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.
Aina, Y. & Susman, J.L. (2006) Understanding Comorbidity with Depression and Anxiety Disorders. Journal of the American Osteopath Association, 106(5 Suppl2), S9-14.
Cameron, O.G. (2007 December 1) Understanding Comorbid Depression and Anxiety. Psychiatric Times.
Grohol, J.M. (2008 January 3) Anxious Depression Predicts Poorer Treatment Results. PsychCentral.
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.
Marano, H.E. (2002 July 1) The Different Faces of Depression. Psychology Today.
Rao, S. & Zisook, S. (2009) Anxious Depression: Clinical Features and Treatment. Current Psychiatry Reports, 11(6), 429-436.
Simon, N.M. & Rosenbaum, J.F. (2003 March 27) Anxiety and Depression Comorbidity: Implications and Intervention. Medscape.
Just wanted to let you know that I feel the same way. I am like you – an anxious depressive. I have not had success in treatment and I felt alone and lost with no significant improvement by treatment from doctors. The one thing that I can advise to you or anyone struggling with this – I study neuroscience and psychology. At the ultimate level, you can help your treatment by believing you will overcome it (which you will!! it may take some time however).
1) Keep a healthy diet,
2) make sure you consume lots of omega 3-6-9’s,
3) EXERCISE every day at least until the point of your first bead of sweat, AND
4) make sure you think positively (which is easier said than done – believe me I try everyday).
The last one is key in re-wiring the way you think and function. Each time to feel sad – force yourself to at least acknowledge one good thing in your immediate surroundings. It may be trivial in comparison to why you feel sad/anxious/mad but this is key to starting to change your outlook on life and how you will live. Think of ONE positive thing each time to begin to feel sad or scared. Tell yourself the fear and saddness is just a thought and temporary reaction. It does not have to be YOU. You can overcome it by switching your attention to that good thing in your surrounding. It may be something stupid like the pleasant colour of a wall or how you finally managed to be on time today (Woohoo!). Lastly,
5) Before you go to bed – thank (the world, your God or even just yourself) for 3 good things that occurred that day. Do this every night.
So far, I am still depressed and anxious most of the time but I do see an improvement compared to three months ago when I first decided to follow these 5 steps. Everyday I feel a tiny bit less sad and anxious because I notice a little more of the good that is in my life. Remember that the way YOU think and see the world is a product of years, perhaps decades, of the same thought patterns. If you were always depressed, you tend to see that shitty side of everything – it will be hard to be optimistic. But the mind is malleable – it changes upon experience. It may take a while before you notice a difference but keep working at it. Eventually you will change the way you think and see the world. There is hope for the alleviation of your pain, stress, and anxious suffering. As a neuroscientist, believe me when I say, “The mind is powerful and has the capacity for change!” Do not give up and try out the items I suggested. I wish you good luck and remember there are others like you out here in the world – You are NOT alone! We’ll get through it eventually.
On some level I already know all those things (people love to give advice), but it is helpful to have them all listed in one place.
I’m not adverse to doing them, I have tried to do them – with some success, but not the consistency necessary to improve – I’ve even written about some of them! The problem is that I find it very hard to do them – and especially to remain consistent – even just remembering to take a supplement. The days when I need to do these things the most are the ones when I’m the least likely to do them.
I’ve been increasingly feeling like I need someone to get me going in the morning, get me to exercise, make sure I’m eating healthy (including cooking for me when I don’t have the energy) and taking my supplements, remind me to think those positive thoughts. But I can’t ask my mom to do it and I think that would be a lot to ask of Fox, especially since he could use the encouragement, too. Hiring someone to do those things isn’t really an option; I’d practically need the person to live with me.
Do you have any suggestions for how to try and stay on top of these things, especially to do them when I feel the least able and willing to take care of myself? What works for you?
I understand – many times (and it still happens) I simply forget to take pills, eat, etc. and I know it can make you feel more stressed out – it sucks when you constantly forget to do the things that are supposed to help you. I usually write them down on a piece of paper and put the list somewhere very visible to me (on a wall or mirror). I’ve tried using a daily planner as well but I find I’ll forget to refer to it for weeks at a time. Recently, I have found that setting daily reminders on my phone has become VERY effective. You should definitely think of doing the same – reminders for taking pills before bedtime, a time to eat something (even if you aren’t hungry), etc.. When your phone alerts you, then do the task. The great thing is that even if you forget, your phone will remind you! I even have seemingly stupid reminders such as “Think positive!” and “Don’t worry! Smile!”. Some days it feels annoying and not necessary, but other days these reminders definitely help!
I also found it helpful to download free apps onto your phone for positive affirmations/thoughts, self-help, quotes, and meditations (Headspace is a good one!). Just search your app store and I guarantee you’ll find some useful free apps. I’ll read through quotes whenever I have a few minutes of spare time in my day and they usually make me feel more positive. They remind me to look on the bright side – there is ALWAYS a bright side to everything.
I still struggle with getting up in the morning and I usually don’t have much energy but I always feel better after some exercise. I won’t lie – its hard to motivate myself to do it everyday but I am improving! Recently, I started doing yoga stretches (using a free App on my phone) and I will suggest this for you as well because it is calming and relaxing and a really nice way to start your day!
I’m not sure about your situation but perhaps ask a roommate/parent to make you breakfast in the morning -tell them you have a hard time waking up and eating. At the very least perhaps they can make you a coffee to help you wake up each morning.
I hope you take this advice and let me know how your doing and what worked for you!
I’ll try your suggestions, but the last one may prove a bit difficult. My husband would be willing to make me breakfast in the morning, if someone made him tea first!
Though now that you mention it, an automatic coffee maker is rather tempting …
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I read this when you first posted it, but I came back to it after reading today’s post and checked out some of the articles you researched. Thanks for posting those links. My daughter has a combination of anxiety and depression, and she has not been doing well the past few months. Reading your blog gives me a lot of insight into the things she struggles with. It also gives me hope to see you navigating your mental illness with such honesty.
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