Genetics Play a Role in Social Anxiety Disorder, Study Finds

The serotonin transporter gene “SLC6A4” is linked to social anxiety disorder.

Researchers at the Institute of Human Genetics at the University of Bonn in Germany recently discovered that a specific serotonin transporter gene called “SLC6A4” is strongly correlated with someone's odds of suffering from social anxiety disorder (SAD). The initial findings of this research were published online ahead of print March 9 in the journal Psychiatric Genetics.

Social anxiety disorder (or social phobia) is a common and heritable psychiatric disorder that is driven by a combination of genetic and environmental factors. Until now, genetic studies on SAD have been rare. According to the researchers, "This is the largest association study so far into social phobia."
For this study the German’s researcher genotyped 321 patients with SAD and 804 controls without social phobia. Then, they carried out a single-marker analysis to identify a quantitative association between SAD and avoidance behaviors. Their results provide evidence that the serotonin transporter gene SLC6A4 is frequently correlated with anxiety-related traits.

Notably, selective-serotonin reuptake inhibitors (SSRIs) are often prescribed to treat depression and anxiety disorders. SSRIs are believed to target the serotonin transporter gene SLC6A4.



People with social anxiety tend to avoid larger groups and situations in which they fearbeing judged by others. SAD is marked by symptoms such as increased heart rate, sweaty palms, shakiness, shortness of breath, etc.

The physiological discomfort of social anxiety reinforces avoidance behaviors and a withdrawal from face-to-face social contact. The fear of social encounters can lead to isolation and loneliness that snowballs. Unfortunately, people with social anxiety who rely excessively on social media to maintain a sense of connectedness may actually exacerbate their feelings of perceived social isolation, according to a recent study by researchers at the University of Pittsburgh, School of Medicine.

In 1948, when Maurice M. Rapport first isolated the chemical serotonin (5-hydroxytryptamine, 5-HT) in the human body and brain, serotonin was initially classified as a “serum agent that affected vascular tone.” Today, serotonin is commonly viewed as a neurotransmitter that helps to maintain mood balance.

Although there is a strong link between serotonin, depression, and social anxiety disorders; scientists remain uncertain about which comes first in terms of driving the correlation vs. causation dynamic between serotonin and psychiatric disorders. For example: Do low levels of serotonin contribute to social anxiety or does social phobia trigger a decrease in serotonin levels?

Interestingly, a 2015 study, "Serotonin Synthesis and Reuptake in Social Anxiety Disorder,“ published in JAMA Psychiatry reported that Individuals with social phobia have too much serotonin—not too little.

Surprisingly, the researchers found that the more serotonin someone with SAD self-produced, the more anxious he or she became in social situations. This raises doubt about the common assumption that selective serotonin reuptake inhibitor (SSRIs) help to lower social anxiety by keeping more serotonin in circulation.
In a statement, co-author Andreas Frick, a doctoral student at Uppsala University Department of Psychology said,



"Not only did individuals with social phobia make more serotonin than people without such a disorder, they also pump back more serotonin. We were able to show this in another group of patients using a different tracer which itself measures the pump mechanism.
We believe that this is an attempt to compensate for the excess serotonin active in transmitting signals. Serotonin can increase anxiety and not decrease it as was previously often assumed."

Taken together, all of this new research marks a significant leap forward when it comes to identifying changes in the brain's chemical messengers in people who suffer from social anxiety disorders. That said, much more research is needed to fully understand the enigmatic and complex workings of serotonin and transporter gene SLC6A4.

"There is still a great deal to be done in terms of researching the genetic causes of this illness," Andreas Forstner from the Institute of Human Genetics at the University of Bonn concluded.

If you would like to get involved in the genetic research on social anxiety disorder, Forstner and colleagues are encouraging the general public to participate in their research online by visiting their website: Social Phobia Research. The more people that get involved in the study of social anxiety disorder, serotonin, and SLC6A4, the more precisely the researchers will be able to decode these complex mechanisms.
References: Psychology Today
Andreas J. Forstner, Stefanie Rambau, Nina Friedrich, Kerstin U. Ludwig, Anne C. Böhmer, Elisabeth Mangold, Anna Maaser, Timo Hess, Alexandra Kleiman, Antje Bittner, Markus M. Nöthen, Jessica Becker, Franziska Geiser, Johannes Schumacher, Rupert Conrad.

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Mindfulness Meditation and Anxiety Disorders

Research evaluates the effects of meditation training on patients’ biological reaction to stress

Characterized by persistent and excessive worry, generalized anxiety disorder affects nearly seven million adults in the U.S

Those who are prone to anxiety tend to have greater difficulty managing and coping with stress, experts say, where chronic stress is shown to have physiologic effects including raising heart rate and blood pressure and increasing one's risk for heart attack and stroke. In an effort to find calm, research shows those struggling with anxiety may be well-served by turning to mindfulness meditation – a technique that involves focusing on the present and non-judgmentally paying attention to thoughts and feelings as they arise.

“If you think of anxiety – there are anxious thoughts and there are anxious feelings, and those go together,” says Judson Brewer, director of research for the Center for Mindfulness at the University of Massachusetts Medical School. “There are two ways that we can deal with them.”

One is our natural learned response that since anxiety feels bad, he says, we need to do something to make it feel better. “So we avoid it, we suppress it, we repress it – we do all these things to distract ourselves from the anxiety itself.” However, attempts to avoid uncomfortable thoughts and feelings may worsen anxiety. “The paradox here is that mindfulness helps us turn toward those and learn to change our relationship to the actual thoughts and the physical sensations, rather than try to change them in any way,” Brewer says. “By changing that relationship, we actually stop feeding those cyclical processes and they start to die off on their own.” By learning mindfulness-based stress reduction – an approach first developed at UMass that uses meditation to lower stress levels – research finds many people report reduced anxiety and stress levels.



Taking that a step further, a recent National Institutes of Health-funded study published in January in the journal Psychiatry Research also looked at the biological responses of patients with generalized anxiety disorder to stress, after they’d undergone MBSR. In the study, 70 participants were randomly assigned either to receive the mindfulness meditation training or to undergo stress management education – the study’s control group. “This was a sort of a wellness class where there was a series of lectures on different topics, like sleep improvement and exercise and nutrition,” says Dr. Elizabeth Hoge, an associate professor of psychiatry at Georgetown University Medical Center in Washington. Hoge conducted the research while she was a postdoctoral researcher at Massachusetts General Hospital.

Participants were asked to give an impromptu speech in front of an audience of testers – a typically stress-inducing experience – before and after the 8-week intervention, either the mindfulness meditation training or the stress management class. They were also asked to do mental arithmetic: “Start with the number 996 and subtract by seven all the way down to zero, which is really hard to do in front of an audience,” Hoge notes. “The testers had all the numbers in front of them on a clipboard and they were wearing white lab coats, and we videotaped and had microphones and photography flood lamps. [We] basically set up the laboratory stress test to be like the worst kind of speech challenge that a person can experience.”

Even so, blood testing revealed that study participants had significantly lower levels of the stress hormone ACTH and inflammatory reactions to stress (measured by looking at inflammatory proteins IL-6 and TNF-α) following mindfulness meditation training. That compared to the control group for whom biological stress responses actually increased somewhat the second time they underwent the social stress test.



The results offer biological data showing how mindfulness meditation training can affect the ability of a person with generalized anxiety disorder to be resilient in the face of stressful circumstances. “You can’t fake that,” Hoge says; nor could the results be explained by the placebo effect or a patient’s expectation that meditation would help, since their reactions were measured at a physiological level. “For people who have generalized anxiety disorder, our research provides evidence that this might be a reasonable treatment option,” she says.

Hoge says one of the reasons she was interested in pursuing the research was to look at alternatives to standard treatments for anxiety disorders, typically antidepressant medication and psychotherapy. “It’s hard for some people to get those treatments, either because of insurance, financial limitations and also the stigma that’s involved with coming to a psychiatric clinic for treatment," she says. "And a lot of people don’t want to go on medications.”

Though standard treatments work well for many patients, experts say it’s important to provide various options to match individual preference.

One question that remains is whether the stress levels – measured on a biological level – would be reduced over the long term by meditative techniques, says Dr. Madhav Goyal, an internist at NorthBay Healthcare in Vacaville, California, and an assistant professor of general internal medicine at Johns Hopkins University School of Medicine in Baltimore. Goyal has done research on meditation programs to address stress and improve well-being. “We know that people who are more stressed in general tend to be more susceptible to getting infections” among other health issues, Goyal says.



If meditation can treat anxiety disorder and help those with anxiety better cope with stress, it could also improve a person’s overall health in the long term. But more research is needed to determine the impact that meditation might have on chronic stress levels, Goyal says.

In the immediate term, for individuals considering meditation to treat anxiety disorder, Brewer suggests MBSR, which has been well-studied in this regard. The Center for Mindfulness has a worldwide online directory of MBSR teachers certified by the UMass Center for
Mindfulness.

Ultimately, experts say, meditation may help those with anxiety gain a greater understanding of more troubling underlying emotions, such as sadness or anger, while improving their ability to cope with stress. “Instead of being drawn into these long worry bouts, people can have more freedom to deal with those thoughts in a way that’s more constructive,” Hoge says.
Writer: Michael O. Schroeder / Health.news.com

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Depression: Are the symptoms correctly explained?

The standard rating scales used by healthcare professionals and researchers to diagnose this disease often differ in the symptoms they list, perhaps explaining why a one-size-fits-all treatment has to date been so ineffective, new research suggests.

Depression is generally considered to be a specific and consistent disorder characterized by a fixed set of symptoms and often treated with a combination of psychotherapy and medication. However, the standard rating scales used by healthcare professionals and researchers to diagnose this disease often differ in the symptoms they list, perhaps explaining why a one-size-fits-all treatment has to date been so ineffective. This is the finding of research conducted by psychologist Eiko Fried from the University of Amsterdam (AU). His results are published in the latest edition of the Journal of Affective Disorders.

Depression is often viewed as a common medical disorder like measles -- one either has it or one doesn't. As a result, diagnosis is generally followed by assigning specific treatment options. But unlike physical disorders where blood tests or other objective tests enable a reliable diagnosis, there are no such measures to determine whether someone is depressed. Instead, researchers and clinicians query patients about symptoms that are indicative of depression, such as sadness, suicidal ideation and sleep problems. If a person has many depression symptoms, she is considered depressed.



Heterogeneity
In his study, Fried used a content analysis to investigate the symptom overlap of 7 rating scales of symptoms that are commonly used in depression research. One of the scales is the Hamilton Rating Scale of Depression, which contains 17 predominantly physical depression symptoms like paralysis, weight loss and psychomotor retardation. Another is the Beck Depression Inventory, which includes 21 mostly cognitive-affective symptoms such as feelings like worthlessness, guilt, crying and self-dislike.

What he found was that these and other rating scales show surprisingly little symptom overlap. Moreover, together they feature a total of 52 different depression symptoms ranging from sadness, lack of interest and suicidal ideation to genital problems, irritability and anxiety.

These findings underline the striking heterogeneity of depression, a disorder mostly viewed as one consistent syndrome, says Fried. 'Patients diagnosed with depression are often thought to have similar kinds of problems and therefore receive very similar treatment. However, the fact that 7 common rating scales of depression contain over 50 different symptoms shows how strikingly different depressed patients can be in terms of the problems they experience. This seems to indicate the need for more personalized treatment and might explain why current "one-size-fits-all" solutions like antidepressants show so little efficacy.'



Predetermined outcome
Fried believes his findings could also pose a major problem for depression research because the type of scale used by researchers might determine the outcome of a scientific study. Fried: 'For example, imagine you are a researcher and want to study the brain structure of depressed patients. This is usually done by giving a large group of people one specific depression scale, and if these people have a certain number of symptoms they are enrolled into the study as depressed.

According to Fried, his findings suggest that the type of scale a researcher uses might dictate the kind of people who are enrolled in the study. 'For instance, if a researcher uses Hamilton's scale, which is focused on physical symptoms, the kinds of participants she examines in her brain study will differ dramatically from those who would be enrolled if she were to use Beck's cognitive-affective scale. And these different groups of people will likely differ in their brain structures.

As this and prior studies show, depressed people differ considerably in the problems they experience and symptoms they exhibit. This likely explains why so many different depression studies come to very different conclusions.'
Source: Material provided by Universiteit van Amsterdam (UVA).

Journal Reference: Eiko I. Fried. The 52 symptoms of major depression: lack of content overlap among seven common depression scales. Journal of Affective Disorders, 2016;

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