1. How to Identify and Manage Depression and Anxiety

    December 12, 2013

    Manage Depression and Anxiety

    by Vickie Parker, LMFT

    In the DSM-IV (Diagnostic and Statistical Manual, # IV) there are three stages of depression; mild, moderate, and severe. There are nine criteria used to diagnose Major Depressive Disorder (MDD);   

     

    –  Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks.

    –  Mood represents a change from the person’s baseline.

    –  Impaired function: social, occupational, educational.

    –  Specific symptoms, at least 5 of these, present nearly every day:

    1.  Depressed mood or irritable most of the day, nearly everyday, as indicated by either  subjective

    report: (e.g., feels sad or empty) or observation made by others (e.g., appears tearful).

    2.  Decreased interest or pleasure in most activities, most of each day

    3.  Significant weight change (5%) or change in appetite

    4.  Change in sleep: Insomnia or hypersomnia

    5.  Change in activity: Psychomotor agitation or retardation

    6.  Fatigue or loss of energy

    7.  Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt

    8.  Concentration: diminished ability to think or concentrate, or more indecisiveness

    9.  Suicidality: Thoughts of death or suicide, or a suicide plan

    Depression can be caused from unfortunate circumstances in our life, like loss of a loved one, losing a job, or moving to a different location.  There are many other examples, but these are just a few.  When depression is caused from a situation it is called situational depression and the depression should pass in a reasonable amount of time.

    If the depression continues for more that 6 months it could turn into clinical depression, which means the brain is not producing enough neurotransmitters for us to work through our depression and a lot of times antidepressants need to be prescribed from a physician to help us think better, thereby helping to alleviate the depression.

    Depression is usually treated with Cognitive Behavioral Therapy (CBT).  One book that helps to deal with depression is “Feeling Good” by Dr. David Burns.  This book discusses the exercises that help with identifying destructive thought patterns, so we can change them and start looking at things differently and “feel better”.

    Depression can also be cause from a lack of connection with others.  We isolate ourselves when we start feeling depressed or we feel isolated from others and that leads to depression.  It is important to always stay connected to others through some sort of social activities.  Could be through your church, volunteer groups, or social clubs.

    If we do not have a good balance in our life, depression usually only gets worse.  It is important to get at least 7 to 8 hours of good sleep every night and have a routine of going to bed and getting up at a regular time each day.

    Exercising helps us sleep and feel better. Without some form of exercise in our life we are much more prone to depression.  Just taking a 30 minute walk daily can make the difference in how we feel. Work on getting a walking partner and that will help you stay connected to someone.

    Eating a balanced diet and keeping our weight down is also essential in feeling good and not getting depressed. There is good information on eating a good balanced diet on the web and creating a healthy lifestyle. Make a plan and find an accountability partner to help make the changes. Discipline and a desire to change and do the work makes the difference in our success.  It will not happen over night so be patient with yourself.  The secret is commitment and consistency.

    Anxiety that escalates to the level of clinical condition is called Generalized Anxiety Disorder (GAD) and the symptoms are;

    • Irrational worry
    • Preoccupation with unpleasant worries
    • Trouble relaxing
    • Feeling tense
    • Fear that something awful might happen

    Anxiety is also treated with Cognitive Behavioral Therapy and relaxation exercises help with relieving the intensity of the anxiety.  Practicing the relaxation exercises daily trains our brain to know what it feels like to relax.  Deep breathing and visualizing a peaceful place is where it starts.  Don’t get discouraged if your brain has a hard time staying focused and slowing down, just keep practicing.  It works. Create a quiet, peaceful environment with some soft music and low lights to practice every day at least three times.

    Often anxiety can lead to clinical depression, if not treated properly. When we are anxious our bodies are in a constant “Fight or Flight” mode. This puts a great deal of stress on our bodies and eventually we crash and go into depression. Feeling “Burned Out” is a term we use when we are feeling exhausted and have no energy for an extended amount of time.

    If you think you are depressed or have anxiety, seek professional help. It can make the difference in overcoming the sadness or anxiety.  Depression and anxiety are not fun and it can suck the life right out of us. It is important for you to know that you are not alone in how you are feeling, but there is hope. It takes courage to seek help and make the changes, but it is worth it.

    Author Bio: Vickie Parker, is a therapist licensed in Marriage and Family Therapy. To read more of Mrs. Parker’s blogs visit her web site vickiemft.com

    Image credit: http://www.flickr.com/photos/evarinaldiphotography/9213376274

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  2. Anxiety Disorders in Women

    November 19, 2013

    Anxiety Disorders in Women

     

    “Women have higher overall prevalence rates for anxiety disorders than men. Women are also much more likely than men to meet lifetime criteria for each of the specific anxiety disorders: generalized anxiety disorder (GAD), obsessive-compulsive disorder (OCD), social anxiety disorder (SAD), post traumatic stress disorder (PTSD), simple phobia, panic disorder, and agoraphobia” (Pigott TA, 2003).

    Anxiety disorders are widespread psychological problems.  Anxiety is normal and helpful to us if the intensity is not severe. But, when it lingers for days after the anxiety-triggering event, it turns into a troubling disorder. Women are diagnosed with anxiety disorders at twice the rate of men, according to the Anxiety Disorders Association of America. Is there a biological reason behind women’s tendency to be victimized by anxiety more often than men? Are we raising our girls in a way that makes them more anxious? Some people rationalize the disparity by claiming that men are simply less likely to admit to suffering from any psychological problem, but the fact is, no one knows, and all of these questions need to be answered.

    Anxiety disorders in women can negatively affect their social life, work and relationships. It reduces their feeling of self-worth. Many factors can cause anxiety in women, including biological, psychological, and social factors. For example, women have to deal with the considerable biological issues related to pregnancy and childbirth. Young girls can get anxious at the start of menstrual cycles. There is also the immense responsibility of being both a wife and a mother, which can sometimes trigger negative thoughts and fears. In addition, the different ways which parents raise their children and discriminate between genders has an impact on our personalities. Young girls are expected to be polite, sensitive and nice. Boys are taught not to cry because it’s not a “manly” thing to do. These parental approaches are universal and could very well be a factor behind women’s high rate in anxiety.

    The most common anxiety disorder faced by women is social phobia, which is an extreme fear of being embarrassed or judged by others. Women are more concerned and care more about their public image and appearance than men. Living in a patriarchal world, where men have greater authority in most of the institutions of society, the anxiety faced by women struggling to make their way is realistic.  It is normal to be nervous while giving a presentation to a meeting room full of male colleagues but sweating, freezing or shaking in front of them as you give your presentation is not normal, and is a sign of a social phobia.
    Generalized anxiety disorder is unreasonable excessive worry about past, present or future events. Triggers can include relationship problems, a recent divorce, the loss of a loved one or just about any traumatic event or natural disaster. Women are considered to be more sensitive by society, which means they are more likely to allow themselves to worry. Research from the Children’s Hospital of Philadelphia concluded that the female brain may be less able to adjust to high levels of stress hormones and is also more sensitive to them. Specific phobias include irrational fears about a particular thing or event. Women are mostly afraid of animals, insects and darkness. When a woman is stricken by an obsessive compulsive disorder, she is anxious and remains anxious unless she acts on a compulsion to lessen her obsessions. Women tend to be more obsessed about locking doors, washing their hands because of a fear of germs, putting things in what they feel is the proper order, nail biting or hair pulling. When having an anxiety attack; women feel more fearful than simply feeling sad or worried, as in depression. Anxiety disorders pose a threat to a woman’s health, because it can lead to symptoms such as insomnia, dizziness or headaches, among other things.

    Experts have developed some strategies to overcome panic and fear in women and everyone else. Exercise and yoga have a strong connection to improved mental health, and a psychotherapist can show relaxation exercises that can help relieve you. Eating healthy food and avoiding junk and over-processed food can also help, as can discussing your feelings with a friend or family member. The relief we get after sharing our problems with someone is irrefutable, so go ahead and do so. Participate in social activities. Sleep well.  Some women believe that being a wife and mother requires giving it their all, but, being a human, you have the right to receive some, too. Give some of your time to yourself, too. You deserve to live a life without fear and worry.

    References:
    1.      Pigott TA. Anxiety disorders in women. Psychiatric Clinics of North America. 2003 Sep; 26 (3):621-72, vi-vii.

     

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  3. Anti Anxiety Medication List – Benefits, Disadvantages, Side Effects

    November 15, 2013

    Anti Anxiety Medications

    Almost everyone suffers from anxiety at some point in their lives. Yet, if you are among 3.1% of Americans who suffer from Generalized Anxiety Disorder, medications could be a necessary component of your multimodal treatment. Anti anxiety medications should never be considered a permanent solution, regardless of what your doctor tells you. These could be used to control your condition, while you are working with a therapist and learn to manage your repetitive, negative, and often irrational thoughts. Psychotherapy is the only  permanent solution for anxiety, and it works best when combined with meditation, yoga, and regular physical exercise.

    Once you have been diagnosed with a Generalized Anxiety Disorder and it has been decided (by your physician or psychiatrist) that you need to take anti anxiety medication for  your treatment, it is important to know and understand all of the options available. The following is an anti anxiety medication list containing information about medications commonly used to treat anxiety. We describe here specifics of each medication, their benefits, disadvantages and possible side effects.

     

    BENZODIAZEPINES

     

    *Xanax – panic, generalized anxiety, phobias, social anxiety and OCD

    *Klonopin – panic, generalized anxiety, phobias and social anxiety

    *Valium – panic, generalized anxiety and phobias

    *Ativan – panic, generalized anxiety and phobias

    *Serax – generalized anxiety and phobias

    *Librium – generalized anxiety and phobias

     

    Benzodiazepines are psychoactive drugs whose use results in sedative, hypnotic, and muscle relaxant properties. In general, these types of drugs are safe and effective for the short term. You can take benzodiazepines as a single dose therapy or several times a day for months at a time. Studies suggest that they are effective in reducing symptoms of anxiety in about 70% of patients. They are very quick acting, tolerance does not develop, and overdose is not dangerous. Generic alternatives are available which can greatly reduce cost.

     

    Sometimes patients experience side effects such as drowsiness, lethargy, difficulty with speech, a decrease in coordination, unsteady gait, and headache. These types of side effects tend to be present the first few weeks of treatment, but usually clear up. Some patients experience irritability and agitation. Taking benzodiazepines can increase the effects of alcohol. Long-term use is still controversial due to possible psychological and physical effects. It can cause tolerance in some people as well as dependence and withdrawal symptoms. Benzodiazepines are also controversial for use in pregnant women.

     

    BETA BLOCKERS

     

    *Inderal – social anxiety

    *Tenormin – social anxiety

     

    Beta blockers help to treat the physical effects of anxiety such as trembling, shaking, uncontrolled blushing and controlling rapid heart beat in anxious social situations for several hours. They are safe for most people with few side effects. Beta blockers are also non-habit forming.

     

    Sometimes the social anxiety symptoms present are so strong that beta blockers cannot provide sufficient relief. They also tend to lower blood pressure so those with a heart condition or low blood pressure may not use them. Beta blockers are not recommended for anyone with diabetes or with respiratory issues such as asthma.

     

    TRICYCLIC ANTIDEPRESSANTS

     

    *Tofranil – panic, generalized anxiety, PTSD and depression

    *Norpramin or Pertofrane – panic, generalized anxiety, PTSD and depression

    *Aventyl or Pamelor – panic, generalized anxiety, PTSD and depression

    *Elavil – panic, generalized anxiety, PTSD and depression

    *Sinequan or Adapin – panic and depression

    *Anafranil – panic, depression and OCD

     

    Tricyclic antidepressants are among the earliest antidepressants developed. They are effective, but have been generally replaced with other types of antidepressants that cause fewer side effects. They are effective in reducing panic attacks and in elevating depressed moods. They are usually given in single daily doses with no tolerance development or withdrawal symptoms.

     

    Taking tricyclic antidepressants have a delayed onset of 4-12 weeks. Possible side effects include insomnia, tremors or both and both can last up to three weeks. Overdose is a dangerous issue with thee medications and the side effects are considered to be significant.

     

    MONOAMINE OXIDASE INHIBITORS (MAOIs)

     

    *Lardil – panic, generalized anxiety, social anxiety, depression and OCD

    *Parnate – panic, generalized anxiety, depression, OCD and PTSD

     

    MAOIs reduce panic attack, elevate depressed moods and increases confidence. These medications are well researched, cause no tolerance development and are non-habit forming.

     

    There are some dietary and medicinal restrictions that must be adhered to when taking MAOIs. Thee can be inconvenient for many patients. Aged cheeses and meat as well as certain medications need to be avoided when taking this medication. There can be significant agitation during the first days of treatment. There can also be a delayed onset of weeks to months and they are very dangerous in overdose. Patients that take MAOIs need to be extremely responsible.

     

    SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)

     

    *Prozac – panic, generalized anxiety, social anxiety, depression, OCD and PTSD

    *Luvox – panic, generalized anxiety, social anxiety, depression, OCD and PTSD

    *Zoloft – panic, generalized anxiety, social anxiety, depression, OCD and PTSD

    *Paxil – panic, generalized anxiety, social anxiety, depression, OCD and PTSD

    *Lexapro – panic, generalized anxiety and OCD

    *Celexa – panic, generalized anxiety, depression, OCD and PTSD

     

    SSRIs are a newer type of medication introduced in the 1980’s. They assist the brain in maintaining enough supply of serotonin in the brain. A deficiency of serotonin is associated with many anxiety disorders.  They are a well-tolerated medication that is safe for medically ill or frail patients. They are safe in overdose with no withdrawal symptoms unless abruptly stopped. No dependency develops and they do not promote weight gain.

     

    There is a delayed onset of 4-6 weeks  and full range effect can take up to 12 weeks. A worsening of anxiety symptoms can happen during the first two weeks of treatment.

     

    SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs)

     

    *Effexor or Effexor XR – panic, generalized anxiety, social anxiety, depression and OCD

    *Cymbalta – panic, generalized anxiety, social anxiety and OCD

     

    With Cymbalta, therapeutic response can take up to 4-6 weeks and alcohol must be avoided. Nausea and dizziness are common side effects. SNRIs are more expensive than most anxiety medications.

     

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