Depressive Disorders

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Depressive disorders are characterized by low moods, feeling blue, or having apathy on exposure to a painful situation such as loss, disappointment, relationship problems, financial difficulties, and/or trauma. Bereavement, also known as grief, is differentiated from depression, in that bereavement is a normal reaction to the loss of a loved one and short-lived, whereas depression is more chronic, impacts your functioning, and lingers even with time passing. In addition to bereavement, sadness is a normal response to painful situations, where sadness is short-lived, while depression lingers and impacts your functioning. Both bereavement and sadness can turn into depression if the depressive symptoms linger past 2 weeks and you have multiple symptoms which impact your functioning.

Depression can occur when you are presented with a painful situation, and you start thinking negatively about the situation and about yourself. In response to the painful situation, you may think the situation is hopeless, you may think you are worthless, you may have no hope for the future, and/or you may think nothing will change. This negative thinking may then lead to feeling depressed. Depression may also be associated with other feelings, like shame, guilt, anger, or anxiety. Your self-esteem may also be low, you may not find pleasure in things, you may have difficulty concentrating, and you may have no hope for the future, to the point where you may also have thoughts of suicide. In addition to feeling low moods, you may have physical sensations of depression, including fatigue, exhaustion, lethargy, sleep disturbance, appetite changes, body pains, and headaches. Because you are depressed from the negative thinking and have fatigue, sleep problems, pain and eating problems, you tend to do less and less. Soon, you start to isolate and stop doing the things that used to bring you pleasure. You may also stop going to work, stay in bed, and ignore your relationships. These isolating behaviors in turn make you feel more depressed, getting you caught up in a vicious cycle of depression.

Depression, also called major depressive disorder, occurs when the depressive symptoms cause impairment of your functioning in relationships and work/school. The major depressive disorders include major depressive disorder, dysthymic disorder, and bipolar depression. Other depressive disorders include substance induced mood disorder, mood disorder due to a general medical condition, adjustment disorder with depression, minor depressive disorder, recurrent brief depressive disorder, and premenstrual dysphoric disorder. The major disorders are associated with the following:

  • Major depressive disorder- low moods or anhedonia with other symptoms of depression for at least 2 weeks
  • Dysthymic disorder- chronic depression for at least 2 years
  • Bipolar depression- depression that occurs in bipolar disorder

Depression treatment involves psychotherapy, with cognitive behavioral therapy (CBT) having the most evidence for efficacy. CBT works on the premise that events or situations do not directly cause the depression; rather, the thoughts we have or the meaning we give the events causes the depression. CBT works by identifying the maladaptive thoughts, working on more adaptive thoughts, and suppressing/distancing oneself from the maladaptive thinking. In addition, CBT addresses the avoidant and isolative behaviors which serve to sustain the depression over the long term. Other forms of psychotherapy include depth or insight oriented psychotherapy, which addresses the causes and the proximal determinants of the depression. If psychotherapy is not effective, or if the depressive symptoms are severe, then pharmacotherapy with depression medications can be considered after a psychiatric assessment. Other treatments for depression include self-help treatments, natural supplements, and alternative interventions for depression like exercise, meditation, and diet. If you are experiencing severe depressive symptoms or have suicidal thoughts, please contact your doctor immediately.

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Anxiety Disorders

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Anxiety disorders are characterized by extreme fear, nervousness, or worry on exposure to a feared stimulus, which can be an object, person, or situation. Fear is differentiated from anxiety, in that fear is a reaction to a current stimulus, whereas anxiety is fear of some future stimulus or anticipation of one. Anxiety becomes a problem when one becomes fearful, nervous, or worried out of proportion to the feared stimulus, or becomes nervous or worried about some future stimulus or anticipated event.

Fear is a normal response, and is a necessary component of survival. When presented with danger in the environment, a physiological reaction is triggered where adrenaline is released into the bloodstream. Adrenaline is a fear-response hormone which causes several physical changes in the body, including increased heart rate, increased rate of breathing, and dilated pupils. In addition, there is shunting of the blood flow from the digestive system and the skin to the skeletal muscles, which can be felt as having the “butterflies” in the stomach or having numbness and tingling sensations of the extremities. These physical changes allow the person to prepare to fight the danger, or to run from it, the so-called “fight-or-flight” response. The increased heart rate and breathing rate allows the blood to supply more oxygen to the skeletal muscles needed to fight or run, and the blood shunting to the skeletal muscles further aids this process. The dilated pupils allows for improved vision to assess the danger, and the brain becomes more alert and hypervigilant for danger, allowing one to scan their environment in order to deal with the external danger. However, this fear response goes awry when one starts to anticipate danger, or starts to have thoughts about events which overestimate the danger and underestimate one’s ability to cope with the danger. In this situation, the fear response is heightened by one’s thoughts about the event or future event, where the overestimation of danger and underestimating of one’s coping leads to anxiety. Unfortunately, the body perceives fear and anxiety the same way, where the adrenaline response is triggered with either fear or anxiety. So when one has anxiety, the fight-or-flight response is activated, and serves no purpose as the danger is more in one’s head and the way they think or give meaning to the situation.

Anxiety becomes an anxiety disorder when the anxiety symptoms cause impairment of functioning in relationships and work/school, and the person has significant distress and is unable to control the anxiety. The major anxiety disorders include generalized anxiety disorder, specific phobia, social phobia, panic disorder, post traumatic stress disorder, and obsessive compulsive disorder. Other anxiety disorders include substance induced anxiety disorder, anxiety due to a general medical condition, acute stress disorder, adjustment disorder with anxiety, separation anxiety disorder, and selective mutism. Each disorder is associated with a specific core anxiety symptom:

  • Generalized anxiety disorder- generalized worries
  • Specific phobia- fear of an object or situation (ie fear of heights)
  • Social phobia- fear of social scrutiny (ie stage fright)
  • Panic disorder- panic attacks
  • Post traumatic stress disorder- flashbacks and nightmares of trauma
  • Obsessive compulsive disorder- intrusive thoughts and ritualistic behaviors

Anxiety treatment involves psychotherapy, with cognitive behavioral therapy (CBT) having the most evidence for efficacy. CBT works on the premise that events or situations do not directly cause the anxiety; rather, the thoughts we have or the meaning we give the events causes the anxiety. CBT works by identifying the maladaptive thoughts, working on more adaptive thoughts, and suppressing/distancing oneself from the maladaptive thinking. In addition, CBT addresses the avoidant behaviors which serve to sustain the anxiety over the long term; this can be a difficult task, as the avoidant behaviors serve to relieve anxiety in the short term. Other forms of psychotherapy include depth or insight oriented psychotherapy, which addresses the causes and the proximal determinants of the anxiety. If psychotherapy is not effective, or if the anxiety symptoms are severe, then pharmacotherapy with anxiety medications can be considered after a psychiatric assessment. Other treatments for anxiety include self-help treatments, natural supplements, and alternative interventions for anxiety like exercise, meditation, and relaxation. Please see AnxietyBoss.com for more information and help on anxiety.

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