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These communicate not only through neurotransmitters, but also through peptide signals that act as hormones within the brain. While neurotransmitter signals tend to be ephemeral and confined by anatomical connectivity, the hormone signals that hypothalamic neurons generate are potent, wide-reaching, and long-lasting. Leng explores the evolutionary origins of these remarkable neurons, and where the receptors for their hormone signals are found in the brain. By asking how the hypothalamic neurons and their receptors are regulated, he explores how the hypothalamus links our passions with our reason.

The Heart of the Brain shows in an accessible way how this very small structure is very much at the heart of what makes us human.

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Generalized anxiety disorder

As neuroendocrinology blossomed from a boutique field of neuroscience into the prime opportunity to relate molecular biology to hormones and behavior, Leng led by virtue of his productivity and his quantitative thinking. He presents complex ideas in a clear and interesting manner.


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Search Search. Search Advanced Search close Close. Preview Preview. Request Permissions Exam copy. They can't shake the feeling that something bad will happen and they will not be prepared. They may worry to excess about missing an appointment, losing a job, or having an accident. Some people even worry about worrying too much.

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Physical symptoms — racing heart, dry mouth, upset stomach, muscle tension, sweating, trembling, and irritability — are an integral part of generalized anxiety disorder. Over time, these physical manifestations of anxiety may adversely affect health. One example: people with generalized anxiety disorder are at greater risk than other people for heart attack and other cardiovascular problems.

Generalized anxiety disorder often occurs in conjunction with other psychiatric disorders. About two-thirds of people with generalized anxiety disorder also have major depression. About one-quarter have panic disorder.

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Many have substance use disorders or alcohol dependence. Generalized anxiety disorder can also affect cognition — although in a different way than depression does. People with generalized anxiety disorder tend to ruminate about potential misfortune, while people with major depression are more likely to have difficulty making a mental effort.

Generalized anxiety disorder is excessive anxiety and worry that is difficult to control and causes serious distress or interferes with daily activities. These symptoms occur more days than not for at least six months, along with at least three of the following:. Generalized anxiety disorder, like other types of anxiety, probably arises from an excessive activation of the brain mechanism underlying fear and the fight-or-flight response.

When someone confronts a dangerous situation, two brain circuits become active and relay sensory information about the danger — such as the sight and smell of fire — to different parts of the brain. One circuit extends to the cerebral cortex, the outermost part of the brain, which is used for thinking and decision making.

The other circuit involves a deeper structure called the amygdala that is central to emotional processing.


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  • The amygdala monitors the body's reactions to the environment, evaluates an event's emotional significance, and organizes responses that a person may or may not be conscious of. Although several brain circuits are activated simultaneously, the amygdala initiates a fast response to danger. It communicates with the hypothalamus at the base of the brain, prompting quick release of hormones that raise heart rate and blood pressure, tense the muscles, and generally ready the body to fight or to flee.

    This system is activated before the cerebral cortex can process what is happening.

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    This has survival value. For example, a person crossing the street may lunge out of the way of a speeding car before being consciously aware of the danger.

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    The amygdala also works with other brain structures to store emotional memories, including memories of frightening events. In people with anxiety disorders, however, this can become a problem. The amygdala may be so sensitive that it overreacts to situations that aren't really threatening, inadvertently triggering the brain circuits that provoke an emergency stress response.

    Over time, anxiety becomes attached to situations, thoughts, and memories unrelated to genuine sources of danger. In this sense, the brain may inadvertently create its own fears. Life experiences also contribute to anxiety disorders.

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    Severe or constant stress can produce a hyperactive anxiety reaction. People with some personality traits, such as shyness, may also be more vulnerable to developing anxiety disorders. Psychotherapies help people to recognize and address the psychological contributors to anxiety. The medications most often used to treat generalized anxiety disorder are antidepressants such as selective serotonin reuptake inhibitors SSRIs or dual serotonin and norepinephrine reuptake inhibitors SNRIs.

    The Heart of the Brain | The MIT Press

    These drugs take longer to work than the traditional anti-anxiety drugs, benzodiazepines, but also may provide greater symptom relief over time. Antidepressant drugs act on neurotransmitters involved in many regions of the brain, affecting anxiety, mood, and arousal. Side effects of antidepressants include sexual problems, weight gain, and insomnia. There may be a mild and usually preventable reaction when antidepressants are discontinued, but they present no risk of abuse.

    Buspirone BuSpar , a drug with a different mechanism of action, is another option.

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