Depression and Anxiety
BY Frank Spinelli, M D
September 15 2010 3:00 AM ET
In order to make the diagnosis of GAD, symptoms must persist for longer than six months and have to include at least three of the following:
• insomnia or excessive sleep
• muscle tension
• difficulty focusing
Like depression, GAD is treated with behavioral therapy and medication. For the most part, depression and anxiety are said to be 40 to 70 percent inheritable, according to the NIMH.
In addition to family history, gay men endure issues with low self- esteem and shame. Often the complex development of a gay man’s personality and learning how to cope with environmental stress are also major contributing factors toward mental illness. Traumatic experiences especially during childhood involving bereavement, neglect, or abuse can increase the likelihood of depression. Even certain chronic medical conditions like HIV, hepatitis, and hypothyroidism can contribute to depression. Particularly in some gay men, struggles with anabolic steroids, alcohol, benzodiazepines, and recreational drugs can complicate a patient’s battle with psychiatric problems.
With the current state of health care, primary-care providers are faced with the unwanted task of having to treat many common psychiatric illnesses like depression and anxiety. Many doctors increasingly have to attend to these conditions as the “gatekeeper” to all illnesses. Most clinicians agree that screening for depression and anxiety in the gay community is warranted.
Essentially, there are chemical changes or imbalances that affect how information is transmitted in the brain. These neurotransmitters affect mood. Decreased levels of certain ones, specifi cally serotonin and norepinephrine, can result in depression and anxiety. Medications that target these neurotransmitters are called selective serotonin re-uptake inhibitors, or SSRIs. This class of drugs includes such pop u lar brands as Prozac (fl uoxetine), Zoloft (sertraline), Paxil (paroxetine), and Lexapro (escitalopram oxalate). SSRIs work well to alleviate symptoms of depression and GAD but also help restore the brain’s chemical imbalances. Recent advances in psychopharmacology have produced another class of antidepressants that target both serotonin and norepinephrine, called serotonin norepinephrine re- uptake inhibitors (SNRIs). One example is Cymbalta (duloxetine HCL), which in addition to its antidepressant affects also treats such somatic complaints as bodily pain. Still another commonly used antidepressant medication, Wellbutrin (buproprion), works as a norepinephrine/dopamine re- uptake inhibitor. With all these different classes of drugs, making the appropriate choice can be a difficult decision, especially when you have to consider all the different side effects.
As a whole, the SSRIs are associated with sexual side effects, sleep disturbances, as well as weight gain. This can be alarming for some patients; however, it is my experience that they are well tolerated. Before you begin any drug regimen your doctor should discuss not only the potential side effects but also how the medication works and any drug interactions. Most antidepressants take effect after one or two weeks but require two to four weeks for full effect.
Another class of drugs called benzodiazepines, known for their sedating effect, were widely overused in the 1960s and 1970s to alleviate stress but were found to be highly addictive. Many patients to this day request these medications, which include Valium, Xanax, Ativan, and Klonopin because of their immediate onset of action. Unfortunately, they only provide temporary relief of symptoms and tolerance can soon develop. Benzodiazepines are not recommended for long- term treatment of anxiety or depression. They may be necessary for an acute breakthrough of anxiety, but caution needs to be exercised because of the addiction potential.
For the most part, patients usually require antidepressants to aid them through difficult periods in their lives, like the death of a loved one, the loss of a job, or a breakup. In these cases, antidepressants are prescribed for a specific period of time, usually six months to a year. In many cases, especially in complicated circumstances, therapy is also called for.
Traditional psychotherapy can be an essential outlet for most patients experiencing depression or anxiety. It allows some people the ability to express their underlying fears and concerns, while for others it affords the chance to explore more deeply rooted issues. In addition to traditional one- on-one therapy, there is also group therapy. This is a form of psychotherapy in which one or several therapists treat a small group of patients. Sometimes this is essential because of the cost- effectiveness compared to one- on- one counseling. In a group, the members organize around related issues and try to resolve them as a system. This gives the members the opportunity to explore personal issues within a social context.
Feelings of prolonged depression and anxiety should be brought to your health- care provider’s attention. There are many treatment options available, and no one should have to suffer.
Other psychosocial concerns that affect gay men include addiction, especially to alcohol, tobacco, and drugs. Questions regarding eating disorders, especially bulimia and anorexia, should be addressed as well during the initial assessment. Finally, other complex issues that come up time and again for gay men include concerns with sexual compulsivity, domestic violence, and hate crimes.