Episode Details

Why does a night of drinking followed by too much coffee and too little sleep sometimes trigger a full-blown panic attack? This episode unpacks the neurochemistry behind that terrifying experience — and the bigger question it raises about how we treat anxiety. We explore glutamate's central role in the brain's excitation system, why SSRIs (which target serotonin) remain the standard of care despite glutamate being at the heart of panic, and the frustrating gap between what we know and what we can safely prescribe. From the "kindling" effect that makes each episode worse to drugs like ketamine and acamprosate that attempt to modulate glutamate directly, this is a deep dive into the brain's most fundamental balancing act — and why it's so hard to fix.