No More Fear

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Researchers at Duke University and the National Institutes of Health have developed an experimental drug that calms the fears of anxious mice. They also believe that the exact same changes in brain chemistry could work on humans — a discovery that could lead to a "courage pill." But would we want to live in a world without fear?

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Before we get into the discussion of whether or not a fear-reduction pill is a good idea, it's worth reviewing the science behind it. What the researchers at Duke University and the NIH have done is quite amazing. It's no exaggeration to suggest that their breakthrough could have serious implications to how therapy is done in the future — and a pill to cure fear really might be right around the corner.

The common element in their studies is a gene-encoding enzyme called fatty acid hydrolase, or FAAH. This enzyme breaks down a natural endocannabinoid chemical in the brain, in the same way that your brain processes cannabis — hence the name endocannabinoid. In fact, FAAH creates a similar feeling of decreased anxiety that marijuana does.

To test the effects of this enzyme, a research team led by Andrew Holmes used a drug that blocks FAAH activity in fear-prone mice that had been conditioned to be fearful through experiences in which they were given foot shocks. What they discovered is that the ability of those mice to get over their bad experiences was determined by the drug that allowed a faster recovery from fear, owing to higher brain endocannabinoid levels. Looking deeper into the mice's brains, the researchers discovered that the drug's effects could be traced to function in the amygdala, a small area of the brain that serves as a critical hub for fear processing and learning.

To see if this might work in humans, the team studied middle-aged adults who were placed in an fMRI and shown images of threatening faces. Researchers were curious to see what kind of activity could be traced to the amygdala, and how genetic variability could affect their response.

What they discovered was that activity in the amygdala decreased over repeated exposures to the pictures, but people who carried the version of the FAAH gene associated with lower enzyme function and higher endocannabinoid levels showed a sharper decrease in activity. The researchers concluded that those people may be better able to control and regulate their fear response.

Pharmacological treatments

This discovery suggests that those people who are not genetically endowed with the lower enzyme function could be treated pharmacologically to modify their fear response in the same way that the mice were.

This prospect greatly excites Ahmad Hariri, a neurobiologist who worked on the study. "What is most compelling is our ability to translate first from mice to human neurobiology and then all the way out to human behavior," he says. "That kind of translation is going to define the future of psychiatry and neuroscience."

Specifically, Hariri believes that this new understanding of the brain's fear circuitry may hold particular promise for people at risk for anxiety disorders, including those suffering post-traumatic stress disorder (PTSD). In fact, the research team is now looking to expand the study and further explore the connections between FAAH variation and PTSD risk — as well as potential treatments for other fear-related disorders.

A world without fear?

Now, it's worth noting that these sorts of drugs would likely have subtle effects on those taking them. It's doubtful that fear could be eliminated outright with this approach. But the research suggests that more substantive therapies to remove fear altogether might someday be possible — including a "courage pill."

Moreover, like so many other advances in pharmaceuticals, it's very likely that a fear-mitigating drug will eventually be used by relatively well-adjusted people, in an off-label manner. Today, many people use stimulants like Ritalin and Adderall not for ADHD or narcolepsy, but to increase their focus and attention. It's reasonable to suggest that people, given the opportunity, will use this sort of pill to reduce feelings of anxiety and stress.

This might actually turn out to be a good thing. Anxiety and stress is unpleasant; confidence and poise is highly desired. The fear-reducing pill could be seen as a kind of nootropic, a next-gen sort of cognitive enhancer. It may allow people to pierce through their anxieties and reservations and engage more deeply in life and their passions. It could even help people with stressful jobs, such as police officers, firefighters, soldiers, and athletes. Fear can be severely disabling. Perhaps it's time that we sent it to dust heap of our Paleolithic psychological history.

The question now is, just how "fearless" should people be? What would a second and third generation pill look like? As the Duke University and NIH study suggested, the intervention goes straight to work in the amygdala, which is a potent area for regulating fear response and learning. It's worth noting that psychopaths have an impaired amygdala — the kind of impairment that could illicit fearlessness, and in turn, unempathetic and anti-social behavior. And then there's the risk that a lack of fear would lead to way more risky behavior — leading to more injuries, but also higher costs to society?

An issue of choice

It's conceivable that a world doped up on anti-fear medication would be a far stranger, far different place than it is today. But that doesn't mean it would be a bad thing. To get a better sense of the ethics and issues involved, we contacted James Hughes, a bioethicist working out of Trinity College in Connecticut.

Hughes tells io9 that effective therapies to control fear would be a tremendous benefit for the hundreds of millions of people around the world who suffer from anxiety disorders as a result of violence and abuse. "This benefit outweighs any of the ethical hand-wringing about hypothetical side-effects - such as people abusing courage pills and taking stupid risks," he says. "But then, I am a strong advocate for cognitive liberty. I think adults have a right to determine exactly which mental states, and how much pain, fear and disgust, they want to experience."

Hughes concedes that we don't know what kinds of side effects or toxicities that future anti-fear therapies could bring, but that we'll have to judge them when they happen. As a consequence, they may be made as readily available as aspirin, or as restricted as opiates.

Hughes is also wonders whether fear is responsible for keeping us away from dangerous behaviors — or rationality. "Removing fear might actually make people more rational in their risk assessments. People have a lot more reason to fear cheeseburgers and driving than spiders and immigrants," he says.

He also imagines that a reduction in general fear levels among the population might change the political tilt of the voting public. Research has shown, again and again, that certain political platforms that are based on fear of certain groups tend to be more effective on individuals with more sensitive amygdalas. Says Hughes: "Widespread use of anti-fear drugs might make society a lot more liberal and socially tolerant."

It's difficult to predict whether a fear-mitigating pill will work to the degree that we're speculating about here, or whether people will take to it in the ways we suggest. But given the high rates of anxiety and stress in modern society — and given that even healthy people tend to show interest in psychopharmacological interventions — it's very likely to happen. And when it does, perhaps we will have nothing to fear but fear itself.