Anxiety and depression

Can someone have too much anxiety?

Yes, while anxiety is a normal emotion, it is possible to have too much. When anxiety is excessive, the ability to function is compromised.

There are many causes of excessive anxiety, including medical or psychiatric disorders, medications, and drugs of abuse (including caffeine). The most common cause of anxiety, though, is when a person's ability to cope is exceeded by their stressors. Stress is any physical or mental demand placed on a person. Similar to pain, anxiety can be a signal to a person. That signal is telling them their systems are being overwhelmed.

The best way to deal with this type of anxiety is to both reduce stressors and increase the ability to cope. Ways to reduce stresses might include dropping a course, cutting back hours on a job, or saying no to some social demands. While a simple decision, it can be a difficult one to make. Ways to increase coping ability might include exercise, adequate sleep, a healthy diet, improved time management, and increased relaxation time. Relaxation strategies include such things as muscle relaxation, meditation, or listening to music. These strategies are best done on a regular basis, as they work better to prevent excessive anxiety. (It's hard to relax when anxiety is excessive.)

Medical disorders (such as a thyroid problem) and psychiatric disorders (such as panic disorder or depression) can also cause excessive anxiety. In the college-age population, psychiatric disorders are a common cause of anxiety. Most anxiety disorders do respond to treatment. In addition to the above strategies, treatment might include medications and/or psychotherapy.

How do I know if I have depression?

Depression affects more than 16 million people a year. You may frequently hear someone say, "I'm depressed," but clinical depression differs in many ways from a sad mood. It lasts longer (at least two weeks) and affects more than just one's mood. It is not something that you can just "snap out of."

Clinical depression has several types:

• Major depression (significant symptoms lasting at least two weeks)
• Dysthymia (chronic depression or persistent depressive disorder)
• Bipolar or manic-depressive illness (presence of both depressive and manic episodes)
• Seasonal affective disorder (depression that comes on during winter)

Symptoms of clinical depression usually begin by early adulthood. In addition to depressed mood, symptoms of depression can include:

• Change in appetite with significant weight loss or gain 
• Disturbed sleep patterns (sleeping fitfully or sleeping too much) 
• Loss of interest and pleasure in life 
• Inability to concentrate or make decisions 
• Loss of energy 
• Feelings of inappropriate guilt 
• Recurring thoughts of death or suicide 
• Physical changes (headaches or constipation) 

Treatment

The good news is depression is a very treatable disorder. About 80 to 90 percent of people will improve significantly with treatment with almost all obtaining some relief of symptoms. Treatment for depression can include psychotherapy (individual or group) and medications, often used in combination. Psychotherapy is done by many mental health professionals, including social workers, psychologists, and psychiatrists.

All of the commonly used antidepressants are effective for clinical depression. They are not addictive substances, but they do take time to work (on average about two weeks).

The decision to use a medication is ultimately the patient's. This is made in consultation with a physician. Most psychiatric disorders respond to treatment with medications. In general the antidepressants are safe and well tolerated medications. Common side effects include nausea, dry mouth, sedation, headaches, agitation, and sexual dysfunction. Most of the time side effects, if present, are mild and transient. These risks of medications must be balanced against the risks of the illness. An illness such as clinical depression can have lethal complications (suicide).

Sertraline (Zoloft) is a type of an antidepressant known as a selective serotonin reuptake inhibitor (or SSRI). It works by altering the levels of serotonin in the brain. Through mechanisms not fully understood the brain will adapt to the change in serotonin. These changes increase the chance the depression will lift. Other medications in this class include fluoxetine (Prozac), citalopram (Celexa) and escitalopram (Lexapro). While all of these medications work in the same way, they differ some in side effects. The most common reason to use an antidepressant is for treatment of a clinical depression. Other conditions for which SSRIs are used include anxiety disorders (such as obsessive-compulsive disorder and panic disorder). 

If you or someone you know thinks they might benefit from a medication, then an evaluation with a psychiatrist or primary care provider is warranted.