Category: blog

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Hallo, hallo, and happy Monday. Or just normal Monday. Dave says, “Melancholy Monday,” but we don’t really want to entertain anything Dave says. He’ll start to think he’s people. Welcome to part two of Mood and Anxiety Disorders. We’re past the science dump and onto the human side of these disorders. Three volunteers agreed to be interviewed. The questions for each interviewee were essentially the same in order to get a scope of how differently these disorders affect individuals.

From the top, I want to give a huge thank you to the participants—whose names I will be changing for privacy purposes.

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Internal Struggles

The first task I asked of my participants was to try to describe what their depressive and anxiety episodes felt like and whether they differed from day to day. The participants included one male (based in Alabama), and two females (one based in California, and one in Florida). So, going forward, the participants will be called Alabama, California, and Florida. It’s nice when I don’t have to be creative and make up actual names.

Both Alabama and Florida suffer from depression and anxiety. If you remember from the previous post, anxiety and depression tend to show up together—first one, then the other. The symptoms of these disorders also overlap quite a bit. While California suffers from anxiety, her chances of battling depression in the next few years are statistically higher than average.

So, what do depression and anxiety feel like, day to day, for our participants?

Alabama: The depression feels like you’re all alone, no one cares, and you’d be better off not being here. The anxiety makes me feel like I can’t breathe, like I’m going to cave in on myself. I don’t want to be around anyone. It’s different from day to day. Some days I don’t want to leave the house and others I’m just fine and seem normal to everyone, but inside I’m screaming.

Florida: My anxiety feels like someone is sucking the life out of me. Having anxiety and anxiety attacks are very scary. Recently I had three very bad attacks where I thought I was having a heart attack and needed to go to the hospital. I ate tums, drank cold water, laid down, and focused on my breathing. It lasted roughly 15 minutes, then the next one came on and the same thing happened. I had to take my prescribed medication. I eventually fell asleep and slept for several hours. I was okay after that.

My depression is a feeling of just being in a funk and not wanting to do anything or go anywhere. After my dad passed in December 2017, I became really depressed and was diagnosed with severe depression. If I was talking to someone, I would just burst into tears for no reason. I would sleep a lot and didn’t want to take a shower—it didn’t even cross my mind until my husband asked me if I took one that day. The depression and anxiety differ from day to day. Some days/weeks I do not leave my house, I don’t talk to anyone (I used to be a social butterfly and talk to a lot of people, now I don’t). I am withdrawn from life. I don’t sleep well and can fall asleep anywhere from 11 pm to 3 am. At night my mind races and I can’t get it to slow down (even with meds) enough to relax and fall asleep.

California: Anxiety has different types of feelings or levels. Some days it’s no big deal. When I’m dealing with a lot of stress at work, with the kids, etc., it’s harder to sleep. I find my mind can’t stop thinking about whatever the problem is. Sometimes, even if nothing is going wrong, I have anxiety about what could potentially go wrong.

Insomnia and losing the will to do anything are common symptoms of depression and anxiety. These two symptoms feed a cycle that exacerbates depressive episodes especially. You can see this in cases of insomniacs suffering depressive episodes, though they might not be clinically depressed. In the most basic of terms: Lack of sleep can fuck you up. The lack of will to do the things you normally love is crippling. At a certain point, it turns into a lack of will to do anything and the less you do, the worse the depressive episode can become.

Florida: Depression is every day, really. It is just learning to focus on you and say, “Today is going to be a good day,” and accomplish one task. Just doing one task a day helps me a lot and I end up doing more sometimes.

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External Struggles

Individuals suffering from depression and anxiety aren’t just battling internally. Getting medical help, getting understanding, the pressure of trying to hide the illness is sometimes brutal. I asked our participants when they first realized something was wrong, when they sought help, and what frustrations they encountered while seeking treatment.

Alabama: I was about 12 [when I realized something was wrong]. I was 15 when I started receiving help. Then I stopped, thinking I’d be fine. It wasn’t until ’09 that I received the proper help I really needed. It was a slow, tedious process to find out what would work best for me [in terms of medication]. The first med was Lexapro. It is evil. I became meaner and angrier and gained a shit-ton of weight on it. I was then put on Wellbutrin, and it has been the best thing for me.

California: I want to say in my early 20s I noticed an issue with [anxiety]. Shortly after having kids. I still haven’t sought professional help. I’ve just realized in the past year that I need to do so. I plan to next week. Since I haven’t been “clinically diagnosed,” I’ve self-medicated for years without even knowing. I always drink before bed so that my mind doesn’t keep me awake. I’ve smoked pot before, but all it does is make me paranoid, which makes the anxiety worse.

Florida: I initially had my first bout with depression when I was 16, after my grandmother committed suicide. I lost weight, was tired all the time, slept a lot, cried a lot. We were out of town for a week and all I did was cry and yell to “go home.” The next week I didn’t go to school because I was physically sick. The next time it happened I was in my early 20s and I just felt low and disconnected. I went back to the doctor right away and went back on meds. I have been on and off [medication] throughout my life. This stint has been the longest, since I had my back surgery in July 2014. I really don’t know what happened, but I just don’t feel like the same person after the surgery.

The frustrations of being diagnosed are always being asked, “Do you want to end your life? Do you want to hurt yourself or other(s)?” In my opinion, I wouldn’t be seeking help if I was suicidal. I have already been through it, and I know the devastation it causes for a family/others left behind. The thought has never crossed my mind—I never wanted my parents to have to endure the hurt of losing a child.

Throughout the process of getting diagnosed and finding the right medication, many individuals must fight certain perceptions of depression and anxiety. This added external pressure sometimes keeps sufferers from seeking help in the first place. Sometimes that turns out okay … And other times, not so much. Suicide is often associated with depression and there are plenty of clinical studies to back that up, but it’s different for every individual. For some individuals, suicide is never a conscious thought—it’s a snap decision (and I hesitate to really even call it a decision). For other individuals, it’s just not an option. And, for some individuals, it’s a plague of a thought. Regardless, it’s not comfortable when you seek help and the first question is, “Are you suicidal?” It is a question that needs to be asked, but it’s also a stigma associated with depression.

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Clearing up Misconceptions

Friends and family can be some of the biggest tools in an individual’s arsenal while going through depressive or anxious episodes. Tools … in the toolbox. Weapons in the arsenal. Mixing metaphors again. The point is, it’s very helpful when the people you surround yourself with understand what depression is, what anxiety is, and are able to be supportive. I asked our participants how their friends and families treat them and what the biggest hurdle is when dealing with these disorders

Alabama: My family treated me like I was angry all the time. Well, I was. Friends are more understanding—they know why and what has conspired in my life to cause [the depression] to be worse as I’ve gotten older. I have a few friends that can tell when a really bad episode will take place. My biggest hurdle dealing with these [disorders] are people not understanding why I feel the way I do. It’s like, “You can get over it and be fine.” Okay, that’s not the case. People call you crazy or a nutcase—which may be true, but they don’t know what causes it.

Florida: My mom suffers from both depression and anxiety also, my sister has been diagnosed with depression since my dad became ill, my dad was on depression and anxiety meds, my grandfather is on depression meds since my dad has passed. It is hereditary on both sides of my family, unfortunately. My husband has suffered from both also, so he is understanding. [My biggest hurdle is] trying to overcome it, trying to have a “normal” life again. I don’t like taking pills and having to keep track of when I need more and of doctor appointments. I just want things to be okay again. I hate being like this. It makes my brain run slower. I can’t think of the answers to questions as quickly, especially when someone asks what I want to do—I don’t really want to do anything. I isolate myself, so I don’t have to be forced into a situation where I have to respond because it’s exhausting. Also eating maybe 1.5 meals a day, having no appetite. Trying to smile or laugh daily. I can’t remember the last time I laughed, seriously. My depression has gotten a lot worse since I lost my dad, too.

California: [Friends and family] treat me normal, I guess. I talk to my mom about it more than anyone, and she sympathizes more than anyone. I think she has the same issue. [My biggest hurdle] is trying not to think something is wrong. Every time things are going right, I get scared because it’s too good.

Well, it’s about time to wrap this up, folks. The final question I asked our participants is what they want people to understand about depression and anxiety. I think it’s a fitting place to leave off with this question since it offers a neatly-packaged take-away to the series. You’re welcome.

Alabama: I want people to understand that we do suffer from an illness and have no control over it except with medication. This isn’t something that can be turned on and off like a light switch. Those who have loved ones who do suffer, try to be understanding—we don’t mean to be harsh or reclusive or angry. It’s the chemical imbalance we were born with, or perhaps a traumatic experience. Whatever the case, educate yourselves on our behalf so you’ll get a better understanding of why we act the way we do.

Florida: It is a real illness; it is not fake. Anyone who suffers from depression and/or anxiety didn’t ask for either one of these illnesses. They can be debilitating for some people and life-consuming. I would like them to answer these questions:

1. Do you enjoy getting up and going to a job every day and socializing with people?
2. Do you like making money? Could you survive on $500-1,200 a month?
3. Do you like going to the doctor and being reminded to get medications and when to take them?
4. Do you enjoy going anywhere and not having a breakdown? Being able to breathe and not gasping for air, or not crying at the drop of a hat?
5. Do you like to be reminded to shower daily, to accomplish one task a day?

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Hallo, darlings. I feel like we had so much fun in our previous discussion on depression that we should do it again! My last post came from a personal place and was definitely one-sided. Well, I’ve decided we need to split the difference between the science behind depression and speaking with sufferers. And not just depression, but anxiety disorders as well. Mood and anxiety disorders have numerous overlapping symptoms and often having one will lead to eventually suffering from the other.

I mentioned last time that depression isn’t an emotion—it’s a state being. So now, I’ll back that up with the—drumroll, please, Dave—science around depression and anxiety. As with any kind of neuroscience, nothing is completely concrete here. Every day we are learning more about the brain. That said, the clinical studies included in this post reflect the most in-depth researched and medically accepted causes for depression and anxiety.

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Serotonergic and Noradrenergic Systems

The prevailing science behind depression and anxiety disorders centers around serotonin and norepinephrine dysfunction. When you first get on an antidepressant, chances are it’s an SSRI (selective serotonin reuptake inhibitor) or SNRI (serotonin and norepinephrine reuptake inhibitor), which is usually prescribed before MAOI (monoamine oxidase inhibitor) or atypical antidepressants. Depending on who you talk to, SSRIs—though having the least side effects—are probably the least viable option long term. In an overview in Depression and Anxiety, Charles B. Nemeroff, M.D., Ph.D., states: “There has been increasing evidence […] that antidepressants that inhibit both norepinephrine and serotonin reuptake (SNRI) are more effective in severe and refractory depression than those that inhibit uptake of a single monoamine neurotransmitter. In addition, patients with major depression treated with dual reuptake inhibitors may achieve remission more frequently than those treated with single monoamine reuptake inhibitors.” Conversely, depressive episodes for patients on SSRIs often hit harder. In the event you think you have depression and are about to look for treatment, be ready for a whirlwind of ups and downs before you get the right meds.

Of course, there’s more to it than just serotonin and norepinephrine dysfunction. In Role of Serotonergic and Noradrenergic Systems in the Pathophysiology of Depression and Anxiety Disorders, Nemeroff and Kerry J. Ressler explain: “There is abundant evidence for abnormalities of the norepinephrine (NE) and serotonin (5HT) neurotransmitter systems in depression and anxiety disorders. […] The underlying causes of these disorders, however, are less likely to be found within the NE and 5HT systems, per se. Rather their dysfunction is likely due to their role in modulating, and being modulated by, other neurobiologic systems that together mediate the symptoms of affective illness.”

It’s important not to think of depression and anxiety as something you can throw pills at and be done with. These illnesses are more complicated than that, and their origins are not singular. Continues Nemeroff and Ressler: “Disrupted cortical regulation may mediate impaired concentration and memory, together with uncontrollable worry. Hypothalamic abnormalities likely contribute to altered appetite, libido, and autonomic symptoms. Thalamic and brainstem dysregulation contributes to altered sleep and arousal states. Finally, abnormal modulation of cortical-hippocampal-amygdala pathways may contribute to chronically hypersensitive stress and fear responses, possibly mediating features of anxiety, anhedonia, aggression, and affective dyscontrol.” When dealing with depression and anxiety, it is important to rule out symptoms that are caused by a secondary problem.

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It’s in Your Genes … And Environment

I’m assuming we all know the nature vs nurture argument, especially pertaining to mental illnesses. And, as with most cases to which this argument can be applied, the likelihood of suffering depression or anxiety are both attributed to nature and nurture. Nemeroff and Elizabeth B. Binder, M.D., Ph.D, explain: “Susceptibility to depressive or anxiety disorders is now well established to be due to the combined effect of genes and the environment, with heritability estimates for these disorders ranging from about 30% to 40%. The CRF system, being highly responsive to the environment, has been posited to serve as a key interface between environmental stressors and the development of depression.”

Research based on Hopelessness Theory (HT) and Beck’s Theory (BT) further backs up this claim. The team behind Cognitive Vulnerability-Stress Theories of Depression: Examining Affective Specificity in the Prediction of Depression Versus Anxiety in Three Prospective Studies posits that: “The cognitive vulnerability-stress component of HT, a depressogenic cognitive style is hypothesized to interact with negative life events to contribute to increases in depressive symptoms. In HT cognitive vulnerability is conceptualized as a tendency to make negative inferences about the cause […] consequences, and meaning for one’s self-concept, of a negative life event. Similarly, BT posits a vulnerability-stress component in which dysfunctional attitudes are hypothesized to interact with negative events to contribute to elevations of depressive symptoms. In BT, cognitive vulnerability is conceptualized as depressive self-schemas containing dysfunctional attitudes, such as one’s worth derived from being perfect or needing approval from others.”

For non-sufferers, it is important to realize that depression and anxiety are not normal emotional responses. They are abnormal and out of the sufferer’s control. Saying something like, “Relax,” or, “You’re overreacting,” to someone who suffers from depression or anxiety only serves to alienate the sufferer more.

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Complex Illnesses

I wanted part one of this series to really show that depression and anxiety are not personality defects, not cries for attention, not someone being overly dramatic or sensitive. Although, sure, there are some of those types of people scattered about. Depression and anxiety stem from the very genetic level of the sufferer. And from there, it’s a cycle. You’re genetically predisposed to negativity and so you find it everywhere, which doubles down on depressive or anxious episodes.

Part two of this post is going to balance out the science with the human aspect. We’ll be getting a peek into the lives and struggles of individuals suffering from depression, anxiety, or both.

Be on the lookout for part two next Monday!