This is quite possibly going to be the most self-aggrandising article I will ever write. Maybe I have finally descended into pure and utter delusion. But the experimentalist in me strongly believes that what I say in the title is true. I think my life accidentally became the near perfect experiment to discover biochemical causes of anxiety.
“How did I miss this?” I say to myself. I had just found a case study by Catalano et al. [1] describing the development of panic attacks in two patients shortly after initiation of the antidepressant Sertraline. Importantly, the patients had no personal or family history of any anxiety condition. I had been searching for an article like this since 2015. It was now 2021.
Finally, after years of clinician after clinician staring blankly at me while I described my severe reaction to Sertraline, I had proof. My clinicians were all wrong. Being worried about putting my hand up in school 15 years ago did not mean I must have been suffering from an anxiety condition. I didn’t have a weird form of bipolar depression where I never got mania. I wasn’t harbouring some dormant form of anxiety that the Sertraline “Unlocked”. Anxiety induced by Sertraline was possible. It was possible.
Of course, like the proverbial London buses, I then immediately found similar case studies by González-Berríos [2], Zinner [3], Varon et al. [4] and Korkmaz et al. [5]. “Am I an idiot?” I humorously wonder.
I sent the case studies to the clinicians who currently had the responsibility of treating me. Alas, I got nothing back. It didn’t matter. For the first time in 6 years, I had a lead.
If I told you there exists a set of initial conditions of the brain, that with slight perturbation, could initiate the progression of nearly all anxiety conditions, you would call me mad. But, that is exactly what happened to me.
I took the Sertraline in November 2015. I had just had an extremely stressful first year of my PhD after a series of unfortunate events. My depression was the worst it had ever been. For the first time in my life, the depression stopped me from working for over 2 weeks. I had been in university counselling 4 times and it didn’t seem to have done anything to help 1.
My illness was purely depressive. I had never suffered an anxiety symptom up until the point I decided to take an antidepressant. I need to clarify what I mean by an anxiety symptom as the term has been softened to mean “worry” in today’s culture. An anxiety symptom is one that causes pain, incapacitates the individual and is persistent (it is difficult/impossible to remove through behaviour alone). I have no family history of anxiety conditions and/or symptoms either. Just like the patients in the case studies I found.
It took four introductory doses of the Sertraline to initiate severe panic attacks (and in all likelihood serotonin syndrome). Very similar to the case studies, they started without much warning other than a building “energy” I felt a few seconds earlier. I can still recall the feeling of pure liquid fear coursing through my brain.
In the case studies, after cessation of the Sertraline, every patient’s anxiety symptoms went away. Most of mine didn’t. The ocular clonus and hyperreflexia did go away. Unfortunately, I went on to develop agoraphobia, shivering (that lasted for 4 months), hypochondria, severe panic disorder, severe generalised anxiety disorder, and a lot more conditions/symptoms I cannot even remember.
Why did my anxiety symptoms persist and get worse, while the symptoms of those in the case studies went away? This is the question that stumps me to this day. Its answer, I believe, will open the door to the secrets of anxiety disorders.
The current philosophy of psychiatry seems to be to try and obtain an overarching solution for every single presentation of an illness. Is it nature or nurture? Is depression caused by a lack of “X” Neurotransmitter? (where “X” is Serotonin, Dopamine etc.) Or is it due to sociological problems? (i.e. upbringing, stigma etc.)
In my opinion, this philosophy is misguided.
From my understanding of how complex interconnected systems work (which, I believe, is what all biological organisms are) the answer is always going to be complex. It is always both Nature and Nurture, biochemical and sociological. I have a strong belief that psychiatry needs to get away from “ors” and towards “ands”. Trying to extract the underlying roots, the general rules, of any complex problem is difficult.
This is why I believe in special cases [6]. Situations where there is a known and severe skew towards either nature or nurture. Finding the exception to the general rules that underlie complex problems will help discover what the rules are. I think what happened to me was a special case.
From my understanding, the vast majority of those suffering from anxiety, develop the condition over a long period of time. It is difficult to separate these complex long-term environmental effects from the short-term biochemical changes.
In my case, however, there was a clear and obvious separation. One day I wasn’t anxious, the next I was. All due to a very simple mechanism. In such a short space of time at an introductory dose, I believe the only significant change in my brain was from the Sertraline’s primary mode of action. The inhibition of the Serotonin transporter.
I, therefore, know a significant root cause of all the anxiety disorders I went on to suffer from (with negligible environmental influence). I believe that if someone could be bothered to look, that is, to take measurements of my brain with a clever experimental set-up, some of the dots could be connected to the simple root cause. The start of a complex solution could be constructed.
My anxiety is really weird. It isn’t based on any past traumatic experience. For example, when I step outside, nothing is running through my head, no specific thoughts or fears about what might happen when I trek away from my home. I just feel this generic anxious pain. I would be utterly fascinated by it if it was not impinging on my ability to live a normal life.
It is this weirdness which makes me feel like there are some secrets to the understanding of anxiety conditions sitting here in my head. I believe I accidentally became the near perfect experiment to study the biochemical roots of anxiety conditions. Why do I feel so confident? Because the same thing happened to my identical twin brother (though with 5HTP tablets so the severity was much reduced). I still remember the horror I felt when it happened.
I think I am worth at least a conversation. The tragedy of my life has not been the pain and suffering I have experienced; it has been other people’s reaction to this pain and suffering. I have faced so many blank faces, ignored by almost everyone. Too scared to start a conversation. If an interested scientist were to sit down and listen to my story, even for only an hour, I think there is a lot I can add.
I don’t want my life to be an opportunity missed.
[1] G. Catalano, S. M. Hakala, and M. C. Catalano, ‘Sertraline-induced panic attacks’, Clin. Neuropharmacol., vol. 23, no. 3, pp. 164–168, Jun. 2000, doi: 10.1097/00002826-200005000-00007.
[2] N. González-Berríos, ‘Sertraline-induced panic attack’, Boletin Asoc. Medica P. R., vol. 101, no. 1, pp. 59–60, Jan. 2009.
[3] S. H. Zinner, ‘Panic attacks precipitated by sertraline’, Am. J. Psychiatry, vol. 151, no. 1, pp. 147–148, 1994, doi: 10.1176/ajp.151.1.147b.
[4] J. Varon, A. E. Lechin, and T. V. Taylor, ‘“Impending death” and sertraline’, J. Emerg. Med., vol. 13, no. 2, p. 246, Mar. 1995, doi: 10.1016/s0736-4679(99)80014-6.
[5] S. Korkmaz, M. Kuloğlu, U. Işık, M. N. Namlı, H. Korkmaz, and M. Atmaca, ‘A case report with panic attack induced by single dose of sertraline’, Dusunen Adam J. Psychiatry Neurol. Sci., pp. 300–301, Dec. 2010, doi: 10.5350/DAJPN2010230412t.
[6] ‘A physicist’s experience of the mental-health system’, Physics World, Feb. 09, 2022. https://physicsworld.com/a-physicists-experience-of-the-mental-health-system/ (accessed Mar. 03, 2022).
