Anxiety and Depression

We live in a world that thrives on immediacy,  24 hours a day, 365 days a year.

Even in the consultation room we see patients that are worried about their work or other issues and are constantly checking their mobile devices. Many times, they are physically there but their minds are elsewhere.

When they go on vacation to a remote area, if they find out there is no internet connection, they start to feel uneasy, restless and what was meant to be leisure time turns into a tortured fear that something bad might happen while they are out of touch.

As there is day and night, we need time to engage and time to disengage, time to work and time to rest, time to connect and time to disconnect.

As there is spring, summer, autumn, and winter, there is time for productivity and growth, but also a time for rest and restoration.

Disregarding the laws and limits we were born with can lead to poor health.

That is one reason we see so many successful professionals and young people coming to the doctor complaining of headache, shortness of breath, chest pain, dizziness, cold sweats, palpitation, stomach pain related to stress and anxiety.

Generalized anxiety disorder (GAD) one of the most common mental disorder in the community and clinical settings have a lifetime prevalence  of 5.1 percent  to 11.9 percent.in the USA. .

Symptoms and signs of anxiety may include:

• Excessive worrying
• Difficulty relaxing
• Restlessness
• Sweating
• Palpitation, high blood pressure
• Tingling
• Dizziness, fainting and headaches
• Cold hands and feet
• Dry mouth
• Diarrhea, stomach pain
• Insomnia

Another mental health condition that we often see in the office is depression.

In stressful environments like Shanghai, we may at times feel tired, overburdened, have a lack of energy and motivation, or even feel worthless and hopeless.

If these symptoms are mild and don’t affect your daily life it may be transitory, but if it is impacting your work, school grades or family relationships, it might be symptoms of depression.

In the United States, the lifetime prevalence of major depression is 17 percent, and between 10-14% of patients visiting a primary care physician have depression, but unfortunately only one-third of sufferers ever receive appropriate diagnosis and treatment.

Symptoms of depression include:

• Depressed mood
• Diminished interest or pleasure
• Weight loss or gain
• Insomnia or hypersomnia
• Agitation
• Fatigue or loss of energy
• Feelings of uselessness, worthlessness or excessive or inappropriate guilt
• Indecisiveness or decreased reasoning ability and concentration
• Recurrent thoughts of death or suicide

Depression is a whole-person disorder that includes biological, psychological and social aspects. Environmental factors such as the death of someone close, separation or divorce, changes in employment, overwork, lack of rest, failures on exams or at work, rejection, or any situation that ends in frustration and guilt, are all other common catalysts.

The consequences of untreated depression can be enormous, often resulting in personal and family suffering, professional regression, alcohol or other substance abuse, increased risk of accidents, or suicide.

The good news is that treatment is available.

Successful treatment of depression often includes a combination of therapy, medication and rest.

However, the first, and arguably most important, steps in treatment are to recognize we are depressed and seek treatment

If any of what I have said about anxiety or depression sounds like I am describing you or someone close to you, I encourage you to talk to your doctor or if you have moderate to severe depression, anxiety  or panic, or symptoms such as hallucinations, thoughts or hurting yourself, euphoria (which is opposite of depression) or problem with addictions  a visit with a psychiatrist is recommended.

References:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.

David Baldwin, MA, DM FRCPsych. Generalized anxiety disorder in adults: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis. This topic last updated: Apr 03, 2018.

Wittchen HU, Zhao S, Kessler RC, Eaton WW. DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51:355.

Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62:593.

Kessler RC, Gruber M, Hettema JM, et al. Co-morbid major depression and generalized anxiety disorders in the National Comorbidity Survey follow-up. Psychol Med 2008; 38:365.

Leon AC, et al. “Prevalence of Mental Disorders in Primary Care: Implications for Screening.” Archives of Family Medicine. 1995; 4(10):857-861.

Maurer, DM. “Screening for Depression.” American Family Physician. January 15, 2012; 85(2).

Sharp, LK and Lipsky, MS. “Screening for Depression across the Lifespan: A Review of Measures for Use in Primary Care Settings.” American Family Physician. September 15, 2002; 66(6):1001-1009.

Recommended reading: 

David H Barlow and Michelle Craske, Mastery of Your Anxiety and Panic. Oxford, UK: Oxford University Press, 2007