Medications for Fear
It would seem that if we had a drug that could get rid of the symptoms of
sympathetic arousal—panic, pain, dizziness, tense muscles, flooding
adrenaline, hammering heart, and ragged breathing—we’d be rid of fear
disorders for good. Many would agree, especially some of the people who
have them. And drug companies.
Psychiatric medications make people feel better. In some cases the
effect is nothing short of miraculous. But as I suggested in Chapter 2, feel-
ing betterdoes not necessarily mean cured. Explosive people have to feel
well enough to do better, but if they feel too good, there’s no motivation
left to do anything differently. It’s a dilemma that must be resolved
through careful consideration of all the variables. To consider the role of
medications in fear disorders, you’ll need a basic grasp of the neurophys-
iology involved.
The Neurophysiology of Fear
The brain is made of nerve cells, which consist of a cell body with long
extensions called axonsthat divide at their tips into terminal fibers. These
are the parts that send impulses. The cell body also has rootlike receptive
structures, called dendrites. Terminal axon fibers and dendrites of many
nerve cells overlap in areas called the synapses.To make matters more
complicated, synapses can be axon to axon or axon to cell body as well.
The firing of nerve cells is a change in the polarity of chemical ions
on the inside and outside of the cell that yields a tiny electrical current.
That current is propagated from one cell to another by dumping minuscule
amounts of chemicals called transmitter substancesinto the synapse. If
there is enough of the chemical in the synaptic area, the firing of one cell
will cause others to fire.
There are about 100 known transmitter substances (also called neuro-
transmitters), and more are being discovered almost daily. The most famous
is serotonin, which we’ve previously mentioned, as well as norepinephrine.
Others you may hear about includeGABA and dopamine. Transmitter
substances affect only cells that have specific receptors to which that sub-
stance can bind.Each cell has binding sites for many—but not all—of the
different transmitter substances. For one cell to fire another, it has to
82 ❧Explosions into Fear