What can depression and anxiety do to you, and how do you get over them?

Depression is a psychological disorder that affects more than 264 million people worldwide according to the WHO (World Health Organization). It manifests as persistent, constant sadness and lack of interest or pleasure in previously rewarding or enjoyable activities. This feeling goes on for weeks and months rather than just some morning blues. It disturbs sleep and appetite, and it usually causes tiredness and poor concentration in day-to-day activities.

It is the most common cause of disability of patients in terms of work productivity, quality of work, and the life which greatly contributes to the global burden of the disease. Most often a person finds the need to stay alone, trying to “figure” things out but eventually being unsuccessful about it. The ones suffering usually say that they’re feeling ‘low”, “alone”, “gloomy”, have no interest to do any work, disinterest to eat, “loss of sleep’, “untimely” sleeping patterns. The symptoms range from mild to severe ones, at the mildest, it might be a feeling of persistent low in spirit, while severe depression can make one feel suicidal, that life is no longer worth living, or the feeling of “uselessness” and “unworthy of being alive”. A trigger is almost always present for the depression to begin. They range from, relationship issues, life-changing events, career-oriented problems, or sometimes no reason at all. Depression is a recurrent and progressive disorder with neurobiological changes leading to a “chemical imbalance” in the brain. There is a disruption of serotonin, norepinephrine, and dopamine transmission which is responsible for turn-off the stress response and overall reduction of monoamine levels. The treatment of depression is a holistic one, which includes therapy sessions which include a combination of cognitive-behavioral therapy, medications that set right the chemical imbalance such as anti-depressants, SSRIs, etc based on the severity of presentation of the disease. But seeking help should be an emergency and mandatory.

Anxiety is different from depression

Occasional anxiety is a normal part of life, but anxiety disorders include just more than temporary or short-lasting anxiety which goes beyond cold-clammy hands. Anxiety could be a state of emotion that is unpleasant and causes uneasiness, discomfort, and fear. For a person with the disorder, the anxiety does not go away and also gets worse with time. These are categorized as a group of disorders known as ‘Anxiety Disorders’ which include panic disorders/attacks and various phobia-related disorders. The symptoms usually are constant, they display anxiety or worry most of the days for at least 6 months. Triggers for anxious states can vary from minor, manageable situations to severe ones. Not always, the trigger has to be a present ongoing incident. An unsettling emotional experience that repeatedly haunts, previous trauma such as accidents, personal assaults, natural- or human-caused disasters, military combat, etc. also sets off an anxiety attack. Management of anxiety disorders needs medical help as well as cognitive-behavioral therapy. Triggers have to be identified, and a mindful attempt has to be made to combat it. Medical management includes the use of anxiolytics (Anxiolytics are a group of drugs which control the symptoms of anxiety, produce a restful state of mind without interfering with normal mental or physical functions.) such as benzodiazepines (Diazepam, Zolpidem, Lorazepam, etc. ), anti-depressants (serotonin-reuptake inhibitors-SSRIs, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants (TCAs).

Depression: Causes and types

A chemical imbalance is known to cause a state of depression. But the cause for the chemical imbalance has many possible causes such as, genetic vulnerability, stressful/traumatic life events, medications, faulty mood regulation by the brain, medical problems, etc. regions in the brain which get affected in depression include, amygdala (responsible for emotions such as anger, pleasure, sorrow, fear and sexual arousal), the thalamus (speech, behavioral reactions, movement, thinking and learning, differentiates pleasant and unpleasant feelings), and the hippocampus (processing of long term memory and recollection). Research suggests that the size of the hippocampus reduces in depressed patients. Genetic predisposition is a valid argument in the causal of depression. A HARVARD research suggests that a person who has a first-degree relative who suffered major depression has an increase in risk for the condition of 1.5%-3% over normal. One’s Temperament, their view of the world, and, in particular, their unacknowledged assumptions about how the world works also influence how one feels. So, a person develops their viewpoint early on and learns to automatically fall back on it when loss, disappointment, or rejection occurs. A few hormones which are released during stress, such as Corticotropin-releasing hormone and adrenocorticotropic hormone tend to be at high levels in depressed individuals. Some medical disorders such as Alzheimer’s, Huntington’s disease, stroke, Vitamin B12 deficiency, parathyroid hormone disorders, etc are also known to cause depression.

A major depressive disorder is diagnosed as so when, the patient has 5 or more of the following symptoms on most days for 2 weeks or longer- loss of interest in daily activities, weight loss or gain, trouble sleeping during the night, or excessive sleeping during the day, agitation or restlessness, tiredness, guilt feeling/feeling of worthlessness, difficulty in decision making, suicidal tendencies. Persistent Depressive Disorder is when the symptoms mentioned above last for 2 years or longer, Bipolar Disorder or also known as Manic depression is when a person has mood episodes that range from extremes of high energy with an “up” mood to “low” depressive states, Seasonal Affecting Disorder is when a person has depressive symptoms during winter or fewer sunlight days and goes away in summer/spring, Psychotic Depression when the patient represents with hallucinations, delusions, and paranoia, Peripartum Depression is seen in women during or after childbirth and finally, Premenstrual Dysphoric Disorder is seen in women when they are on their menstrual cycle.

Causes and types of anxiety:
A wide range of causes from life-changing situations/events, a trauma in terms of personal assaults, accidents, work/personal life-related harassment, sexual molestation, traumatic childhood, over-dominating parent, stressful work environment, medications, medical problems, etc.

Generalized anxiety disorder: Characterized by a generalized long-standing, anxiety, increased worry, and tension when the trigger is normal for any other person. It is diagnosed as so only when the anxiety is presented on most of the days for the week for more than 6 months.

Panic disorder: repeated, unexpected panic attacks that occur fast and reach their peak within minutes. The attacks occur at odd hours even when a trigger is not obviously present.

Phobia-related disorders: Phobia means- intense fear or aversion to specific objects or situations. They can be simple phobias, agoraphobia- fear of public places, social phobia, etc.

Post-traumatic stress disorder: Develops after a stressful/traumatic incident/ ordeal in which the person has been a part of or has been the victim.

Obsessive-compulsive Disorder: Presents with repeated unwanted thoughts (obsessions) and repeated behaviors to counter the thoughts (compulsions).

How are they treated?

Depression is treated with a combination of psychotic therapy and pharmacological therapy. Psychotic therapy includes cognitive behavioral therapy, interpersonal therapy which are structured didactic that help the individuals to identify the causes and modify the behavioral patterns.

Pharmacological therapy for depression includes MAO inhibitors, selective serotonin-reuptake inhibitors (SSRI), tricyclic antidepressants, serotonin, and noradrenaline reuptake inhibitors (SNRI), etc. Sleeping disorders in depression are treated with a group of drugs known ad Benzodiazepines, which give a sense of calmness thus helping in better sleep patterns, also having tranquilizing effects.

Anxiety is treated mostly with drugs which help in calming the mind and reducing the race of thoughts which causes the trigger of panic attacks. These drugs are available online. However, they are sold as prescription medicines in the US, UK, and India.

The drugs such as lorazepam, clonazepam, etizolam belong to the group of drugs known as benzodiazepines which act by relaxing the muscles, chemically help in causing the “calming effect” in the brain, helps in reducing intermittent awakening, and gives good refreshing sleep.

These drugs act on the midbrain by acting as a tranquilizer with a muscle relaxant, amnesic, and sedative properties. Sometimes, panic attacks lead to aggressive behavioral patterns. In such cases, sedative drugs help.

Anti-anxiety doses are usually 2mg or 5mg diazepam or alprazolam. It is the safest drug for anxiety as it has little effect on other body systems and has lower dependence compared to other drugs. Galenika Bensedin is the brand name for diazepam. The drugs are given only when prescribed by the physician.

Alprazolam has sleep-inducing actions and has a long duration of action in the body lasting for about 11-12 hours. It reaches a peak in the body within 1.5-2 hours. Abuse and dependence potential for alprazolam is high. The safe dosage is about 3-6mg orally per day for anxiety.

Ativan which is the drug name for Lorazepam enhances the activity of neurotransmitters in the brain. It causes marked amnesia and stays in the blood for about 10-20 hours. It reaches peak levels in the blood within 0.5 hours. It takes time to cross the blood-brain barrier and is safe to use in elderly patients. Ativan is used in doses of 1mg, 2mg for anxiety management.

Pregabalin acts by binding to a particular receptor in the nerve ends and controls the “over-excited” calcium ion channels. It is structurally similar to a molecule found in human nerve endings known as Gamma Amino Butyric Acid (GABA). It is used when alternative medications such as benzodiazepines need an additive. It helps in the prevention of relapse of anxiety disorders, reduces broad spectrum severity of psychological and physical symptoms of anxiety. Lyrica which is available as tablets and capsules are taken in the dosage of 150-600mg a day split over 2 or 3 separate dosages as prescribed by the physician.

Recent is another drug which predominantly contains pregabalin, available as capsules or tablets. The dose range of Lecaent for anxiety disorder is about 150-600mg in divided dosages. Buspirone is another drug used for the management of OCD. It’s slow in action and takes about 2 weeks for its maximum therapeutic effect to be seen. Available as tablets 5-15mg, Anxipar/Busicalm are the trade names-10mg taken once or twice a day.

The heart palpitations are treated with drugs known as beta-blockers (propranolol, atenolol). All of these drugs can be available with online prescription in the UK, US, and India.

Uses of antidepressants and anti-anxiety medicines.

The group of drugs known as Benzodiazepines which include alprazolam, diazepam, lorazepam, nitrazepam, clonazepam, etizolam, etc. They act as an anxiolytic, sedative-hypnotic, muscle relaxant, anesthetic and are also used for emergency control of seizure.

These drugs can be taken orally or in the form of injections (intravenous or intramuscular).

Injections are administered only in emergencies. These drugs help in inducing sleep from which the person can be easily awakened thus giving a feeling of refreshed sleep. They also reduce intermittent awakening and increase total sleep time. They also help in relaxing the muscles, by acting centrally through all muscles in the body and at the same time not having any effects on involuntary muscle action.

The group of drugs for depression, are in general known as mood elevators. Tricyclic antidepressants take 2-3 weeks to produce maximum action and thus help in gradual mood elevation. The patients on TCA start to become more communicative and start taking interest in self and surroundings. They also help in improving the sleep patterns of individuals.

The SSRIs and SNRIs have a duration of action of approximately 7-10 days. These improve the “energy” levels, by making the individuals more active and interested in life. They do not cause psychomotor and cognitive impairment. These are used for the management of OCD, PTSD, Premenstrual Dysphoric Disorder, and anxiety disorders as well.

They may have some disadvantages too

The benzodiazepines cross the human-fetus barrier readily, thus warranting its use in pregnant mothers. They are excreted through the urine and hence, if the person has an underlying kidney problem, the physician should be informed before as it can cause an accumulation of the drug. They also cause some undesirable effects such as gastritis, acidity, bowel irritability, general malaise, delirium.

The antidepressants also have many disadvantages ranging from, nausea and bowel issues to increased agitation or aggressive behavior. TCAs cause increased weight gain and increase appetite, sexual distress, and cardiac issues such as dysrhythmia. Some SSRIs induce seizures or reduce the seizure threshold. They also cause agitation and dermatological reactions along with, dyspepsia, flatulence, nervousness.

Both anti-anxiety and antidepressant drugs have high drug interactions and hence, the physician has to be informed about any other ongoing medications.

Summary

Depression and anxiety are disorders that are caused by life-changing situations and can also be treated by making lifestyle changes along with physician and psychiatric help. Genetic predisposition, other medical conditions also cause depression and anxiety. It will be wrong to not foresee the associated health problems. They usually have a trigger that needs to be identified and combated to manage the disease. Holistic combination therapies which include medications and psychotherapy sessions have been implemented for better management. A close watch by a known person, friend, family member has to be kept on the patient to notice any sort of small changes before and after the start of treatment. Non-medical management such as yoga, tai-chi, self-help activities, group sessions also helps in improving the person’s confidence. The stigma of the disease prevents people from stating about their mental health, thus it’s imperative for others as well to look out for behavioral changes.

Medical management with anti-depressants and anti-anxiety drugs have to be prescribed by the physician only. Self-medication is dangerous as they have inter-drug and diet interactions. Dosages that are high can be fatal sometimes. Such disorders are not permanent but are progressive. Thus, they are completely curable.