When an emotional injury takes place, the body begins a process as natural as the healing of a physical wound. Let the process happen.
Trust that nature will do the healing. Know that the pain will pass and, when it passes, you will be stronger, happier, more sensitive and aware.
Generalized Anxiety Disorder
SATURDAY, Jan. 20 (HealthScout) -- It can be so debilitating that its sufferers can't function, yet experts say generalized anxiety disorder is often missed and tough to treat.
"If it's bad enough, it can lead to people actually not being able to work because they're so caught up in their worries their productivity goes way down and they can lose their jobs," says Dr. David Spiegel, research professor and director of clinical and medical programs at the Center for Anxiety and Related Disorders, Boston University.
"In severe cases, it can be quite disabling," he says. "Most people don't have it to that extent, but their quality of life can be pretty seriously affected."
Generalized anxiety disorder (GAD) affects 3 percent to 5 percent of Americans -- mostly women. It has a number of symptoms, including excessive and unrealistic worry and anxiety lasting six months or more, muscle pain, stomach upset, insomnia, dizziness, irritability and poor concentration.
It differs from other anxiety disorders, experts say.
"It's a more persistent, generalized anxiety. It's not necessarily focused on one thing. It's just feeling anxious, typically uncontrollable worry about more than one different area of a person's life," Spiegel says.
He says GAD often escapes diagnosis. For example, while someone with panic disorder would have severe symptoms that would send them to their doctor, GAD's symptoms may not be excessive enough for someone to seek treatment.
"So, I think probably there's more of a tolerance for it from people, where they may see it as just something they should get control of," he says.
Spiegel says GAD diagnosis can be a challenge because sufferers typically have other disorders, including depression.
There's even some debate about whether it actually exists.
"The quality of its definition has not been as good as with some of the other disorders, partly because I think to some extent it was sort of the leftover category as we pulled out things that were more clearly unique," Spiegel says. "Among all the anxiety disorders, this has been the one that has had the lowest agreement among clinicians as to whether or not it's present and has undergone the most change from one (professional manual) revision to the next."
Other experts agree.
"It's like Yogi Berra said: 'I wouldn't have seen it if I hadn't believed it,' " says Dr. R. Bruce Lydiard, professor of psychiatry and director of the Mood and Anxiety Program, Medical University of South Carolina.
He agrees it can be difficult to diagnose GAD, but says there's no doubt it can be found. In his own studies, he's been able to recognize GAD when it exists with other disorders by asking patients about key symptoms.
But Lydiard says he's not sure enough health-care professionals can pinpoint it. And that means GAD is a major public health issue that doesn't get enough attention.
"Here we have a disorder that affects one in every 33 people, and we're not looking for it and we know the ramifications of having it and not having it treated are substantial," Lydiard says.
Treatments for GAD include mediation and cognitive behavior therapy. A combination of the two treatments is often used, Spiegel says.
He says treatments have not been as developed as for some of the other anxiety disorders.
"In the treatment of GAD, we're a little bit behind where we are for the treatment of other anxiety disorders, both in terms of the availability of treatments and the extent of research that's been done," Spiegel says.
What To Do
You can get more information from the Anxiety Disorders Association of America or the National Institute of Mental Health.
Did you mark most of those statements as true about yourself? If so, you could be suffering from the beginning stages of Anxiety or Panic Attacks.
The first step toward achieving freedom from it is to recognize that you need to change. The second is to realize that you can choose to change. And the Third is to make a commitment to change. You deserve happiness, peace, success, good health, and self-esteem. All it takes now is a decision that you are going to change!
From Anxiety and Panic Attacks: Their Cause and Cure by Robert Handly and Pauline Neff. Ballantine Books, 1985
|Anxiety A-Z - Extensive, alphabetized guide to subjects and topics related to this disorder.|
|0 - 6 months||Loss of support, loud noises|
|7 - 12 months||Strangers, heights; sudden, unexpected and looming objects|
|1 year||Separation from parents; toilet, injury, strangers|
|2 years||A multitude of sources, including loud noises (vacuum cleaners, sirens/alarms, trucks, and thunder) animals (e.g., large dogs), darks rooms, separation from parents, large objects or machines, change in person environment, strange peers|
|3 years||Masks, dark, animals, separation from parents|
|4 years||Separation from parents, animals, dark, noises (including at night)|
|5 years||Animals, "bad" people, dark, separation from parent bodily harm|
|6 years||Supernatural beings(e.g., ghosts, witches, "Darth Vader"), bodily injuries, thunder and lightning, dark, sleeping or staying alone, separation from parent|
|7-8 years||Supernatural beings, dark, media events (e.g., news reports on the threat of nuclear war or child kidnapping), staying alone, bodily injury|
|9-12 years||Tests and examinations in school, school performance, bodily injury, physical appearance, thunder and lightning, death, dark|
|Teens||Social performance, sexuality|
WHAT YOU CAN DO TO HELP YOURSELF IF YOU SUFFER FROM SEVERE ANXIETY
|Learn relaxation techniques. They are available everywhere - yoga
classes, video tapes, meditation, etc.
||Eliminate alcohol and unprescribed drugs from your system.
||It is a good idea to begin with a thorough physical exam by a
physician. Many times symptoms are caused by a physical condition or
illness, such as allergies.
||Be aware of what you eat and drink. Food additives such as
Aspartame, the sugar substitute, or caffeine, can be toxic to some people
and cause anxiety symptoms. Packaged meats contain preservatives and other
chemicals. A high intake of sugar can also trigger anxiety symptoms.
||Physical exercise is often an excellent temporary antidote for mild or
||Be confident that you will find relief for your symptoms. Many
other people have suffered with the same unpleasant or uncomfortable
conditions and have successfully gotten relief -- often permanently.
||Educate yourself about what you suspect is your disorder|
so that you can communicate more effectively with your medical doctor or your potential therapist.
Dysthymic Disorder: When Depression Lingers
- What is dysthymic disorder?
Dysthymic disorder, or dysthymia, is a type of depression that lasts for at least 2 years. Some people suffer from dysthymia for years. The depression is usually mild or moderate, rather than severe. Most people with dysthymia can't tell for sure when they first became depressed.
Symptoms of dysthymic disorder include a poor appetite or overeating, difficulty sleeping or sleeping too much, low energy, fatigue and feelings of hopelessness. But people with dysthymic disorder may have periods of normal mood that last up to 2 months. Family members and friends may not even know that their loved one is depressed. Even though this type of depression is mild, it may make it difficult for a person to function at home, school or work.
- When does dysthymic disorder begin?
Dysthymia can begin in childhood or in adulthood. Like most types of depression, it appears to be more common in women. No one knows why depression is more common in women.
- How common is dysthymic disorder?
Dysthymic disorder is a fairly common type of depression. Up to 3% of people have dysthymia. From 5 to 15% of patients in a family doctor's office have dysthymia.
- What causes dysthymic disorder?
No one knows for sure what causes dysthymia. There may be some changes in the brain that involve a chemical called serotonin. Personality problems, medical problems and chronic life stress may also play a role.
- How is dysthymic disorder diagnosed?
If you think you have dysthymia, discuss your concerns with your doctor. Your doctor will ask you questions to find out if you have depression and to identify the type of depression you have. Your doctor may ask you questions about your health and your symptoms, such as how well you're sleeping, if you feel tired all of the time, if you have trouble concentrating. Your doctor will also consider medical reasons that may cause you to feel depressed, such as problems with your thyroid or a medicine you may be taking.
- What is the treatment for dysthymic disorder?
Dysthymic disorder can be treated with an antidepressant medicine. This type of drug relieves depression. Antidepressants are commonly prescribed, and they are safe. They do not create an artificial "high," and they are not addicting.
If you are given an antidepressant, it may take a number of weeks or even several months before you and your doctor know whether the drug is helping you. It is important for you to take the medicine as it is prescribed. If the antidepressant drug helps you feel better, you may need to take this medicine for several years. In other words, continue to take the antidepressant drug even though you begin to feel better. If you stop taking the medicine, you may get depressed again.
- Will I have to see a therapist?
You will probably not have to see a psychiatrist or psychotherapist unless the medication is not working or you have problems taking the drugs that are usually prescribed for depression. Sometimes, in addition to taking an antidepressant medicine, patients are referred for psychotherapy to help them deal with specific problems. This type of therapy can be very helpful for some people. In general, the treatment of dysthymic disorder is specifically planned for each person.
|What can I do to help myself feel better?
Talking to your doctor about how you're feeling and getting treatment for the dysthymic disorder are the first steps to feeling better. Other ways to make yourself feel better are:
(Rev. February 2000)
This handout provides a general overview on this topic and may not apply to everyone. To find out if this handout applies to you and to get more information on this subject, talk to your family doctor.
Visit familydoctor.org for information on this and many other health-related topics.
Copyright © 2000 by the American Academy of Family Physicians.
Permission is granted to print and photocopy this material for nonprofit educational uses. Written permission is required for all other uses, including electronic uses.
Landmark Study Proves Chronic Depression Treatable
CHICAGO, December 1, 1998 -- A just-published landmark study of patients who suffered from untreated chronic depression on average for almost two decades has found that these patients can find relief with antidepressant medication, the National Depressive and Manic-Depressive Association (National DMDA) announced.
This double-blind, randomized, multi-center treatment study is the first to report results of treatment of chronic major depression and double depression with a selective serotonin reuptake inhibitor (SSRI) antidepressant medication. Patients' response to treatment was examined in three phases: acute, continuation and maintenance. Three companion papers of the study are published in the November issue of Journal of Clinical Psychiatry, including the acute phase trial for safety, psychosocial functioning outcomes in the acute phase, and another focused on the rationale for this unique, multi-faceted study design. The maintenance phase, published in the November 18th issue of The Journal of the American Medical Association (JAMA), compared the efficacy of the SSRI versus placebo in preventing recurrence and reemergence of chronic depression in patients. The size of the patient population in the study is the largest database to date in chronic major depression and double depression and their treatment.
"Although the National DMDA was not a sponsor of the research, we are announcing the results because they are of such potential importance to the more than 18 million Americans annually who struggle with depression," said Lydia Lewis, Executive Director of National DMDA. Of these patients, it is estimated that approximately one-third who are treated for a depressive episode suffer from chronic depression. The total medical costs and functional impairments associated with all forms of depression were estimated to cost society $43 billion annually in 1990, of which $23.8billion (55 percent) represents decreased work productivity and lost work days.
Dr. Martin B. Keller, Professor and Chairman of the Department of Psychiatry and Human Behavior at Brown University, and former chair of National DMDA's Scientific Advisory Board was overall director of this research program and lead author of two of these articles. He noted the findings are "of major significance" for a number of reasons. "In measuring the psychosocial impact of chronic depression, for the first time we have quantified the impact on quality of life and worked productivity this devastating illness has on patients, their families and those they work with--so it tells us why this is such an important problem," said Keller."On the hopeful side, it clearly demonstrates that even patients who have suffered for decades can benefit substantially from treatment with modern antidepressants. Most importantly, recovered patients are highly likely to remain well if they stay on medication on the same dose which brought about their recovery."
Lewis was equally enthusiastic about the results. "The results of this study offer enormous hope to the millions of patients who have never received proper medical treatment for the serious medical condition we call chronic depression," Lewis said. "This finally proves that chronic major depression is a treatable illness, and there is no need for patients to struggle for years in the mistaken belief that it is some kind of character defect or personality weakness."
Effective, Well-Tolerated Treatment is Available
The acute phase of the study compared treatment with an SSRI to treatment with a tricyclic antidepressant, and found both treatments were effective in combating symptoms of chronic major depression. However, the researchers found the SSRI was better tolerated than the tricyclic antidepressant; patients randomized to the SSRI were only about half as likely to discontinue treatment because of side effects.
In the final phase of the study, the maintenance phase, researchers compared an SSRI with placebo, and found the SSRI was not only well-tolerated, but had significant efficacy in preventing recurrence or reemergence of depression in chronically depressed patients. Furthermore, the therapy can extend the time in remission. Specifically, after 18 months, patients who received placebo were four times likely to experience a reemergence of depression than patients taking the SSRI. It is unknown whether these results are generalizable to all SSRIs as a class. With an effective and tolerable long-term treatment option, patients who may have battled with chronic depression for most of their lives may have the opportunity to lead more productive social and professional lives, according to Lewis.
The Impact on Quality of Life
One of the major preliminary findings of this study at baseline was the duration and extent to which chronic depression can negatively affect a person's psychosocial functioning -- interpersonal and social functioning. However, by the end of the acute phase of the study, patients who had been suffering with chronic depression on average for nearly two decades exhibited significant improvement in psychosocial functioning by four weeks of treatment and continued to improve through 12 weeks of treatment. Psychosocial functioning variables include overall functioning, quality of life, work functioning and interpersonal functioning.
"This research demonstrates that patients' quality of life is severely limited by their depressive illness," said Lewis, "but that treatment with antidepressants can markedly improve their ability to work, relate to their families and friends, and function in society."
At the beginning of the study, the researchers found that almost 80 percent of the chronically depressed patients had psychosocial adjustment rated as "poor" or "very poor" -- and less than two percent had "good" or "very good" adjustment. For example, there was a remarkable discrepancy between the educational achievements of these patients and their current work status:
By the end of the acute phase of the study, almost 88 percent of those whose depression was in remission (an absence or lessening of symptoms) were rated as having "good" or "very good" psychosocial adjustment, one-half percent fell into the "poor" category, and none was rated as "very poor."
Study Design & Background
The 12-week acute phase was designed to compare the efficacy and safety of two antidepressant treatments in 635 patients. Those patients who exhibited a satisfactory response to either treatment entered a 16-week continuation treatment phase. In the maintenance phase, patients who had successfully completed the continuation phase with the SSRI therapy entered an 18-month trial to compare the efficacy of the SSRI with placebo. These protocols were designed together to provide important descriptive information in the treatment of the chronic depression, a largely understudied area.
Researchers looked at patients with two types of chronic depression:
Investigators from 10 leading universities in the United States conducted the study, including the following members of National DMDA's Scientific Advisory Board: Jan A. Fawcett, M.D., of Rush-Presbyterian St. Luke's Medical Center in Chicago; Alan J. Gelenberg, M.D., of University of Arizona at Tucson; Robert M.A. Hirschfeld, M.D., University of Texas at Galveston; Martin B. Keller, M.D., of Brown University; A. John Rush, M.D., of the University of Texas at Dallas; Alan F. Schatzberg, M.D., of Stanford University and Michael E. Thase, M.D., of University of Pittsburgh. Other investigators included James H. Kocsis, M.D., of Cornell University; Daniel Klein, Ph.D., of State University of New York, Stony Brook and James P. McCullough, Ph.D., of Virginia Commonwealth University.
Based on the study's important results, National DMDA's Lewis encourages patients to seriously consider enrolling in clinical trials. "Because people volunteered for this clinical trial, we now know that chronic depression can be successfully treated," she said. "Without these volunteers we would not have these new findings, which offer a very positive message for those suffering needlessly from depression, and those who care about them. This study shows research can change lives."
Speaking on behalf of all the principal investigators, Dr. Keller expressed "enormous gratitude to all of the people suffering from depression who were willing to participate in this research for over two years not knowing what treatment they were on. Their self-sacrifice and courage is extraordinary, making it possible for new discoveries about treatments to be made. This, in turn, helps millions of other patients."
National DMDA is the nation's larges patient-run illness-specific organization. Founded in 1986 and headquartered in Chicago, IL, National DMDA's mission is to educate patients, families, professionals, and the public concerning the nature of depressive and manic-depressive illnesses as treatable medical diseases; to foster self-help for patients and families; to eliminate discrimination and stigma; to improve access to care; and to advocate for research toward the elimination of these illnesses.
For membership information and free educational materials, please call National DMDA at 800/826-3632.
National DMDA does not endorse or recommend the use of any specific treatment or medication listed. For advice about specific treatment or medication, patients should consult their physicians and/or mental health professionals.
Depression in Teenaged Girls Carries Over into Adulthood
Adolescent girls are at very high risk of depression and remain at high risk as they enter their early adult years, reports a study in the July 1999 issues of the Journal of the American Academy of Child and Adolescent Psychiatry.
High rates of depression among girls may have significant consequences for the transition from adolescence to young adulthood, suggests the new study, led by child and adolescent psychiatrist Uma Rao, M.D., of the University of California, Los Angeles.
The researchers followed up 155 young women every year for five years, starting in their senior year of high school. Thirty-seven percent of the women had an initial episode of major depression during this period.
Nearly 50 percent of the women developed a first or repeated episode of major depression within five years after high school graduation.
Risk remained high throughout the age range studied, but the women were most likely to have an initial episode of depression between the ages of 18 and 19 years. This corresponded to the time they graduated high school and started college or moved away from home.
Depression was more likely to develop in women with other types of psychiatric disorders, especially anxiety and substance abuse.
Depression had a significant negative impact in several areas of the young women's lives. Depressed girls had difficulties in their school work or in managing the demands of work and school They also had problems with their romantic relationships, including a possibly increased risk of coercion or abuse by their boyfriends.
Previous child and adolescent psychiatry research has shown high rates of depression among adolescent girls. However, few studies have looked at what happens to depressed girls they grow into adulthood.
The new results suggest that young women continue to be at high risk of depression through their early twenties, and those who have had an initial episode of depression are at very high risk of recurrent episodes.
The high risk of depression in the years after high school is a particular concern, as this is a time when young women are developing crucial social and occupational skills. Women's risk for depression during the early reproductive years may also pose a significant social problem in view of the risk to children of depressed mothers. Child end adolescent psychiatrists need to develop new ways of identifying girls and young women at high risk of depression so as to target them for early intervention.
M.D. Continuity of Depression
During the Transition to Adulthood:
The American Academy of Child and Adolescent Psychiatry represents over 6,900 child and adolescent psychiatrists with at least five years of additional training beyond medical school in adult, child, and adolescent psychiatry. AACAP members actively research, diagnose, and treat psychiatric disorders affecting children, adolescents, and their families. Your Child and Your Adolescent, the AACAP's new books on parenting, give us an in-depth look at child development from infancy to adulthood; discussing what's normal, what's not, and when to seek help. The AACAP actively refers the media to expert spokespeople on child and adolescent issues.
Good Website http://www.healthline.com/channel/depression.html
Depression is a brain disease.
people don't go for treatment of their depression.
Ivan is interviewed about depression and its treatment.
depression is and what it is not.
best things to say to someone who is depressed.
worst things to say to someone who is depressed.
does clinical depression feel like?
The difference between
unipolar (major) depression and Bipolar depression.
Depression Inventory to measure the severity of depressive symptoms
Mania Inventory to measure the severity of manic symptoms.
to many aspects of depression from the NIMH.
official DSM-IV criteria for mood disorders.
Eleven unethical practices of
illness is no myth!
introduction to Bipolar Disorder from the NIMH.
to heal depression.
under-treatment of depression.
extensive depression FAQ from alt.support.depression.
Hints to speed
your recovery from depression.
and mood disorders.
evolutionary hypothesis to explain depression.
in the work place.
Dealing with school
reading list for professionals on affective disorders.
research at the National Institute of Mental Health (NIMH).
Material on depression in Chinese, Croatian, Greek, Italian, Spanish and Vietnamese.
Dealing with Depression - Defines depression, explains who is affected, gives possible causes, lists common symptoms and describes treatment options. Includes a quiz.
|NDMDA - National Depression and Manic Depression Association gives an explanation of these conditions and an overview of treatments.|
PANIC ATTACKS - WHAT ARE THEY?
Dr. Debra Moore
Jon Kabat-Zinn in his book Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness, provides plenty of help in learning to live with stress, chronic illness and chronic pain. He suggests that we need to have a mindful attitude towards life. Mindfulness is about paying attention on purpose. So being mindful means paying attention, being awake, and owning your moments. It is about being present in the moment. Below are a few of his suggestions for maintaining awareness of the present and being mindful in everyday life.
|Stress Management Resources|
to calm down in under a minute
A quick way to relax when you need to
It's easy to do. Learn a simple technique to help you relax and focus your mind.
How to Meditate Mindfully
Another meditation technique. It started as a Buddhist practice, but you can do it too.
The fight-or-flight response is not the whole story for women. They tend-and-befreind.
to worry less
It doesn't help
About Stress Management
Melissa Stöppler, M.D. has a whole About site on stress management. Learn more at her site.
The Fight-or-Flight Response
Learn about the fight-or-flight response and a way to calm it down.
The Relaxation Response
Learn about this form of meditation that can help you calm down.
Managing Stress - Too Much of a
Moderate stress can be positive, but too much is a problem.
Stress Information from MEDLINE Plus
The National Library of Medicine has compiled links and resources on stress. The focus is in government resources, but there is other good stuff here too.
|What, Me Worry?|
The title of this article is a quote from Alfred E. Neuman of Mad Magazine fame. With his toothless grin it was easy to get the impression that worry was a good thing - if you didn't worry you might end up like Alfred. When I was first married my wife, Susan, would get angry at me when I refused to worry about things. She was worried, why wasn't I? I had learned that worry does not accomplish anything.
One of my early supervisors, Jay Chambers, used the term "negative fantasy" as a synonym for worry. When we are worrying about something we are essentially fantasizing about bad things that might happen. What's the point? it sometimes helps to plan for the future, but it almost never helps to worry about it. Worrying actually ruins the present by bringing in an anticipated negative event from the future.
Psychologists have coined the phrase "anticipatory anxiety" to describe a specific type of worry and negative fantasy that often accompanies anxiety disorders. When a person has an anxiety attack or a panic attack it can be disruptive and even immobilizing. The fact that an attack has occurred can weigh heavily on one's mind. This can lead to a fear of similar attacks. If this fear gets strong enough it itself creates anxiety, and this itself is sometimes enough to trigger another attack.
What's the solution? Stop worrying. This is easier said than done, of course. There are several different 'thought-stopping" techniques that can help. A popular one involves wearing a rubber band around your wrist and snapping it whenever you catch yourself worrying. Yell "stop" to yourself, and shift mental gears to think about something else. It helps to have the "something else" in mind beforehand - a relaxing image or a compelling problem that your mind will latch onto.
Another very effective technique involves setting aside time to worry every day. This sounds counter productive, but it actually helps you gain control over your thinking. Complete instructions for this technique are found in How to Worry Less. If these simple techniques are not enough, consider counseling or therapy. Extreme worry is a form of obsessive thinking, and can be a part of a disorder such as obsessive compulsive disorder.
Other Links and Newsgroups Related to Feelings, Emotions
|SA\VE - Suicide Awareness \ Voices of
Information Center - Mental Health Infosource ***
||Depression Alliance (U.K.)
- Ivan Goldberg, M.D. ***
||Joy Ikelman's Info on
Bipolar Disorder (Manic Depression) ***
||National Depressive and Manic-Depressive
||National Foundation for Depressive
||Pendulum Resources on Bipolar Affective
Disorder, Manic Depression ***
Depression Page - Andrew Fineberg **
||Bipolar Disorder - About.com **
||Bipolar Significant Other (BPSO) **
||Bipolar World **
||Child & Adolescent Bipolar Foundation
||CANMAT - Canadian Network for Mood
and Anxiety Treatments **
Education Program - National Institute of Mental Health **
||Depression - About.com **
Resource & Education Centre (DIRECT) - McMaster University, Dept. of
Depression & Manic Depression Support Group **
||Fyreniyce - Australia's
Bipolar Site **
||Harbor of Refuge: Bipolar
Disorder/Manic-Depression Support **
||Have a Heart's Depression Home
Bipolar Disorder **
||Minds Eye -
Information on depression **
||Mood Disorders Association of
British Columbia **
Clinic, University of British Columbia **
||moodswing.org - for people with
Bipolar Disorder **
||Walkers in Darkness - Information
and support for mood disorders **
||Winds of Change - Bipolar/Manic
Depression Support Group **
||Wing of Madness: A Depression Guide
- Deborah M. Deren **
||Bipolar Brain *
||Bipolar Disorder Sanctuary
Bipolar Research Program - Massachusetts General Hospital *
||McMan's Depression and Bipolar Web *
||The Mercurial Mind - Living
with Bipolar Disorder *
||Mixed Nuts Depression Support Community
||Organization for Bipolar Affective Disorders
||The Society for Manic Depression *
||Sparrow - support
resources for depression, manic depression & mental illness *
||Tampa Bay Depressive and Manic Depressive
Association (TBDMDA) *
Bipolar Disorders Links
Mood Disorders Links
Depression Bulletin Board