We all know what it's like to feel low, or anxious or not quite in control of our lives, and these feelings are a normal part of the spectrum of human emotions. However, feelings of this kind can become out of control, or out of proportion to the situation that provokes them, and this is then regarded as a mild form of mental illness.
Depression and anxiety are known medically as affective disorders and are commonly seen by GPs. It is thought that one in five people seeking help from GP surgeries has psychological problems, and one in 10 suffers from depression. Combinations of anxiety and depression can also occur, particularly amongst women.
Depression
It has been estimated that 2.3 million people suffer from depression in the UK at any one time. The majority of these are suffering from a mild to moderate reactive depression, which relates to life circumstances. Many sufferers don't seek medical help, as they feel that a diagnosis of a mental-health problem is stigmatising. Polls have shown that 60% of people think that they would feel too embarrassed to consult their GP with a mental-health problem.
Symptoms of minor depression include low mood, tearfulness, loss of appetite, tiredness, poor sleep pattern, loss of sex drive and poor concentration. In patients with a mild depressive illness, the symptoms are distressing but not disabling. About 70% of mild to moderate depressive illnesses clear within six months.
Major depression is a much more severe, though less common illness. Symptoms are similar to mild illness but are more severe and disabling. With major depression, the mood is persistently low, often worse in the mornings. Feelings of despair, guilt and worthlessness are common. In the worst cases, speech, thought and movement become sluggish and a profound apathy develops. Suicidal thoughts are a frequent feature, and suicide amongst sufferers of major depression is not uncommon.
How can this be treated?
In cases of mild to moderate depression, a sympathetic ear, social support, and possibly counselling can help a lot of people, and provide a good alternative to drug therapies.
St John's Wort has been shown in clinical studies to be as effective as some prescribed medications in the treatment of mild to moderate depression. However, it has the potential to interact with a number of prescribed medications including digoxin, warfarin, and the combined contraceptive pill, so should only be considered after discussion with a pharmacist. It isn't available on prescription.
There are a number of prescribable anti-depressants that can be used where necessary. They almost all need to be taken for a minimum of three months to achieve permanent benefit. An average of 6-12 months treatment is not unusual. Major depressive illness often requires a combination of drug and psychological treatment and may require hospital admission. Severe depression may need treatment with ECT (electro-convulsive therapy), but this is much less commonly used than in years gone by.
Are anti-depressants addictive?
Unlike tranquillisers, such as Valium, anti-depressants do not cause physical addiction. For people who have had great benefit from them, and who have taken them for a long period of time, a psychological dependence can develop, whereby they are afraid to stop them in case their symptoms come back again. Some patients feel that they wouldn't be able to cope without them. This is not the same thing as addiction.
There has been a lot of publicity recently about the difficulties associated with stopping one particular anti-depressant drug called paroxetine (brand name Seroxat). Some patients have reported side-effects when trying to stop this medication. These can be avoided by gradual dose reduction.
Anxiety
Short-term situational anxiety is common and not abnormal, but around 5% of people develop what is known as a generalised anxiety disorder (GAD). This is a long-term condition that usually fluctuates in severity. It produces a variety of psychological and physical symptoms, including dry mouth, tremor, dizziness, headache, indigestion, palpitations, chest pain, hyperventilation, pins and needles and chest tightness. Sufferers often describe feelings of fearfulness, irritability, restlessness, sensitivity to noise and may experience nightmares and insomnia.
Other anxiety-related disorders include panic attacks and phobias. A less serious but well-recognised entity is the 'anxious personality', a person who has a lifelong tendency to experience tension and anxiety and seems to live in constant anticipation of adversity. Their medical records often carry a tag saying 'a worrier'.
What treatments are available?
Anxiety symptoms can be reduced by eliminating caffeine and other stimulants. The physical symptoms associated with anxiety disorders can be relieved by drugs called beta-blockers. Relaxation techniques and breathing exercises can be used to relieve tension and control anxiety surges.
Psychotherapy can be useful for long-term anxiety sufferers, especially therapies that encourage patients to rationalise their fears. Stress-management techniques can also be taught by trained therapists.
Drug treatment of anxiety disorders involves either the use of tranquillisers or one of a small number of anti-depressant drugs that are known to relieve anxiety as well. Benzodiazepine tranquillisers such as Valium can be very effective for short-term use, but aren't suitable for longer-term use because they are addictive. There is another tranquilliser called buspirone, which is not thought to be addictive, and so can be used for a longer period of time. Sufferers of (generalised anxiety disorders) GAD are more often treated with one of the anti-depressants that are also suitable for treating anxiety.
