What Happens to Your Brain When You Have Anxiety (Spoiler, It's Not All Bad)

Anxiety is the Big Bad Wolf of the modern wellness conversation: How to get rid of it, how to get to sleep with it, how to meditate it away. But what if there’s another way of interpreting anxiety? To explore its possible benefits (like, can it motivate positive changes in our behavior and lives?) along with the downsides, we spoke to an expert— a triple board-certified psychiatrist—to learn just what’s happening in our brains when we experience anxiety.

Dr. Raafat Girgis, MD, is the medical director of Moment of Clarity, a mental health facility in Costa Mesa, California. He has three board certifications from the American Board of Psychiatry and Neurology: general psychiatry, addiction medicine and psychosomatic medicine.

“The  definition of anxiety is a feeling of unease, worry or fear. It is an emotional response that is characterized by feelings such as tension, physical changes like rapid heart rate, increased blood pressure, heavy breathing, tingling in your extremities and worry and fear," Dr. Girgis says. "While this reaction is actually a warning, it is very common for most people. However, there are those who suffer from it to the point of needing medication and therapies to manage. Anxiety is both a mental and physical state of negative expectation. Mentally it is characterized by increased arousal and apprehension tortured into distressing worry, and physically by unpleasant activation of multiple body systems—all to facilitate response to an unknown danger, whether real or imagined."

He continues, “This being said, I firmly believe that anxiety can be a common and natural way of your brain/body giving you warning signals that something needs to change. It is actually a natural biological component of the brain's reaction to an experience and when it is acknowledged it can be a reason for making changes in one's life in a healthy way. An example would be leaving a job that is heading nowhere, taking all of your energy and joy making it difficult to have balance in your life. While change is stressful and can create anxiety it does not mean you are in crisis and need medical treatment. I have seen people make positive changes and begin a life lived well by recognizing where the anxiety is coming from.”

Basically, something called “anxiety cells” (yep, that’s actually a thing) in the brain’s hippocampus signal the hypothalamus. The hypothalamus is basically a switching center that communicates with the body, triggering response. “The amygdala communicates with the hypothalamus, which then sets off the stress response,” Dr. Girgis says. “Your heart rate increases, blood pressure rises and breathing quickens. Your brainstem areas switch on, plunging you into a state of high alertness and vigilance.” That’s not all—simultaneously, the hippocampus, or memory hug, draws on past experiences to contextualize the threat. “It tries to make sense of what’s happening. Think of it as the librarian who retrieves relevant memories from the shelves,” Dr. Girgis says.  

“The biochemistry of anxiety is complex and vast,” Dr. Girgis explains. “Studies have shown that nearly every type of neurotransmitter and hormone can play some role in anxiety, as can anything that reduces blood flow to the brain (like dehydration). Anxiety, in many ways, is simply your body's reaction to brain stress.” Here’s a breakdown of this cornucopia of sloshing skull chemicals:

• Levels of the neurotransmitter serotonin fall: Low levels of serotonin are linked to both anxiety and depression.

• The brain overproduces thyroid hormones: An overproduction of thyroid has been linked to severe anxiety attacks.

• GABA production decreases: This neurotransmitter is a primary anti-anxiety agent in the brain, and low levels of it have been linked to anxiety, sad feelings and mood swings.   

• Epinephrine/Norepinephrine spike: Both neurotransmitters and hormones, these result in both the adrenaline and energy we associate with anxiety, as well as the rapid heart rate and sweating.

• Endorphins spike: These proteins act as neurotransmitters to block pain signals. They elevate before and after a stressful situation—so if your endorphins aren’t correctly balanced, your anxiety may linger.

• Dopamine is disregulated: This neurotransmitter and hormone is newly being examined for its role in anxiety modulation in different areas of the brain. Some studies have also shown that those with social anxiety may have problems with dopamine.

Good news: According to Dr. Girgis, there are some benefits to experiencing anxiety. “There is a thing called ‘good stress’ (eustress: psychologically it is a moderate or normal, psychological stress, interpreted as being beneficial),” he says. “The positives from eustress give the individual a sense of accomplishment and confidence, mostly due to being prepared with abilities to cope with any situation.” Understanding that the stress reaction is both a warning signal (danger, danger) as well as a motivating tool (get moving or be left behind!) is a useful lens through which to experience anxiety as a transitory experience.

Below, Dr. Girgis shares symptoms that should inspire patients to seek therapy, explaining, “When any of these symptoms are experienced there is no shame in seeking help. You may just need counseling to address some issues. However, therapy and medication may be something to start with to create balance and focus while working on your issues.”

• Symptoms of Physical Discomfort: Examples include tension, increased high blood pressure, rapid heart rate, at times intestinal issues such as irritable bowel or stomach aches, headaches and difficulty falling or staying asleep.  
• Extreme Restlessness and Irritability: Not being able to sit still or concentrate, pacing, snapping at people and surroundings
• Persistent Stress: If your daily ability to function is impaired, that’s a warning bell.
• Depression: When it impacts your mood, energy and quality of life.
• Chronic Worrying: Expectations of the worst of outcomes and a constant feeling of fear.
• Hyper-Vigilance: Interferes with your ability to function in life in general, work, home, socially and the ability to function or complete the simplest of tasks.