Anxiety and depression are two of the most common mental health challenges affecting millions of people globally. As the conversation around mental health becomes more prevalent, so does the search for solutions. Fortunately, in the last 4 years since the beginning of the COVID-19 pandemic, therapy and mental health treatment has become more accessible. There are many online therapy services available including online psychiatric evaluation.
What is Depression?
Depression is a condition marked by persistent feelings of sadness and decreased interest or enjoyment in activities. There are various types of depression, each with its own characteristics and symptoms. By understanding the different types, individuals and their loved ones can better recognize the signs and seek appropriate depression treatment.
Types of Depression
Major Depressive Disorder (MDD)
Major Depressive Disorder (MDD), also known simply as clinical depression, is the most common form of depression. People with MDD experience persistent sadness or a lack of interest in daily activities for at least two weeks. Other symptoms include:
- Fatigue or loss of energy
- Difficulty concentrating
- Changes in sleep patterns (insomnia or excessive sleeping)
- Changes in appetite
- Feelings of worthlessness or guilt
- Thoughts of death or suicide
Persistent Depressive Disorder (PDD)
Persistent Depressive Disorder (PDD), formerly known as dysthymia, is a form of depression that lasts for at least two years. The symptoms are less severe than those of MDD, but they are long-lasting. Individuals with PDD might function day-to-day, but they often feel consistently down or hopeless. Common symptoms include:
- Low self-esteem
- Trouble making decisions
- Lack of energy
- Difficulty experiencing pleasure
Bipolar Depression
Bipolar Disorder is a mood disorder that includes depressive episodes. Typically the lows in bipolar disorder can be more severe and difficult to treat than people with unipolar depression.
The symptoms in bipolar depression are similar to the symptoms seen in MDD above
The key difference with bipolar is that the individual also demonstrates manic or hypomanic symptoms.
Seasonal Affective Disorder (SAD)
Seasonal Affective Disorder (SAD) is a form of depression that occurs at certain times of the year, typically during the fall and winter months when daylight is shorter. The reduction in sunlight can disrupt the body’s internal clock and lead to symptoms of depression, including:
- Low energy
- Difficulty sleeping
- Weight gain
- Irritability
- Social withdrawal
Postpartum Depression
Postpartum Depression occurs in women after childbirth. It’s more intense than the “baby blues,” which involve mild mood swings and anxiety. Postpartum depression can last for months or longer if untreated and may include symptoms such as:
- Severe mood swings
- Difficulty bonding with the baby
- Overwhelming fatigue
- Feelings of worthlessness or guilt
- Anxiety or panic attacks
Premenstrual Dysphoric Disorder (PMDD)
Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that causes emotional and physical symptoms before menstruation. Symptoms typically include:
- Extreme irritability or anger
- Severe mood swings
- Anxiety or tension
- Physical symptoms such as bloating, headaches, and joint pain
Atypical Depression
Atypical Depression is a subtype of depression with specific symptoms, such as:
- Increased appetite or weight gain
- Sleeping too much
- Heavy feeling in the arms or legs
- Sensitivity to rejection
- Temporary improvement in mood in response to positive events
Psychotic Depression
Psychotic Depression is a severe form of depression accompanied by psychosis, including hallucinations or delusions. People with psychotic depression may experience:
- False beliefs (delusions)
- Hearing or seeing things that aren’t there (hallucinations)
- Intense feelings of guilt or worthlessness
Treatment Options
Psychotherapy (Talk Therapy)
One of the most common and effective treatments for depression is psychotherapy, also known as talk therapy. It involves meeting with a mental health professional to explore emotions, thoughts, and behaviors that contribute to depression. Different types of psychotherapy have been proven effective, including:
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) helps individuals identify and change negative thought patterns and behaviors that contribute to their depression. It focuses on developing healthier ways of thinking and coping with stress, ultimately improving mood and behavior. CBT is highly structured and short-term, making it a popular choice for many people.
Interpersonal Therapy (IPT)
Interpersonal Therapy (IPT) is designed to improve communication and resolve issues in personal relationships that may be contributing to depression. It helps people identify and address interpersonal problems, such as conflicts with family or friends, that can cause or worsen depression.
Psychodynamic Therapy
Psychodynamic Therapy involves exploring unconscious patterns of thinking and behavior rooted in past experiences. By gaining insight into these patterns, individuals can better understand their emotions and develop healthier coping mechanisms.
Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy (DBT), a form of CBT, emphasizes regulating emotions and building skills to handle stress more effectively. DBT is especially useful for individuals who experience extreme emotional reactions or have difficulty managing intense feelings.
Medication
Antidepressants can be an important tool in addressing depression. They work by temporarily altering the brain’s chemistry to improve mood, increase energy levels, and reduce anxiety. There are several classes of antidepressants
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are the most commonly prescribed class of antidepressants. They work by increasing levels of serotonin, a neurotransmitter associated with mood regulation. Common SSRIs include:
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Escitalopram (Lexapro)
SSRIs are typically well-tolerated, but side effects may include nausea, weight gain, or sexual dysfunction.
Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
SNRIs work by increasing levels of both serotonin and norepinephrine, two neurotransmitters involved in mood regulation. Examples of SNRIs include:
- Venlafaxine (Effexor)
- Duloxetine (Cymbalta)
SNRIs are typically well-tolerated, but side effects may include nausea dry mouth, dizziness, or insomnia.
Tricyclic Antidepressants (TCAs)
Tricyclic Antidepressants (TCAs) are an older class of antidepressants that are generally prescribed when newer medications don’t work. TCAs are effective but may have more side effects, such as constipation, blurred vision, or drowsiness. Common TCAs include:
- Amitriptyline (Elavil)
- Nortriptyline (Pamelor)
- Atypical Antidepressants
Atypical Antidepressants don’t fit into other categories and work in various ways to alleviate depression. One common example is Bupropion (Wellbutrin), which works on dopamine and norepinephrine to improve mood and energy levels.
Ketamine
Ketamine, originally an anesthetic, has shown promise in treating depression by acting quickly to reduce symptoms, particularly in individuals with treatment-resistant depression. It works by influencing glutamate, a key neurotransmitter involved in mood regulation, which leads to rapid improvements in mood and cognition. Unlike traditional antidepressants, ketamine can provide relief within hours to days, making it a valuable option for those who haven’t responded to other treatments. Preliminary data shows that Ketamine assisted psychotherapy may provide more long lasting results than Ketamine alone.
Lifestyle Changes
Along with professional treatment, making certain lifestyle adjustments can help manage symptoms of depression. While lifestyle changes alone may not be enough to treat severe depression, they can complement other treatments and improve overall well-being.
Exercise
Regular physical activity has been shown to reduce symptoms of depression. Exercise releases endorphins, which are natural mood lifters. Even moderate activities like walking, swimming, or yoga can make a difference in how you feel.
Nutrition
A healthy diet plays a role in mental health. A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help regulate mood. Omega-3 fatty acids, found in fish like salmon, have been linked to improved brain health and reduced symptoms of depression.
Sleep Hygiene
Sleep disturbances are common in depression, but establishing good sleep hygiene can help. Sticking to a regular sleep schedule, creating a relaxing bedtime routine, and limiting screen time before bed are some ways to improve sleep quality.
Mindfulness and Meditation
Practicing mindfulness and meditation can help people with depression focus on the present moment, reduce stress, and regulate emotions. Techniques like deep breathing and body scanning are useful tools for calming the mind and reducing negative thought patterns.
Alternative and Complementary Therapies
Some individuals find relief from depression through alternative or complementary therapies, which can be used alongside traditional treatments.
Acupuncture
Acupuncture, the ancient practice of inserting thin needles into the body at specific points, has been used to relieve symptoms of depression. Some studies suggest that acupuncture may help by balancing energy in the body and reducing stress.
Light Therapy
For individuals with Seasonal Affective Disorder (SAD), light therapy can be particularly effective. It involves sitting in front of a lightbox that mimics natural sunlight for about 20-30 minutes each day. This exposure helps regulate the body’s sleep-wake cycle and improves mood.
Electroconvulsive Therapy (ECT)
Electroconvulsive Therapy (ECT) is a highly effective treatment for severe or treatment-resistant depression. ECT involves delivering controlled electrical currents to the brain while the patient is under anesthesia. This triggers a brief seizure, which alters brain chemistry and can rapidly relieve symptoms of depression. Despite misconceptions, ECT is a safe and often life-saving procedure used when other treatments haven’t worked.
Transcranial Magnetic Stimulation (TMS)
Transcranial Magnetic Stimulation (TMS) is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. TMS is often used when traditional treatments, such as medication and therapy, have not been effective. It’s generally well-tolerated and has fewer side effects than ECT.
What is Anxiety?
Anxiety is characterized by excessive worry or fear that is difficult to control and that significantly interferes with daily functioning.
Anxiety Symptoms
Symptoms of anxiety can vary depending on the individual but commonly include both physical and emotional signs. Some key symptoms include:
Emotional Symptoms:
- Excessive worry or fear
- Restlessness or feeling on edge
- Difficulty concentrating
- Irritability
- Anticipating the worst or catastrophizing
- A sense of impending danger or panic
Physical Symptoms:
- Rapid heart rate (palpitations)
- Sweating
- Trembling or shaking
- Shortness of breath
- Dizziness or lightheadedness
- Muscle tension
- Fatigue
- Headaches
- Trouble sleeping (insomnia)
Managing and Treating Anxiety
A lot of anxiety treatments overlap quite a bit with the treatments described above for depression. A lot of the therapies including CBT, IPT, psychodynamic therapy, and DBT are effective for anxiety as well. Similarly, a lot of the antidepressants above are also first line treatments for anxiety. Some notable differences for treatment are as follows:
Therapies
Exposure Therapy
Exposure therapy is particularly effective for specific phobias, panic disorder, and social anxiety. It involves gradually exposing a person to the source of their fear in a controlled way to help them overcome it. Over time, this can reduce the anxiety associated with the feared object, situation, or thought.
Acceptance and Commitment Therapy (ACT)
ACT encourages individuals to accept their anxious thoughts and feelings rather than trying to avoid or fight them. It emphasizes living in alignment with one’s values despite anxiety and teaches mindfulness strategies to stay grounded in the present moment.
Mindfulness-Based Cognitive Therapy (MBCT)
MBCT combines mindfulness practices with cognitive therapy to help individuals become aware of their anxiety without judgment. This approach focuses on preventing the recurrence of anxiety and depression by breaking negative thought patterns through mindfulness.
Eye Movement Desensitization and Reprocessing (EMDR)
EMDR is often used to treat trauma-related anxiety, such as in cases of PTSD. It involves the patient recalling distressing memories while receiving bilateral stimulation (like side-to-side eye movements), which helps reprocess the traumatic event and reduce its emotional impact.
Medications
- Antidepressants as described above
- Buspirone
Buspirone is a medication that impacts Serotonin and Dopamine but is indicated just for anxiety.
- Benzodiazepines
Benzodiazepines are fast-acting medications used for short-term relief of severe anxiety symptoms. They work by enhancing the effects of a neurotransmitter called GABA, which has a calming effect on the brain. However, they can be habit-forming, so they are usually prescribed for short-term use.
- Beta-Blockers
Beta-blockers are primarily used to manage physical symptoms of anxiety, such as rapid heart rate and trembling. They are often prescribed for situational anxiety, such as performance anxiety.
- Antihistamines
Certain antihistamines, like Hydroxyzine (Vistaril), can be used short-term to manage anxiety symptoms. They have sedative effects but are non-habit forming and are sometimes prescribed when benzodiazepines are not appropriate.
Can Anxiety and Depression be Cured?
Anxiety and depression can often be effectively managed rather than cured.. Many people can achieve long-term remission with appropriate treatment. For some, symptoms may significantly improve or disappear for extended periods, but stress, life events, or other triggers can sometimes cause a recurrence.
Treatments like therapy (especially Cognitive Behavioral Therapy), medication (such as antidepressants), and even lifestyle changes (like exercise and mindfulness) promote neuroplasticity, helping to “rewire” the brain. By encouraging the formation of healthier neural pathways, neuroplasticity enables individuals to break free from negative thought loops and develop more positive, adaptive coping mechanisms, ultimately building resilience against future episodes.
Finding a Psychiatrist or Therapist for Anxiety and Depression
Our goal at A Better Day Psychiatry is to help our patients develop coping strategies, reduce symptoms, and improve their overall quality of life. While anxiety and depression may not always be “cured,” many people live fulfilling, symptom-free lives with the right support.