health

Anxiety and Depression

Are we all getting more depressed? 

Depression is the third most common reason for people to visit the GP, with anxiety being the most common psychiatric disorder people suffer.  It’s difficult for people to unpick whether they’re anxious or depressed because they often co-exist.  Like with most health problems there’s a scale: some people suffer with mild mood disorders and require a bit of support, but for others anxiety and depression can be severe, life-altering and, in its extreme fatal.  

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How are anxiety and depression defined?

They are officially two separate conditions:

Anxiety usually refers to generalised anxiety disorder (GAD) which is one or a range of anxiety disorders which can also include more specific variants such as obsessive compulsive disorder, social phobia, post-traumatic stress disorder and so on.

  • Someone who suffers which GAD is described as suffering uncontrollable and widespread worry with the presence of physical and psychological symptoms.

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  • These symptoms can include (but are not limited to):
    • fast heart rate
    • awareness of thumping heart beat (palpitations)
    • sweating
    • chest pain
    • dry mouth
    • shakes or tremors
    • rapid breathing
    • dizziness or light-headedness
    • feeling sick (nausea)

Depression is the feeling of low mood or inability to take pleasure in things which is persistent and interferes with your normal life.  It is completely normal to have variations in mood and feel really low from time to time, particularly at times of stress, or as a reaction to a life-event, but if the feeling stays for at least two weeks and is accompanied by other physical and behavioural symptoms it could be depression.

  • Like with anxiety, depression can give a range of symptoms.  These include:
    • Difficulty sleeping: typically waking up early in the morning, but sleeping too much can be an issue.
    • Difficulty concentrating
    • Feeling tired or lethargic
    • Change in appetite: like with sleep this can go either way with people not eating or overeating
    • Thoughts or death and dying: this is not always as extreme as wanting to end your own life but commonly in mild to moderate depression a feeling that other people would be better off without you or that life “isn’t worth living”.  In more severe cases this can develop into thoughts of or even plans for suicide.
    • Feeling agitate or conversely slowing down of movements.

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Who is likely to suffer?

Depression can affect anyone.  Some people seem more likely to suffer from it than others but the mechanism which drives this is not fully understood.  Certain life-situations make people more likely to suffer (such as unemployment, marital breakdowns and money trouble) but undoubtedly genetics, upbringing and personality play a part too.  Having any form of chronic illness such as diabetes or heart trouble increases peoples risk.

It’s a slightly different picture for anxiety.  Although it too is a complex disorder certain characteristics make people more likely to suffer:

  • being female
  • experiencing difficulties in childhood (bullying, abuse etc)
  • having lifestyle stressors such as unemployment or dissatisfaction with work, money troubles, physical or emotional pain (such as from a a traumatic event)
  • Dependence to drugs or alcohol: this can be the cause or can just augment existing anxiety
  • Long term illnesses

Are we more depressed and anxious?

The answer to the question I asked at the beginning of the article is not straight forward.  If we look at the stats the suicide rates these tend to fluctuate year on year with the latest data showing this has fallen in the UK.  But the concerning feature that is often highlighted in the media is the high rate of male suicide which has accounted for 75% of all suicide since the 1990s.  As I said above, this is not because men are more likely to suffer from depression or even severe depression then women but it is thought that men are less likely to seek help about it.  This has prompted lots of campaigning to ensure men recognise the signs of depression, and know where to go for help.

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The other thing we look at is numbers of people seeing their GP about anxiety or depression.  These numbers are high but this may be because we are more willing to recognise it as a problem now than in the past.  There is still a stigma attached and people will wait 6-8 years to seek help for anxiety and depression.

What can we do about it?

There are a number of tests or questionaires you can do on the internet which ask how stressed, anxious or depressed you are but truthfully if you feel you are anxious or depressed and it is interfering with your life you should go an see your GP.  It is important to see a GP if you have any thoughts of suicide.  A lot of people worry that they’re “wasting the GPs time” or that they may just be “fobbed off” with tablets. 

Generally speaking there is no “one-size fits all” approach to anxiety and depression and discussing your problems with your GP can help to identify which treatment route would be best.  There are some avenues you can explore yourself:

  • Mindfullness: this essentially means being more aware of our surroundings and our own thoughts and feelings.  It’s the basis behind a lot of meditation and can help to treat anxiety and depression as well as being more aware of developing symptoms.  Some people use apps such as headspace or calm or more information can be accessed here.

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  • Exercise is also helpful in treating anxiety and depression.  This is due to the chemicals released during exercise (endorphins).  There is also emerging evidence that exercising regularly reduces the risk of future anxiety and depression at any age and although there was no specific “dose” suggested they advised a minimum of 150 hours of moderate to vigorous activity per week can reduce the risk of developing depression in the future by 10%.

The mainstay of treatment is counselling usually “talking therapy” using a method called cognitive behavioural therapy (CBT).  This type of therapy is useful for changing patterns of behaviour and thus reduces the symptoms of anxiety or depression.  CBT can be given as part of a group or individually, via computer programmes or, in some areas via Skype.  Most GP practices will have information on how to access this type, or other forms of counselling.

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Medication is still used, particularly for moderate to severe anxiety or depression.  It is important to realise that this is not a “magic bullet” but can help to stabilise things in order for people to be able to access therapy or other treatments.  There are lots of different types of medications used and there is a lot of overlap between the tablets used for both anxiety and depression (for example selective serotonin re-uptake inhibitors or SSRIs are commonly used for both anxiety and depression).  Generally speaking we expect people to be on these tablets in the short-term (6-12 months) but obviously some people will need longer term treatment.

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There are also tablets which can help with the symptoms of anxiety such as palpitations, nausea, sweating and chest pain.  Often beta-blockers such as propranolol are used.  These can be taken as and when to help with symptoms. There are not many side-effects but some people can experience dizziness, fatigue and vivid dreams   They are not suitable for asthmatics.

Suggested Links

If you need further advice please see:

Mind www.mind.org.uk 

The Calm Zone for men aged 18-35 http://www.thecalmzone.net/ 

Anxiety UK http://www.anxietyuk.org.uk/ 

Samaritans www.samaritans.org.uk 

Young Minds: support for young people and parents of those struggling with mental health issues https://youngminds.org.uk 

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