Imagine yourself on a massive highway, surrounded by a billion cars. That’s how all the internal processes in our body operate. Each individual signal is like a separate car on the road. One side of the highway leads to the brain, the other — sends signals back to the rest of the body. And even if every driver follows the rules, the traffic light can still become a bottleneck. Because if there’s a power outage, it can trigger a chain reaction of chaos. That’s what the beginning of an anxiety disorder might look like — in cases where it’s caused by a serotonin imbalance in the body.
In this episode of the Misery Shared Podcast, Slava explains how antidepressants work — what you shouldn’t expect from them, and where it’s important to approach the decision with caution. The episode is dedicated to how brain biochemistry functions — explained in very simple terms. You’ll also learn why there’s still no universal medical solution for OCD — but there’s every chance to overcome anxiety.
Disclaimer: the author makes it clear that he is not a psychologist or a psychotherapist. He strongly opposes any form of online diagnosis. This podcast is not intended for self-diagnosis or self-treatment. Its purpose is to explain things in simple terms and to encourage people to seek help from a therapist — even if it feels like a waste of time. It also aims to help listeners choose a good mental health professional.
At the root of anxiety, there’s often a serotonin imbalance — a kind of “electricity” in the “traffic lights”. Of course, that’s a big simplification. It’s not really electricity — it’s a chemical. This comparison is just meant to help convey the scale of the issue. You could also compare serotonin to a national currency: When the supply is stable, your “salary” allows you to “pay for” joy, restful sleep, and clear thoughts.
Serotonin is synthesized in the gut (for digestion) and in the brain (for mood), but only brain serotonin affects emotions. And the brain can’t receive serotonin from external sources. That’s why serotonin-related problems aren’t corrected by adding more of it — but by interfering with the process of how it’s “cleared away”.
Here’s the thing: after a signal is transmitted (now a bit of science without metaphors), serotonin remains in what’s called the synaptic cleft. If it stayed there permanently, it would start sending false signals — ones that no longer match the real situation. Like a messenger app that keeps sending endless notifications about a message you’ve already read. That’s why, after the signal is delivered, serotonin is taken back in by the SERT transporter — a kind of special “vacuum cleaner” for serotonin.
So, if there’s too little serotonin, or if the receptors’ sensitivity to it has changed — then by contrast, the work of a “vacuum cleaner” seems too dynamic. The signals disappear too quickly. This means that the message doesn’t have time to be “read”. Or, going back to the national currency analogy — it seems like you aren’t seeing the full amount that you earned because your salary (serotonin) was heavily taxed, in a country with high inflation.
Other “happiness hormones” (scientifically, they’re different substances, but they all contribute to feelings of pleasure and motivation) — like dopamine, oxytocin, and endorphins — could be compared to discounts, coupons, or free samples, if our body were a store. Of course, that’s a major simplification. But in this example, without the national currency (serotonin), all those “offers” would lose their meaning.
Just like no discount can bring peace of mind if you don’t have any money — without serotonin, dopamine becomes useless. So trying to regulate dopamine in this case is like trying to set off fireworks in a burning shed. Dopamine won’t feel like a reward — it’ll just be noise.
When serotonin is out of balance over the long term, both the braking and accelerating systems of the body begin to suffer: GABA (the main “brake”) and glutamate (the main “gas”). Of course, their balance is also regulated by many other systems — but serotonin plays a significant role. And when GABA is lacking, the nervous system stays “on the gas”, even when there’s nowhere left to rush. Over time, the body becomes less sensitive to GABA — the brakes don’t respond in time, they squeak, and the “vehicle” becomes harder and harder to control.
Returning to the topic of serotonin reuptake, Slava explains how the medications typically prescribed for anxiety disorders work. These are selective serotonin reuptake inhibitors (SSRIs), and they act like HR managers — extending the shift of the “conductor” serotonin, so that messages are delivered more accurately, and other systems don’t suffer from a “currency” shortage.
The effects of the medication usually take a few weeks to develop. It’s important to understand that during the initial period, your condition might actually get worse — you may experience insomnia, nausea, or dizziness. But this is a natural part of the body’s “readjustment” process.
And although benzodiazepines exist for emergency situations — capable of instantly “putting out the fire” of anxiety like a fire extinguisher — they don’t address the root cause. With long-term use, they can lead to dependence, impair memory and concentration. And unlike antidepressants, suddenly stopping them can cause serious consequences.
That’s why, even though the effects of selective serotonin reuptake inhibitors don’t happen instantly — and they need to be taken for at least six months — they’re prescribed to correct the imbalance in the long term.
Slava emphasizes that in cases of OCD and anxiety disorders, teamwork between a psychologist and a psychiatrist is crucial. Because antidepressants don’t rewrite ingrained behavioral patterns — they only adjust the brain’s “chemistry.” With OCD, habitual cycles can remain in place like the “control system of the old regime”: Unless a psychologist conducts a kind of “inventory audit” and reprograms the responses, they’ll return — deeply embedded in the body over many years. That’s why only a combination of “rewiring the system” and “retraining the autopilot” offers a real chance to maintain inner balance for the long term.
The next episode of the Misery Shared Podcast will focus on panic attacks — how they work on a biochemical level (explained in simple terms), and what techniques you can use if you don’t have immediate access to a psychologist.
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