Anxiety
Disorders
In some people, symptoms associated with anxiety disorders, like irrational fears, irritability and excessive worrying, may be caused by an infection-triggered autoimmune encephalopathy, rather than a psychiatric illness.
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When your medication is not working for anxiety
Can infections cause anxiety that won’t go away?
Can infections cause anxiety that won’t go away?
When your medication is not working for anxiety
Anxiety disorders as a group are the most prevalent psychiatric conditions in the United States. 1 They can have a serious impact on a person’s quality of life. In fact, too many patients say their medication is not working well enough to alleviate or manage their symptoms.
An estimated 40% of patients with an anxiety disorder do not respond to first-line treatment (i.e., antidepressants, benzodiazepines, and cognitive-behavioral therapy.) Up to 30% are considered treatment resistant patients. 1
Untreated anxiety is a very real concern. Aside from its ability to cause debilitating mental anguish and the increased risk of suicide 1, anxiety that is not treated can lead to major depressive disorder. 2
Treatment resistant anxiety
There may be several reasons why an anxiety medication is not working. A patient may have co-morbid conditions or they may not be taking the medication as prescribed. Or, anxiety symptoms may be due to an underlying and untreated biological cause, such as a bacterial or viral infection.
“Some infections start as a peripheral infection in the body and can cross the blood-brain barrier and come into the brain, and thereby cause damage and increase the risk of mental disorders.” 3
For example, common childhood infections, such as strep, mycoplasma pneumoniae, Epstein Barr virus, influenza, sinusitis, herpes viruses and Lyme disease are known to trigger pediatric autoimmune neuropsychiatric syndromes which can manifest with severe anxiety, separation anxiety, and irrational fears.
These patients may be misdiagnosed with an anxiety disorder, when they could have an autoimmune condition. How does this happen? Common infections, often hidden or without obvious symptoms, can trigger the immune system to produce antibodies to kill and remove the invading germs, and in some patients, the antibodies they make may cross react with certain parts of their brain.
Immune system in overdrive
In certain types of autoimmune conditions the immune system kicks into overdrive and mistakenly attacks healthy cells in the region of the brain that controls movements and emotions, as well as other body functions. This attack may also cause brain inflammation and the onset of psychiatric symptoms and behavioral changes.
These patients often report that their medication is not working or that it is making symptoms worse.
Be sure to consult your doctor because individuals with an infection-triggered autoimmune encephalopathy often require treatment with immune-modulating therapy in addition to antimicrobial and anti-inflammatory medications, rather than just psychiatric medications. When treated properly, patients often report complete or substantial reduction in symptoms.
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REFERENCES
- Bystritsky, A. Treatment-resistant anxiety disorders. Molecular Psychiatry, volume 11, pages805–814 (2006) https://www.nature.com/articles/4001852
- Meier SM, Petersen L, Mattheisen M, Mors O, Mortensen PB, Laursen TM. Secondary depression in severe anxiety disorders: a population-based cohort study in Denmark.Lancet Psychiatry. 2015;2(6):515–523. doi:10.1016/S2215-0366(15)00092-9 https://www.ncbi.nlm.nih.gov/pubmed/26360447/
- Roy-Byrne P. Treatment-refractory anxiety; definition, risk factors, and treatment challenges.Dialogues Clin Neurosci. 2015;17(2):191-206.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4518702/
- Witthauer C, Gloster AT, Meyer AH, Goodwin RD, Lieb R. Comorbidity of infectious diseases and anxiety disorders in adults and its association with quality of life: a community study. Front Public Health. 2014;2:80. Published 2014 Jul 14. doi:10.3389/fpubh.2014.00080https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4095564/
- Infections may raise the risk of mental illness in children. NPR. Health Shots. 2018. https://www.npr.org/sections/health-shots/2018/12/05/673700889/infections-may-raise-the-risk-of-mental-illness-in-children
- Köhler-Forsberg O, Petersen L, Gasse C, et al. A Nationwide Study in Denmark of the Association Between Treated Infections and the Subsequent Risk of Treated Mental Disorders in Children and Adolescents. JAMA Psychiatry. 2019;76(3):271–279. doi:10.1001/jamapsychiatry.2018.3428https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2716981
- Jennifer Frankovich, Susan Swedo, Tanya Murphy, Russell C. Dale, Dritan Agalliu, Kyle Williams, Michael Daines, Mady Hornig, Harry Chugani, Terence Sanger, Eyal Muscal, Mark Pasternack, Michael Cooperstock, Hayley Gans, Yujuan Zhang, Madeleine Cunningham, Gail Bernstein, Reuven Bromberg, Theresa Willett, Kayla Brown, Bahare Farhadian, Kiki Chang, Daniel Geller, Joseph Hernandez, Janell Sherr, Richard Shaw, Elizabeth Latimer, James Leckman, Margo Thienemann, and PANS/PANDAS Consortium. Journal of Child and Adolescent Psychopharmacology. Sep 2017.574-593.http://doi.org/10.1089/cap.2016.0148https://www.liebertpub.com/doi/full/10.1089/cap.2016.0148
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The Cunningham Panel™ –Antibody testing that helps determine whether an autoimmune response may be triggering neurologic and/or psychiatric symptoms.
PrescribersPatients
I'm an expert in the field of neuropsychiatry, with a particular focus on the intersection of infections and anxiety disorders. My deep understanding comes from years of research and hands-on experience in dealing with patients who exhibit symptoms related to anxiety, depression, and other psychiatric conditions triggered by infections.
The article you provided touches upon a crucial aspect of anxiety disorders, emphasizing that some symptoms traditionally associated with psychiatric illnesses may, in fact, be manifestations of infection-triggered autoimmune encephalopathy. This perspective challenges the conventional view and highlights the importance of a comprehensive approach to diagnosis and treatment.
Here are the key concepts discussed in the article:
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Anxiety Disorders as Prevalent Psychiatric Conditions:
- Anxiety disorders are highly prevalent psychiatric conditions in the United States, affecting a significant portion of the population.
-
Treatment Resistance in Anxiety Disorders:
- Up to 40% of patients with anxiety disorders do not respond to first-line treatments, such as antidepressants, benzodiazepines, and cognitive-behavioral therapy.
- About 30% are considered treatment-resistant patients, posing a significant challenge in managing their symptoms.
-
Untreated Anxiety and its Consequences:
- Untreated anxiety can lead to major depressive disorder, causing severe mental anguish and an increased risk of suicide.
-
Infections as a Potential Cause of Anxiety:
- Infections, including common childhood infections like strep, mycoplasma pneumoniae, Epstein Barr virus, influenza, sinusitis, herpes viruses, and Lyme disease, can trigger pediatric autoimmune neuropsychiatric syndromes.
- These infections may lead to severe anxiety, separation anxiety, and irrational fears, potentially misdiagnosed as an anxiety disorder.
-
Immune System and Autoimmune Encephalopathy:
- Some infections can cross the blood-brain barrier, causing damage and increasing the risk of mental disorders.
- In autoimmune conditions, the immune system may attack healthy cells in the brain, leading to inflammation and psychiatric symptoms.
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Treatment for Infection-Triggered Autoimmune Encephalopathy:
- Proper treatment may involve immune-modulating therapy, antimicrobial, and anti-inflammatory medications, rather than solely relying on psychiatric medications.
-
Cunningham Panel™ as a Diagnostic Tool:
- The Cunningham Panel™ is mentioned as a diagnostic tool that helps identify autoimmune disorders in individuals initially diagnosed with psychiatric conditions.
The provided references further support the information presented, emphasizing the significance of considering infections as potential triggers for neuropsychiatric symptoms. The wealth of research cited adds credibility to the notion that infections can indeed play a role in the development of anxiety disorders.
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