肌醇有助於神經原更有效率地運用神經傳導物質血清素。根據一項針對13名強迫症患者研究報告，18克肌醇能顯著減輕症狀

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恐慌症的原因就是大腦有問題嗎？------談恐慌症的成因、非藥物改善及根本解決之道！
copy from 鄭醫師的部落格
分類：有壓力怎麼辦？如何健康減重？
2011/03/14 11:05
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何謂恐慌？恐慌發作（PANIC ATTACK）通常是突發性的，患者也許先經驗到某些器官的不適，諸如胸悶、眩暈、或腸胃不適等等，旋即引發不明原因的極度驚嚇感、緊迫的恐懼感和隨時面臨災難降臨的感覺，伴隨有心跳加速或心悸、呼吸急促或窒息感、胸痛或胸部不適、噁心或腹部不適、頭暈盜汗、顫抖或戰慄，血壓及心跳通常會隨之上升。當事人會經驗到自己隨時可能會失控、發狂甚至死亡的感覺（感覺快死掉）。一般從出現症狀到最嚴重症狀出現不超過十分鐘。
一般精神科的診斷，就是依據症狀來成立診斷，儘管少數的研究會以腦部影像的研究來試圖強調恐慌症是大腦出問題，然而，大腦的某些區域反應失衡，到底是結果還是原因，讓我們參閱六星期大腦健康計畫這本書的作者馬克˙希曼醫師綜合許多的臨床研究的結果來看看到底恐慌症是從何而來？
思想、認知、信念與態度如何影響我們？
許多人都經歷過腎上腺素急速分泌的情況，千鈞一髮的車禍、或是認為自己身陷危險的想法。幾年前的一個夜晚，我醒過來，聽到屋裡有翻閱紙張與砰然撞擊的聲音。我抓起電話撥打119。我的心跳加速、呼吸急促。我可以清楚看到黑暗中的動靜，聽到最細微的聲響。
警察趕到了，從外面盯著看，看到我們新養的小狗跳離牠的小窩，在屋裡四處玩耍。
我的生理與心理都「 知道」有竊賊闖入。想像的「認知」轉變成真實的生理反應，觸動我逃之夭夭或挺身對抗的反應。
壓力（與放鬆）反應是由大腦的指揮與控制中心--下視丘所控制的。當我聽到「竊賊」的聲音時，啟動了壓力反應，透過神經系統的自動反應部分-- 交感神經系統， 將訊息傳遞到身體的每個部位。
當這個部分的神經系統啟動時(大部分的人在大部分的時間都是啟動的狀態)，我們的腎上腺釋出更多的皮質醇與刺激性的神經傳導素--腎上腺素 (腎上腺素)與正腎上腺素。這些化學物質充滿活性與激勵性。
這個系統是我們的寶貝，尤其是當我們遇到麻煩或危險時。想想看在大草原吃草的斑馬。在飢腸轆轆的獅子逼近時，承受突發性壓力的斑馬拔腿狂奔。直到有一隻被撲倒之後，其他斑馬恢復冷靜，繼續吃草。基本上，我們的身體在啟動壓力反應時，情況就和斑馬一樣。
美國史丹佛大學生物科學及神經學教授羅伯特薩波斯基(Robert Sapolsky)的說法，那是斑馬沒有潰瘍的原因。牠們會有瞬間急遽升高的壓力，然後，斑馬又恢復冷靜，繼續吃草。牠們的壓力反應是瞬間啟動的，在危機解除之後就關閉了（但人是不一樣的）。

神經科學家布魯斯‧麥克尤恩(Bruce McEwen) 在他的著作「我們所知的壓力盡頭」(The End of Stress as We Know It)中，解釋長期的壓力如何損耗我們的生理系統。他將這種情況稱為「適應負荷」4，可以視為一生當中所有壓力源的總和。

所有這些過量的壓力源，人體無法長期不斷應付的壓力源，導致交感神經系統與壓力反應的過度激化，緊接著就是能量的消耗殆盡。

薩波斯基博士詳細闡述這種慢性壓力損傷大腦的方式。主要的壓力荷爾蒙--皮質醇，居高不下的數值損傷了海馬迴。

然而，在現代的社會裡，這套生理系統受到過度的激化。我們不需要記憶我們認知為壓力的每個情況。長期的大量皮質醇損傷了海馬迴，導致記憶力受阻5、失智症與沮喪6。加拿大麥基爾大學(McGill University)神經學科學家桑妮雅 魯皮恩(Sonia Lupien)博士已經說明壓力如何緊縮我們的記憶力中心，並對我們的大腦與認知功能造成有害有的影響7,8。
壓力簡直就是大口啃噬著我們的大腦。
長期壓力對身體與心理都有許多不良的影響，這可以解釋現代社會中普遍的肥胖、健康與大腦功能問題。所有來自身體的回饋，以及大腦往下傳遞的訊息，都是透過這個重要的HPATGG（連接大腦與全身的溝通網路）系統運作。

從以上的整理內容，我們發現，真正導致恐慌症的源頭，仍在於壓力，而且是不知如何舒緩的壓力，

藥物控制的療法，無法根本解除壓力，放鬆療法或者認知療法若進行得宜，可以多少減少對藥物的依賴，撇開藥物治療來說，放鬆技巧其實人人可學，而且一定多少有助於焦慮的減輕，建議有恐慌症困擾的人，一定要學習及應用這些方法來幫助自己放鬆。然而對想根本解決問題，以及服藥容易出現副作用的患者而言，可以多瞭解更自然及根本的解決方式。

在非藥物改善上若不論及腎上腺功能的影響，可以先考慮以肌醇來協助症狀減輕，這種被知名的腦部影像醫學研究專家丹尼爾‧亞門（Daniel G. Amen)醫師盛讚的B群之一的成分：

根據研究報告，肌醇有助於神經原更有效率地運用神經傳導物質血清素。根據一項針對13名強迫症患者精心設計的研究報告，與安慰劑組對照，18克肌醇能顯著減輕症狀。根據研究報告，憂鬱時，脊髓液的肌醇濃度較低。另一向針對28名憂鬱症患者精心設計的研究顯示，與糖果組對照，12克肌醇所產生的改善作用令人印象深刻。該研究也讓21名罹患恐慌症的患者每天服用12公克的肌醇，持續四周。跟安慰劑組相對照，肌醇效果最好且最沒有副作用。
肌醇就好像是一種藥性溫和的百憂解，但副作用比百憂解少。如果你愛操心，卻又不知道如何消除負面思想，常常固執、缺乏彈性，或者容易記恨可以考慮試試肌醇。

此外，一般醫師不推薦的運動，其實，也可以幫助恐慌症改善：
根據104件從1960年到1989年針對運動與焦慮所做的研究報告顯示，運動具有減低焦慮的作用。在2005年由安卓亞斯.使特勒爾（Andreas Strohle)所做的一位嚴謹的報告顯示：三十分鐘的跑步機運動在減少恐慌症發作比安靜休息還有效（高出一倍），這顯示運動在某些案例中確能立即改善症狀。
另外還有德國的學者Andreas Broocks針對服用藥物、運動及服用安慰劑的恐慌研究，他發現運動改善焦慮症狀的速度較慢，但過了六週以後，運動那組得到的改善與進展，效果完全不亞於藥物那組。儘管有些實驗對象在運動過程中出現恐慌症狀，但是他們還是能繼續跑下去，症狀也跟著消除了。如果我們能靠自己力量達到幫助自己狀況穩定，為何還需要有副作用的藥物來控制？尤其是藉由自己力量達成還能增加自己對情緒處理的信心，不是嗎？
關於這方面，其實有學理可以支持，當我們運動時，心房利鈉胜肽(ANP)會從心肌分泌出來，然後一路通過血腦屏障與下視丘的受器結合，調節壓力系統（HPA軸，下視丘-腦下垂體-腎上腺）。由於ANP在動物及人體實驗都呈現出鎮靜效果，因此研究人員認為它可能是運動與焦慮減輕的一道重要連結。2001年有一項關於ANP與恐慌的研究，足以支持此一論點。一項針對嚴重心臟衰竭患者所做的研究也發現，患者體內的ANP愈高，焦慮就越少。一些研究也發現，恐慌症經常發生的患者，血液普遍有缺乏ANP的現象。
在功能性醫學的建議上，腎上腺功能的評估，有助於瞭解身體處理壓力系統的荷爾蒙是否已經失調，當然自律神經檢測也可以提供一些客觀的數據評估，這些檢測若有問題，也能用自然的營養品來幫助調整與改善。在臨床上許多恐慌症的患者，常常合併有能量代謝的問題，這是某些原因持續累積，導致細胞的粒腺體（能量產生中心）功能不佳，目前許多大腦退化疾病其根本原因其實就是粒腺體功能不佳導致，因此如果評估有狀況，能夠一併處理，除了可以預防大腦功能退化，疾病恢復效率必定更佳。

不管身體如何改善，心理壓力的源頭還是最關鍵的部分，所以，如果身體穩定些，務必透過相關的生活改善技術及心靈處理技術的協助，針對生活中的壓力源頭來做根本的清理，如此身心雙管齊下，才是正本清源以及預防復發的處理方式。最後提醒大家：恐慌症是一個結果，原因不處理，只想單純用藥物來控制，後續的治療往往會沒完沒了，關鍵還是造成當事人壓力的根源最好能瞭解及處理。

最後，我想引述知名的醫療專家Erwin K. Koranyi對壓力的解讀：
學會評估自己的能力、潛在弱點及抵抗力，將會獲益不淺。但我們在最後的分析上不能失去的觀點在於：每個人都必須為自己生活的好不好負責，否則，不論採行哪種治療方法，還是會繼續遭到壓力所引起的疾病折磨。
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許多美國OCD病人嘗試肌醇很長一段時間。
似乎結果是不壞的。我已經從網上買8盎司。

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在互聯網上英語世界中的強迫症治療的信息有很多，也有很多
的信息是非常有幫助的。
例如像一些健康食品，行為治療經驗.
台灣強迫症患者的團隊治療信息資源看起來只是像在沙漠中的
水很少，而且質量差。
如果你能閱讀英文，你可以去那裡看一看
ocdjourney.wordpress.com/

goo.gl/kK8vz

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Inositol and OCD
Inositol and OCD

By Frederick Penzel, Ph.D.

At the American Psychiatric Association (APA) conference in 1996, a paper was delivered on the treatment of Obsessive-Compulsive Disorder with inositol, one of the B-vitamins. It seemed to indicate that this might be a viable treatment for OCD. As someone who treats OCD and related disorders, I am always on the lookout for new approaches. I did some further research, and found that since the early 1970s, a number of papers have been published on the use of inositol in the treatment of OCD, depression, and anxiety. It seems that inositol is converted by the body to two secondary neurotransmitter chemicals that enhance the action of serotonin in the brain. Serotonin, as we know, is a brain transmitter chemical that has been implicated in OCD and related disorders. Not all of these studies were conducted in the most scientific manner, but nevertheless, my curiosity had been piqued.
After several discussions with one of the psychiatrists at my clinic, we looked into its safety and possible interactions with other drugs. It appeared that most people took in an average of about 1 gram of inositol each day in their diets. We discovered that apart from some harmless digestive tract side effects, it appeared to be quite tolerable, and would not interact harmfully with any of the SSRIs our patients were taking for their OCD. At about the same time, (September, 1996) a double-blind placebo-controlled study on the use of high doses of inositol was published in the American Journal of Psychiatry. Dr. Mendel Fux and colleagues in Israel conducted the study. Although it was only a small study involving thirteen individuals, inositol was found to have a significant effect upon the symptoms of OCD. It was shown to work as well and as quickly as the SSRIs Prozac and Luvox. The patients in this study had either not been able to find relief via standard medications, or were unable to tolerate medication side effects. Dosages in the study were gradually built up to 18 grams per day.
The article proved to be the convincer for us. We had a number of OCD patients, who were only getting partial relief from prescription antidepressants, so we decided to suggest the possibility of their trying inositol as an augmenting agent, in addition to what they were already taking. I should mention here that our clinic is a rather busy treatment center, and unfortunately, not really geared toward conducting research, so we really didn't collect any data on this. I know my learned colleagues will shake their heads at this, and they would be right. In any case, we started to see some positive results among some of those who tried it. In most cases, these results ranged from at least mild to moderate relief of symptoms. A few reported even more improvement. We have generally built up our patients over a six-week period, starting with 1 teaspoon (2gms) twice per day, and going as high as 3 teaspoons, three times per day. It turned out that not everyone required the full 18 grams used in the Fux study. One person was seen to improve on just 2 grams daily.
Since that time, we have also seen some positive results child cases as well. I have also received some positive e-mails and phone calls from O-C around the country who have heard of inositol, and tried it. Although it was probably not as precise as we would have liked, we based our children's doses on body weight, figuring roughly that a 40-lb. child could tolerate a maximum dose of up to 6gms. of inositol per day.
I do not believe that inositol is a 'miracle drug' for everyone with OCD. There are no miracle treatments. I am sharing this information with sufferers out there in hopes that it may help at least some people who have not otherwise been able to get relief, or who are too afraid of prescription medications to try anything. I also decided to write about this because I felt that some people might hear of this through some other sources, and try inositol without any guidance.
**Please note the following: This advice is purely informational, and not in any way meant to be a substitute for treatment by a licensed physician. Do not try this, or anything else, without first consulting your physician. If your M.D. has not heard about it, refer them to the American Journal of Psychiatry article and let them decide.
Obviously, before you run out and try anything new, you should always consult your physician. If your physician recommends trying this, you might also want to mention the following information to him or her:
It cannot be taken together with Lithium, as it seems to block its action.
The chief side effects of inositol are gas and diarrhea. Some people get this for the first few days and then it clears up. Many of those taking it never have this side effect, and some only get it when they take more than a particular amount.
I have heard reports that caffeine lowers inositol levels in the body, so if you are a heavy coffee drinker, you might consider cutting down or eliminating this from your diet. Actually, stimulants such as caffeine can sometimes contribute to anxiety, jitteriness, etc.
It should be purchased in powdered form, and taken dissolved in water or fruit juice. It has a sweet taste, and is chemically related to sugar. If it is allowed to stand for about 10 minutes after mixing it, it seems to dissolve better. Vigorous mixing for a few minutes also helps. If it still doesn't dissolve well (not all brands do), stir it up and drink it quickly before it settles. The use of powder is recommended, as the larger doses required could require taking as many as 36, 500 mg. capsules per day.
Inositol is a water-soluble vitamin, so although the doses appear to be large, it will not build up to toxic levels in the body. Whatever the body doesn't use is excreted. The average person normally takes in about 1 gram of inositol each day via the food they eat. There are no reports of any harm associated with the long-term use of inositol. Some of our patients have been taking it as long as eight years now, with no problems.6. It can be built up according to the following schedule (1 teaspoon=2 grams, and be
sure to use a measuring spoon) for an adult:
Week 1 - 1 teaspoon/2x per day
Week 2 - 1 teaspoon/3x per day
Week 3 - 1.5 teaspoons/3x per day
Week 4 - 2 teaspoons/3x per day
Week 5 - 2.5 teaspoons/3x per day
Week 6 - 3 teaspoons/3x per day
A child can be built up to 3 teaspoons per day over the same six-week period. Dosages for adolescents can be adjusted according to weight. In either case, it is best to allow side effects to be the guide. If they begin to occur, it is not considered wise to increase the dosage unless they subside.
Once a person has reached either the maximum dosage, or the greatest amount they are able to tolerate, it is best to try staying six weeks at that level to see if there is any noticeable improvement. If there is none by the end of that time, it should probably be discontinued. As with any treatment, those who are absolutely positive that it will help are only setting themselves up, and may wind up more than disappointed. Everything works for someone, but nothing works for everyone.
One further note. I know personally of one case where an adolescent with trichotillomania was administered a combination of inositol and a substance known as 5-HTP, which is a breakdown product of the amino acid L-Tryptophan. The body manufactures serotonin from 5-HTP, and serotonin is believed to be one of the brain transmitter chemicals implicated in trichotillomania. Taking this is believed to raise serotonin levels in the brain. This adolescent got partial results with inositol, and seemed to get a complete remission of the urge to pull with the addition of 100 mg. of 5-HTP daily. 5-HTP can cause drowsiness, and is usually taken at bedtime. It should never be taken with any prescription antidepressant (such as an SSRI) or herbal products such as St. John's Wort, as it can cause a very serious condition called serotonergic syndrome.
Again, none of the above is meant to be a substitute for expert medical advice. As with inositol, 5-HTP should not be taken without the supervision of a licensed physician. I find reports such as this rather interesting. and further study is clearly needed. It may have implications for the future treatment of trich.
*** As an interesting side note, a study was published (Seedat et al, 2001) since this article was written, in which three women with hair pulling and compulsive skin picking were treated with inositol. All three were seen to improve and this improvement was seen to continue through a 16-week follow-up period. Hopefully, there will be further studies on the usefulness of this compound.
If you would like to read more about what Dr. Penzel has to say about OCD, you may be interested in his self-help book, "Obsessive-Compulsive Disorders: A Complete Guide To Getting Well And Staying Well," (Oxford University Press, 2000). You can find out more about it at http://www.ocdbook.com.

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