Anxiety, ADHD, and the Basal Ganglia

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Neurophysiology 101

The basal ganglia (or basal nuclei) are a collection of four deep structures in the brain, but they are grouped together under the same heading because they act in concert with one another.  They are responsible for the modulation of movement, meaning stimulation and inhibition, when appropriate.  Disorders of the basal ganglia therefore include those with both inability to initiate movement (Parkinson’s disease), and lack of control over movement (as in Huntington’s disease and hemiballismus).

However, the basal nuclei has a limbic component as well (the limbic system is the seat of emotions in the brain).  Thus, some of the disorders related to the basal nuclei include inability to stimulate behavior (such as in ADD/ADHD), and inability to control behavior – for example, Tourette syndrome (characterized by inability to control speech), stuttering, OCD, and anxiety disorders.

Overactivity of the Basal Ganglia

Assuming we are not talking about cases involving the movement disorders listed above, those with overactive basal ganglia structures tend to experience:

  • Anxiety and nervousness
  • Panic attacks
  • Predicting the worst
  • Insomnia
  • Increased motivation and energy (these patients often have a hard time relaxing)
  • Paralysis due to strong emotions, either in speech, thoughts, or movement
  • Muscle tension and soreness
  • Tremors and fine motor problems
  • Chronic irritability
  • Tendency towards OCD

Overactivity of the basal ganglia usually corresponds to a relative excess of dopamine and a relative deficit of the neurotransmitters GABA and/or serotonin.

Underactivity of the Basal Ganglia

Remember, the basal ganglia help to modulate behavior, so they can be either over or underactive.  Those patients with underactivity in their basal ganglia tend to experience:

  • Low motivation and drive
  • A tendency toward ADD/ADHD.  

Underactivity of the basal ganglia generally corresponds to a relative deficit of dopamine  and a relative excess of serotonin and/or GABA.  The basal ganglia is also mediated by the neurotransmitter glutamate, and this one comes into play especially with the hyperactive variety (ADHD, see below).

Treatment Approaches for Underactivity of the Basal Ganglia

The well-known ADD/ADHD pharmaceutical Ritalin/Adderall works by increasing the available dopamine in the basal ganglia.  (Cocaine also increases dopamine, but it does it much faster and its half life in the body is significantly shorter.)  Because of this, side effects of Ritalin include those listed under overactive basal ganglia.

First of all, I wouldn’t leap to the conclusion that you (or your child) has ADD/ADHD.  In my opinion, it’s way overdiagnosed.  Another possibility for these symtpoms is an emerging “condition” dubbed ADT, and it is a product of a chaotic and overstimulated environment (for more on this, read here).

Second, many, many patients with ADD/ADHD do significantly better when food sensitivities are identified and removed, blood sugar is stabilized, and the gut is cleaned up generally.  Sometimes these patients also have an overabundance of environmental toxins which disrupt dopamine levels.  It’s important to remove food additives – some of them (for example monosodium glutamate, or MSG) can trigger stimulating neurotransmitters (in this case glutamate) and worsen hyperactivity.

You’re probably getting the picture that these cases can be rather complicated.  I’d recommend a full evaluation and work-up.

Treatment Approaches for Overactivity of the Basal Ganglia

Treatments for overactivity of the basal ganglia are essentially those for anxiety.  Take a step back and pay attention to your thinking.  You very well may be falling into one of the classic traps of overgeneralization, labeling, and worst-case scenario thinking.  If this is you, I’d encourage you to check out this article.

Once you’ve done that, you’ve essentially already done the hardest part!  Here are six more self-help techniques that are very effective in controlling mild to moderate anxiety symptoms.

Finally, because an overactive basal ganglia corresponds to high dopamine and a relative deficit of serotonin and/or GABA, I’d recommend serotonin precursors or GABA itself in order to modulate the high levels of dopamine.

  • L-Tryptophan: this is an amino acid, most famously present in high concentration in turkey meat.  This becomes 5HTP, which becomes serotonin, which becomes melatonin (the sleep hormone) – and that’s why the joke is that everybody goes to sleep after Thanksgiving dinner!  I like to suggest this as the first supplement to try, because your body gets to decide what it wants to make with it (as long as you’ve got enough of the basic nutrients to facilitate the process).  Recommended dose: 1000 mg before bedtime.
  • GABA: this inhibitory neurotransmitter has a calming effect on many patients.  Start around 250 mg daily.

For resistant cases, I test for neurotransmitters through a company called NeuroScience.  This tells me which neurotransmitters are high, which are low, and which precursors and cofactors an individual needs in order to help restore balance.  Unfortunately the test is not covered by insurance, but I have found it to be very helpful for many of my more challenging patients.

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