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CHAPTER 1
RECOGNIZING ANXIETY & DEPRESSION
In this book, we consider anxiety and depression together even though they are distinctly different disorders. We do so because depression and anxiety often occur together, meaning that they are often co-morbid. This term simply means you have more than one illness at the same time. A high percentage of people who have symptoms of anxiety also present with symptoms of depression; the opposite is true as well. While for the purpose of this essay the two will be presented individually, it is important to remember anxiety and depression often hang out together.
Notice that anxiety and depression are referred to as illnesses. How so? With both physical and psychological components that interfere with a person's ability to function, left untreated they can pose major physical risk to a person.
Physical consequences of anxiety can include loss of sleep, a feeling of never being rested or extreme fatigue, headaches, gastrointestinal distress, and more. If the anxiety disorder has progressed to or started as panic disorder, rapid heartbeat, profuse sweating, feelings of dizziness, feeling like you are having a heart attack can occur. If the condition of anxiety is caused by a traumatic event, symptoms may also include emotional or physical withdrawal, and excessive, universalized anger at everybody or everything. Often, if anxiety is left untreated, people may turn to addictive substances to self-medicate. If the substance abuse being used to self-treat is not treated, then all the physical and cognitive illnesses caused by the abuse of alcohol and drugs can occur.
Depression has physical symptoms as well. Depression lowers most people's sensitivity to bodily aches and pains, decreases sex drive, and can lead to eating too little or too much. Depression can cause you to hardly sleep at all (insomnia) or cause you to want to sleep day and night. Depression also compromises your immune system; your ability to ward off infection may be lowered. As with anxiety, substance abuse can also be a symptom or byproduct of depression. At times, depression can make you feel so bad you will opt for feeling nothing. In those moments, your depressed and disordered thinking may convince you that numbing yourself with alcohol or drugs is good; however any drug taken that is a downer or depressant (alcohol, Xanax®, heroin, OxyContin®, Vicodin® and sedative drugs) when you are depressed will only worsen the depression.
If you are depressed, you are at a higher risk of suicide. Suicide was the 10th leading cause of death in the United States according to the Centers for Disease Control and Prevention (CDC). In 2014, 42,826 people died by suicide with half of these cases involving the use of firearms.
If you are reading this and want to die, have the means to kill yourself, and a plan to do so, please reach out for help. Go to the nearest emergency room or call the suicide line 1-800-784-2433 or the deaf hotline 1-800-799-4889. Contact your doctor, minister, a family member, your partner, or other trusted adult. If you are a teenager, reach out to your parents, foster parents, grandparents, aunt or uncle, parent of a friend, or a teacher. Find an adult to help you.
AM I SAD OR DEPRESSED?
Being sad is a part of what it means to be human. Data even suggests that animals become both sad and depressed. If we all get sad at times, how do you know if you are merely feeling sad or if you are depressed? Is it time to get help beyond the solace of your friends? On the one hand, you do not want to overreact when you are "merely" sad and call in counselors, psychiatrists, and medication. On the other hand, you do not want to underreact and feel more and more sadness, fatigue, and the full, painful range of emotions that come with anxiety and depression without support.
One distinction between normal sadness and depression is the degree to which it affects your day-to-day functioning. Many things in life hurt us. Parents get divorced, layoffs happen, our dreams never materialize, and yet we usually find ourselves adapting to the "new normal" and moving forward. Clinical depression is not that way. With depression there may (or may not) be a life event that makes you sad. Before you know it, that sadness has consumed your life so that every aspect of your life feels sad. Suddenly you feel, think, and act like you are in a deep dark hole. Taking physical and emotional care of yourself becomes hard. You have trouble getting out of bed. You drag yourself through your day. Sleeping is difficult or excessive. Eating patterns are affected. You function more poorly at your job and in other areas of responsibility. You experience feelings of hopelessness.
HOW COMMON IS DEPRESSION?
You are not alone. According to a 2016 national survey on drug use and health, 16.2 million adults have experienced at least one major depressive episode. This number is 6.7% of all adults in the US. Females tend to suffer from depression more often than men (8.5% compared to 4.8%). However, men tend to ignore their feelings; thus they are more likely to go undiagnosed and untreated. Men are also more prone to self-medicate with drugs or alcohol compared to women.
In this survey, the age cohort reporting the highest incident of a major depressive episode was 18- to 25-year-olds. Almost eleven percent (10.9%) of this age range reported at least one major depressive episode. This survey also asked about depression within race/ethnicity. The highest reporting was among persons of two races at 10.5%. In the 12 to 17 age range, an estimated 2.2 million adolescents have had at least one major depressive episode. This represents 9% of 12- to 17-year-olds in the United States. In the adult population, 64% showed severe impairment; in the adolescent population, 70% showed severe impairment due to their depression.
WHAT ARE THE SIGNS OF DEPRESSION?
According to the Diagnostic and Statistical Manual of the Mental Disorders, Fifth Edition, the following must be true to be diagnosed with major depressive disorder: Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do not include symptoms that are clearly attributable to another medical condition.
1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful). (Note: In children and adolescents, can be irritable mood.)
2. Markedly diminished interest or pleasure in all, or almost all activities most of the day, nearly every day (as indicated by either subjective account or observation).
3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day. (Note: In children, consider failure to make expected weight gain.)
4. Insomnia or hypersomnia nearly every day.
5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
6. Fatigue or loss of energy nearly every day.
7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
If five or more of these signs of depression are impacting your life, and they cannot be attributed it to a medication you are taking or another mental illness for which you are already in the care of a doctor, consulting your doctor is in order. If you think you are going to hurt yourself or others, call 911 or go to the nearest emergency room.
DOES DEPRESSION ALWAYS LOOK THE SAME?
The faces of depression are as varied as the thousands of individuals living with it. Not everyone acts sad when they are depressed. Gender and age can play a major role in how a person exhibits depression. Teens often exhibit depression with a drop in grades or other performance measure. They are likely to isolate, going to their room and playing on their computer or smartphone. Teens are likely to self-medicate using alcohol, illicit drugs, sex, or other high risk/high feel behaviors in order to dull the pain. Often, they act more angry than sad. Teens are often on high alert for adult criticism and become more emotionally reactive to adult criticism.
Your depression will likely present differently depending on your cultural setting. For example, in the United States, black women report depression less often than white women. People from individualistic cultures report more depression than people from collectivistic cultures. Perhaps the lack of focus on "self" is a preventative to depression. Being aware of how your culture interacts with your depression can help you identify potential resources for and roadblocks to healing. In a more private culture, will you be shamed for showing emotion? Do you have a large extended or church family to support you?
Even the dynamics of your family of origin or current family make up will affect how you appear when you are depressed. Were you raised in a family where everyone had to appear perfect and function highly? You might take great pains to make sure your depression doesn't show on the outside. Was your home life volatile? You may be more likely to exhibit depression through angry outbursts, or you may repress your anger for fear of hurting others. A caring relationship with a trained medical or mental health professional can help you tease out the shape of your particular depression so that you can begin addressing it.
WHAT ARE THE SIGNS OF ANXIETY?
Anxiety presents itself in a variety of different forms and functions; we see and diagnose a broad range of anxiety-related disorders. Many of these disorders will be discussed more fully in the next chapter, but all kinds of anxiety share some common symptoms, such as: rapid and/or shallow breathing, racing heart, dizziness, sweaty palms, dry mouth, difficulty concentrating, fatigue/restlessness, irritability, or a sense of impending doom or overwhelming fear that may be out of proportion to the present threat.
At times it feels like these symptoms may take over your entire body. Some people say that their mind feels hijacked by the anxiety. You may experience all or some of these symptoms. The degree to which they affect your ability to live as you would like will help your treatment team diagnose and care for you.
DOESN'T EVERYBODY GET ANXIOUS SOMETIMES?
Yes. Everybody experiences anxiety. In fact, anxiety is essential to our survival. It helps us detect threats and motivates us to prepare for them. Even so, anxiety can be limiting and even crippling.
Anxiety occurs in everyday situations such as: speaking in public; social situations, particularly when expected to mingle and make "small talk"; being watched while doing a task; flying on a plane; taking a test or facing an interview; or undergoing a medical exam.
When we become anxious our bodies mount a physical response. Physical symptoms of anxiety, even everyday anxiety may include sweaty hands, blushing, dry mouth, trembling, or upset stomach.
For some people, anxiety is an annoyance, but for others it is intense reaction leading to impairment of daily functioning. Anxiety become diagnosable if its effects keep you from completing (or beginning) work or school assignments, sleeping, eating normally, parenting as you normally or otherwise would, etc. Fortunately, for most people, even severe anxiety is treatable. We will explore treatment options further in chapter 4.
DEPRESSION, ANXIETY, AND ADDICTION
A mental health disorder like depression and/or anxiety, along with a substance abuse disorder or other addiction, is called a dual diagnosis or a co-occurring disorder. According to the Substance Abuse and Mental Health Administration of the United States government, 7.9 million adults in the US had co-occurring disorders in 2014. Often people with anxiety and depression will self-medicate to avoid the feelings of fear, shame, hopelessness, or sadness. Over time it takes an increasing amount of alcohol, drugs, or other addictive substance or behavior to achieve the desired feeling (and avoid the undesirable feeling). This need for an increasing amount to get the same effect can lead to addiction.
If you are depressed or anxious and addicted, the mental health and substance abuse issues must be treated together in order to prevent relapse into the health issue, addiction, or both. Combined treatment leads to better outcomes and a lower treatment cost. While not uncommon in any socio-economic status, individuals with dual diagnoses are often seen in the criminal justice system and the homeless population, as the effects of addiction and mental disorder can be deep and broad, affecting one's life in many ways.
If you have a dual diagnosis your treatment will likely begin with detoxification, then be followed up with inpatient rehabilitation. After rehab, your treatment team will likely advise some combination of counseling, medication, and 12-step recovery groups to help you stay clean and healthy. Often additional support services like housing assistance, vocational rehabilitation, and further medical care are included to promote long-term recovery.
WHEN TO SEEK HELP
When you have anxious, worrying thoughts and feelings for no apparent reason and they get in the way of your daily living, it is time to reach out for outside help. Always overthinking or overresponding to your life (even unintentionally) is very draining and can be hard to see from the inside out. Since you may be perceiving situations as threatening, even when they are not, the people around you may notice before you do. If the people you trust and who know you well are suggesting you need help, it's a good idea to schedule an appointment with a physician, therapist, or other care provider just to check in.
The warning signs of significant depression are similar to those of anxiety. While everybody feels sad at some point, not everybody has trouble getting out of bed, falling asleep, eating regularly or is unable to complete essential work, school, home, or parenting tasks. If you or the people who know and love you best recognize these symptoms in you, please visit a medical or mental health professional to hear their opinion. If you are lost in feelings of hopelessness and have a plan, the means, and the intention to harm yourself (or anyone else), please go to the nearest emergency room or call 911. Our first responders are trained to help keep you safe and gauge the need for further evaluation.
In either (or both) conditions, the more open and honest you can be with your care provider, the more likely you are to receive the help you need. You may even be surprised by what you hear yourself describing when you talk about your day-to-day existence. Sometimes speaking our reality to another person is enough for us to recognize that this is not how we would like to live life. Depression and anxiety tell our minds and bodies lies. The truth is that you are a beloved child of God and deserve to live a whole and fulfilling life, not constantly tormented by the demons of anxiety and depression. You are worth getting help.
CHAPTER 2
FORMS OF ANXIETY
At its root and in the moment, all anxiety essentially feels the same. Symptoms such as shallow breathing, tight chest, dizziness, and sweaty palms occur regularly with all forms of anxiety. The context in which these symptoms appear vary greatly from disorder to disorder, and understanding the nuances of your particular anxiety disorder is essential to treatment. In this chapter we discuss a few of the most common forms of anxiety.
GENERALIZED ANXIETY DISORDER (GAD) Everyone has anxiety in their life due to stressors. However, if you worry excessively about everyday events, it may be Generalized Anxiety Disorder (GAD). What is an everyday concern that under usual circumstances would not warrant excessive worry?
• Are my children safe?
• Do I have cancer?
• Is today the day I'm going to get fired?
• Is my child sick? (when there is no indication of illness)
• Will I ever be able to complete this task?
• What if we have another hurricane this year?
• Is this assignment good enough to turn in?
To be diagnosed with GAD, you must have this excessive anxiety and worry more days than not for a minimum of six months. The worry comes unbidden, and you are at a loss about how to control it.
(Continues…)
Excerpted from "Out of the Depths: Your Companion Through Depression and Anxiety"
by .
Copyright © 2018 Abingdon Press.
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