Metainflammation and autonomic instability in the genesis of anxiety

Anxiety is a complex condition that encompasses a range of mental disorders. It can manifest as a core symptom in various neurotic disorders, including anticipatory anxiety, pervasive anxiety, panic attacks, obsessive-compulsive, conversion and somatoform disorders. Anxiety is often linked to autonomic instability, which can be both observed and felt subjectively. However, anxiety does not arise solely from mental disorders; it can also occur alongside somatic conditions related to autonomic instability and cardiorenometabolic syndrome. Obesity and cardiorenometabolic syndrome, which can lead to diabetes and are associated with metainflammation, represent significant societal challenges that adversely impact mental functioning. In this context, neuroinflammation should be viewed as a consequence within the central nervous system of systemic inflammation and may be related to anxiety. Anti-inflammatory strategies have been shown to stabilize mental functioning, exhibit anxiolytic properties, and promote balance in the autonomic nervous system and metabolic homeostasis, with interconnected effects. While certain medications and procedures can influence these interrelated processes, they may also lead to undesirable side effects. This narrative review aims, for the first time, to jointly explore the triad of metainflammation, autonomic instability, and anxiety, in an attempt to clarify these important associations for future research and implementation in clinical practice.