October 31, 2014

Anxiety/Depression

Depression and anxiety are the most common psychological disorders. These disorders affect us all. Not only they affect our daily functioning at work, in school, and relationally, but they also create financial burden through decreased productivity and treatment cost. Find out what the symptoms of anxiety and depression are.

Depression

Depression is the fourth-ranked cause of disability and premature death worldwide. Depression-related lost productivity costs the U.S. economy more than $33 billion a year. Depression is now recognized as a chronic illness with variable recovery patterns from patient to patient. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM IV, provides the criteria needed to make the diagnosis of major depression. Symptoms of major depression include:

  • Depressed mood (in children and adolescents can be irritable mood)
  • Markedly diminished interest or pleasure in all, or almost all, activities
  • Significant weight loss when not dieting or weight gain (in children consider failure to make expected weight gain)
  • Insomnia or hypersomnia
  • Psychomotor agitation or retardation
  • Fatigue or loss of energy
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate, or indecisiveness

To be considered clinically depressed the individual should have depressed mood or loss of interest or pleasure plus at least four more symptoms for two weeks or longer.

The symptoms are experienced nearly every day and for most of the day. They also cause significant distress or impairment in social, occupational, or other important areas of functioning. If depression continues for two years, it is called chronic depression.

Other types of depression include Melancholic, Post Partum, and Seasonal.

  • Melancholic depression includes loss of pleasure in all or almost all activities with a distinct quality of depressed mood. Depression is usually worse in the morning and can also cause early morning awakening. Other symptoms are psychomotor retardation or agitation, significant anorexia or weight loss, and excessive or inappropriate guilt.
  • Post Partum depression, which occurs within four weeks after child delivery, is very different from the “baby blues,” which happens within three to four days and is short-lived. Psychotic symptoms can unfortunately be present, in addition to psychomotor agitation, anxiety, insomnia, and disinterest in the new baby. Based on severity, the mother may even have obsessive thoughts about inflicting physical harm on the child.
  • Seasonal depression is more likely to happen among women and young people, as well as among those who live in higher latitudes. Depressive symptoms also include anger, hypersomnia, overeating and weight gain, and a craving for carbohydrates.

Anxiety Disorders

Anxiety Disorders are among the most prevalent mental disorders in the general population. Anxiety itself is a natural adaptive response. But in anxiety disorders, anxiety has become pathological. Not only is it no longer adaptive but also it impairs interpersonal functioning, work performance, and at times simple daily functioning. Anxiety Disorders are diagnosed based on specific criteria described in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR). Boston CBT Center™ provides services for some of these Anxiety Disorders, specifically for Generalized Anxiety Disorders (GAD), Social Anxiety Disorders or Social Phobia, and Panic Disorders with or without agoraphobia.

DSM IV-TR Criteria for a Panic Attack

A panic attack is a period of intense fear or discomfort, developing abruptly and peaking within 10 minutes, and requiring at least four of the following:

  • Chest pain or discomfort
  • Chills or hot flushes
  • Derealization (feelings of unreality) or depersonalization (being detached from oneself)
  • Fear of losing control
  • Feeling dizzy, unsteady, light-headed, or faint
  • Feeling of choking
  • Nausea or abdominal distress
  • Palpitations or tachycardia
  • Paresthesias (numbness or tingling sensation)
  • Sensations of shortness of breath or smothering
  • Sense of impending doom
  • Sweating
  • Trembling or shaking

DSM IV-TR Criteria for Generalized Anxiety Disorder

  • Excessive anxiety about a number of events or activities, occurring more days than not, for at least 6 months.
  • The person finds it difficult to control the worry.
  • The anxiety and worry are associated with at least three of the following six symptoms (with at least some symptoms present for more days than not, for the past 6 months):
    • Restlessness or feeling keyed up or on edge
    • Being easily fatigued
    • Difficulty concentrating or mind going blank
    • Irritability
    • Muscle tension
    • Sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

DSM IV-TR Criteria for Panic Disorder

  • Recurrent unexpected panic attacks
  • At least one of the attacks has been followed by at least 1 month of one or more of the following:
    • Persistent concern about having additional panic attacks
    • Worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, “going crazy”)
    • A significant change in behavior related to the attacks
  • Presence or absence of agoraphobia
  • The panic attacks are not due to the direct physiologic effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).
  • The panic attacks are not better accounted for by another mental disorder such as Social Phobia (e.g. occurring on exposure to feared social situation)

DSM IV-TR Criteria for Agoraphobia

  • Fear of being in places or situations from which escape might be difficult (or embarrassing) or in which help might not be available in the event of having unexpected panic-like symptoms.
  • The situations are typically avoided or require the presence of a companion.
  • The condition is not better accounted for by another mental disorder.

DSM IV-TR Criteria for Specific Phobia

  • Persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).
  • Exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, which may take the form of a situationally bound or situationally predisposed panic attack.
  • Patients recognize that the fear is excessive or unreasonable.
  • Patients avoid the phobic situation or else endure it with intense anxiety or distress.
  • The distress in the feared situation interferes significantly with the person’s normal routine, occupational functioning, or social activities or relationships.
  • In persons younger than 18 years, the duration is at least 6 months.
  • The fear is not better accounted for by another mental disorder.

DSM IV-TR Criteria for Social Phobia

  • A fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others. The individual fears that he or she will act in a way that will be humiliating or embarrassing.
  • Exposure to the feared social situation provokes anxiety, which may take the form of a panic attack.
  • The person recognizes that the fear is excessive or unreasonable.
  • The feared social or performance situations are avoided or are endured with distress.
  • The avoidance, anxious anticipation, or distress in the feared situation interferes significantly with the person’s normal routine, occupational (academic) functioning , or social activities or relationships, or there is marked distress about having the phobia.
  • The condition is not better accounted for by another mental disorder, substance use, or general medical condition
  • If a general medical condition or another mental disorder is present, the fear is unrelated to it.
  • The phobia may be considered generalized if fears include most social situations.

All above information come from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text rev. Washington, DC, American Psychiatric Association, 2000.