Mental Health Information on Depression, Stress, Anxiety Disorders

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Mental Health Information:

This page contains detailed information about:

Depression
Anxiety Disorders
Phobia
Stress

These can all be treated by our specialists. Please feel free to print out a copy for your personal use.

Depression:

Everyone gets low - some people think of this as the mental health equivalent of the common cold.

But for some people, low mood can be much more serious. It can paralyse a person's ability to get on with life - it can make them feel that there is no hope, and no point, in carrying on.

As with many mental health problems there are a number of symptoms; it's very rare for all symptoms to occur in one person. Unsurprisingly, the symptoms of depression include feeling generally miserable, and in addition to this other symptoms are:

Variation of mood over the day. It is often worse in the morning, and improves as the day goes on - but the pattern can be the other way around.

Disturbed sleep, usually waking early in the morning and being unable to get back to sleep. This is often because of all the negative thoughts that are racing through your head;

A general slowing down of thought, speech and movement;

Feelings of anxiety;

Short temper;

Lack of energy;

Inability to enjoy things;

Lack of concentration;

Feeling that you are forgetful;

Negative thoughts about the future;

Feelings of guilt;

Blaming self and low self-esteem;

Feeling hopeless;

Becoming pre-occupied with illness;

Loss of appetite and as a result loss of weight

Reduced desire for sex.

It is important to remember that depression is not an absolute, it is not a case of either you are depressed or you are not. There is a progression from simply feeling blue, to the full clinical illness described in this list.

Even then, not every symptom will occur. It is also important to remember that depression is treatable, and if you take the right steps, can be avoidable.

Though we all suffer low moods, from 7% to 12% of men will suffer diagnosable depression in their lifetime. The figure is from 20% to 25% for women. There are many theories as to why the figure is higher for women. The incidence of post-natal depression certainly contributes to the higher number.

Other theories include views on the position of women in society, and the difficulties they face in achieving life goals. It could also be that women may tend to be more honest about their emotions than men - and hence their depression is easier to detect.

Monitoring your mood and thoughts is the starting point for managing this problem. Doing this with the help of a psychiatrist can help you develop the skill of spotting an episode of depression before it becomes too late. Using the �thought monitoring technique�, you can decide which thoughts represent a true view of what is going on around you - and which thoughts are probably unrealistic and created by your mood beginning to lower.

You will not always spot every episode of depression before it happens. Those closest to you will often be able to recognise the early signs. Being able to talk to them about this problem is probably one of the most valuable strategies that you can have in dealing with this problem.

What support is available?

There's nothing like speaking to someone who has been through the experience and come out the other side or alternatively a psychiatrist who has many years experience with such cases. A listening ear is often the greatest help to a depressed person.

The use of a technique called cognitive behavioural therapy is recommended; there is a growing body of evidence for the effectiveness of this approach. A professional is usually the best person to see about cognitive therapy (or to assess an alternative form of therapy).

For some people, therapy alone may not be enough.There are now a number of anti-depressants (Psychotropic Medication) for psychiatrists to prescribe, which can be given in association with cognitive therapy. All the treatments listed above are carried out by privatepsychiatry.co.uk who have many years experience at dealing with such cases.

Anxiety Disorders:

Everyone experiences anxiety - in fact, being unable to experience anxiety can be a sign of quite a serious problem. We live in a world of hazards and anxiety is one of the strategies that the body uses to help the mind recognise danger and keep well out of its way.

As with most mental illnesses, it's not the presence of anxiety alone that creates problems. It is more about how severe it is - and how much it gets in the way of life.

Psychiatrists divide anxiety up into 4 main types:

i) General Anxiety (Generalised anxiety disorder - Gad)

ii) Panic Disorder (intense anxiety leading to crisis)

iii) Other Anxiety disorders (OCD)

iv) Phobias (i.e. Arachnophobia: fear of spiders...)

Treatments for all anxiety disorders are largely behavioural therapy based however, some drug intervention may be needed in some cases. See What support is available? below

i) Generalized anxiety disorder (GAD) is a severe and chronic anxiety disorder characterized by uncontrollable worrying and somatic anxiety (tension, insomnia and hypervigilance). It is a common condition, with lifetime prevalence rates for GAD in the general population of approx. 5-6% being reported.

Unlike phobia and panic, with general anxiety it is not always clear to the anxious person exactly what it is they feel so anxious about - they are just aware of feeling anxious all the time. When there is no identifiable cause, the sufferer often becomes anxious about feeling anxious all the time, and the problem starts to feed off itself.

Sufferers of generalised anxiety find that they:

easily lose their patience,

have difficulty concentrating,

expect the worst outcome in every situation,

think constantly about the worst outcome,

have difficulty sleeping

become depressed

become preoccupied/obsessional about one subject.

These mental symptoms lead to, and are supported by physical symptoms. These can include:

excessive thirst, stomach upsets, passing wind, loose bowel movements, frequent passing water, failure to respond to sexual stimulation, tight and painful chest, periods of intense pounding heart, periods of feeling winded, muscle aches, headaches, dizziness, pins and needles tremors, (and women may stop having periods or have painful periods).

The relationship of physical and mental symptoms can create a vicious cycle which can be triggered off by a symptom at any point.

ii) Panic Disorder (intense anxiety leading to crisis) is very similar in symptoms to GAD however with panic disorder the cycle of symptoms intensify and develop quickly to a crisis. With generalised anxiety, however, the sufferer often manages to keep things under control and the cycle grumbles on. The effort of keeping things under control is itself very stressful - and so adds fuel to the problem.

Panic Attack (PA) - an episode of panic that resembles an extreme form of anxiety attack and may sometimes result in temporary paralysis or fainting. People often describe a panic attack as, "a frantic feeling that I am about to die." Sensations of horror or terror can be extremely acute during a panic attack, to the degree that a person may fear going insane as a result. In panic disorder, such attacks typically last about half an hour; however, in extreme cases attacks may last several hours or even several days.

iii) Other Anxiety disorders:

Obsessive-compulsive disorder (OCD), one of the anxiety disorders, is a potentially disabling condition that can persist throughout a person's life. The individual who suffers from OCD becomes trapped in a pattern of repetitive thoughts and behaviours that are senseless and distressing but extremely difficult to overcome. OCD occurs in a spectrum from mild to severe, but if severe and left untreated, can destroy a person's capacity to function at work, at school, or even in the home.

Key Features of OCD are listed below:

Obsessions

These are unwanted ideas or impulses that repeatedly well up in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common. Again and again, the individual experiences a disturbing thought, such as, "My hands may be contaminated--I must wash them". These thoughts are intrusive, unpleasant, and produce a high degree of anxiety. Sometimes the obsessions are of a violent or a sexual nature, or concern illness.

Compulsions

In response to their obsessions, most people with OCD resort to repetitive behaviours called compulsions. The most common of these are washing and checking. Other compulsive behaviours include counting (often while performing another compulsive action such as hand washing), repeating, hoarding, and endlessly rearranging objects in an effort to keep them in precise alignment with each other. Mental problems, such as mentally repeating phrases, listmaking, or checking are also common. These behaviours generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals while others have rituals that are complex and changing. Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary.

Insight

People with OCD show a range of insight into the senselessness of their obsessions. Often, especially when they are not actually having an obsession, they can recognize that their obsessions and compulsions are unrealistic. At other times they may be unsure about their fears or even believe strongly in their validity.

Resistance

Most people with OCD struggle to banish their unwanted, obsessive thoughts and to prevent themselves from engaging in compulsive behaviours. Many are able to keep their obsessive-compulsive symptoms under control during the hours when they are at work or attending school. But over the months or years, resistance may weaken, and when this happens, OCD may become so severe that time-consuming rituals take over the sufferers' lives, making it impossible for them to continue activities outside the home.

Shame and Secrecy

OCD sufferers often attempt to hide their disorder rather than seek help. Often they are successful in concealing their obsessive-compulsive symptoms from friends and coworkers. An unfortunate consequence of this secrecy is that people with OCD usually do not receive professional help until years after the onset of their disease. By that time, they may have learned to work their lives--and family members' lives--around the rituals.

Long-lasting Symptoms

OCD tends to last for years, even decades. The symptoms may become less severe from time to time, and there may be long intervals when the symptoms are mild, but for most individuals with OCD, the symptoms are chronic.

iv) Phobia - an exaggerated fear. Anxiety and panic disorders are known to enhance pre-existing phobias or even introduce phobias not previously experienced. The so-called "simple phobias" or "specific phobias" are phobic responses to a specific thing; such as height. Simple phobias can often be treated with the progressive exposure techniques of behavioural therapies. However, agoraphobia and social phobia are often more complicated than a simple phobia and may require more sophisticated therapies.

The most common Phobias are listed below:

Animal

Arachnophobia - a fear of spiders.

Cynophobia - a fear of dogs

Ophiciophobia - a fear of snakes

Natural environment

Acrophobia - a fear of heights

Aquaphobia - a fear of water

Blood-injection-injury - (seeing blood or receiving an injection)

Hemophobia - a fear of blood

Trypanophobia - a fear of injections

Situational type

Aerophobia - a fear of flying.

Claustrophobia - a fear of closed spaces or being trapped. often occurs with elevators, escalators

Ochlophobia - a fear of crowds

Other type

Agoraphobia - a fear of anxiety or panic attacks that results in a growing avoidance of things or situations.

Xenophobia - a fear of anything unfamiliar. Though some anxiety is natural and healthy when encountering anything unfamiliar, xenophobia is an exaggerated form of this anxiety.

What support is available?

All the illnesses examined above are very similar, anxiety is a broad topic with different degrees and focuses (many of these illnesses relate to childhood experiences). By seeking professional help early, these symptoms can be overcome through a combination of drug and behavioural therapies, sufferers can often resume their daily lives after a fairly short treatment programme.

The first step is to understand how anxiety works. Anxiety is a mixture of physical and mental symptoms. They are part of what psychologists call the 'fight or flight' response. If tensions build up in an anxious person, as a result of having to face difficult situations, these tensions can be dealt with in the following ways.

Relaxation

By practising relaxation techniques such as breathing exercises. Tensions in the body can be more easily controlled.

Exercise

Another strategy for breaking the physical symptoms of the vicious cycle is taking aerobic exercise. This is exercise that is low impact - not involving carrying heavy weights or sudden exertion - and acts mainly on the heart. Any gentle physical activity that leaves the heart slightly racing will help.

Diet

Caffeine is present in tea, coffee and soft drinks. Try to cut out caffeine as much as possible, since it can set up its own vicious cycle. It can have both an effect on the heart (speeding it up) and also disturb your sleep.

If you're tired you will be less in control of your emotions and more likely to feel anxious. Trying to overcome tiredness by drinking more caffeine only makes the long-term problem worse.

Saying 'no'

This can be the very best therapy. It is simply too easy to take on too much. You can find yourself in a situation where you have too many demands on your time. Often, no one thing is causing you anxiety. But as you try to fit more and more into your life, you can become slightly anxious about each extra task.

Monitor your mood and thoughts

It can be useful to check your anxiety level regularly. You can do this by using mood monitoring technique - developing the skills (with the help of a psychiatrist) of spotting potential areas of anxiety and then using the methods above to cope with the situation.

The self-help exercises outlined above may help most people overcome their anxiety. However, professional treatments such as cognitive behavioural therapy, have been found to be very effective in difficult cases.

It may also be necessary to look at the need for anti-depressant (the benzodiazepines) medication, and possibly at the wider context of a person's relationships, self-esteem and expectations of life.

Dr Winbow, himself, has produced leaflets on 'Anxiety and phobias' -which has useful tips and can help put the condition into some perspective.

Stress:

We all feel stressed at various times in our lives. Even when 'stress' was still, strictly speaking, an engineering term, people experienced stress in response to life crises.

Stress is a normal response to challenging circumstances, and it can be caused by good, as well as bad events. A new partner or a holiday can trigger stress just as much as the death of a loved one or a job loss.

A little bit of stress isn't always a bad thing; it mobilises our bodies, and energises us during the coping process. But being over-stressed may result in a range of health problems, including headaches, upset stomach, high blood pressure - even strokes or heart disease.

One of the first steps to coping with stress is learning to recognise your personal signs and symptoms. The way you function on a daily basis may change, or you may notice a difference in your body (like tense shoulders), thinking, or general sense of well-being.

Stress is part of life; everyone knows what it's like to be anxious. But we don't need to compound our problems by putting ourselves down and thinking irrational thoughts like 'I'm weak', or 'Nobody gets stressed out like I do.' We're not weak or neurotic because we're stressed - we're stressed because we're human. We shouldn't waste energy on blaming ourselves or doling out negative thoughts as self-imposed punishment.

It can be tempting to hide from the people, places and tasks which make life stressful. By removing yourself from the situation, it's possible to find immediate relief - but these sources of stress will never go away unless we confront them. Being haunted by these stressors means that we can't be relaxed in case the sources of stress return.

Post Traumatic Stress Disorder (PTSD) - any anxiety or panic disorder based on a traumatic experience; such as combat, rape, child abuse, witnessing a violent or troubling event, or any serious medical or psychological trauma. People with PTSD typically have triggers that evoke flashbacks; however, untriggered flashbacks (intrusive thoughts or memories) may also occur in the absence of distractions (e.g., when trying to relax or sleep).

What support is available?

Positive confrontation is a good coping skill when faced with stress. Instead of avoiding a difficult boss, why not take every opportunity to work in his or her presence? 'Throwing ourselves in the deep end until we master it, is one way to desensitise ourselves to the people, places and work we find stressful. Taking action is good for our self-esteem too.

Another approach to tackling stress head-on is to keep records while we're working on our stress. Logging the time of day, situation, how strong the feeling of stress were, how we coped, and how stressed you felt afterwards can be a useful tool for some people. This can give us an accurate idea of when and where we get anxious, and what coping skills work for us in certain situations.

Another way to take action on stress is to control body and mind. Self-relaxation leading up to stressful times (as well as afterwards) and positive self-talk ('I have the skills to do this job well', 'I've done this a dozen times before') are excellent skills in anyone's coping arsenal. Sometimes our perceptions of a situation may be inaccurate - interpretations of an event or situation may be more negative when we're down or dissatisfied.

It is possible to test our perceptions. Keeping a log (as recommended above) can be a way to get a fresh view of a situation. Also, we can label the strong, stressful emotions we're feeling as either positive or negative - so, before the next bout of stage fright, try calling it 'excitement' and see what happens.

Enduring, mastering (and surviving) what life throws at us - converting stress into a positive force - is a lifelong challenge. Everyone needs a certain amount of stress in order to live well; it's what gets us out of bed in the morning.

Professional services provided by a psychiatrist can often be useful in helping us analyse stresses and how to deal with them �before they get out of hand�.