Depression and Anxiety Disorders

Anxiety disorders frequently accompany depression, but they are different maladies that often require different treatments.

DEPRESSION

I've discussed the symptoms of depression, in depth, in an earlier article, "Identifying Depression", so I will just briefly summarize those symptoms here:
**Insomnia or sleeping more than usual.
**Change in appetite, often with weight loss or weight gain.
**Feeling sad, irritated, or angry.
**Fatigue or low energy level.
**Loss of interest in things that you normally enjoy.
**Feeling hopeless, helpless, guilty.

Once depression is diagnosed, it is usually treated with an antidepressant medication (see "Pharmaceutical Treatment of Depression"). These medications include SSRI's, which are used for treating anxiety as well as depression. But others, such as buproprion, are not useful in treating anxiety.

Talk therapies that tend to work best with depression are interpersonal psychotherapy and analytical therapies (see "Types of Therapy" and "Talk Therapies 2").

ANXIETY

Generalized anxiety disorder (GAD) often accompanies, and complicates, depression. GAD tends to have more physical symptoms than does depression, yet there also cognitive changes. Among the symptoms of GAD are:
**Excessive worry
**Feeling restless or on edge.
**Irritability.
**Muscle tension and headaches.
**Sweating.
**Nausea.
**Tremors or shaking.
**Having to go to the bathroom more frequently.
**Trouble falling asleep.
**Difficulty concentrating.

The physical symptoms are the same as those of the "fight or flight" mechanism. "Fight or flight" is triggered by potential harm or a threat to one's well-being, and we normally experience it at times we should fight or run. But, in people with GAD, the "fight or flight" mechanism is "on" all the time, or at least a good deal of the time.

GAD can be treated with a group of medications known as benzodiazepines - which include Xanax, Ativan, and Valium. These tranquilizers decrease the physical symptoms of GAD, by way of the GABA receptors in the brain. Though GABA is implicated in GAD, it is not a factor in depression.

The benzodiazepines tend to be sedating and can lead to dependence (or addiction), so doctors most often prescribe one of the more sedating SSRI's such as Paxil. Effexor is another antidepressant (but not SSRI) that is often prescribed for anxiety.

Cognitive-behavioral therapy, which focuses on changing behaviors and thought patterns, is considered to be the most effective talking therapy for GAD. Biofeedback and relaxation techniques are also helpful.

PANIC

When people talk about "anxiety attacks," they are really describing panic attacks, which are a type of anxiety disorder.

As with GAD, the symptoms of a panic attack are mostly physical and symptomatic of the "fight of flight" reflex.
**Shortness of breath.
**Heart pounding or racing.
**Chest pain.
**Dizziness or light-headedness.
**Tremors or shaking.
**Sweating.
**Nausea or stomach pain.
**Numbness or tingling in arms, hands, or toes.
**Hot flashes or chills.
**A sense of impending doom.
**A feeling of not being in control.
**A sense of terror or a feeling that you're going to die.

Panic attacks usually last about 10 to 20 minutes. They can be so intense that the person having one feels that she may be having a heart attack. Patients have reported to me that, during the most intense part of a panic attack, they have thought of death or suicide.

Between panic attacks, the person may have "anticipatory anxiety" - a fear that she will have another attack. This is especially true if there are no apparent triggers for the panic attacks.

Benzodiazepines are commonly used for people who have infrequent panic attacks. The person takes one as soon as she feels an attack beginning. However, if she has frequent panic attacks (several a week), SSRI's are prescribed.

As with GAD, the "talking" therapy of choice is cognitive-behavioral.

SUMMARY

Anxiety disorders are being diagnosed more frequently nowadays, and they often complicate depression. If an anxiety disorder is diagnosed along with depression, an SSRI may work well for both maladies. But this is not always the case and, frequently, both a benzodiazepine and an antidepressant are prescribed.

Like depression, the anxiety disorders can be treated with some success - and often with a great deal of success - with both medication and "talking" therapies.

WEB RESOURCES

Generalized Anxiety Disorder
Panic
The Anxiety Network International