ANXIETY DISORDERS/DEPRESSION

Everyone feels anxious now and then. It’s a normal emotion. For example, you may feel nervous
when faced with a problem at work, before taking a test, or before making an important decision.

Anxiety disorders are different, though. They are a group of mental illnesses, and the distress
they cause can keep you from carrying on with your life normally.

For people who have one, worry and fear are constant and overwhelming, and can be disabling.
But with treatment, many people can manage those feelings and get back to a fulfilling life.

Types of Disorders

Anxiety disorder is an umbrella term that includes different conditions:

 Panic disorder. You feel terror that strikes at random. During a panic attack, you may also
sweat, have chest pain, and feel palpitations (unusually strong or irregular heartbeats).
Sometimes you may feel like you’re choking or having a heart attack.
 Social anxiety disorder. Also called social phobia, this is when you feel overwhelming
worry and self-consciousness about everyday social situations. You fixate about others
judging you or on being embarrassed or ridiculed.
 Specific phobias. You feel intense fear of a specific object or situation, such as heights or
flying. The fear goes beyond what’s appropriate and may cause you to avoid ordinary
situations.
 Generalized anxiety disorder. You feel excessive, unrealistic worry and tension with little
or no reason.

Symptoms

All anxiety disorders share some general symptoms:

 Panic, fear, and uneasiness

 Sleep problems
 Not being able to stay calm and still
 Cold, sweaty, numb or tingling hands or feet
 Shortness of breath
 Heart palpitations
 Dry mouth
 Nausea
 Tense muscles
 Dizziness
Causes

Researchers don’t know exactly what brings on anxiety disorders. Like other forms of mental
illness, they stem from a combination of things, including changes in your brain and
environmental stress, and even your genes. The disorders can run in families and could be linked
to faulty circuits in the brain that control fear and other emotions.

Diagnosis

If you have symptoms, your doctor will examine you and ask for your medical history. She may
run tests to rule out medical illnesses that might be causing your symptoms. No lab tests can
specifically diagnose anxiety disorders.

Depression
Losing a loved one, getting fired from a job, going through a divorce, and other difficult
situations can lead a person to feel sad, lonely and scared. These feelings are normal reactions to
life's stressors. Most people feel low and sad at times. However, in the case of individuals who
are diagnosed with depression as a psychiatric disorder, the manifestations of the low mood are
much more severe and they tend to persist.

Depression occurs more often in women than men. Some differences in the manner in which the
depressed mood manifests has been found based on sex and age. In men it manifests often as
tiredness, irritability and anger. They may show more reckless behavior and abuse drugs and
alcohol. They also tend to not recognize that they are depressed and fail to seek help. In women
depression tends to manifest as sadness, worthlessness, and guilt. In younger children depression
is more likely to manifest as school refusal, anxiety when separated from parents, and worry
about parents dying. Depressed teenagers tend to be irritable, sulky, and get into trouble in
school. They also frequently have co-morbid anxiety, eating disorders, or substance abuse. In
older adults depression may manifest more subtly as they tend to be less likely to admit to
feelings of sadness or grief and medical illnesses which are more common in this population also
contributes or causes the depression.  

Types of Depression
There are different types of depressive disorders, and while there are many similarities among
them, each depressive disorder has its own unique set of symptoms.

The most commonly diagnosed form of depression is Major Depressive Disorder. In 2015,
around 16.1 million adults aged 18 years or older in the U.S. had experienced at least one major
depressive episode in the last year, which represented 6.7 percent of all American adults.
Depression is the leading cause of disability in the United States among people ages 15-
44.  View the NIMH website for statistics from the 2016 National Survey on Drug Use and
Health
Major depression is characterized by at least five of the diagnostic symptoms of which at least
one of the symptoms is either an overwhelming feeling of sadness or a loss of interest and
pleasure in most usual activities. The other symptoms that are associated with major depression
include decrease or increase in appetite, insomnia or hypersomnia, psycho motor agitation or
retardation, constant fatigue, feelings of worthlessness or excessive and inappropriate guilt,
recurrent thoughts of death and suicidal ideation with or without specific plans for committing
suicide, and cognitive difficulties, such as, diminished ability to think, concentrate and take
decisions. The symptoms persist for two weeks or longer and represent a significant change from
previous functioning. Social, occupational, educational, or other important functioning is also
impacted. For instance, the person may start missing work or school, or stop going to classes or
their usual social activities. 

Another type of depression is called Persistent depressive disorder (dysthymia). The essential

feature of this mood disorder is a low, dark or sad mood that is persistently present for most of
the day and on most days, for at least 2 years (children and adolescents may experience
predominantly irritability and the mood persist for at least 1 year). For the individual to receive
the diagnosis of persistent depressive disorder they should also have two of the diagnostic
symptoms which include poor appetite or overeating, insomnia or hypersomnia, low energy or
fatigue, low self-esteem, poor concentration, difficulty making decisions, or feelings of
hopelessness. During this period, any symptom-free intervals last no longer than two months.
The symptoms are not as severe as with major depression. Major depression may precede
persistent depressive disorder, and major depressive episodes may also occur during persistent
depressive disorder.
Premenstrual dysphoric disorder is another manifestation of depression which is a severe and
sometimes disabling extension of premenstrual syndrome (PMS). Although regular PMS and
Premenstrual dysphoric disorder (PMDD) both have physical and emotional symptoms, the
mood changes in PMDD are much more severe and can disrupt social, occupational, and other
important areas of functioning. In both PMDD and PMS, symptoms usually begin seven to 10
days before the start of a menstrual period and continue for the first few days of the period. Both
PMDD and PMS may also cause breast tenderness, bloating, fatigue, and changes in sleep and
eating habits. PMDD is characterized by emotional and behavioral symptoms that are more
severe, such as sadness or hopelessness, anxiety or tension, extreme moodiness, irritability or
anger.
Some medical conditions can trigger depressive symptoms in individuals. This is
called depressive disorder due to another medical condition. Endocrine and reproductive
system disorders are commonly associated with depressive symptoms. For example, people with
low levels of the thyroid hormone (hypothyroidism) often experience fatigue, weight gain,
irritability, memory loss, and low mood. When the hypothyroidism is treated it usually reduces
the depression. Cushing's syndrome is another hormonal disorder caused by high levels of the
hormone cortisol which can also cause depressive symptoms. Other conditions that have been
found to cause depression include conditions such as HIV/AIDS, diabetes, strokes, Parkinson’s
disease etc.
Adjustment Disorder with Depressed Mood is diagnosed when symptoms of depression are
triggered within 3 months of onset of a stressor. The stressor usually involves a change of some
kind in the life of the individual which he/she finds stressful. Sometimes the stressor can even be
a positive event such as a new job, marriage, or baby which is nevertheless stressful for the
individual. The distress is typically out of proportion to the expected reaction and the symptoms
cause significant distress and impairment in functioning. The symptoms typically resolve within
6 months when the person begins to cope and adapt to the stressor or the stressor is removed.
Treatment tends to be time limited and relatively simple since some additional support during the
stressful period helps the person recover and adapt.
Another type of depression is related to changes in the length of days or seasonality. This type of
depression is called Seasonal affective disorder (SAD). People with SAD suffer the symptoms
of a Major Depressive Disorder only during a specific time of year, usually winter. This appears
to be related to the shorter days of winter, and the lack of sunlight in many parts of the country.

Depression and Anxiety Disorders: Not the Same

Depression and anxiety disorders are different, but people with depression often experience
symptoms similar to those of an anxiety disorder, such as nervousness, irritability, and problems
sleeping and concentrating. But each disorder has its own causes and its own emotional and
behavioral symptoms.

Many people who develop depression have a history of an anxiety disorder earlier in life. There
is no evidence one disorder causes the other, but there is clear evidence that many people suffer
from both disorders.