Depression and Anxiety

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When depression and anxiety interfere with your life, professional help can offer valuable support.

What are the differences between normal sadness and depression or nervousness and anxiety? Sometimes it’s not so easy to determine the differences.

Where do I find help if I think I am suffering from depression or anxiety?
A psychiatrist is the best health care professional to see for providing care for people with mental health problems like depression or anxiety. Depression can be difficult to diagnose because the signs and symptoms are oftentimes vague; and there are several different types of depression, including Seasonal Affective Disorder (S.A.D.), Dysthymia, and major depression. The first step in identifying a depressive disorder is to rule out physical causes of behavior or mood change. In people who have Spina Bifida and shunted hydrocephalus, this is especially important because many signs and symptoms of depression may actually be caused by medical conditions (shunt malfunction, infections, or medications) rather than depression. In those situations, the symptoms disappear when the underlying medical condition is treated or corrected.

To help determine if a person is depressed, it is critical to know his or her medical history including healthy or unhealthy behaviors such as drug use, eating, and physical activity. Other information regarding a person’s surroundings or past experiences such as family history and living environment are important. Other questions to ask include: Have any relatives had depression? What’s happening at home? Has there been recent stress? Is the patient alone, or does he or she have lots of friends? Does he or she find pleasure in things that are normally enjoyable? Does he or she sleep well? Does the person look depressed? Does he or she make eye contact?

What should a health care provider do if he/she suspects depression?
Two screening questions are asked:
1) During the past month, have you felt down, depressed or hopeless?
2) During the past month, have you been bothered by decreased interest or pleasure in life?

If the person answers “yes” to either or both questions, more screening is needed. Sometimes you can learn a lot by simply asking: Are you depressed? Few doctors ask this. If the answer is “yes,” even fewer doctors ask the patient whether they’ve thought about suicide. These are very important questions to ask.

What should family or friends consider if they suspect depression?
How are daily experiences affecting my loved one? Does he interact with peers and family? Does she sleep well? How is his appetite? Has she lost interest in pleasurable things? Is he able to go to work, do his homework, study and concentrate? Is she complaining about being generally unwell? Everyone has been sad, anxious, or even a little depressed; but clinical depression is more serious. Symptoms are more severe, last longer and generally don’t go away on their own. Clinical depression affects daily functioning.

What are the symptoms of clinical depression?
According to the National Institute of Mental Health, symptoms of depression may include:

  1. Difficulty concentrating, remembering details, and making decisions
  2. Fatigue and decreased energy
  3. Feelings of guilt, worthlessness, and/or helplessness
  4. Feelings of hopelessness and/or pessimism
  5. Insomnia, early-morning wakefulness, or excessive sleeping
  6. Irritability, restlessness
  7. Loss of interest in activities or hobbies once pleasurable, including sex
  8. Overeating or appetite loss
  9. Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment
  10. Persistent sad, anxious, or "empty" feelings
  11. Thoughts of suicide, suicide attempts

What causes depression?
Most experts believe that depression is caused by problems with certain chemicals in the brain. These chemicals, called neurotransmitters, send signals from one nerve to the other. There are many of these chemicals, but there are three that control our moods: 1) norepinephrine, 2) serotonin and 3) dopamine.

Who is at high risk for depression?
The following people are at high risk of depression: people with Spina Bifida and hydrocephalus, chronic pain sufferers, women, especially those with hormonal imbalances. In addition, people with Attention Deficit Hyperactivity Disorder (ADHD) and/or learning disorders have higher rates of depression. This may be because of school failures, low self-esteem or a chemical imbalance in the brain. Research suggests that depression is more common among people in northern climates, especially in winter.

Depression is linked to family history. If one person has depression, his family members are more likely to have depression at some time. In identical twins this link is clear. If one twin is depressed, the chance of the other twin being depressed is 46 percent.

Stress, especially chronic stress, plays a role in depression. This stress could be from home, school or work, or from something else like a surgery. Depression is more common following a major personal loss, such as the death of a parent.

Low self-esteem is associated with depression, which is one reason why people with Spina Bifida are more likely to be depressed. Other risk factors include decreased social support and isolation. Learned helplessness — where people feel that there is nothing they can do to improve their situations — may contribute to depression.

How is anxiety related to depression?
If someone is anxious, they’re more likely to be depressed. The reverse also is true. Many drugs used to treat depression are used to treat anxiety. Like depression, anxiety runs in families. Signs of anxiety include feeling tense or afraid, a sense of dread, panic or terror. People who are anxious may worry a lot. Anxiety breaks up concentration and tends to result in a focus on oneself.

One type of anxiety disorder is obsessive-compulsive disorder (OCD). Signs include repeated, purposeful behaviors that try to reduce anxiety. Behaviors may include repeated hand washing, counting objects and needing objects to be arranged in a certain order. Severe OCD interferes with functioning and should be treated. The good news is that anxiety and depression are treatable!

How are depression and anxiety treated?
There are many ways to treat depression and anxiety. Studies show that exercise can have a great effect. So one thing people can do is be more active. For people in wheelchairs, wheelchair-based sports are great way to do this. Sports provide a good workout and make it easy to meet people. Horseback riding is fun, too. It stretches the muscles and joints.

Drugs and counseling may be needed. Today’s drugs of choice are the SSRIs (selective serotonin reuptake inhibitors), which include Prozac, Paxil, Zoloft, Effexor and Serzone. Each drug has its own side effects that can be different in each person. Sometimes these side effects can be severe. It is important not to stop the drugs suddenly. Taper off instead. A sudden stop can cause dizziness, fatigue, headache, nausea and/or insomnia.

Counseling (including a type called cognitive-behavioral therapy) can be crucial, especially with anxiety. Counseling also helps if the person has low self-esteem or learned helplessness. Sometimes it’s very helpful for the entire family to receive counseling. Drugs alone won’t improve self-esteem or stop behaviors based on learned helplessness.

How long do you treat depression with drugs?
For people who have severe depression, troubles at home, low self-esteem or a hard time taking care of themselves, drugs and counseling are often necessary. Depression is very different for different people, but generally, doctors try not to give kids drugs for more than six months. Treatments can last much longer in cases where it is necessary. For someone who has mild depression for the first time, treatment usually lasts for two to three months and then the drug is tapered off, but counseling may need to continue for weeks, months or longer.

Get help
If you or someone you know seems to be depressed, talk to a doctor or nurse. If you try to talk about depression or anxiety and your health care provider doesn’t react the way you think he or she should, find another provider who will listen more. You can also find help by calling your local mental health hotline.

This information does not constitute medical advice for any individual. As specific cases may vary from the general information presented here, SBA advises readers to consult a qualified medical or other professional on an individual basis.

Contributing Editor
Gregory S. Liptak, MD, MPH


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