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Introduction Empowering People with Anxiety and Depression
Anxiety and depression are two of the most serious medical disorders. The suffering caused by these conditions is not only miserable, grinding, and so intolerable that suicide can appear a welcome relief, but it is diabolically long- lasting if not treated. We used to view anxiety and depression as afflictions of middle age. We now know that they strike the young with equal force and can be ruinous throughout life unless treated. We used to think that anxiety and depression were purely mental ills—disorders of emotion, thinking, and perspective. In fact, anxiety and depression are deeply rooted in the body, and their corrosive effects raise a person’s risk of contracting a host of diseases, including heart disease, stroke, diabetes, and osteoporosis.
Depression alone is the leading cause of disability in the United States and the rest of the world. It costs employers an estimated $44 billion a year in lost productivity, according to a 2003 article in the Journal of the American Medical Association. Tragically, not only is the true magnitude of the damage wrought by these diseases widely unknown, but millions of people do not recognize their own anxiety or depression, or if they do, they suppress this recognition because of the stigma that stubbornly clings to psychological conditions of all kinds.
This book is our attempt to fight that stigma, raise awareness about the true nature of anxiety and depression, help people find optimal treatment, and empower them so they can better navigate often complicated health-care systems.
We live in remarkably stressful times, filled with information overload, demands to perform at high speed, and pressure to multitask. The terrorism and war that have touched all of us in recent years have also added uncertainty and tension to our lives. Unfortunately, humans are not built for this kind of stress. Our brains, our moods, and our emotional responses evolved over millions of years to deal with the challenges of a hunter-gatherer lifestyle, in which new information came at a trickle and the pace of life was, literally, at a walk. The contrast with the demands of the twenty-first century is so stark that the steady rise in anxiety and depression is not surprising. Between 1987 and 1997, for example, the percentage of Americans diagnosed and treated for depression more than tripled. Anxiety and depression are now the two most common mental disorders, affecting 38 million people in the United States alone.
We urgently want to address these dire statistics by improving care for those who are anxious, depressed, or both. Until now no comprehensive and authoritative guide has existed for people seeking the optimal treatment they deserve. In part, that’s because until recently experts have considered anxiety and depression separate maladies. We now know this is false: people often experience symptoms of both, and proper diagnosis and treatment require an appreciation for the interrelatedness of these two disorders.
This book offers the most up-to-date and high-quality information available anywhere about the science and treatment of anxiety and depression. Our recommendations, suggestions, and guidance are grounded in evidence-based medicine, which simply means that we back up our assertions with findings from recent well-designed studies published in peer- reviewed professional journals. We have been fortunate to be involved with dozens of such studies, thousands of patients, and key national patient- advocacy groups. One of us, Dennis S. Charney, oversees scores of research projects every year as chief of Mood and Anxiety Disorder Research at the National Institute of Mental Health. The other, Charles B. Nemeroff, is a professor and chair of the Department of Psychiatry and Behavioral Sciences at Emory University, a leading center for research, training, and clinical care of patients with mood and anxiety disorders. He has treated many of the patients whose stories appear in this book. Because of our prominence in the field, we often consult with leading companies involved in treating anxiety and depression. In the spirit of full disclosure, we list these relationships in the endnotes. Such arrangements, very common in psychiatry, are mutually beneficial and do not compromise our commitment to writing a book based solely on the state of the science and weight of the latest medical evidence.
Our understanding of anxiety and depression is not just a matter of long clinical experience and formal academic training, however. We are not removed from the conditions about which we write. We have our own human foibles and have experienced our share of grief, trageedy, and pain. We would never pretend to know exactly how anybody else feels, but we do have a profound empathy and compassion for everrrrryone who struggles with anxiety and depression—an empathy rooted in our own struggles with life’s slings and arrows.
Our fundamental message is hopeful: people can overcome anxiety and depression and find well-being, zest, and greater emotional resilience. Everyone can make progress. Everyone can get better. Everyone can be happier and healthier. We’re not saying the path will be easy, quick, or painless, but we are certain that good information is the foundation for any successful treatment—and that is what this book contains.
In tackling anxiety or depression, recognize a fact sometimes overlooked by physicians and the medical establishment in general: nobody knows more about you than you do, and you may understand yourself better than you realize. That doesn’t mean you are all-knowing or have plumbed the depths of your own multilayered consciousness. It simply means that you are the ultimate judge of when you need help, when you feel well, and when you think a change is needed in your treatment plan. Like most people, you are wiser and stronger than you may think you are. In the grip of depression or anxiety, you may minimize or dismiss your ability to change, heal, and grow, and this self-doubt is in fact part of the insidious nature of these illnesses.
Though we cannot hear your story directly or tailor what we have to offer to your particular circumstances, we acknowledge the primacy of your own unique life and all of the strengths and weaknesses you bring to bear on dealing with challenges to your health and well-being. There is no magic formula, no “absolutely effective” therapy, no “best” medication that works for everyone. You must weigh the ideas, suggestions, and options presented in this book against your own life, your own values, your own situation, and then act.
Not Just Treatment, but Optimal Treatment
Sadly, millions of people with anxiety and depression are not achieving the relief they deserve. Only about one in five of those with major depression gets adequate treatment, according to a 2003 study. “Adequate” was defined as at least eight half-hour sessions of counseling with a mental health professional or four visits with any type of physician for prescription and management of an antidepressant drug, used for at least thirty days.
Many people simply don’t realize they are sadder, more tired, or more anxious than they need to be. Others know they suffer but don’t seek treatment out of fear, embarrassment, or shame. Such concerns persist despite decades of testimony by people from all walks of life that anxiety and depression are medical conditions just like any other. Nobody is embarrassed to admit they have high blood pressure or diabetes, and nobody should be embarrassed to admit they are dealing with anxiety or depression. Almost all medical diseases involve complicated interactions between mind and body, and no clear distinction can be drawn between “physical illnesses” and “mental illnesses.” Unfortunately, this relatively new way of looking at illness has not become common knowledge.
Even people currently receiving treatment often do not get optimal treatment. Their psychotherapy may be stuck or simply not working. Their medication dose may be too low, it may have lost its effectiveness, or perhaps it wasn’t effective to begin with. Efforts to adopt a healthier lifestyle may be bogged down because of lack of time, money, or energy. This book offers many suggestions for overcoming barriers and getting the treatment one deserves.
It’s also true that despite the breakthroughs of the past two decades, treating anxiety and depression is a complicated and still inexact science. Don’t get us wrong—we have the tools, both psychotherapeutic and pharmacological, to heal most of the people who seek help. But clinicians need skill and experience in order to use these tools correctly, and patience and commitment on the part of both the patient and the clinician are essential. Often people need to try a number of approaches until one, or a combination, works. If the search continues for months, people may stop before they have wrung the most from today’s arsenal of treatments. Don’t accept a “quick fix” approach. A brief medical history, a fifteen-minute chat with a family doctor, and a prescription for an antidepressant or anti-anxiety medication are seldom enough. Everyone deserves more—a true therapeutic alliance with attention to the subtleties, both physical and psychological, that determine how well and rapidly a person will overcome anxiety or depression.
Using This Book
We have organized this book in three parts. Part I covers basic information relevant to everyone and is important for understanding later chapters. Part II covers the diagnosis and treatment of anxiety and depression. Part III explores how anxiety and depression affect people at different stages of life. The appendixes contain valuable information about special topics such as complementary therapies, how to evaluate health information claims, and where to find nearby psychiatric help.
The stories of real people and their struggles with anxiety and depression are woven into every part of the book. Some patients have allowed use of their real names because they want to combat the stigma lingering around anxiety and depression. Others have chosen anonymity out of concern for the privacy of others involved in their story. We are deeply grateful to all of them for sharing some of the most difficult or painful times of their lives. We believe these stories add an invaluable dimension to the factual information we present.
A few anxiety-related afflictions are not addressed in this book. For instance, we do not discuss obsessive-compulsive disorder (OCD) because current research suggests it is a distinct psychiatric entity that should not be lumped with other anxiety disorders. Although patients with OCD need as much help as any, this subject is better treated in a book of its own. Interested readers might consider The Boy Who Couldn’t Stop Washing: The Experience and Treatment of Obsessive-Compulsive Disorder, by Judith Rapoport. We also do not specifically cover so-called simple phobias—abnormal reactions to specific things such as snakes, spiders, or blood. Such phobias are relatively uncommon in the general population (as opposed to simply disliking or fearing snakes or spiders). In addition, simple phobias are seldom disabling, and their treatment is relatively straightforward.
We have written this book because we know that healing and happiness are possible, and people can lead more rewarding, satisfying, and pleasurable lives by taking advantage of everything we know about anxiety and depression. By opening this book you have already taken the immensely important step of seeking help and information. We wish you courage, patience, and tenacity as you apply what you learn here to your own life and loved ones.
Copyright © 2004 by Dennis S. Charney and Charles B. Nemeroff. Reprinted by permission of Houghton Mifflin Company.
|Introduction: Empowering People with Anxiety and Depression||1|
|Part I||The Power of Mood|
|1.||Thieves of Happiness||9|
|2.||Building Emotional Resilience||18|
|3.||Mood and Physical Health||31|
|Part II||Diagnosing and Finding Optimal Treatment for Anxiety and Depression|
|4.||The World of Anxiety Disorders||45|
|5.||Finding Optimal Relief from Anxiety Disorders||68|
|6.||The World of Depression||80|
|7.||Finding Optimal Relief from Both Major and Low-Level Depression||98|
|8.||Bipolar Disorder: Diagnosis and Optimal Treatment||120|
|9.||Reducing the Risk of Suicide||133|
|Part III||Anxiety and Depression Among Women, Men, Children, and Older Adults|
|10.||Anxiety and Depression in Women||147|
|11.||Anxiety and Depression in Men||156|
|12.||Anxiety and Depression in Children and Teens||165|
|13.||Anxiety and Depression in Older Adults||191|
|Appendix I||Complementary and Alternative Medicine||201|
|Appendix II||Making Sense of Health Information||204|
|Appendix III||Medications That Can Cause or Exacerbate Anxiety and Depression||209|
|Appendix IV||Finding Help||212|
|Appendix V||Who Does What?||217|