I received a call several months ago from Ethel, a middle-aged woman living in Northern England. Ethel had read an interview I did with The Times of London about the clinical uses of oxytocin.
The reporter who interviewed me kept asking if oxytocin would cure shyness, or autism, or other psychiatric disorders. I repeatedly said a "cure" was not possible for these disorders as oxytocin is only one of the contributing causes, and that simply replacing oxytocin in patients would have only limited effects. Of course, "cure" appeared in the article and a frenzy of media coverage led to Ethel's call to me.
Ethel called seeking help for her daughter who had such severe social anxiety that she had trouble at her job. Because I had developed an oxytocin nasal spray for use in my research studies, The Times wanted to hear about its possible clinical applications. "Was this shyness spray available in the UK?" Nope. Several clinical trials are underway in the US, but there was no easy way to get intranasal oxytocin in the UK. I told Ethel I could not diagnose or treat her daughter, but I could tell her about how the research we are doing at the Center for Neuroeconomics Studies may help those who are socially anxious. The same caveat holds for you: this is my opinion about how to use our research but should not be considered a clinical treatment regime if you suffer from social anxiety.
To be honest, the intensive media coverage about oxytocin since my lab discovered that it mediates trusting behaviors in humans in 2004 has worried me. Oxytocin is a media darling. My staff discovered that in the first nine months of 2008, the TV, radio, and print interviews I had done (and could track) were seen by 84 million people worldwide. Wow! And that number assumes each story is seen only once. With online posting, blogs, and the newswires, many of those stories were seen two or three times above the stated circulation. Even a recent meeting I attended sponsored by the National Institutes of Health produced a bevy of psychiatrists around me wanting to know how they could get a hold of oxytocin inhalers for their patients. Although I'm normally an oxytocin cheerleader, I had to restrain the rumpus.
In this article I want to cut through the hype and focus on what we know scientifically about oxytocin and how you can use it. The human behavioral research on oxytocin is still in its infancy, so findings are in still in flux. Still, I think there is enough solid evidence for a number of recommendations to be given.
The first important finding is that 98% of the hundreds of people I have tested release oxytocin properly when they are trusted. The human oxytocin system motivates a desire to interact with others, and those whose brains release a spike of oxytocin reciprocate the trust they have been shown. Now, the other 2% of people I have tested have dysregulated oxytocin-typically high and non-responsive to signals of trust. These people do not develop strong attachments to others.
In research with Dr. Elizabeth Hoge and her colleagues at Massachusetts General Hospital in Boston, I have also found those diagnosed with social anxiety disorder have high and dysregulated oxytocin. You can read the research paper reporting these results here. A quick neuroscience digression on what this means. The brain seeks contrast-on or off-this must be clear to affect behavior. In healthy people, oxytocin is a fast on-off switch; it is released a couple of seconds after a stimulus. The release of oxytocin signals that social interactions are safe. In patients who have the oxytocin switch stuck in the on position, there is no contrast. This means oxytocin is not providing the brain with a clear signal to guide behavior. As a result, high oxytocin does not result in increased sociality, it means the social factors that typically cause oxytocin release are behaviorally impotent.
So, should those with impairments in social behaviors be dosed with additional oxytocin? The "stuck on high" profile of these patients indicates that they may have a problem with oxytocin receptors. That is, oxytocin is not binding to the receptors and producing an "off" signal for oxytocin production. Increasing oxytocin in these patients is likely to have little or no effect. Having said that, I have infused oxytocin safely into hundreds of people and oxytocin infusion is unlikely to hurt anyone. Several groups are now testing whether flooding the brain with oxytocin alleviates psychiatric symptoms.
Unlike those with social anxiety disorder, those with autism have been shown to have low levels of oxytocin. Dr. Eric Hollander at Mt. Sinai Hospital in New York City has had modest success in reducing stereotyped behaviors and improving sociality when giving high-functioning autistics intranasal oxytocin. Brain imaging studies have shown that oxytocin reduces the activity of brain regions that produce anxiety. Those with autism and other social disorders are often highly anxious and when these patients are given oxytocin anxiety wanes.
So what can people do to ease their social anxiety short of putting oxytocin up their noses? There are ways to coax your brain into releasing more of its own oxytocin. These include
1. Use of selective serotonin reuptake inhibitors (SSRIs), drugs typically used to treat depression, such as Prozac or Paxil. Serotonin and oxytocin co-release in the brain so increasing serotonin likely increases oxytocin, too. Speak to a psychiatrist about this.
2. Get a dog. Petting a dog releases oxytocin in the dog and the human. Starting with a canine companion can help some patients become more comfortable with human companionship.
3. In research my lab published in September, 2008, we have shown that moderate-pressure massage primes the brain to release oxytocin and motivates interactions with strangers.
After I went through this list with Ethel, she told me something amazing. Her daughter had recently quit her corporate job-she couldn't take the stressful social interactions. She was now attending school to be a massage therapist. Her daughter said that the only time she felt that she could comfortably connect to another person was while giving a massage. To my mind, this is diagnostic of an oxytocin dysfunction.
Will we cure shyness, social anxiety or autism with oxytocin? Unfortunately, no. We are, though, gaining important insights into how the human brain makes us social creatures that we are, and new ways to apply this knowledge to patients.