Today’s Daily Prompt asks:
If you could create a painless, inexpensive cure for a single ailment, what would you cure and why?
My immediate reaction to this prompt was “depression (duh!)” – but then I thought, “you know, my anxiety causes at least as many problems as the depression, possibly more. It may actually be the cause of the depression.” I bounced back and forth for a couple of seconds, on the assumption that I had to choose one.
I’ve long believed – particularly as I read other people’s mental health blogs – that I have one disorder and the “anxiety” and “depression” I experience are overlapping subsets of the symptoms of it. Treating one subset of symptoms won’t do anything for the other subset, nor the underlying disorder. Anyone who wants to treat me needs to treat the whole package, even if it doesn’t fit neatly into a convenient label. This is actually a very common problem among those of us with mental illness.
I need to thank Michelle W. for today’s prompt because it, well, prompted me to do some research. I’m hopeful that if I bring my findings to potential health care providers (particularly psychiatrists) I’ll be better able to receive the treatment I actually need.
The research supports my idea that, at least for some people, anxiety and depression are symptoms of the same disorder – called “anxious depression” in much of the literature. Cameron (2007) compared individuals with anxiety alone, individuals with depression alone, individuals with comorbid anxiety and depression, and healthy individuals. The individuals with comorbid anxiety and depression were unique in that their hypothalamic-pituitary-adrenocortical (HPA) axes (plural of axis) were hyperactive. It seems to me like finding a way to address this hyperactivity directly may provide a key to effectively treating this disorder.
And it’s a very important thing to do, not just for me! A good 5% to 9% of the adult population struggle with this disorder every year (Cameron 2007). “These patients have greater severity of symptoms, increased risk of suicidality, a more chronic and persistent course, and more functional impairment. This syndrome is also more difficult to treat, with longer time to remission and need for increased medication.” (Cameron 2007). Most if not all of the other articles I read agree that people with anxious depression have a poor response to medication – probably because they’re receiving the wrong medication!
There are some guidelines for treating anxious depression differently from other types of depression. While they may be helpful, I’m concerned that they seem to conceptualize anxious depression as one or more variations of a disorder (anxiety or depression) rather than as a distinct disorder (which may itself have subtypes). Simon & Rosenbaum (2003) suggest multiple courses of treatment depending on the specific type of anxiety disorder that is comorbid with depression. Marano (2002) describes different types of depression – including anxious depression – and how they can be treated.
The latter article is particularly relevant to me because I found the description of atypical depression to be quite accurate to my experiences. I’m hoping I can use the information therein to help my someday mental health provider make a more accurate diagnosis and treat instead of poisoning me. Maybe I have “atypical-anxious depression?” I don’t know, I just want to find a way to fix it! And if I could create a painless, inexpensive cure for it, I wouldn’t hesitate to do so.
Hirschfield, R.M.A. (2001) The Comorbidity of Major Depression and Anxiety Disorders: Recognition and Management in Primary Care. Primary Care Compantion Journal of Clinical Psychiatry, 3(6), 244-254.