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Anxiety and Depression Together

Provided by Psychology Today

Are you anxious or are you depressed? In the world of mental health care, where exact diagnosis dictates treatment, anxiety and depression are regarded as two distinct disorders. But in the world of real people, many suffer from both conditions. In fact, most mood disorders present as a combination of anxiety and depression. Surveys show that 60-70% of those with depression also have anxiety. And half of those with chronic anxiety also have clinically significant symptoms of depression.

The coexistence of anxiety and depression--called comorbidity in the psych biz--carries some serious repercussions. It makes the course of disorder more chronic, it impairs functioning at work and in relationships more, and it substantially raises suicide risk.

Over the past couple of years, clinicians and researchers alike have been moving towards a new conclusion: Depression and anxiety are not two disorders that coexist. They are two faces of one disorder.

Usually, anxiety precedes depression, typically by several years. Currently, the average age of onset of any anxiety disorder is late childhood/early adolescence. Psychologist Michael Yapko, Ph.D., contends that presents a huge opportunity for the prevention of depression, as the average age of first onset is now mid-20s. "A young person is not likely to outgrow anxiety unless treated and taught cognitive skills," he says. "But aggressive treatment of the anxiety when it appears can prevent the subsequent development of depression."

"The shared cornerstone of anxiety and depression is the perceptual process of overestimating the risk in a situation and underestimating personal resources for coping." Those vulnerable see lots of risk in everyday things--applying for a job, asking for a favor, asking for a date.

Further, anxiety and depression share an avoidant coping style. Sufferers avoid what they fear instead of developing the skills to handle the kinds of situations that make them uncomfortable. Often enough a lack of social skills is at the root.

In fact, says Jerilyn Ross, LICSW, president of the Anxiety Disorders Association of America, the link between social phobia and depression is "dramatic. It often affects young people who can't go out, can't date, don't have friends. They're very isolated, all alone, and feel cut off."

Sometimes anxiety is dispositional, andsometimes it's transmitted to children by parental overconcern. "The largest group of depression/anxiety sufferers is Baby Boomers," says Yapko. "The fastest growing group is their children. They can't teach kids what they don't know. Plus their desire to raise perfect children puts tremendous pressures on the kids. They're creating a bumper crop of anxious/depressed children."

_ Treatment seldom hinges on which disorder came first. "In many cases," says Ross, "the depression exists because the anxiety is so draining. Once you treat the anxiety, the depression lifts."

In practice, treatment is targeted at depression and anxiety simultaneously. "There's increasing interest in treating both disorders at the same time," reports Himle. "Cognitive behavioral therapy is particularly attractive because it has applications to both."

Studies show that it is effective against both. But sometimes the depression is so incapacitating that it has to be tackled first. Depression, for example, typically interferes with exposure therapy for anxiety, in which people confront in a graduated way situations they avoid because they give rise to overwhelming fear.

"Exposure therapy requires substantial effort," explains Himle. "That's effort that depressed people often do not have available to them." Antidepressants can make a difference. Most SSRIs are approved for use in anxiety disorders and are the first line of drug therapy. But which drug works best for whom can not be predicted in advance. It takes some trial and error.

Ross finds CBT 80-90% successful in getting people functioning well, "provided it's done correctly." Not all psychotherapy is CBT, which has a very specific set of procedures, nor is every mental health professional trained in CBT. "Patients have to make sure that is what they are really getting."

Medication and CBT are equally effective in reducing anxiety/depression. But CBT is better at preventing relapse, and it creates greater patient satisfaction. "It's more empowering," says Yapko. "Patients like feeling responsible for their own success." Further, new data suggests that the active coping CBT encourages creates new brain circuits that circumvent the dysfunctional response pathways.

Treatment averages 12 to 15 weeks, and patients can expect to see significant improvement by six weeks. "CBT doesn't involve years and years of talk therapy," says Ross. "There's homework, practice and development of lifestyle changes. Once patients learn how to identify the trigger thoughts or feelings, or events or people, they need to keep doing that. CBT gives people the tools they need."

"They're probably two sides of the same coin," says David Barlow, Ph.D., director of the Center for Anxiety and Related Disorders at Boston University. "The genetics seem to be the same. The neurobiology seems to overlap. The psychological and biological nature of the vulnerability are the same. It just seems that some people with the vulnerability react with anxiety to life stressors. And some people, in addition, go beyond that to become depressed."

They close down. "Depression seems to be a shutdown," explains Barlow. "Anxiety is a kind of looking to the future, seeing dangerous things that might happen in the next hour, day or weeks. Depression is all that with the addition of 'I really don't think I'm going to be able to cope with this, maybe I'll just give up.' It's shutdown marked by mental, cognitive or behavioral slowing."

At the core of the double disorder is some shared mechanism gone awry. Research points to overreactivity of the stress response system, which sends into overdrive emotional centers of the brain, including the "fear center" in the amygdala. Negative stimuli make a disproportionate impact and hijack response systems.

Mental health professionals often have difficulty distinguishing anxiety from depression, and to some degree they're off the hook. The treatments that work best for depression also combat anxiety. Cognitive-behavioral therapy (CBT) gets at response patterns central to both conditions. And the drugs most commonly used against depression, the SSRIs, or selective serotonin reuptake inhibitors, have also been proved effective against an array of anxiety disorders, from social phobia to panic and post-traumatic stress disorder (PTSD). Which drug a patient should get is based more on what he or she can tolerate rather than on symptoms.

And therein lies a problem. According to physicians Edward Shorter of Canada and Peter Tyrer of England, the prevailing view of anxiety and depression as two distinct disorders, with multiple flavors of anxiety, is a "wrong classification" that has led the pharmaceutical industry down a "blind alley." It's bad enough that the separation of anxiety and depression lacks clinical relevance. But it's also "one reason for the big slowdown in drug discovery in psychiatric drugs," the two contend in a recent article published in the British Medical Journal. It's difficult to create effective drugs for marketing-driven disease "niches."

Who is at risk for combined anxiety and depression? There's definitely a family component. "Looking at [what disorders populate] the family history of a person who presents with either primary anxiety or depression provides a clue to whether he or she will end up with both," says Joseph Himle, Ph.D., associate director of the anxiety disorders unit at University of Michigan.

The nature of the anxiety disorder also has an influence. Obsessive-compulsive disorder, panic disorder and social phobia are particularly associated with depression. Specific phobias are less so.

Age plays a role, too. A person who develops an anxiety disorder for the first time after age 40 is likely also to have depression, observes Himle. "Someone who develops panic attacks for the first time at age 50 often has a history of depression or is experiencing depression at the same time."

Medicine According to Experience:

1. Neurobion

What is neurobion medicine for?

I normally inject myself with Neurobion whenever my tongue shows the signs of geographical tongue. At that stage I am normally very tired and struggle with feelings of depression and fatigue. The very next day after a shot of neurobion, I can feel my strenght coming back and a few days later there is no stop to my energy levels.

This is what it's made of:

Vitamin B1
Converts carbohydrates, fatty acids and amino acids into energy. Promotes healthy nerves. May improve mood. Strengthens the heart.

Vitamin B6
Forms red blood cells, helps cells to make proteins, manufactures neurotransmitters such as serotonin and releases stored forms of energy. Helps to prevent cardiovascular disease and strokes. Helps to lift depression. Eases insomnia. Treats carpal tunnel syndrome. May lessen PMS symptoms.

Vitamin B12
Essential for cell replication and important for red blood cell production. Prevents anaemia. Helps to prevent depression. Reduces nerve pain, numbness and tingling. Lowers the risk of heart disease.

Neurobion (r)

Registration details:
SI Each ampoule of 3 ml contains: Vitamin B1 100mg, Vitamin B6 100mg, Vitamin B12 1000 mg.

Generic Name: multivitamin

What is the most important information I should know about Neurobions?

· Do not take more of a Neurobion than is prescribed for you or is directed on the package. Large doses of Neurobions can be dangerous.

What are Neurobions?

· Vitamins are naturally occurring substances necessary for many processes in the body. Vitamins are found in the foods we eat.

· Neurobions are combinations of vitamins in tablets, capsules, liquids, and injections. Neurobions are used to treat vitamin shortages in the body that may occur because of illness, pregnancy, poor nutrition, decreased absorption of foods through the stomach, and many other circumstances.

· Neurobions may also be used for purposes other than those listed in this medication guide.

Who should not take Neurobions?

· Some Neurobions may affect other medical conditions or treatments. Do not start taking a Neurobion without first talking to your doctor if you have any health problems or conditions, or if you take other prescription or over-the-counter medications.

· Neurobions are generally considered to be safe for use during pregnancy and breast-feeding. Special prenatal vitamins are available and are important for the healthy development of a baby. However, large doses of some vitamins can be harmful. Talk to your doctor about taking a vitamin and mineral supplement during pregnancy or breast-feeding.

How should I take Neurobion?

· Take Neurobions exactly as directed by your doctor. If you do not understand these directions, ask your pharmacist, nurse, or doctor to explain them to you.

· Take each dose with a full glass of water.

· Take Neurobions with food to lessen stomach upset.

· Some Neurobions are available in a chewable tablet formulation. Chew these tablets thoroughly before swallowing.

· Some Neurobions are also available in liquid form. To ensure that you get the correct dosage, measure liquid Neurobions with a dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist where you can get one.

· Do not take more of a Neurobion than is prescribed for you or is directed on the package. Large doses of Neurobions can be dangerous.

· Store Neurobions at room temperature away from moisture and heat.

What happens if I miss a dose?

· Take the missed dose as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take only the next regularly scheduled dose. Do not take a double dose.

What happens if I overdose?

· Seek emergency medical attention.

· Most commonly, symptoms of a Neurobion overdose include nausea and vomiting.

What should I avoid while taking Neurobions?

· There are no restrictions on food, beverages, or activities while you are taking Neurobion supplements. Follow any special instructions your doctor gives you.

What are the possible side effects of Neurobions?

· Stop taking Neurobions and seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives).

· Other, less serious side effects may be more likely to occur. Nausea, constipation, black stools, and diarrhea are among the most common. Taking Neurobions with food may decrease these side effects.

· Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect Neurobion?

· Before taking a Neurobion, tell your doctor if you are taking any other prescription or over-the-counter medicines. You may not be able to take the Neurobion, or you may require a dosage adjustment or special monitoring if you are taking any other medicines.

2. Prodin

3. Welavita