PANICSeparation Distress Grief and Social Bonding

Among the most common and powerful human feelings are those related to "pain" of loss, especially the grief of social loss. This emotional process has been modeled by the study of the neurochemistries that are able to specifically reduce separation distress in young animals isolated from their social support systems (Panksepp, 2003b). The resistance of this emotional system to most psychotropic drugs has been a surprise, with only antidepressants such as imipramine and in some species benzodiazepines having modest effects (Panksepp et al., 1988). The neuropeptides that have yielded very robust and specific effects on animal crying are, in order of efficacy, oxytocin, opioid peptides that activate mu receptors, and prolactin (Panksepp, 1998a).

It is probably common knowledge among psychiatrists involved in hospice care that opiates, even at low doses, can powerfully counteract feelings of social loss and despair. However, this trade secret must be used cautiously because of potential drug tolerance and addictive potentials that can backfire in the long-run (intensifying negative feelings during withdrawal periods). Even more beneficial may be nonpeptide oxytocinergics in the regulation of emotions related to social loss, since molecule for molecule oxytocin is the most powerful way to reduce separation distress in various animal models (Panksepp, 1992). Also, the potential opioid antitolerance effects of oxytocin could be recruited to help sustain efficacy and minimize withdrawal (Kovacs et al., 1998). Likewise, the ability of CRH to promote separation distress (Panksepp et al., 1988; Panksepp and Bekkedal, 1997), and CRH antagonists to reduce such emotional responses (Kehne et al., 2000) suggests that the latter agents may effectively help control excessive separation anxiety. Furthermore, some of the peptides that have been implicated in FEAR mechanisms, for instance CCK, may actually be more important for modulating PANIC responses. Future work needs to contrast several animal anxiety models against each other more systematically.

We will cover the last emotional system in Table 21.1, playfulness, in the next section, as we consider two of the most controversial childhood psychiatric problems of our times, autism and attention deficit hyperactivity disorder (ADHD). The first has no adequate, generally accepted medications (although many psychotropics provide relief of specific symptoms), while the other has many "adequate" medicines, but professionals who prescribe them express little appreciation of the potential long-term brain/mind changes that can be provoked in animals with psychostimulants such as methylphenidate and amphetamines (Moll et al., 2001; Nocjar and Panksepp, 2002).

Dealing With Sorrow

Dealing With Sorrow

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