Day: March 21, 2011

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Never Let Go of Hope, Even When Depressed and Anxious

Linda, Lake of the Woods Run, 15 K

Image by ex_magician via Flickr

Self-Care Tip #214 – Never let go of hope, even when depressed and anxious.

Some blog-posts ago, Be Aware of Your Feelings was written and “M” asked,

What is the difference between depression and anxiety?

Anxiety and depression are like brother and sister.  They often go together.  When we think of “paradigms,” we think of an arch that might intersect with another arch.  However, when I think of the affective (or mood) spectrum intersecting with the anxiety spectrum, I see them weaving, interlaced or chasing each other.  Not a line and nothing tidy.  So understanding the difference also includes understanding their relationship.

In training, I remember presenting a patient with anxiety and depression to my psychiatry attending physician.  I hadn’t clarified the timeline of onset of symptoms.

When presenting, every resident physician knows the moment when they are found out.  The other residents on the rounding team instinctively lean back, try to take a step away even, so the lightening doesn’t singe them when it strikes.  I’m sure I smelled like fear too.

The reason the time of onset of symptoms is important, is that it tells us the primary disease process.  Knowing that, influences the speculations on patient recovery, duration of illness and our choices for treatment.  Some medications for depression can really activate anxiety and the patient might not enjoy the free-fall into hell after starting the antidepressants.  Also, there are some treatments that work better for different disease processes and such.

It’s common for someone who has suffered from depression on and off for years, but never from anxiety, to have their first panic-attack out of the blue, without trigger.  Bummer!  Then they start to roll.  Bam!  Bamm!  BAm! BAAM! BBBAm!  The panic attacks may come in spurts and then go away for a time.  The opposite is also true, starting off with anxiety, and followed by depression.

I don’t think anyone, including “M,” is asking me to talk about the differences between anxiety and depression in that depression is a state of sadness, and anxiety is a state of autonomic nervous system activation.  Rather there is the wonder of why they follow each other in course, why the are so often in each other’s company, why so many medications that treat one will treat the other, why they run in family histories and/or why they are both “so common.”  We have some ideas we use to answer but we don’t have enough objective information to explain.

Some of the good news is that these diseases are treatable.  The sooner they are treated and when treated to full recovery, the better the hope for long-term brain health is.  I have seen people feel defined by these diseases and trapped.  My job isn’t to minimize that, but rather to highlight what might bring hope.  Selling hope turns out to be one of my biggest jobs.  The same attending physician I mentioned above told me that.  He never stopped talking about hope.  Even for me.

Questions:  How do you answer “M’s” question?  How have you seen depression and anxiety move together and how have you responded to it?  What has given you hope when they did?  Or, when you saw this in someone else.  Please tell me your story.

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