Anxiety and Depression causes, symptoms, and treatments

According to the American Psychological Association, anxiety is an emotion characterized by feelings of tension, worried thoughts and physical changes like increased blood pressure. Anxiety is not the same as fear but the terms are often used interchangeably. 

Depression is a mood disorder that causes persistent feeling of sadness and loss of interest. The American Psychiatric Association`s diagnostic statistical manual of mental disorders, fifth edition classifies depressive disorders into:

1. Disruptive mood dysregulation disorder 
2. Major depressive disorder
3. Persistent depressive disorder (dysthymia)
4. Premenstrual dysphoric disorder
5. Depressive disorder due to another medical condition (https://www.ncbi.nlm.nih.gov/books/NBK430847/)

What are the potential causes of anxiety? 

Certain medical problems that maybe linked to anxiety may include:

• Heart disease
• Diabetes
• Thyroid disorders for e.g. hyperthyroidism
• Respiratory disorders such as chronic obstructive pulmonary disease or asthma
• Drug misuse or withdrawal
• Alcohol withdrawal, anti-anxiety medication (benzodiazepines) or other medication
• Chronic pain or irritable bowel syndrome
• Rare tumors that produce certain fight-flight hormones

Risk factors such as exposure to trauma, suffering from a serious chronic illness, stress, personality type or having other mental illness may contribute to anxiety. (https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961) 

What are the causes of depression?

Several factors contribute to develop depression which may include:

• Brain chemistry: an imbalance of neurotransmitters including serotonin and dopamine
• Genetics: having a first degree relative diagnosed with depression predisposes an individual thrice likely to get depression
• Stressful life events: such as death of loved one, trauma, divorce, isolation and lack of support can trigger depression
• Medical conditions: such as long-term illness, diabetes, cancers can lead to depression
• Medications: can cause depression as side effect. Alcohol abuse can also cause depression or make it worse. 

What are the various types of anxiety disorders?

1. Generalized anxiety disorder: this condition causes fear, worry and a constant feeling of being overwhelmed. It`s characterized by excessive, frequent and unrealistic worry about everyday things such as job responsibilities, daily chores or health.
2. Agoraphobia: this condition causes an intense fear of becoming overwhelmed or unable to escape or get help. People with agoraphobia often avoid new places and unfamiliar situations, like large, open areas or closed spaces.
3. Panic disorder: this condition involves multiple unexpected panic attacks usually without a warning.
4. Specific phobia: a phobia is when something causes extreme fear or anxiety that disrupts life. There are several types of phobias linked to specific diagnosis for e.g. claustrophobia is a fear of closed spaces. 
5. Social anxiety disorder: a condition of having intense fear of being judged negatively or being watched by others.
6. Separation anxiety disorder: is the feeling of excessive anxiety after being separated from a loved one like a care giver. 
7. Selective mutism: happens when one avoids to talk in certain situations because of fear or anxiety. (https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders) 

How are anxiety and depression treated?

Other than treating the underlying health condition, following are known treatments that help treat anxiety and depression:

• Medications such as selective serotonin reuptake inhibitors (SSRIs viz citalopram), serotonin/norepinephrine reuptake inhibitors (SNRIs viz venlafaxine), atypical anti-depressants (mirtazapine), tricyclic anti-depressants (amitriptyline) are used to treat depression and anxiety. 
• Interpersonal therapy (IPT) is a time limited treatment for major depressive disorder. IPT draws from attachment theory and emphasize the role of interpersonal relationships, focusing on current interpersonal difficulties. Specific areas of emphasis include grief, interpersonal disputes, role transitions and interpersonal deficits. (https://www.ncbi.nlm.nih.gov/books/NBK430847/) 
• Exposure therapy is a type of therapy where the therapist creates a safe environment to expose the patient to fears. Fears maybe things, situations or activities. Exposure therapy helps demonstrate the patient of his/her capabilities to confront fears by attaching new realistic beliefs to the things they`re afraid of. (https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders) 

Regular exercises: The WHO guidelines (2020) recommend at least 150-300 minutes of moderate to vigorous exercise each week for adults aged between 18-64 years. Benefits of exercises in mental health are known to be triggered by exercise-induced increased blood circulation in the brain which leads to physiological changes in the hypothalamic-pituitary axis (HPA). The HPA communicates with various regions within the brain including the limbic system, which controls motivation and mood; the amygdala, which generates fear in response to stress; and the hippocampus, which plays and important part in memory formation as well as in mood and motivation. Depending upon the intensity of exercise, the brain releases chemical messengers called the “neurotransmitters” which relays communication throughout the various parts of the nervous system. The most common neurotransmitter released during a bout of exercise are endorphins which is responsible for blocking pain within the body, increase sensation of pleasure and relaxation. Studies have suggested that the combined effects of endorphins and endocannabinoids working in tandem produces euphoria. 

Psychotherapy in the form of cognitive-behavioral therapy (CBT) is a structured, and didactic form of therapy that focuses on helping individuals identify and modify maladaptive thinking and behavioral patterns. CBT for depression typically includes behavioral strategies (i.e. activity scheduling) as well as cognitive re-structuring to change negative automatic thoughts and addressing maladaptive schemas. Research indicates that mindfulness-based cognitive therapy (MBCT) is effective in reducing the risk of relapse in patients with recurrent depression, especially in those with the most severe residual symptoms. 

Dopamine is another neurotransmitter released after exercise which produces the feeling of pleasure. It is also responsible for other processes in the body like regulating heart rate, sleep cycle, mood, attention, motivation, memory, learning and pain processing. 

• Limiting or avoiding caffeine and alcohol.
• Participating in support groups for people having anxiety and depression can provide opportunities to relate with others, share experiences and learn different coping strategies. (https://my.clevelandclinic.org/health/diseases/9536-anxiety-disorders) 
• Use stress management and relaxation techniques: visualisation techniques, imagery, meditation, yoga, breathing techniques and practicing mindfulness can help ease anxiety and cope with depressed moods. 
• Writing a journal can help keep track of personal life events and spot triggers for anxiety or cause of stress. 
• Learn time management techniques to prioritise and organise schedule to minimise stress and anxiety. (https://www.mayoclinic.org/diseases-conditions/anxiety/diagnosis-treatment/drc-20350967) 

A one-hour massage lowers cortisol in your body while also releasing serotonin. This hormone neurotransmitter is sometimes called the "happy chemical" because it reduces feelings of depression and carries signals between nerves and your body. By lowering cortisol and increasing serotonin, you're boosting your body's ability to fight off pain, anxiety and feelings of sadness. (https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/massage-for-depression-anxiety-and-stress) 

Eating a healthy diet: Studies have compared "traditional" diets, like the Mediterranean diet and the traditional Japanese diet, to a typical "Western" diet and have shown that the risk of depression is 25% to 35% lower in those who eat a traditional diet. Scientists account for this difference because these traditional diets tend to be high in vegetables, fruits, unprocessed grains, and fish and seafood, and to contain only modest amounts of lean meats and dairy.

Quality sleep of about 7 to 8 hours consistently at night is highly recommended for better mental health. A study led by researchers at University of York, conducted in 2020 included 600 participants, highlighted that chronic stress chronic stress is a major risk factor for a number of mental health disorders including depression and anxiety. Conclusively, the research shows quality sleep can bolster resilience to depression and anxiety.