If there is a person with panic disorder in your life, you should be aware
of the dangers of benzodiazepines and watch out for overuse. Ask what he
or she is taking, how much, and how often. If you don’t know what the drugs
are, look them up. Be especially careful if the person is seeing several
different doctors. Often, one may not know that another is treating
symptoms of the same condition. The best way to have a positive effect is
to insist that the patient tell each doctor about all the others so they can
communicate among themselves.
Serotonergics
One thing is certain: Drugs that increase the amount of available serotonin
in the brain make a lot of people feel better, regardless of what is wrong
with them. What is not certain is why this is so. Serotonin pathways go
just about everywhere in the brain, and serotonin circuitry regulates most
of the processes involved in most mental disorders. Other transmitters are
involved as well, but serotonin connects to them all.
(I should note that I use the loose, generic term serotonergic to cover
a whole class of drugs that work by increasing the amount of available sero-
tonin in the brain. Some also affect norepinephrine, acetylcholine, and
dopamine as well. The transmitter substances may be different, but the
theory is the same. In writing about psychiatric drugs, I try to use the name
you will most commonly hear, usually the brand name. See Appendix 1
for specific classifications and generic and brand names of all medications
discussed in this text.)
There is absolutely no mental disorder that hasn’t been ascribed to
a serotonin deficiency or, more rarely, overabundance. Serotonin is to psy-
chiatry as self-esteemis to psychology—both seem to explain everything.
To be fair, I must admit that increasing available serotonin is a far more
effective treatment for psychological disorders than increasing self-esteem.
Serotonergics were first used for depression, so we’ll save the extensive
discussion of how they work for that section. For more than 40 years sero-
tonergics have been used to improve mood and motivation. More recently
they have been widely and effectively used for other explosive disorders as
well. Needless to say, if you improve a person’s mood, everything looks
better, but I suspect that the effect on emotional explosions is through
another pathway entirely.
Explosions into Fear ❧ 87