Tearing down the stigma of anxiety and depression

Are people with anxiety and depression weak? Hopeless? Helpless? Hypochondriacs?

Depression and anxiety are, in majority of cases, emotional signals that your psychological health is not ideal and that your psychosocial or relational needs are not met. As deeply relational beings, humans have need for good relational value in areas of family, friendship, romantic partners, group/occupational/social identity and of utmost importance relationship with themselves and the extent to which they feel proud and accepting of themselves (or the reverse)7.

Let us take an example, if you break an arm and go to the emergency room they don’t say you have a pain-in-my-arm disorder. The pain is the signal of the problem – a broken arm. Similarly, anxiety and depression are signals of psychosocial needs and threats. They should not be considered alien feelings that need to be eliminated or fixed, any more than we would treat pain from a broken arm, coldness and hunger with pills that takes away the feelings, as opposed to fixing the arm, getting warmer or feeding the hungry individual7.

In reality every day thousands of people are suffering from mental health issues and hiding it deep inside. They look just like any normal person you’d pass on the streets.

Understanding Anxiety and Depression

Anxiety disorder is a spectrum of disease ranging from agoraphobia, panic disorder to selective mutism. The cause is unknown, but traumatic life experiences trigger anxiety disorder in people prone to it. Vulnerability to the disorder is caused by genetics, stress due to illness, stress buildup, personality (neurotic, introvert, low self-esteem, extremely analytical, emotionally sensitive), other mental health disorders like depression, drugs or alcohol3. Anxiety is tension, worried thoughts accompanied by physical symptoms. Usually these thoughts are recurring and unable to be controlled4.

Depression seems to be a “shutdown” of self, with all the symptoms of anxiety plus the feeling of “I really don't think I'm going to be able to cope with this, maybe I'll just give up.”2 Factors that make certain people vulnerable are differences in certain chemicals in the brain, genetics, personality (low self-esteem, easily overwhelmed by stress, pessimistic) and environmental (violence, neglect, abuse, poverty)5

However, recently psychologist believe these two disorders are actually two sides of the same coin. Both share overlapping symptoms, incidences, vulnerabilities, genetic/biological markers and similar treatment methods6. It’s just that some people with vulnerability react to life stressors with anxiety, some go beyond and become depressed2.

Anxiety and depression both have thoughts that magnify the initial insult and alter the workings of the brain in such a way that the longer an episode exists, the less it takes to set off future attacks. Further, they share an avoidant coping style. Sometimes anxiety is dispositional, and sometimes it's transmitted to children by parental overconcern.2 The person ruminates over and over about the difficulties and disappointments he/she encounters until that's all he/she can focus on2. What makes this happen?

Hijacking of our emotional control center in our brain

When our brain takes in anxiety-provoking information from our surroundings, the brain deals with it in two ways: the automatic, immediate or "fight-or-flight” response; AND thoughtful analysis, drawing on higher levels of cognitive functioning1.

Input from the environment is synthesized by a part of our brain called the amygdala. The amygdala sends that information to the Hypothalamic-Pituitary-Adrenal axis, another area of the brain— the sensitivity of these two systems is due to complicated interaction of genetics and environmental factors. People prone to depression or anxiety will usually have a system response that is more extreme than indicated.1

At the core of these two disorders are some shared mechanism gone awry. The automatic response area of the brain overwhelms the higher level of cognitive function. Research points to over-reactivity of this whole stress response system, which sends the "fear center" of the brain - the amygdala into overdrive. Any negative stimuli make a disproportionate impact and hijack our whole response systems2

There are people vulnerable to these two disorders occurring concurrently due to family history, nature of anxiety (higher risk in panic disorder, obsessive-compulsive disorder, social phobia) and age. Usually anxiety precedes depression2.

Treatment

Medications can bring the systems’ response back into appropriate range so that the higher cognitive function response can work. Combination of medication and psychotherapy (eg. CBT) is also very effective1. Regardless of the diagnosis, both anxiety and depression seem to respond to similar medications (mostly antidepressant agents).6 Aggressive treatment of the anxiety when it appears, can prevent the subsequent development of depression.

How people respond to medication is the result of a complex interaction of genetics, environment and what kind person they are. And it’s not so much due to that person’s will power, self-control, the experiences of your childhood, or even your parents1.

Medication and Cognitive Behavioral Therapy (CBT) are equally effective in reducing anxiety/depression. But CBT is better at preventing relapse, and it creates greater patient satisfaction. CBT teaches people to monitor the environment for troubling emotional landmines that seem to set them off. New data suggest that active coping CBT encourages the creation of new brain circuits that circumvent the dysfunctional response pathways.2

CBT works to replace negative and unproductive thought patterns with more realistic and useful ones. Therapist help break down the problems into separate parts – thoughts, physical feelings and actions. These areas are analyzed to determine if they're unrealistic or unhelpful and their effect on each other and on you are examined, thus eventually working out how to change these unhelpful thoughts and behaviors. Treatment often involves facing one’s fears as part of the pathway to recovery. Interpersonal relational therapy and problem-solving therapy are also effective8.

Exercise is also an important adjunct therapy because it directly alters levels of neurohormones involved in emotions. It calms the hyperactivity of the nervous system and improves function of the brain's emotion-sensing network. It improves the ability of the body to tolerate stress. It also reduces negative thoughts and changes perception of self, providing a sense of personal mastery and positive self-image2.

Like most mental illness, depression and anxiety are also multifactorial. Therefore, there is need to carefully examine all aspects of the person’s life – relational, perception of self, environment, finances etc, all these factors need to be simultaneously addressed9.

So how do you recognize symptoms of anxiety and depression?
Anxiety Disorders
Depression

References:
1Psychology Today, Jan 14th 2018 Jeff Corbin, MD MPH Anxiety, Depression and other “Gifts” You may have. Don’t blame your mother. It’s not her fault or yours.
2Psychology Today, Anxiety and Depression together June 9th 2016 Hana Estroff Marano
3Mayo Clinic, Anxiety, August 17th 2017
4American Psychological Association
5American Psychiatric Association)
6Anxiety.org Depressed about your anxiety? Jan 3rd 2016
7Psychology Today march 26th 2016 Gregg Henriques PHD Professor in Psychology in James Madison University Anxiety and Depression are symptoms, not diseases. Depression and Anxiety are signs that one is not getting key needs met
8Anxiety Disorders Association of America
9Psychology Today, 11 Natural treatment for depression: An MDs tips for skipping the Prozac, Dr Lisa Rankin, March 31st 2011