The dreaded duo of anxiety and depression are two of the most common psychiatric disorders in the UK. Both belong in the ‘mood disorders’ category in psychiatric problems.
Most cases occur as a normal reaction to what we percept. But can be triggered by multiple factors and few examples are,
- Physical : disabilities, diseases (infectious/noninfectious), injuries etc.
- Life events: child birth, financial problems, divorce, death of a relative etc.
- Racial : Adult blacks 20 percent more prone for mental problems than whites.
- Substance abuse: opioids, hallucinogens sedatives, stimulants etc.
- Genetic predisposition: positive family history
- Certain drugs : Accutane to treat acne, certain antiviral drugs
In anxiety disorders sufferer experiences a sudden onset of anxious thoughts/panic attacks with or without a precipitating trigger. Basically an overreaction to a situation in which our mind sees as troublesome. Here the sufferer expects a future threat and holds on to it and succumbs to fear, grief or panic in situations where a normal person will not.
Generalized anxiety is the most common type but many other subcategories prevail. Few examples are
- Post-traumatic stress disorder (PTSD)
- Obsessive compulsive disorder (OCD)
- Panic disorders
Psychiatry considers anxiety as a high mood/high energy mental state in contrast to depression which is a low mood/low energy state.
The evil twin of anxiety. Characterized by a devastating low mood and low energy state. The sufferer feels sad and can interfere with day to day activities such as sleeping, working, eating etc. Can seriously cripple the mental state of one and in some cases leads right into suicide. The affected person may experience reduced energy, loss of appetite, pessimistic ideas, repeated headaches and loss of interest in day to day activities.
Symptoms of depression vary vastly. Not everybody will get all the characteristic symptoms and in many, the symptoms will be milder.
Do they mix?
As it may seem unusual at the first glance, anxiety and depression often go hand in hand. Even though they work in opposite energy states of mind they really do mingle.
Having anxiety/depression alone will significantly predict that sufferers will be prone to the other at some point. The reason for this is not yet understood. In one study 85% of people with depression were diagnosed with anxiety disorders. Of the 35% had panic disorders (a subcategory of anxiety disorder).
Let me give you an example.
A depressed individual experiences lack of interest in work. So he stops going to work and neglect his route of income. But after some time utility bills pile up, bank accounts dry and financial instability occurs and causes the person to panic in addressing the money problem. And the anxiety strikes. So basically they are two sides of the same coin and usually, anxiety precedes depression.
Combined symptoms are more serious and devastating and depression complicated with anxiety has a high suicidal rate than depression alone.
Who are at risk?
Any person having anxiety/depression is at risk of developing both. Family history is also vital to predict combined disease. The type of anxiety disorder is also significant. Obsessive-compulsive disorder, panic disorder and phobias specifically social phobia (agoraphobia) can lead to depression when compared to others. Age is important too. If a person develops anxiety for the first time after 40 years of age most likely to develop depression.
How to manage?
The treatment plan is vital to address the combined disorder. One common misconception is that medical treatment will be obsolete in treating combined symptoms and it is not. It has been proven that judicious use of medicine plus behavioural therapy (CBT) significantly reduce the symptoms and pave the way back to normal life.
This is called an integrated approach and combines physical, mental, medical and spiritual therapies to combat.
If thoughts of suicide arise, a psychotherapist or a physician should be consulted immediately and is considered one of the psychiatric emergencies. If the sufferer doesn’t willingly inquire help, a family member or any person close to him should take immediate action.
When having moderate to severe combined symptoms it is vital to have a provider or a group of providers which can include a physician, nursing officer, psychotherapist and someone to address the spiritual needs of the person.
But recovery will be time-consuming and patients will have to be mentally strong to battle these demons. And the only way to do that is through self-determination and not giving up.