Depression and Anxiety

BY Frank Spinelli, M D

September 15 2010 3:00 AM ET

The three major depressive disorders include:

1. Major depression, which is characterized by symptoms that interfere with the ability to work, sleep, or eat, and persist for at least two weeks. These episodes may occur only once but usually crop up several times in a lifetime. Major depressive episodes without symptoms of mania have also been referred to as unipolar depression. The diagnosis of major depression excludes cases where the symptoms are a result of normal bereavement as in loss of a loved one, except when it persists for a period of over one year.

2. Dysthymia is characterized by a less severe form of depression. Symptoms are more chronic, lasting for at least two years with brief periods of improvement but for no more then two months. Patients are usually not disabled by their symptoms. In fact they usually carry on their normal daily functions; however, they are unable to perform to the best of their ability and are usually dissatisfied with their performance.

3. Bipolar disorder, also called manic- depressive illness, is characterized by episodes of mania followed by severe depression. Mania is described as an extreme change in mood that is often dramatic and energetic. During the manic phase the patient may appear overactive and talkative. Manic episodes affect a patient’s rational thinking and judgment. Commonly, they may go on expensive shopping sprees and proclaim to have grand schemes. Socially their behavior is inappropriate and can be embarrassing. Usually the manic person dresses wildly with vibrant colors. Untreated, the manic episode can worsen into a psychotic state. The transition from depression into mania can be rapid or gradual, but there is a marked change in mood. In the depressed phase, symptoms are consistent with major depression.

Signs and symptoms to look for that might lead you to believe that you or someone you know is depressed include:

1. Constant fatigue
2. Insomnia or sleeping throughout the day
3. Disinterest in normal activities
4. Increased use of recreational drugs or alcohol
5. Sad or irritable mood
6. Tearfulness and feelings of despair
7. Change in appetite with either weight loss or weight gain

Despite the different categories of depression, anxiety may often co- exist. The National Comorbidity Survey (U.S.) reports that 58 percent of those with major depression also suffer from episodes of anxiety. It is also evident that even mild symptoms of anxiety can have a major impact on the course of a depressed individual.

The National Institutes of Mental Health (NIMH) define generalized anxiety disorder (GAD) as chronic anxiety, exaggerated worry, and prolonged tension, even when there is little or nothing to provoke it. People with GAD are often preoccupied with their health, money, and family issues. Usually they find that even the least troublesome task can be thoroughly anxiety producing.

GAD is excessive worry that persists for at least six months. Most patients are even able to rationalize that their worry is unwarranted; however, they are still unable to find comfort or relax, even after discussing their fears openly. Most patients with GAD have an incredibly difficult time concentrating and suffer from erratic sleep patterns.

One patient, David, had a longstanding history of bipolar disorder and such severe anxiety that he suffered from an inability to swallow. This issue complicated his treatment because he had trouble taking medication. After a battery of tests that included an upper endoscopy, he was diagnosed with a narrowing of the esophagus. Despite multiple attempts at dilating the stricture, David still had a poor capacity to swallow and needed to crush all his medications.

Other common symptoms associated with anxiety include headaches, nausea, heart palpitations, and shortness of breath. In mild cases of GAD, most patients can function socially and maintain a job. In more severe cases, patients instinctively avoid situations that are considered anxiety provoking; in some instances, this can interfere with basic daily activities. Social phobias and post- traumatic stress disorder are other forms of anxiety.

























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