Clinical depression is a collection of symptoms characterized by low mood, low self-esteem and the loss of pleasure in activities that are normally enjoyable. It is a disabling condition that can adversely affect all aspects of a person’s life and 3.4 percent of people with clinical depression commit suicide. Fortunately, a variety of medications are able to manage clinical depression. These medications can be classified into the following categories:
- Selective serotonin reuptake inhibitors
- Serotonin-norepinephrine reuptake inhibitors
- Tricyclic antidepressants
- Monoamine oxidase inhibitors
Selective Serotonin Reuptake Inhibitors
SSRIs work by increasing the level of serotonin in the brain, which is a mood elevator. They are currently the preferred medication for severe depression due their broad effect on depression and relatively mild side effects. Common SSRIs include escitalopram (Cipralex, Lexapro), fluoxetine (Prozac) and sertraline (Lustral, Zoloft). Patients who don’t respond to the first SSRI are typically switched to another SSI, which improves the patient’s condition in nearly half of all cases. SSRIs typically have limited effectiveness against mild and moderate depression.
Serotonin Norepinephrine Reuptake Inhibitors
SNRIs elevate the levels of the mood elevators serotonin and norepniphrine. They include desvenlafaxine (Pristiq), duloxetine (Cymbalta), milnacipran (Ixel) and venlafaxine (Effexor). SNRIs are the newest type of anti-depressants and have side effects that are generally similar to those of SSRIs, although they are slightly less severe. SNRIs are typically administered in low doses at first and then gradually increased until the therapeutic level is reached. Similarly, a patient must taper off SNRIs gradually to minimize the risk of side effects.
Tricyclics are so-named because their chemical structure is characterized by three carbon rings. This is an older class of anti-depressants that have more side effects than SSRIs. Tricyclics are typically used only when patients do not respond to the newer anti-depressants, especially inpatients. Many tricyclics are available, although amitriptyline is the most common tricyclic still in use.
A monoamine oxidase inhibitor reduces the ability of monoamine oxidase, which breaks down monoamine neurotransmitters. MAOIs are typically used only when all other types of anti-depressants have failed due to their interactions with other drugs which can be lethal. They are most effective in treating atypical depression, in which the patient can experience an improvement in mood when a positive event occurs. The most recent form of MAOI is Emsam, which is a transdermal patch of selegiline that was approved by the FDA in 2006.Read More
Anxiety is a problem that seems to have a way of getting under people’s skin and controlling their minds and bodies. Here are symptoms some people report when they experience anxiety:
- restlessness or feeling on edge
- being easily fatigued
- difficulty concentrating
- muscle tension
- problems with sleep such as restless sleep or difficulty falling or staying asleep
- rapid heartbeat
- shortness of breath
People often try to understand these symptoms in terms of their physical health, at least initially and sometimes at other times. Usually these symptoms continue, however, even after reassurance about physical causes. These experiences are usually paired with a sense of dread or worry and may include intrusive memories of traumatic events. Because they are so pervasive, they can have far-reaching effects on a person’s life.
Such experiences often rob people of self-confidence and prevent them from being in touch with their best qualities and possibilities. Given this state of alarm, these worries can often have an impact on people that they then withdraw from social contexts and work and become inactive. Therefore, for some, life with anxiety means a shrinking world, a shrinking life, and often a shrinking sense of security and identity.
Even if a person overcomes anxiety enough to go about her usual routines, she may have feelings of dread and inadequacy, so that her sense of mastery and accomplishment are gone.
Living with anxiety can include feeling that each day will involve a struggle or that restrictions will need to be faced.Read More
Here are some solutions, what should you do with anxiety:
- Notice how it is affecting you and pay attention to how you would rather be feeling.
- Remember to breathe.
- Focus on something interesting and engaging: a hobby, a project, a conversation with a friend, an activity.
- Play with a pet. Arrange flowers. Play a sport. Watch a movie.
- Stay active in your life. Continue going to work and/or school. Take care of children. Keep your house clean. Take care of your personal hygiene.
- Surround yourself with people who care about you. Spend time with your spouse, children, parents, colleagues, friends, neighbors.
- Engage in conversation that is interesting and meaningful.
- At other times, engage in trivial talk!
- Try to limit discussion about the anxiety to less than 5% of your conversation.
- Pay attention to whether what you are doing or thinking is what you want to be doing or thinking and whether or not it fits for you.
- Don’t isolate yourself. Anxiety will try to get you to think you should be alone. Don’t listen to it.
- Don’t spend time thinking about how you feel. Anxiety will take over.
- Don’t talk about anxiety more than 5% of the time and then only about your successes over it.
- Don’t let anxiety get you to second-guess yourself.
- Don’t let anxiety get you to imagine what others are thinking.
- Don’t fall prey to anxiety’s ploy to engage in repetitive behaviors.
- Don’t let it put images of disaster in your head.
Carrie went to lots of doctors; she began to take the anti-anxiety medication Paxil, which was somewhat helpful; it at least allowed her to sleep. But she continued to feel upset most of the time, unable to concentrate, uncertain about her life, and, at its worst, crying and exhausted.
What finally began to help was when she went to a therapist who encouraged Carrie to pay attention to what had worked for her before. Together they learned that focusing on what was important to her was the best antidote to anxiety. Carrie called it “mindless focusing.” Once Carrie could focus, then she could sort out what were some of the contributors to the anxiety. She began to see the huge cultural expectations that society inadvertently puts on young people; they were all the things she herself had said: a career, a relationship, meaningful goals. Even more, she felt the pressure to accomplish all those things “right now.”
Carrie found she could “back off” from that pressure. She accepted that she did want certain things and had specific goals, but that she could accomplish them in ways that worked for her and within her own time frame. She then experienced more peace and much less of the unsettledness, or what people were calling anxiety. Recently, Carrie said,
“Anxiety is just not a part of my lexicon anymore, and certainly not a part of my experience.”
- Can you think of some ways that anxiety may be generated by the larger culture in which we live?
- What messages from the culture specifically support anxiety in your life?
- How has anxiety contributed to making your life smaller?
- How has anxiety made you feel “less than” others or “less than” how you think you should be in your life?
- What does anxiety do to isolate you and keep you from finding support from others?
- How does anxiety affect you physically? Do you recognize this as anxiety?
- If you could notice the physical symptoms of anxiety, such as difficulty breathing, tightness in your chest, a rapid heartbeat, and identify them as anxiety working on you; would that be helpful, or would it add to your fear?
- When you are not experiencing anxiety, can you notice what you are doing or thinking? What information does that give you?
- Can you think of some other ways that you don’t get caught up in these ideas and behaviors?
- Are there some ways that the larger culture supports you in getting free from anxiety? What are those?
- What specific messages or practices from society support you and help you fight anxiety?
- Are there particular times of the day, social contexts, situations, or events that seem to make it less possible for anxiety to get a hold on you?
- Are there particular strategies that you have found helpful in escaping the influence of anxiety?
- Do you know of others who have practiced some of these strategies?
- If you were to connect with others who had found ways to escape anxiety, do you think that would be helpful?
- What would be some of the ways these others might help?
- How could you connect with them more?
- What would you do next if you were to feel more support against anxiety in your life?
- What would your life look like?
Questions to Ask Others
Here are some questions you might ask others in your life who could be members of a support system for you
- Would you be willing to listen to my experience and acknowledge my feelings without making suggestions or telling me how you think I should feel?
- If I seem to talk about anxiety too much and pay too much attention to it, do you think we could create a plan together where we could focus on other aspects of my life that are not anxiety-laden?
- Will you help me create a reminder system so that I can remember the strategies I have that already work in helping me escape anxiety?
Questions to Ask Your Therapist
If you are experiencing anxiety and want to find professional help, here are some questions you can ask your therapist.
- What are some of your ideas about anxiety and why do you think it occurs in people’s lives?
- What have you learned from others you have seen who have experienced anxiety?
- Do you ever include others in the therapy, such as client’s friends and relatives who help them stay free from anxiety?
- Do you usually refer someone to a psychiatrist or medical doctor for medication, and/or do you search for other ways to help people escape anxiety?
- Do you usually make suggestions to your clients about what they should do, and/or are you interested in learning about some of the solutions they have already found helpful?
- Are you aware of other resources for clients, such as readings, self-help groups, websites, etc.?
What We Can Do About Anxiety
People describe the anxiety they live with as constant, but they can also realize that many times throughout the day the anxiety is not there or is less present.Read More