Losing a loved one, being fired from a job, getting divorced, and other difficult situations can make a person feel sad, lonely, and scared.
These feelings are normal reactions to stressors in life. Most people feel sad sometimes. However, in the case of people who are diagnosed with depression as a psychiatric disorder, the manifestations of low mood are much more severe and tend to persist.
Depression occurs more often in women than in men. Some differences in the way depressed mood manifests have been found based on gender and age.
In men, it often manifests as tiredness, irritability, and anger. They may show more reckless behavior and abuse drugs and alcohol. They also tend not to recognize that they are depressed and do not seek help.
In women, depression tends to manifest itself as sadness, worthlessness, and guilt. In younger children, depression is more likely to manifest itself as school refusal, anxiety when separating from parents, and concern about the death of parents.
Depressed teens tend to be irritable, moody, and get into trouble at school. They also often have comorbid anxiety, eating disorders, or substance abuse.
Types of depression
There are different types of depressive disorders, and while there are many similarities between them, each depressive disorder has its own unique set of symptoms.
The most common form of diagnosed depression is major depressive disorder. Depression is the leading cause of disability in the United States among 15- to 44-year-olds.
Major depression is characterized by at least five of the diagnostic symptoms of which at least one of the symptoms is an overwhelming feeling of sadness or a loss of interest and pleasure in most habitual activities.
The other symptoms associated with major depression include:
- Decreased or increased appetite.
- Insomnia or hypersomnia.
- Psychotic motor agitation or retardation.
- Constant fatigue
- Feelings of worthlessness or excessive and inappropriate guilt.
- Recurring thoughts of death and suicidal ideation with or without specific plans to commit suicide.
- Cognitive difficulties, such as decreased ability to think, concentrate, and make decisions.
Symptoms persist for two weeks or more and represent a significant change from previous functioning. The social, occupational, educational, or other important functioning aspect is also affected.
For example, the person may start to lose work or school, or stop going to class or their usual social activities.
Another type of depression is called persistent depressive disorder (dysthymia). The essential feature of this mood disorder is a low, dark or sad mood.
This state can persist for most of the day and on most days, for at least 2 years (children and adolescents may experience predominantly irritability and the mood persists for at least 1 year).
For the individual to be diagnosed with persistent depressive disorder, they must also have two of the diagnostic symptoms which include:
- Lack of appetite or overeating.
- Insomnia or hypersomnia.
- Energy or fatigue
- Low self-esteem.
- Lack of concentration.
- Difficulty making decisions or feelings of hopelessness during this period.
Symptom-free intervals last more than two months.
The symptoms are not as severe as with major depression. Major depression can precede persistent depressive disorder.
Premenstrual dysphoric disorder is another manifestation of depression, which is a severe and sometimes disabling extension of premenstrual syndrome (PMS).
Although regular PMS and premenstrual dysphoric disorder (PMDD) have physical and emotional symptoms, mood swings in PMD are much more severe and can disrupt social, occupational, and other important areas of functioning.
In both premenstrual dysphoric disorder and PMS, symptoms generally begin seven to ten days before the start of a menstrual period and continue through the first few days of the period.
Both tdpm and pms can also cause breast tenderness, swelling, fatigue, and changes in sleep and eating habits.
Tdpm is characterized by more severe emotional and behavioral symptoms, such as sadness or hopelessness, anxiety or tension, extreme moodiness, irritability, or anger.
Some medical conditions can trigger depressive symptoms in people. This is called depressive disorder due to another medical condition.
Endocrine and reproductive system disorders are commonly associated with depressive symptoms. For example, people with low thyroid hormone levels ( hypothyroidism ) often experience fatigue, weight gain, irritability, memory loss, and poor mood.
When hypothyroidism is treated, it generally reduces depression. Cushing syndrome is another hormonal disorder caused by high levels of the hormone cortisol that can also cause depressive symptoms.
Other conditions that have been found to cause depression include conditions such as HIV / AIDS, diabetes, strokes, Parkinson’s disease, etc.
Depressed mood adjustment disorder is diagnosed when symptoms of depression are triggered within 3 months of the onset of a stressor.
The stressor generally involves a change of some kind in the life of the individual that is stressful for them. Sometimes the stressor can even be a positive event, such as a new job, marriage, or baby, which is nonetheless stressful for the individual.
The distress is often disproportionate to the expected reaction and the symptoms cause significant distress and impairment in functioning.
Symptoms generally resolve within 6 months when the person begins to cope with and adjust to the stressor or the stressor is eliminated.
Treatment tends to be time-limited and relatively simple as a little extra support during the stressful period helps the person recover and adjust.
Another type of depression is related to changes in the length of days or seasonality. This type of depression is called seasonal affective disorder (SAD). People with SAD experience symptoms of major depressive disorder only during a specific time of year, usually in winter.
This appears to be related to shorter winter days and a lack of sunlight in many parts of the country.
Differences between depression and anxiety disorders
Depression and anxiety disorders are different, but people with depression often experience symptoms similar to those of an anxiety disorder, such as:
- Trouble sleeping
- Trouble concentrating
But each disorder has its own causes and its own emotional and behavioral symptoms.
Many people who develop depression have a history of an anxiety disorder earlier in life. There is no evidence that one disorder causes the other, but there is clear evidence that many people have both disorders.
The more specific symptoms of an episode of major depression are:
- Persistent sad, anxious or “empty” mood.
- Feelings of guilt, worthlessness, helplessness.
- Loss of interest or pleasure in hobbies and activities, including sex.
- Decreased energy, fatigue, feeling “slowed down.”
- Difficulty concentrating, remembering, making decisions.
- Insomnia, waking up early in the morning, or sleeping too much.
- Low appetite and weight loss or overeating and weight gain.
- Thoughts of death or suicide, suicide attempts.
- Restlessness, irritability.
- Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and pain for which no other cause can be diagnosed.
Causes of anxiety
In an anxiety-related disorder, your fear or worry does not go away and it may get worse over time. It can influence your life to the extent that it can interfere with daily activities, such as school, work, and / or relationships.
Fear, stress, and anxiety are “normal sensations and experiences,” but they are completely different from having any of the seven diagnosable disorders plus substance-induced anxiety, obsessive-compulsive disorders, and trauma or stressor-related disorders.
There are several different disorders related to anxiety. Some symptoms overlap in many of these disorders, and others are more specific to a single disorder.
In general, however, all anxiety-related disorders feature worry, nervousness, or fear that is ongoing, excessive, and has negative effects on a person’s ability to function.
It can be difficult to decide when anxiety is typical or related to a disorder, so diagnoses must be made by licensed professionals, such as psychologists or psychiatrists.
A useful approach to distinguish normal anxiety from an anxiety disorder is to identify the cause of the anxiety and then assess whether the anxiety symptoms are a proportional response to it.
Intrusive worries, fears, and thoughts that are extreme, unrealistic, or exaggerated and interfere with normal life and functioning could constitute an anxiety disorder.
For example, worrying about getting sick and taking steps to avoid germs, such as using hand sanitizer and avoiding touching door handles, does not necessarily constitute an anxiety disorder.
However, if worry about the illness makes it difficult to leave the house, then the person may have an anxiety-related disorder.
There are many disorders related to anxiety, and they fall into three main categories:
- Anxiety disorders.
- Obsessive-compulsive and related disorders.
- Trauma and stressor-related disorders.
Anxiety disorders: are characterized by a general characteristic of excessive fear (i.e., emotional response to a perceived or actual threat) and / or anxiety (i.e., worrying about a future threat) and can have negative emotional and behavioral consequences .
Obsessive-compulsive and related disorders: characterized by obsessive and intrusive thoughts (eg, constant concern about staying clean or about body size) that trigger related compulsive behaviors (eg, repeated hand washing or excessive exercise) .
These behaviors are done to relieve anxiety associated with obsessive thoughts.
Anxiety disorders related to trauma and stressor: they relate to the experience of a trauma (for example, unexpected death of a loved one, a car accident or a violent incident) or stressful (for example, divorce, beginning of the university, moving).
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the manual used for the diagnosis of mental health disorders, and is widely used by health professionals around the world.
For each disorder, the dsm has a description of the symptoms and other criteria for diagnosing the disorder. DSM is important because it allows different doctors and / or researchers to use the same language when discussing mental health disorders.
The first dsm was published in 1952 and has been updated several times after new research and knowledge became available. In 2013, the latest version of the dsm was released, the dsm-5. There are some important differences from its predecessor dsm-iv regarding anxiety disorders.
First, obsessive compulsive disorder (OCD) is no longer a part of anxiety disorders, but it now has its own category: obsessive-compulsive, stereotypical, and related disorders.
Second : Post-traumatic stress disorder (PTD) now has its own category, too: trauma and stress-related disorders.
However, if you are having trouble with the symptoms of an anxiety disorder, it is not uncommon to feel lonely and misunderstood because the fear that people with an anxiety disorder have is not experienced by others, they may not understand why.
For example, being in a crowd of people, not being able to wash your hands after meeting a new person, or driving down the street where you got into a car accident can be very anxious for someone with an anxiety disorder.
Not everyone understands that someone with an anxiety disorder cannot “just let things go.”
This makes dealing with an anxiety disorder even more difficult, and it can prevent someone from seeking help. However, it is very important to discuss these anxieties with someone and preferably seek a healthcare professional as soon as you experience these symptoms.
Anxiety should be considered as serious as a physical illness; however, most people in society do not appreciate the severity of this disorder.
Some people may view anxiety as a fault or a weakness; however, it may help if people realize that many research studies have shown biological explanations for (some of) the symptoms seen in anxiety disorders.
Brain scans have shown brain abnormalities in certain anxiety disorders, and altered brain function has also been shown in people with anxiety disorders. Also, there is some evidence that anxiety disorders could be related to chemical imbalances in the brain.
Types of anxiety
Anxiety disorders reflect disorders that share a general characteristic of excessive fear (i.e., emotional response to perceived or actual threat) and / or anxiety (i.e., anticipation of a future threat) and demonstrate behavioral and functional disorders as a result.
Panic attacks are a feature that can occur in the context of many anxiety disorders and reflect a type of fear response.
Separation anxiety disorder
Excess anxiety regarding separation from home or major attachment figures that is beyond what would be expected for one’s developmental level. This can occur in children, adolescents, or adults, but is most commonly found in children.
Symptoms vary depending on the type of anxiety disorder.
Generalized Anxiety Disorder – characterized by persistent, excessive, and unrealistic worries about everyday things.
Panic Disorders : The most obvious symptom is a seemingly out of the ordinary spontaneous panic attack and a worry and fear of a recurring attack.
A panic attack is characterized by the abrupt onset of intense fear or discomfort that reaches a peak within minutes, including at least four of the following symptoms.
- Palpitations, a pounding heart, or a racing heart rate.
- Sensations of shortness of breath or suffocation.
- Chest pain or discomfort
- Nausea or abdominal discomfort.
- Feeling dizzy, unsteady, or fainting.
- Chills or feelings of heat.
- Paresthesia (feeling of numbness or tingling).
- Feelings of unreality or being separated from oneself.
- Fear of losing control or “going crazy.”
- Affraid to die.
Social Anxiety Disorder : Symptoms vary from person to person, but the following are some of the most common that people with social anxiety disorder experience:
- Excessive sweating
- Muscle spasms.
- Nausea or other abdominal discomfort.
- Fast heartbeat
- Short of breath.
- Dizziness or lightheadedness
- Feeling separate.
- Loss of self-control.
Phobias – Irrational fears can involve a variety of things, including a fear that people are watching or following you, an extreme fear of objects (for example, dogs or spiders) or situations (for example, flying, elevators, or social situations ).
Irrational fears can become obsessive in nature, leading to persistent and intrusive thoughts that create significant anxiety and disruptive behaviors.
Obsessive Compulsive Disorder (OCD) : Repetitive and irrational thoughts can be accompanied by compulsive actions, routines, and rituals performed over and over again. The thoughts and rituals associated with OCD can cause terrible internal turmoil and interfere with optimal daily functioning.
Post-traumatic stress disorder (PTSD): While both men and women can experience the cardinal symptoms of PTSD (hyperarousal, re-experiencing, avoidance, and numbness), some behaviors are more prevalent in women than in men, including:
- Feeling nervous
- Trouble feeling emotions
- Avoid reminders of trauma.
The role of chronic pain in anxiety and depression
Scientists have always believed that there was a connection between chronic pain and anxiety, but the underlying correlations were not well understood.
Research published in August 2016 showed the expression of PACAP (pituitary adenylate cyclase activator polypeptide), a peptide neurotransmitter that the body releases in response to stress, increases in response to neuropathic pain, and contributes to anxiety symptoms.
While there was a marked increase in anxiety-related behaviors in chronic pain models, anxiety behaviors and pain hypersensitivity were significantly reduced when a PACAP receptor antagonist (designed to block response) was applied.
Management and treatment for depression and anxiety
Cognitive Behavioral Therapy (CBT) : Emotional and mental problems can cause normal information processing abilities to break down due to a consistently negative bias introduced into thinking, perpetuating a continuous cycle of negativity.
Therapy helps the patient to identify, challenge and transform distorted beliefs and negative and irrational thoughts into others that are empowering, realistic and positive.
It also teaches people healthy coping skills and behaviors. When people change the way they perceive themselves, it changes the way they react and see the world around them. As a result, depression, anxiety, and even physical pain are no longer debilitating.
Medications: Antidepressants are used to ease feelings of depression, but some may be prescribed for anxiety disorders and in smaller doses for people with chronic pain.
There are several different types of medications used to treat depression, including selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants, tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (imao).
Alternative therapies : Mindfulness approaches may include relaxation therapy, meditation, or guided meditation walks.
Biofeedback is an alternative therapy that teaches people to consciously control automatic bodily functions, such as reactions to stress or anxiety. Some treatment programs incorporate yoga or tai chi.
Acupuncture can help relieve pain because it is believed to release endorphins that block feelings of pain. Always talk to your doctor to make sure alternative therapies don’t interfere with conventional depression, anxiety, or chronic pain treatments.
When you manage your anxiety, you also take care of your physical health. Most people who seek treatment experience significant improvement and enjoy a better quality of life.
Whether you have everyday stress and anxiety or an anxiety disorder, you can learn strategies to help you manage your anxiety, even in your workplace.
Exercising, good nutrition, getting enough sleep, and trying to reduce stress all contribute to your well-being.