Understanding Anxiety and Depression: Types, Symptoms, and Treatments
Anxiety
Types of Anxiety
Normal anxiety: Adaptive and helpful in certain situations.
Pathological anxiety: Excessive anxiety that interferes with daily life, work, and relationships. This is a treatable condition.
Forms of Anxiety
- Anxiety crisis (frequent in emergencies): Characterized by intense and sudden onset, often triggered by specific circumstances.
- Somatization: Physical symptoms that manifest as a result of anxiety.
Stress: A synonym for anxiety and can exacerbate it. For example, exams or stimulants like coffee and coca-cola can trigger anxiety.
Anxiety can present as an emotion (e.g., fear), a symptom (e.g., palpitations), a syndrome, or a disorder.
States of Anxiety
- Activation: Feeling restless and agitated.
- Somatization: Experiencing physical symptoms like headaches or stomachaches.
- Anticipation: Worrying about future events and potential negative outcomes.
Anxiety Disorders (ICD-10)
- Generalized Anxiety Disorder (GAD)
- Panic Disorder
- Mixed Anxiety-Depressive Disorder
- Phobias (including agoraphobia and social phobia)
- Obsessive-Compulsive Disorder (OCD)
- Reactions to stress (including acute stress reaction, PTSD, and adjustment disorders)
- Dissociative Disorders (including conversion disorder)
- Somatoform Disorders
Generalized Anxiety Disorder (GAD)
Characterized by excessive worry, difficulty concentrating, muscle tension, psychomotor restlessness, headaches, inability to relax, tremors, and vegetative symptoms like dizziness.
Dizziness: If physical objects appear to be moving, it may indicate a physical cause. If the patient feels unsteady and unsafe, it may be related to anxiety.
Panic Disorder
Characterized by a sudden onset of intense fear or discomfort, including a feeling of losing control, going crazy, or dying imminently. Physical symptoms include chest tightness, choking sensation, dizziness, unsteadiness, dry mouth, and hot/cold flashes. May also involve derealization and depersonalization.
Mixed Anxiety-Depressive Disorder
The most frequently diagnosed anxiety disorder. Often has organic causes, such as endocrine disorders (thyroid, hypoglycemia), heart conditions (arrhythmia, anemia), neurological disorders (epilepsy, MS), respiratory disorders (asthma, emphysema), HIV, tumors, collagen disorders, or iatrogenic causes.
Phobias
Agoraphobia: Fear of crowds, leaving home alone, open spaces, entering stores or enclosed spaces, and using public transportation.
Social Phobia: Fear of social situations and performing activities in front of others. Symptoms may include blushing, sweating, and trembling.
Specific Phobias: Irrational fears of specific objects or situations, such as claustrophobia (fear of enclosed spaces) or fear of spiders or dogs.
Obsessive-Compulsive Disorder (OCD)
One of the most distressing mental health conditions. Characterized by repetitive and intrusive thoughts (obsessions) and behaviors (compulsions).
Obsessions: Ideas, thoughts, images, or impulses that are repetitive, intrusive, and unwanted. Common themes include contamination, harm, symmetry, and religious or sexual content.
Compulsions: Repetitive behaviors or mental acts performed to reduce anxiety or prevent a dreaded event. Examples include handwashing, checking, counting, and repeating words silently.
Distinction between compulsions and impulsive behaviors: Compulsions aim to reduce anxiety and discomfort, while impulsive behaviors seek immediate gratification.
Reactions to Severe Stress
Acute Stress Reaction: A normal reaction to a traumatic event. Symptoms typically subside within hours or days.
Post-traumatic Stress Disorder (PTSD): Develops after exposure to a traumatic event. Symptoms include flashbacks, nightmares, avoidance of reminders of the trauma, and emotional numbing.
Adjustment Disorders: Difficulty coping with a stressful life event. Symptoms may include depression, anxiety, and behavioral problems.
Dissociative Disorders (Conversion Disorder)
Hysteria: Occurs when a person experiences a traumatic event that they cannot process or cope with. The psyche responds abnormally, leading to dissociation.
- Dissociative Amnesia: Forgetting specific events or periods, often related to trauma.
- Dissociative Fugue: Sudden and unexpected travel away from home, accompanied by amnesia for one’s identity or past.
- Dissociative Stupor: A state of decreased or absent voluntary movement and normal responsiveness to external stimuli.
- Trance and Possession Disorder: Temporary loss of the sense of personal identity and full awareness of the surroundings.
- Dissociative Identity Disorder (DID): The presence of two or more distinct personality states.
Somatoform Disorders
Characterized by physical symptoms that cannot be fully explained by a medical condition. Individuals with somatoform disorders are often preoccupied with their symptoms and may experience significant distress and impairment.
- Somatization Disorder: Multiple physical complaints across different body systems.
- Hypochondriasis: Preoccupation with fears of having or the idea that one has a serious disease.
- Somatoform Autonomic Dysfunction: Physical symptoms that suggest a medical condition affecting the autonomic nervous system.
- Persistent Somatoform Pain Disorder: Chronic pain that cannot be fully explained by a medical condition.
Treatment for Anxiety and Somatoform Disorders
Treatment typically involves a combination of medication (antidepressants and anxiolytics) and therapy (cognitive-behavioral therapy).
Depression
Prevalence and Risk Factors
Depression affects 5-11% of the population. The risk is higher if there is a family history of depression or personal history of mental health conditions. Depression has a high mortality rate, particularly due to suicide, which is more frequent in women between 20-40 years old. Marital status also plays a role, with separated, divorced, and single individuals having a higher prevalence than married individuals.
Sadness vs. Depression
Sadness: A normal emotion that can be triggered by positive or negative events. It can also be a symptom of a medical condition (e.g., side effect of corticosteroids).
Depression: A mood disorder characterized by persistent sadness, loss of interest in activities, and other symptoms that significantly impact daily life.
Symptoms of Depression
Depression can manifest in various ways, including:
- Affective symptoms: Low mood, sadness, irritability.
- Cognitive symptoms: Difficulty concentrating, negative thoughts, memory problems.
- Motor symptoms: Psychomotor retardation or agitation, fatigue.
- Somatic symptoms: Changes in appetite or sleep, decreased libido, physical aches and pains.
Factors Contributing to Depression
- Social factors: Stressful life events, relationship problems, social isolation.
- Biological factors: Genetics, neurochemical imbalances, hormonal changes.
- Psychological factors: Negative thinking patterns, low self-esteem, difficulty coping with stress.
Types of Depression
- Biological (endogenous): More severe and often requires medication.
- Social (reactive): Triggered by external stressors.
- Psychological: Related to personality traits and coping mechanisms.
Recognizing Depression
Depression often develops gradually, with symptoms such as a flat affect, lack of motivation, social withdrawal, and changes in behavior. Common symptoms include psychomotor retardation, fatigue, sadness, anxiety, anhedonia (loss of interest in pleasurable activities), sleep disturbances, low self-esteem, guilt, difficulty concentrating, changes in appetite, decreased libido, and suicidal thoughts.
Key Features of Depression
- Inability to enjoy previously pleasurable activities
- Loss of emotional reactivity
- Early morning awakening
- Worsening of mood in the morning
- Psychomotor retardation
- Decreased appetite and weight loss
- Significant decrease in libido
Grief
Grief is a natural response to loss. If grief persists and significantly impairs daily functioning, it may indicate a depressive disorder.
Stages of Grief
- Shock and denial (first month): Disbelief, searching for the lost person, intense pain, guilt, and identification with the deceased.
- Intense anguish (2-6 months): Social withdrawal, preoccupation with the loss, anger, and changes in behavior.
- Resolution (months to years): Gradual acceptance of the loss, return to activities, resumption of old roles, acquisition of new roles, renewed ability to experience pleasure, and seeking new relationships.