Depression 101 with Dr. Douglas Moll (Clinical Psychologist)
Is it possible to have anxiety and depression at the same time?
Yes, it is not only possible but very common. Anxiety and depressive disorders have a high rate of comorbidity; this means that they often exist with other disorders. In community samples, it is estimated that approximately 50 percent of people with depression suffer from a coexisting anxiety disorder, such as generalized anxiety disorder and panic disorder. This is especially true in cases of more severe or persistent depression.
Worry and anxiety are often seen in depression even if they do not warrant further diagnosis. In fact, the Diagnostic and statistical manual of mental disorders (DSM-5) includes a specifier “with anxious distress” to be noted during the diagnosis if a person with a major depressive episode or a persistent depressive disorder presents symptoms of anxiety such as feeling of tension, agitation, difficulty in being concentrate because of worry, and fearing that something horrible will happen.
This was added because such anxiety is often seen in major depression and can be an important factor in treatment. The DSM-5 notes that if generalized concern or anxiety is only present during a depressive disorder, it should not be diagnosed separately as it is a common associated characteristic.
There is no consensus explanation for the high rate of comorbidity or why depression often exhibits characteristics of anxiety. Possible reasons include overlapping symptoms, similar underlying disease processes, vulnerability to one if you have the other, genetic and environmental influences, and the theory that depression and anxiety can be different expressions of the same disorder.
Having both anxiety and depression can make treatment more complex, but the good news is that the same types of treatment, such as cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs), can alleviate the symptoms of both types of disorders.
Is it possible to cure depression?
We are not really talking about “remedies” in terms of mental health issues, but rather about remissions. The DSM-5 classifies a major depressive episode into complete remission when “no significant sign or symptom” of the disease is present for a period of 2 months. That said, any treatment is aimed at reducing the severity or eliminating the symptoms of the disease, whether or not complete remission is achieved.
Most people on treatment for depression, about two-thirds according to research, get significant symptom relief, whether through medication, psychotherapy, or a combination of the two.
Based on personal clinical experience, depression resulting from defined environmental or situational events or stressors (such as job loss or separation from a significant other) can be resolved more quickly and permanently than a depression that has a more insidious and less noticeable onset.
In addition, there are many other factors that determine the success of treatment, and your motivation to feel better and engage in treatment is a very important factor and one over which you have some control. Taking an active and collaborative approach to your treatment can help you gain faster and create a sense of success, which can help you feel empowered to make even more positive changes.
It is also important to note that even if a complete or partial remission of symptoms is indeed possible, a person who has suffered from depression is more at risk of experiencing another episode in the future. That is why it is so important to watch yourself for any depressive symptoms and take steps to prevent another episode from occurring. Therapy can teach you the skills to do this and you can use them long after your therapy has ended.
How to differentiate depression and anxiety?
About 50% of people with depression also suffer from an anxiety disorder. As a result, it can be confusing to sort out the symptoms of different disorders, but there are both similarities and differences between them.
Both may involve more physical symptoms such as fatigue and insomnia, difficulty thinking or concentrating, and restlessness or restlessness, and both also involve cognitive distortions such as “all or nothing” thinking. and a focus on the negative excluding the positive. .
In depression, however, you feel depressed (sad, empty and hopeless) almost all the time. You may lose interest in most or all of the things you enjoy, you may feel worthless and guilty, and you may have recurring thoughts of death and suicidal thoughts or behaviors.
With anxiety alone, you usually don’t see hopelessness, sadness, and suicidal thoughts, and you are often in a constant state of worry and apprehension rather than in a state of persistent lethargy that is often seen in the depression.
Another way to tell the two apart is that depression usually encompasses one in a dark and sad look at the past, while anxiety causes a frightening rumination about the future. Interestingly, some believe that depression and anxiety are actually an underlying disorder that is expressed differently depending on the direction in which you look over time.
What can be the side effects of antidepressants?
Although the exact mechanisms of action of antidepressant drugs are not yet fully understood, they are believed to decrease symptoms of depression by acting on neurotransmitters in the brain that are linked to mood regulation; these include serotonin, dopamine and norepinephrine.
All antidepressants have side effects, including short and long term, common and rare, and less serious and more serious. The extent to which one can experience and tolerate it is very specific to the individual.
Common side effects of antidepressants vary by class of medication, but may include dry mouth, nausea, headache, insomnia, weight gain or loss, tremor, drowsiness, fatigue, dizziness and blurred vision, among others. (It is also important to note the FDA’s warning that antidepressants may increase the risk of suicidal thoughts and behaviors in children, adolescents, and young adults.)
New classes of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Paxil, and serotonin and norepinephrine reuptake inhibitors (SNRIs), such as Effexor and Cymbalta, are trending to have fewer and more tolerable side effects than the older classes of antidepressants, such as tricyclics and monoamine oxidase inhibitors (MAOIs).
Often, medications and / or dosages need to be adjusted by the prescribing provider in order to achieve therapeutic success with minimal or manageable side effects. It is very important that before you start any antidepressant, you tell your prescribing provider about any medical condition you have and the medications or supplements you are taking and talk to them about the risks and benefits of taking the medication. .
As a non-prescribing psychologist, I have found that, especially in more severe cases of depression, antidepressant medications can be very helpful in helping to relieve some of its more physical symptoms, such as low energy, lack of motivation and difficulty sleeping, as well as in increasing alertness, the ability to think and focus and, overall, the ability to actively engage in therapy.
What care can you give to someone who suffers from depression?
If you’re looking for treatment for depression, the good news is that most people with depression are getting better, although it may take some time and effort for you and your treatment providers to find the treatment that’s right for you. the best.
There are two basic forms of treatment: medication and psychotherapy. There has been a great deal of research into the effectiveness of these treatments given alone and together.
- The most studied form of psychotherapy in the treatment of depression is cognitive behavioral therapy (CBT). This therapy postulates that depression occurs when an individual develops distorted thinking patterns in which he sees himself, the world and the future through a dark and irrational negative lens. They may think that they are bad people, that they have accomplished nothing and that there is no hope for the future because it will be as dark as the past. CBT aims to help people identify their specific patterns of distorted thinking, challenge their irrational thoughts through strategies such as Socratic questioning, and replace or modify them with more holistic, rational and adaptive thoughts. Over time, this leads to a more positive perception of themselves and their situation, which in turn decreases their depressive symptoms.
- Another popular and well-studied approach is behavioral activation, in which clients are asked to develop and follow a daily program of activities that promote feelings of pleasure or control and decrease the likelihood of adopting behaviors that reinforce their depression.
- Interpersonal therapy has also been well studied in the treatment of depression. This type of therapy aims to improve your relationships with others, focusing on the social context in which depression occurs and is maintained, recognizing that relationships often deteriorate when one is depressed.
These therapeutic strategies have shown success rates comparable to those of antidepressants and have the additional advantage that after the end of treatment, they seem to reduce the risk of relapse better than drugs alone.
However, there is no one-size-fits-all approach to treating depression, and any given individual may need to engage in more than one type of therapy or try more than one drug or combination of drugs before seeing improvement. significant.
Treatment often involves both medication and therapy.
Medications can work faster to alleviate heavy physical symptoms such as fatigue and lack of motivation, which in turn can boost therapy gains, which can teach clients skills that will help them cope and decrease depressive thinking by themselves, which could prevent future episodes.
There is evidence that effective treatments for depression have a similar causal path: increased awareness and thought control related to increased activation of the prefrontal cortex that had been attenuated by depression and an associated reduction in responsiveness emotional linked to the calm of an overactive tonsil. The result is that you are better able to exercise control over your thoughts and emotions. Therapy and medications can have differential effects on these mechanisms of action.
There are many other therapies and treatments for depression, which may or may not be supported by research. For example, a promising line of research involves exercise as a treatment for depression.
- It has been found that regular aerobic exercise or moderate intensity physical activity can be effective in the treatment of mild to moderate depression.
- In addition, a growing number of therapies incorporate mindfulness training, which can help a person become more aware of their thoughts and break away from overly negative thought patterns.
- Treatment-resistant depression has also been increasingly the focus of research, and treatments deemed effective include electroconvulsive therapy and transcranial magnetic stimulation, among others.
In the end, with so many effective treatments available for depression, you are likely to experience significant relief from your symptoms if you seek help.
How can a person cope with depression?
Here are some ways to deal with depression.
Most important: ask a professional for help
If you have symptoms of depression (as noted above), seek help from a qualified mental health professional (psychiatrist, psychologist, mental health counselor, clinical social worker, etc.). You can also talk to your primary care doctor, who can probably refer you to a mental health professional.
Do not abandon
If you are on treatment and feel you have not improved, don’t give up! It may take a while for your treatment to work. Plus, with so many effective treatments for depression, there will most likely be one or a combination of treatments that will work for you.
Actively participate with your therapist
If you are in therapy, be an active participant and collaborate with your therapist in your treatment. Create treatment goals that are important to you and that you really want to work for and achieve.
If your therapist sets all the goals for you, you may not be motivated to do the job. It is your therapy after all, and it is a great opportunity to make the changes in your life that you have always wanted to make. Even reaching a small goal can be the catalyst for creating big changes in your life.
Look at your thinking
Thoughts are very powerful and through our thoughts we can be happy or miserable. Buddha taught that it is our minds and thoughts that create the world in which we live. This is taken up by other spiritualities, philosophies and even by quantum physics. Many therapies are effective because they help you gain power over your thinking, which can change feelings, lead to action, and help you create the life you want to live.
With practice, you can get to a point where you have a lot more freedom to choose what you think and feel, regardless of what’s going on around you.
Change the way you see the world
Many terrible things happen to us and surround us every day. You can easily become depressed if you sit back and linger on these things and think the world is a horrible place and is only getting worse. Instead of seeing things through such a negative filter, create a positive filtered.
Much of the news we watch, read and listen to is constantly negative and repetitive. Just try turn it off and adjust it for periods of time. You will not miss much and you will feel better. Really try to focus on the good of your life that you can take for granted or just not see.
Appreciate the people in your life who care about you. Be thankful if you have the basic things you need to live your life, such as a bed, food and shelter.
Make an effort to pay attention to the good that people do to each other every day. Best of all, do good things for others and do your part to make the world a better place. Just smiling at someone or keeping a door open for someone can create positive feelings for both of you. Such seemingly small acts can have powerful ripple effects for both of you and create even more good.
The bottom line is that the universe needs you, however you can contribute. Find your purpose and your meaning, and you will find your happiness.
- Exercise or do moderate physical activity almost every day of the week if you are able and in good health. This has proven to be an effective treatment for depression and can help prevent it.
- Find a reason to get out of bed every day. It can be as simple as preparing your favorite breakfast or looking forward to talking to people at work.
- Set goals for your day. Try not to let yourself be led by the day, but try to lead your day. It helps you regain power and a sense of control in your life.
- Meditate or practice mindfulness. These practices can really help calm an overactive mind and help you become more aware of your thoughts and detach yourself from negative thoughts.
- Listen to music you love. Your brain will like it and you will feel better and maybe more energized and inspired.
- Do something creative, like drawing, taking photos, writing a poem, keeping a journal, painting, decorating and gardening. This will involve parts of your brain that may have been overlooked while you focus on negative thoughts and can help you see things in a different light.
- Finally, if you have suffered from depression in the past and have successfully overcome it, it is very important that you monitor yourself closely for any depressive symptoms that may be trying to return to your life. This most often happens when someone finds themselves again in a negative or pessimistic thought. This can lead to a downward spiral if it is not caught quickly. Use the skills you have learned to identify these thoughts and turn them into healthier, reality-based thoughts. It is a very effective strategy for keeping your mood in check and not letting depression take over your life.
About Dr. Douglas Moll, clinical psychology: Dr. Douglas Moll has acquired a full range of clinical expertise that has provided cognitive behavioral therapy in individual, group and family settings. He has worked extensively with children and youth struggling with mental health, addiction and crime issues and has served as a liaison with a wide variety of mental health, social services and rehabilitation agencies. Read more…