anxiety, Dr. Kahn emphasizes it is important to discuss with your physician all available treatment options and come up with a personalized plan of action.

Dr. Kahn says you should seek help for your anxiety if you worry much of the time, are unable to relax, have sudden fears that something terrible is happening to you or if you have physical symptoms of anxiety such as racing heart, dizziness or tremulousness.