TREATMENT FOR DEPRESSION WITH ANXIETY

Depression often co-exists with other illnesses; we call this comorbidity. Depression and anxiety almost always occur together. Comorbid depression and anxiety are a common phenomenon. Such illnesses may precede the depression, cause it, and/or be a consequence of it. It is likely that the mechanics behind the intersection of depression and other illnesses differ for every person and situation. Regardless, these other co-occurring illnesses need to be diagnosed and treated.

Distinguishing Between Depression and Anxiety

As a rule of thumb, many psychiatrists assume comorbid depression and anxiety until proven otherwise. During an evaluation this relationship will be assumed, especially since it is often difficult for a patient to tell a doctor that they have both illnesses. All the patient knows is that they feel horrible. Identifying the primary and secondary illness is critical to assuring a positive prognosis. If the secondary illness is treated as the primary illness, often the symptoms will not dissipate, this is especially critical in treating comorbid ADHD and anxiety.

One simple way of knowing the difference between depression symptoms and anxiety symptoms are the following. Depression can be associated with the blues, feeling lethargic, and low-motivation, unhappy feelings and sorrow; often for no apparent reason. Anxiety would be likely to present nervousness, feelings of guilt, stomach or headaches, and hypersensitivity to crowds and noise; feeling like you can jump out of your skin. Both disorders can be accompanied by insomnia.

Anxiety disorders such as post-traumatic stress disorder (PTSD), obsessive compulsive disorder, and panic disorder often accompany depression. People experiencing PTSD are especially prone to having comorbid depression. People with PTSD often relive the traumatic event in flashbacks, memories, or nightmares. Other symptoms include irritability, hyper-vigilance, intense anger, and avoidance of thinking or talking about the traumatic ordeal. In a National Institute of Mental Health (NIMH) funded study, researchers found that more than 40 percent of people with PTSD also had depression at one-month and four-month intervals after the traumatic event.

Alcohol and other substance abuse or dependence may also co-occur with depression. In fact, research has indicated that the co-existence of mood disorders and substance abuse is pervasive among the U.S. population. This might be due to the elevated levels of dynorphin in these individuals brain cells, which fosters addiction.

Depression & Physiological Diseases

Depression also often co-exists with other serious medical illnesses such as heart disease, stroke, cancer, HIV, diabetes, and Parkinson’s disease. Depression is implicated in both the development and adverse outcomes of heart disease. Biological pathways involving the sympathetic nervous system, the hypothalamus-pituitary axis, and the coagulation pathway are all implicated. Many often report severe depression after open heart surgery. Similar data seems to imply and demonstrate a link between anxiety, depression, and other common medical illnesses ranging from stroke and Parkinson disease to irritable bowel syndrome, cancer, and fibromyalgia.

A recent study analyzing data from the US National Comorbidity Survey Part II concluded that anxiety disorders were positively associated with medical disorders after adjusting for depression, substance-use disorders. This conclusion indicates a strong and unique association between anxiety disorders and medical disorders. Indeed, the study noted a stronger association of anxiety disorders and chronic pain syndromes than the association of depression and chronic pain. Thus, depression, anxiety, and chronic medical illness are closely related and hard to treat.

Comorbid Diseases May be More Difficult to Treat

Separating the independent effects of depression and anxiety is difficult given their common concurrence and similar symptoms. Studies have shown that people who have depression in addition to another serious medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have comorbid depression. Moreover, comorbid anxiety and depression may increase greater chances of non-response to treatment, long-term poor outcome, and suicide. Research has yielded increasing evidence that treating the depression can also help improve the outcome of treating the comorbid illness. If you think that you have both depression and anxiety, contact my office so that I can help determine the primary and secondary illness, and treat them together. More about Anxiety