Anxiety, fear, panic... Medication treatment 'tough side effects'

[Hankyoreh S] Shin Chan-young's mind poison, mind medicine - anti-anxiety

Edvard Munch drew <The Scream> while listening to the screams of nature and colors in a fjord stained with blood red clouds. <Anxiety> and <Evening on Karl Johan Street>, which were released before and after this, are representative works that show Munch's original style with the theme of anxiety and fear. In particular, <The Scream> is a modern art work that was ranked in the top 10 search rankings by CNN in 2019, and is a painting that faithfully expresses the basic human emotions. In a modern society where existence and survival itself are uncertain due to intensified competition, people's anxiety and fear are growing.

Anxiety is a state of not being comfortable with what is going to happen, and fear is a situation in which fear is realized. Anxiety is the discomfort experienced in a situation where you have to walk into a dark cave alone, and fear is the physical and mental fear you experience when a bat suddenly flies in and brushes your face. Anxiety and fear are innately imprinted or learned anew. Although it is a negative image, it is also an indispensable emotion for survival. A fearless monkey may be eaten by a lion or leopard, or fall from a tree and break its bones. Fear is an essential emotion for survival. However, in social relationships with too many stimuli, if humans cannot properly control their highly developed cognitive abilities and feel excessive anxiety, it can cause serious disabilities.

Benzodiazepine prescription basics… Causes drowsiness and interferes with memory

In the United States, close to 28% of people experience anxiety disorders at least once in their lives, and the prevalence of anxiety disorders in Korea is around 5%. It is common to be accompanied by depression, so depression is treated first, but if not, various treatments should be taken depending on the cause and symptoms. Anxiety disorders include △Post Traumatic Stress Disorder (PTSD) caused by a specific accident or violence △Obsessive-compulsive disorder where you have to constantly check whether the gas light is turned off, whether your wallet is properly placed, and whether you have washed your hands △Objects such as birds, spiders, heights, squares, etc. A specific phobia of a person or situation △social anxiety disorder that comes from public situations such as presentations or interviews △generalized anxiety disorder in which the degree of anxiety increases in various fields △disaster situation comes to me for no particular reason, and I breathe because I think I will die soon It can be classified as panic disorder to the extent that it is impossible to rest.

Anti-anxiety drugs are commonly prescribed for the treatment of anxiety disorders, and among them, benzodiazepines are the most commonly used drugs. This substance was accidentally synthesized in the late 1950s at the Swiss multinational pharmaceutical company Hofmann La Roche while trying to make another substance. The strong sedative effect of this substance was accidentally confirmed, and since its first commercialization in the 1960s, dozens of drugs with similar chemical structures have been developed and used. Although more than 60 years have passed since their development, these drugs are still widely distributed. In the United States alone, sales of about 3 trillion won a year are being raised. Benzodiazepines strengthen inhibitory neurotransmission by binding to specific sites on GABA receptors, which are inhibitory neurotransmission control receptors. It leads to anti-anxiety, sedation, muscle relaxation, and excessive respiratory depression, reducing symptoms of acute anxiety and excitement. However, it has the side effect of causing drowsiness and interfering with memory. In severe cases, you may not remember what you did, such as when you drank and the film was cut. Some of the sedatives used for sleep endoscopy, such as midazolam, are benzodiazepine analogues. It is because of this drug that we do not remember what happened during sleep endoscopy. In addition, long-term use of benzodiazepines can cause 'ataxia', which can lead to weight gain and inability to exercise properly. The more you use it, the stronger your tolerance and the more addictive it is, which can cause withdrawal symptoms if you stop. In addition to these drugs, buspirone-type drugs that have a serotonin-regulating action are widely used because they have an anxiety-reducing effect, but have a limited effect on phobias.

Problems with benzodiazepines can be aggravated when used with alcohol or opioids. In the case of a male actor who was shocked by the fact that he was recently known to have taken various drugs and dependence drugs, midazolam and alprazolam, which were the last to be revealed, are benzodiazepines. Administering benzodiazepines while intoxicated can lead to death. Deaths related to benzodiazepine abuse are continuously increasing, and this family of substances is evaluated to have greater physical harm and dependence compared to cannabis, LSD, and ecstasy.

The 'cognitive error' that makes you feel anxious needs to be corrected... Cognitive Behavioral Therapy ‘Alternative’

Extreme anxiety and fear cause ‘panic’. Panic is a state of being frightened and bewildered. Just as a frog meets a snake, the normal functions of the body and mind stop. In the stock market, panic trading (panic buying and panic selling) causes huge losses. The relief of anxiety and fear of external stimuli that do not pose an immediate and direct threat eventually begins when we realize that the target does not harm us.

After it became clear that the effects of benzodiazepines are limited and that there are various side effects, the growth of the benzodiazepine drug market has slowed down, and attempts to treat anxiety disorders using cognitive behavioral therapy and electromagnetic neural activation are becoming more active. . Cognitive-behavioral therapy is to correctly recognize cognitive errors about situations, events, and objects that cause anxiety and fear. It is a process of training not to cause harmful anxiety and fear reactions by repeatedly confirming and learning that exposure to similar events directly or indirectly does not actually cause any problems. This exposure is presented weakly at first through imagination, virtual reality, and play, and then progresses in a way that raises the intensity.

<The Sun>, which Munch released about 20 years after <The Scream> and <Anxiety>, boasts intense colors full of hope. Six years later, Munch filled the canvas with a soft yellow color that represents comfort even in the face of death in a self-portrait titled <I Caught the Spanish Flu>. Munch, who overcame the pandemic that hit Europe in the early 20th century, lived another 25 years and died comfortably at the age of 81 at the time he painted “Self-Portrait of the Spanish Flu.”

Konkuk University Medical School Professor Shin Chan-young

A psychopharmacologist who admits that my mind is different from yours. As a pioneer in basic research on brain development disorders, he has published more than 190 papers on animal models and mechanisms of brain diseases.