Depression / Anxiety

Depression

Depression is a "whole-body" illness, involving your body, mood, and thoughts. It affects the way you eat and sleep, the way you feel about yourself, and the way you think about things. A depressive disorder 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 depressive illness cannot merely "pull themselves together" and get better. Without treatment, symptoms can last for weeks, months, or years. Appropriate treatment, however, can help most people who suffer from depression.

The symptoms of depression may vary from person to person, and also depend on the severity of the depression. Depression causes changes in thinking, feeling, behavior, and physical well-being.

  • Changes in Thinking - You may experience problems with concentration and decision making. Some people report difficulty with short term memory, forgetting things all the time. Negative thoughts and thinking are characteristic of depression. Pessimism, poor self-esteem, excessive guilt, and self-criticism are all common. Some people have self-destructive thoughts during a more serious depression.
  • Changes in Feelings - You may feel sad for no reason at all. Some people report that they no longer enjoy activities that they once found pleasurable. You might lack motivation, and become more apathetic. You might feel "slowed down" and tired all the time. Sometimes irritability is a problem, and you may have more difficulty controlling your temper. In the extreme, depression is characterized by feelings of helplessness and hopelessness.
  • Changes in Behavior - Changes in behavior during depression are reflective of the negative emotions being experienced. You might act more apathetic, because that's how you feel. Some people do not feel comfortable with other people, so social withdrawal is common. You may experience a dramatic change in appetite, either eating more or less. Because of the chronic sadness, excessive crying is common. Some people complain about everything, and act out their anger with temper outbursts. Sexual desire may disappear, resulting in lack of sexual activity. In the extreme, people may neglect their personal appearance, even neglecting basic hygiene. Needless to say, someone who is this depressed does not do very much, so work productivity and household responsibilities suffer. Some people even have trouble getting out of bed.
  • Changes in Physical Well-being - We already talked about the negative emotional feelings experienced during depression, but these are coupled with negative physical emotions as well. Chronic fatigue, despite spending more time sleeping, is common. Some people can't sleep, or don't sleep soundly. These individuals lay awake for hours, or awaken many times during the night, and stare at the ceiling. Others sleep many hours, even most of the day, although they still feel tired. Many people lose their appetite, feel slowed down by depression, and complain of many aches and pains. Others are restless, and can't sit still.

Now imagine these symptoms lasting for weeks or even months. Imagine feeling this way almost all of the time. Depression is present if you experience many of these symptoms for at least several weeks. Of course, it's not a good idea to diagnose yourself. If you think that you might be depressed, see a psychologist as soon as possible. A psychologist can assess whether you are depressed, or just under a lot of stress and feeling sad. Remember, depression is treatable. Instead of worrying about whether you are depressed, do something about it. Even if you don't feel like it right now.

Causes of Depression:

You may have heard people talk about chemical imbalances in the brain that occur in depression, suggesting that depression is a medical illness, without psychological causes. However, all psychological problems have some physical manifestations, and all physical illnesses have psychological components as well. In fact, the chemical imbalances that occur during depression usually disappear when you complete psychotherapy for depression, without taking any medications to correct the imbalance. This suggests that the imbalance is the body's physical response to psychological depression, rather than the other way around.

Some types of depression do seem to run in families, suggesting a biological vulnerability. This seems to be the case with bipolar depression and, to a lesser degree, severe major depression. Studies of families, in which members of each generation develop bipolar disorder, found that those with bipolar disorder have a somewhat different genetic makeup than those who are not diagnosed.

However, the reverse is not true. Not everybody with the genetic makeup that causes this vulnerability to bipolar disorder develops the disorder. Additional factors, such as stress and other psychological factors, are involved in its onset as well. Likewise, major depression also seems to occur, generation after generation, in some families, but not with a frequency that suggests clear biological causes. Additionally, it also occurs in people who have no family history of depression. So, while there may be some biological factors that contribute to depression, it is clearly a psychological disorder.

A variety of psychological factors appear to play a role in vulnerability to these severe forms of depression. Most likely, psychological factors are completely responsible for other forms of mild and moderate depression, especially reactive depression. Reactive depression is usually diagnosed as an adjustment disorder during treatment.

People who have low self-esteem, who consistently view themselves and the world with pessimism, or who are readily overwhelmed by stress are more prone to depression. Psychologists often describe social learning factors as being significant in the development of depression, as well as other psychological problems. People learn both adaptive and maladaptive ways of managing stress and responding to life problems within their family, educational, social and work environments. These environmental factors influence psychological development, and the way people try to resolve problems when they occur. Social learning factors also explain why psychological problems appear to occur more often in family members, from generation to generation. If a child grows up in a pessimistic environment, in which discouragement is common and encouragement is rare, that child will develop a vulnerability to depression as well.

A serious loss, chronic illness, relationship problems, work stress, family crisis, financial setback, or any unwelcome life change can trigger a depressive episode. Very often, a combination of biological, psychological, and environmental factors are involved in the development of depressive disorders, as well as other psychological problems. When you feel depressed, and don't know where to turn, talk to someone who can help.... a psychologist.

Diagnosis of Depression:

The first step to getting appropriate treatment, for depression or any emotional problem, is a complete psychological evaluation to determine whether you have a depressive illness, and if so, what type of depression. Consultation with a psychologist will include a review of your physical health history. Some medications as well as some medical conditions can cause symptoms of depression, so your psychologist will ask your family physician to rule out these possibilities if other physical symptoms are evident.

However, physicians often focus only on the physical aspects of depression, and may prescribe medication without referring you for psychological treatment or evaluation. If you experience the symptoms of depression, as described on this website, you should talk to a psychologist, to assess whether psychological treatment is indicated, even if it not suggested by your physician. As a general rule, you should never take antidepressant medication alone, without also beginning psychotherapy, or at least seeing a psychologist for an evaluation.

A good psychological diagnostic evaluation will include a complete history of your symptoms, i.e., when they started, how long they have lasted, how severe they are, whether you've had them before and, if so, whether you were treated and what treatment you received. Your psychologist should ask you about alcohol and drug use, and if you have had thoughts about death or suicide. Further, a history should include questions about whether other family members have had depression and if treated, what treatments they may have received and which were effective.

Lastly, the psychological diagnostic evaluation will include a mental status examination to assess the full range of psychological symptoms and problems. This will help identify any other psychological problems that might be present, and will help determine the most appropriate treatment for you.

Treatment choice will depend on the outcome of the evaluation. Most people do well with psychotherapy, but some require treatment with antidepressants in addition to psychotherapy. Medication can allow you to to gain relatively quick symptom relief, if you are experiencing severe and disabling symptoms. However, medication does not "cure" the depression, it only treats the symptoms. If you are depressed, you need psychotherapy to help you to learn more effective ways to deal with life's problems, and to change the negative thoughts and attitudes that have caused you to develop depression.

Types of Depression:

Depressive disorders come in different forms. There are several different diagnoses for depression, mostly determined by the intensity of the symptoms, the duration of the symptoms, and the specific cause of the symptoms, if that is known.

Psychology Information Online provides information on the following depressive disorders. Follow the title link for more information about each type of depression:

  • Major Depression - This is the most serious type of depression, in terms of number of symptoms and severity of symptoms, but there are significant individual differences in the symptoms and severity. You do not need to feel suicidal to have a major depression, and you do not need to have a history of hospitalizations either, although both of these factors are present in some people with major depression. There is no official diagnosis of "moderate depression."
  • Dysthymic Disorder - This refers to a low to moderate level of depression that persists for at least two years, and often longer. While the symptoms are not as severe as a major depression, they are more enduring and resistant to treatment. Some people with dysthymia develop a major depression at some time during the course of their depression.
  • Unspecified Depression - This category is used to help researchers who are studying other specific types of depression, and do not want their data confounded with marginal diagnoses. It includes people with a serious depression, but not quite severe enough to have a diagnosis of a major depression. It also includes people with chronic, moderate depression, which has not been present long enough for a diagnosis of a Dysthymic disorder.
  • Adjustment Disorder, with Depression - This category describes depression that occurs in response to a major life stressor or crisis.
  • Bipolar Depression - This type includes both high and low mood swings, as well as a variety of other significant symptoms not present in other depressions.

Anxiety

Facts About Anxiety Disorders

Most people experience feelings of anxiety before an important event such as a big exam, business presentation, or first date. Anxiety disorders, however, are illnesses that fill people's lives with overwhelming anxiety and fear that are chronic, unremitting, and can grow progressively worse. Tormented by panic attacks, obsessive thoughts, flashbacks of traumatic events, nightmares, or countless frightening physical symptoms, some people with anxiety disorders even become housebound. Fortunately, through research supported by the National Institute of Mental Health (NIMH), there are effective treatments that can help. How Common Are Anxiety Disorders?

Anxiety disorders, as a group, are the most common mental illness in America. More than 19 million American adults are affected by these debilitating illnesses each year. Children and adolescents can also develop anxiety disorders.

What Are the Different Kinds of Anxiety Disorders?
  • Panic Disorder—Repeated episodes of intense fear that strike often and without warning. Physical symptoms include chest pain, heart palpitations, shortness of breath, dizziness, abdominal distress, feelings of unreality, and fear of dying.
  • Obsessive-Compulsive Disorder—Repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control.
  • Post-Traumatic Stress Disorder—Persistent symptoms that occur after experiencing or witnessing a traumatic event such as rape or other criminal assault, war, child abuse, natural or human-caused disasters, or crashes. Nightmares, flashbacks, numbing of emotions, depression, and feeling angry, irritable or distracted and being easily startled are common. Family members of victims can also develop this disorder.
  • Phobias—Two major types of phobias are social phobia and specific phobia. People with social phobia have an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations, which leads to avoidance of many potentially pleasurable and meaningful activities. People with specific phobia experience extreme, disabling, and irrational fear of something that poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives unnecessarily.
  • Generalized Anxiety Disorder—Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months. Almost always anticipating the worst even though there is little reason to expect it; accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea.
What Are Effective Treatments for Anxiety Disorders?

Treatments have been largely developed through research conducted by NIMH and other research institutions. They help many people with anxiety disorders and often combine medication and specific types of psychotherapy.

A number of medications that were originally approved for treating depression have been found to be effective for anxiety disorders as well. Some of the newest of these antidepressants are called selective serotonin reuptake inhibitors (SSRIs). Other antianxiety medications include groups of drugs called benzodiazepines and beta-blockers. If one medication is not effective, others can be tried. New medications are currently under development to treat anxiety symptoms.

Two clinically-proven effective forms of psychotherapy used to treat anxiety disorders are behavioral therapy and cognitive-behavioral therapy. Behavioral therapy focuses on changing specific actions and uses several techniques to stop unwanted behaviors. In addition to the behavioral therapy techniques, cognitive-behavioral therapy teaches patients to understand and change their thinking patterns so they can react differently to the situations that cause them anxiety.

Do Anxiety Disorders Co-Exist with Other Physical or Mental Disorders?

It is common for an anxiety disorder to accompany depression, eating disorders, substance abuse, or another anxiety disorder. Anxiety disorders can also co-exist with illnesses such as cancer or heart disease. In such instances, the accompanying disorders will also need to be treated. Before beginning any treatment, however, it is important to have a thorough medical examination to rule out other possible causes of symptoms.