Anxiety disorders are real. Anxiety disorders are more than just "nerves". They are characterized by feelings of panic, fear, and discomfort that arise with no clear cause, in situations that are not usually stressful or dangerous. In many cases, anxiety disorders arise for no obvious reason and often without warning. The feelings of anxiety can happen over and over again, unless treatment is received. If left untreated, an anxiety disorder can make everyday life miserable.
Anxiety disorders are common. More than 19 million American adults live with anxiety disorders, which include generalized anxiety disorder (GAD), phobias (including social phobia), post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD) and panic disorder.
Anxiety disorders can interfere with having a full, productive life. People with anxiety disorders may experience extreme responses to non-threatening situations, and these reactions can create lives filled with chronic anxiety, terror or discomfort. However, with therapy and/or medication, people can have full and productive lives.
Anxiety disorders are linked to depression. The life-changing impact of anxiety disorders may trigger depression - and it's also true that depression may generate anxiety disorders. Two out of three people with depression also have symptoms of anxiety. About 80% of depressed individuals suffer psychological anxiety symptoms: unrealistic apprehension, fears, worry, agitation, irritability, or panic attacks. Some 60% of people with depression have anxiety-related physical symptoms: headaches, irritable bowel syndrome, chronic fatigue, and chronic pain, among others. Approximately 65% of those with depression experience sleep disturbances, about 20% feel agitated, 25% have phobia, approximately 17% report generalized anxiety symptoms and 10% suffer panic attacks.
Anxiety disorders are very treatable. Like depression, the most common and successful ways to treat anxiety disorders, are antidepressant medication, psychotherapy or a combination of the two.
Generalized Anxiety Disorder (GAD) is usually the diagnosis if you experience six months or more of continual, extreme worry and tension that is not based on real concerns. Subjects include health, loved ones, finances, and jobs. Sometimes, the "worry" is nameless, taking the form of a constant feeling of dread.
Obsessive-Compulsive Disorder (OCD) is marked by obsessions - repeated, upsetting thoughts and images - that you cannot control by yourself. To combat these images and thoughts and ease anxiety, a person with OCD spends time in repetitive rituals (compulsions), such as hand washing, checking and re-checking, and following rigid procedures.
Panic Disorder is most often characterized by the presence of panic attacks, which are feelings and symptoms such as a pounding heart, chest pain, sweating, trembling, shortness of breath, numbness and fear of dying. Panic attacks happen fast, appear out of the blue and take place over and over again. There is usually no physical cause for these attacks.
Phobias are deep-seated fears that are extreme, irrational and upsetting to a person's life. A person may experience a phobia to a specific object or situation that isn't usually harmful - such as claustrophobia (fear of confined spaces), and acrophobia (fear of heights). Social phobia is fear of being watched, embarrassed or humiliated while doing something in public, such as public speaking, eating, or writing. Agoraphobia is the fear of places or situations from which escape might be hard, like being in a crowd.
Post-Traumatic Stress Disorder (PTSD) is the long-term, severe and continuing reaction a person may experience following a disaster (such as a fire or earthquake) or a very traumatic experience (war, rape, or sexual abuse). PTSD often occurs in people after they have experienced or witnessed one or more acts of violence. Symptoms include nightmares, loss of sleep, and flashbacks. PTSD interferes with concentration and the ability to enjoy life.
What is Depression?
Depression is an illness that involves the body, mood, and
thoughts. It affects the way a person eats and sleeps, the way one feels about
oneself, and the way one thinks about things. A depression is not the
same as a passing blue mood. It is not a sign of personal weakness or a
condition that can be willed or wished away. People with a depression
cannot merely "pull themselves together" and get better. Without treatment,
symptoms can last for weeks, months, or years. Appropriate depression treatment, however,
can help most people who suffer from depression.
Types of Depression
Depression comes in different forms, just as is the case with other
illnesses such as heart disease. This pamphlet briefly describes three of the
most common types of depression. However, within these types there are
variations in the number of symptoms, their severity, and persistence.
Major depression is manifested by a combination
of symptoms (see symptom list) that interfere with the ability to work, study,
sleep, eat, and enjoy once pleasurable activities. Such a disabling episode of
depression may occur only once but more commonly occurs several times in a
lifetime.
A less severe type of depression, dysthymia,
involves long-term, chronic symptoms that do not disable, but keep one from
functioning well or from feeling good. Many people with dysthymia also
experience major depressive episodes at some time in their lives.
Another type of depression is bipolar disorder,
also called manic-depressive illness. Not nearly as prevalent as other forms of
depressive disorders, bipolar disorder is characterized by cycling mood changes:
severe highs (mania) and lows (depression). Sometimes the mood switches are
dramatic and rapid, but most often they are gradual. When in the depressed
cycle, an individual can have any or all of the symptoms of a depressive
disorder. When in the manic cycle, the individual may be overactive,
overtalkative, and have a great deal of energy. Mania often affects thinking,
judgment, and social behavior in ways that cause serious problems and
embarrassment. For example, the individual in a manic phase may feel elated,
full of grand schemes that might range from unwise business decisions to
romantic sprees. Mania, left untreated, may worsen to a psychotic state.
Symptoms of Depression
Not everyone who is depressed or manic experiences every symptom. Some people
experience a few symptoms, some many. Severity of symptoms varies with
individuals and also varies over time.
Depression
- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once
enjoyed, including sex
- Decreased energy, fatigue, being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Appetite and/or weight loss or overeating and weight gain
- Thoughts of death or suicide; suicide attempts
- Restlessness, irritability
- Persistent physical symptoms that do not respond to treatment, such as
headaches, digestive disorders, and chronic pain
Causes of Depression
Some types of depression run in families, suggesting that a biological
vulnerability can be inherited. This seems to be the case with bipolar disorder.
Studies of families in which members of each generation develop bipolar disorder
found that those with the illness have a somewhat different genetic makeup than
those who do not get ill. However, the reverse is not true: Not everybody with
the genetic makeup that causes vulnerability to bipolar disorder will have the
illness. Apparently additional factors, possibly stresses at home, work, or
school, are involved in its onset.
In some families, major depression also seems to occur generation after
generation. However, it can also occur in people who have no family history of
depression. Whether inherited or not, major depressive disorder is often
associated with changes in brain structures or brain function.
People who have low self-esteem, who consistently view themselves and the
world with pessimism or who are readily overwhelmed by stress, are prone to
depression. Whether this represents a psychological predisposition or an early
form of the illness is not clear.
In recent years, researchers have shown that physical changes in the body can
be accompanied by mental changes as well. Medical illnesses such as stroke, a
heart attack, cancer, Parkinson's disease, and hormonal disorders can cause
depression, making the sick person apathetic and unwilling to care for
his or her physical needs, thus prolonging the recovery period. Also, a serious
loss, difficult relationship, financial problem, or any stressful (unwelcome or
even desired) change in life patterns can trigger a depression episode. Very
often, a combination of genetic, psychological, and environmental factors is
involved in the onset of a depressive disorder. Later episodes of illness
typically are precipitated by only mild stresses, or none at all.
Depression Treatment
The first step to getting appropriate treatment for depression is a physical
examination by a physician. Certain medications as well as some medical
conditions such as a viral infection can cause the same symptoms as depression,
and the physician should rule out these possibilities through examination,
interview, and lab tests. If a physical cause for the depression is ruled out, a
psychological evaluation should be done, by the physician or by referral to a
psychiatrist or psychologist.
A good diagnostic evaluation will include a complete history of symptoms,
i.e., when they started, how long they have lasted, how severe they are, whether
the patient had them before and, if so, whether the depression symptoms were treated and
what depression treatment was given. The doctor should ask about alcohol and drug use, and
if the patient has thoughts about death or suicide. Further, a history should
include questions about whether other family members have had a depressive
illness and, if treated, what treatments they may have received and which were
effective.
Last, a diagnostic evaluation should include a mental status examination to
determine if speech or thought patterns or memory have been affected, as
sometimes happens in the case of a depressive or manic-depressive illness.
Depression treatment choice will depend on the outcome of the evaluation. There are a
variety of antidepressant medications and psychotherapies that can be used to
treat depression. Some people with milder forms may do well with
psychotherapy alone. People with moderate to severe depression most often
benefit from antidepressants. Most do best with combined depression treatment: medication
to gain relatively quick symptom relief and psychotherapy to learn more
effective ways to deal with life's problems, including depression. Depending on
the patient's diagnosis and severity of symptoms, the therapist may prescribe
medication and/or one of the several forms of psychotherapy that have proven
effective for depression.
Electroconvulsive therapy (ECT) is useful, particularly for individuals whose
depression is severe or life threatening or who cannot take antidepressant
medication. ECT often is effective in cases
where antidepressant medications do not provide sufficient relief of symptoms.
In recent years, ECT has been much improved. A muscle relaxant is given before
treatment, which is done under brief anesthesia. Electrodes are placed at
precise locations on the head to deliver electrical impulses. The stimulation
causes a brief (about 30 seconds) seizure within the brain. The person receiving
ECT does not consciously experience the electrical stimulus. For full
therapeutic benefit, at least several sessions of ECT, typically given at the
rate of three per week, are required.
