Is the Cause of Anxiety a Chemical Imbalance?

Question:Is there such a thing as a “chemical imbalance” causing anxiety? The term may not be right but I wanted to know if there is something that went wrong in our brains; something misfiring? Or did we all sort of “think” ourselves into these irrational responses to perceived threats of danger?”


Many people have submitted questions asking whether the cause of anxiety is a chemical imbalance. Others suggest it is not a chemical per say, but a chemical imbalance that is the cause of anxiety.  Well let’s look at a couple of scenarios.

If you go to your family doctor, he/she will likely state that the cause of anxiety is a chemical imbalance. Medical doctors use a biological model to explain what is going on.

If you talk to psychologists they will likely recommend treatment with psychotherapy (talk therapy). Properly trained psychologists are familiar with psychopharmacology and the biological basis of behaviour although may not frame your anxiety in terms of a chemical imbalance only.  They will often employ evidenced based practices Cognitive Behavioral Therapy, among other things, to help with your anxiety.

To put things into perspective, I want to discuss some information a\below about whether the cause of anxiety is a chemical imbalance.

The common antidepressants for anxiety and panic attacks and depression, SSRIs (Selective Serotonin Reuptake Inhibitors) are said to work by maintaining/boosting or serotonin levels or otherwise influencing serotonin.

According to the Mayoclinic website:

SSRIs block the reabsorption (reuptake) of the neurotransmitter serotonin (ser-oh-TOE-nin) in the brain. Changing the balance of serotonin seems to help brain cells send and receive chemical messages, which in turn boosts mood. SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters.

Some psychiatrists, such as Dr. Colin Ross, M.D. indicate that SSRI medications are virtually no different from a placebo effect, although they are better than no treatment at all. There is an interesting video online which discusses the findings of studies that support these findings in detail (below).

The placebo effect happens when someone takes a medication and his/her condition improves although not because the medication is working exactly as it is supposed to do but because for some reason it makes us feel better.  At times sugar pills were prescribed by doctors when they would see patients they determined to be hypochondriacs (now referred to as a psychosomatic disorder).  Often patients would improve from taking the pills, even though they contained nothing but sugar.  This is no longer ethical but Dr. Ross indicates that patients can improve from the suggestion that improvement might result from the placebo.

Interestingly studies have shown that psychotherapy (particularly Cognitive Behavioral Therapy) can more effective than SSRI medications in combating anxiety and panic disorder.  Dr. Henry Westra, from York University in Toronto, Ontario, and Dr. Sherry Stewart from Dalhousie University, Nova Scotia did a comprehensive review of literature and found that CBT is the definite best for anxiety and more effective than other forms of psychotherapy and even appears more effective than medications!

Brain imaging studies have revealed that brain activity can be changed by Cognitive Behavioral Therapy (CBT).  (Goldapple et al., 2004) examined changes associated with CBT by looking at cortical and and limbic regions of the brain (areas related to various function one which is emotion).  They concluded that “CBT seems to affect clinical recovery by modulating the functioning of specific sites in limbic and cortical regions.”

Bottom Line:

The message here is not to stop taking medication, but consider the inclusion of CBT if you are not doing so.  In other words, look at things from both a biological and psychotherapeutic approach.  You can click here for an intro to CBT.  But before doing so, don’t forget to sign up for my newsletter.

References (What Chemical Causes Anxiety?)

Mayoclinic. Depression (major depression). Retrieved on January 16, 2013, from:

Goldapple K, Segal Z, Garson C, et al. Modulation of Cortical-Limbic Pathways in Major Depression: Treatment-Specific Effects of Cognitive Behavior Therapy. Arch Gen Psychiatry. 2004;61(1):34-41. doi:10.1001/archpsyc.61.1.34.
Retrievable from:

Psychetruth. (2012, November 26). Do Antidepressants Cure Depression? Are Psych Drugs Safe? Dr. Colin Ross & Corrina Psychetruth. [Video file].

Stewart S. & Westra H. Cognitive Behavioral Therapy and Pharmacotherapy: Complimentary or Contradictory Approaches to the Treatment of Anxiety?. Clinical Psychology Review 18, no. 3 (1998): 307-340.