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Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. National Institute of Mental Health |
My depression - my enemy
Both fear and anxiety send signals through the body that prepare all systems for possible danger. Hormones, such as adrenaline and catecholamine, are released in what is known as the "fight or flight" response. The sudden increase in hormone levels speeds up the heart and increases the amount of blood being pumped. At the same time, the muscles tighten, increasing the individual's ability to fight or flee from danger. The intensity of these physiological responses varies according to the seriousness of the event or thought that sparked the emotion, the strength of the individual's fear or anxiety, and his or her previous experience and genetic makeup. Effective treatments for anxiety disorders are available, and research is yielding new, improved therapies that can help most people with anxiety disorders lead productive, fulfilling lives. If you think you have an anxiety disorder, you should seek information and treatment. Thousands of scientific studies over the past several years show that high blood pressure, ulcers, migraine headaches, strokes, alcoholism, depression, anger, fatigue, drug addiction and many other medical conditions are often due to the long-term effects of stress. Among the professionals who can help are psychiatrists, psychologists, social workers, and counselors. However, it's best to look for a professional who has specialized training in cognitive-behavioral therapy and/or behavioral therapy, as appropriate, and who is open to the use of medications, should they be needed. Remember, though, that when you find a health care professional that you're satisfied with, the two of you are working together as a team. Together you will be able to develop a plan to treat your anxiety disorder that may involve medications, cognitive-behavioral or other talk therapy, or both, as appropriate. You may be concerned about paying for treatment for an anxiety disorder. If you belong to a Health Maintenance Organization or have some other kind of health insurance, the costs of your treatment may be fully or partially covered. There are also public mental health centers that charge people according to how much they are able to pay. If you are on public assistance, you may be able to get care through your state Medicaid plan. Depressed people will seem sad, or "down," or may be unable to enjoy their normal activities. They may have no appetite and lose weight (although some people eat more and gain weight when depressed). They may sleep too much or too little, have difficulty going to sleep, sleep restlessly, or awaken very early in the morning. They may speak of feeling guilty, worthless, or hopeless; they may lack energy or be jumpy and agitated. They may think about killing themselves and may even make a suicide attempt. Some depressed people have delusions (false, fixed ideas) about poverty, sickness, or sinfulness that are related to their depression. Often feelings of depression are worse at a particular time of day, for instance, every morning or every evening. Not everyone who is depressed has all depression's symptoms, but everyone who is depressed has at least some of them, co-existing, on most days. Depression can range in intensity from mild to severe. Depression can co-occur with other medical disorders such as cancer, heart disease, stroke, Parkinson's disease, Alzheimer's disease, and diabetes. In such cases, the depression is often overlooked and is not treated. If the depression is recognized and treated, a person's quality of life can be greatly improved. The hallmark of this problem is chronic worry and tension with no apparent cause. People suffering from generalized anxiety disorders may worry excessively about health, money, family, or work, often anticipating disaster. Although they are usually aware that their anxiety is more intense than necessary, they can't seem to let it go. Constant worrying contributes to trouble sleeping and relaxing. People with anxiety disorders may startle easily and have trouble concentrating. Generalized anxiety disorder often leads to depression. Physical symptoms of this disorder include: trembling, twitching, muscle tension, headaches, irritability, sweating, nausea, hot flashes, light-headedness, and difficulty breathing. GAD is diagnosed when psychological and physical symptoms of anxiety last more than a month and are not accompanied by the symptoms of other anxiety disorders. Using brain imaging technologies and neurochemical techniques, scientists are finding that a network of interacting structures is responsible for these emotions. Much research centers on the amygdala, an almond-shaped structure deep within the brain. The amygdala is believed to serve as a communications hub between the parts of the brain that process incoming sensory signals and the parts that interpret them. It can signal that a threat is present, and trigger a fear response or anxiety. It appears that emotional memories stored in the central part of the amygdala may play a role in disorders involving very distinct fears, like phobias, while different parts may be involved in other forms of anxiety. Other research focuses on the hippocampus, another brain structure that is responsible for processing threatening or traumatic stimuli. The hippocampus plays a key role in the brain by helping to encode information into memories. Studies have shown that the hippocampus appears to be smaller in people who have undergone severe stress because of child abuse or military combat. This reduced size could help explain why individuals with PTSD have flashbacks, deficits in explicit memory, and fragmented memory for details of the traumatic event. In addition, with new findings about neurogenesis (birth of new brain cells) throughout life, perhaps a method will be found to stimulate growth of new neurons in the hippocampus in people with post-traumatic stress disorder. Scientists are also conducting clinical trials to find the most effective ways of treating anxiety disorders. For example, one trial is examining how well medication and behavioral therapies work together and separately in the treatment of obsessive-compulsive disorder. Another trial is assessing the safety and efficacy of medication treatments for anxiety disorders in children and adolescents with co-occurring attention deficit hyperactivity disorder. For more information about clinical trials, for example the National Library of Medicine's clinical trials database. It is not entirely clear why psychotropic medications work; yet, it appears that they reestablish balance within the chemistry of the brain. Behavior is determined through messages transmitted within the brain from one nerve cell to another through various chemicals. These chemicals are called neurotransmitters. Through the millions of nerve cells within the brain, chemicals trigger memories, sleep patterns, perceptions, feelings, moods and thoughts. The electric current that carries the messages are received by nerve ends, called synapses, which then release the neurotransmitter. These chemicals, in turn, propagate the message by stimulating the next nerves in line to send on the electrical message. Once used, the neurotransmitter chemical is returned and stored in the nerve end. This recycling process is called reuptake. When this signaling process goes askew, the effects are seen in a person's behavior and experienced in his emotions, perceptions, sensations, and ideas. Although there are numerous chemicals that perform vital functions within the brain, three basic chemicals, or neurotransmitters, seem most critical in regulating this process and maintaining balance: serotonin, which is related to anxiety, depression, and aggression; dopamine, which affects reality perception and pleasurable experiences; and norepinephrine, which affects attention, concentration, and mood. Experts have yet to agree on the root cause of anxiety disorders. In fact, most concede that several factors may be at work in each case. Psychoanalytic theory holds that anxiety stems from unconscious conflict arising from discomfort or distress during childhood. Once the source of the anxiety is identified, it can be eliminated by resolving the underlying conflict. However, most studies find that people with anxiety disorders come from stable homes, with childhood backgrounds similar to those of people without anxiety disorders. There's little doubt that all our thoughts and feelings are rooted in transmissions between nerve cells in the brain. These signals are passed from cell to cell by chemical neurotransmitters released at the synapse (tiny gap) between one cell and the next. 1. Remember that though your feelings and symptoms are very frightening, they are not dangerous or harmful. 2. Understand that what you are experiencing is an exaggeration of your normal bodily reactions to stress. 3. Do not fight your feelings or try to wish them away. The more you are willing to face them, the less intense they will become. 4. Do not add to your panic by thinking about what "might" happen. 5. Stay in the present. Notice what is really happening to you as opposed to what you think might happen. 6. Label your fear level from zero to 10 and watch it go up and down. Notice that it does not stay at a very high level for more than a few seconds. 7. When the fear begins to trigger "what if" thinking, focus on and carry out a simple and manageable task such as counting backwards from 100 by threes or snapping a rubber band on your wrist. 8. Notice that when you stop adding frightening thoughts to your fear, it begins to fade. 9. When the fear comes, expect and accept it. Wait and give it time to pass without running away from it. 10. Be proud of the progress you make, and think about how good you will feel when you succeed this time. Diet also can be a culprit. The most common dietary offenders are caffeine and caffeine-like substances found in coffee, tea, and many soft drinks. In sensitive individuals, the jitteriness precipitated by caffeine can reach panic levels. In rare cases, extreme vitamin deficiencies may also lead to anxiety. The anxiety associated with taking or discontinuing medications and other substances can usually be easily relieved once the cause is recognized. It's therefore essential to provide your doctor with a complete run-down of your medicines--including over-the-counter products and of your eating and drinking habits. The family is of great importance in the recovery of a person with an anxiety disorder. Ideally, the family should be supportive without helping to perpetuate the person's symptoms. If the family tends to trivialize the disorder or demand improvement without treatment, the affected person will suffer. You may wish to show this booklet to your family and enlist their help as educated allies in your fight against your anxiety disorder. Stress management techniques and meditation may help you to calm yourself and enhance the effects of therapy, although there is as yet no scientific evidence to support the value of these "wellness" approaches to recovery from anxiety disorders. There is preliminary evidence that aerobic exercise may be of value, and it is known that caffeine, illicit drugs, and even some over-the-counter cold medications can aggravate the symptoms of an anxiety disorder. Check with your physician or pharmacist before taking any additional medicines. Unrestrained anxiety can lead to any of several emotional disorders, all characterized by an unpleasant and overwhelming mental tension with no apparent identifiable cause. While most people with anxiety disorders are completely aware that their thoughts and behavior are irrational and inappropriate, this insight gives them no help in controlling their symptoms. Each anxiety disorder has its own distinct features, but they are all bound together by the common theme of excessive, irrational fear and dread. If you have been treated previously for an anxiety disorder, be prepared to tell the doctor what treatment you tried. If it was a medication, what was the dosage, was it gradually increased, and how long did you take it? If you had psychotherapy, what kind was it, and how often did you attend sessions? It often happens that people believe they have "failed" at treatment, or that the treatment has failed them, when in fact it was never given an adequate trial. In many instances, medications are essential. If you suffer from mania, a major depression, or a paranoid disorder, medications may actually be able to restore you to your normal self. For other conditions, such as schizophrenia, medications control and modify symptoms to the degree that a person can stay in his community. Medications also ease the more distressing symptoms, allowing a person to engage in a therapeutic relationship and re-engage in the activities of her daily life. Sometimes a drug is a useful additional measure during particularly stressful times, perhaps in the initial stage of treatment or at a time of crisis. Those patients with thought disorders or hallucinatory experiences can be maintained only with appropriate antipsychotic medications.
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