How do you know when it’s time to talk with your doctor about medication to treat anxiety and depression?
First things first. To treat something, it’s helpful to know what the “something” is and if it has a name.
So let’s first define anxiety and depression. After that we’ll address talking with your doctor about medication to treat anxiety and depression.
Occasional anxiety is normal. It’s natural, for example, to have anxiety preparing for an exam, meeting, or other important event. Generally, feeling anxious at times is not in and of itself problematic. In fact, anxiety can actually help you stay energized, motivated, and well prepared – depending on its intensity.
Anxiety is a problem when it happens a lot, regardless of what’s going on in life, and/or it causes distress. Especially when anxiety affects other areas of your life, including school, work, and family.
There are different types of anxiety. Often they include negative thinking and ‘what if’ scenarios.
What are common signs of anxiety that indicate it is time to seek help?
- Concentration difficulties
- Sleep problems
- Muscle tension and other physical symptoms such as a pounding heart or headaches.
Often the first place to seek help is with a psychotherapist. Together, you and the therapist can discuss when it is time to talk with your doctor about medication to treat anxiety (and depression). This especially makes sense if you know of a therapist you feel comfortable talking with.
Another resource is your primary care doctor (PCP). This option may make more sense than finding a therapist on your own, especially if you have a relationship with your PCP. Meeting with your PCP is also a good idea so you can have lab work done to rule out physical causes, such as hyperthyroidism.
All of us at times feel sad or discouraged. Depression is more than that, and it can last days, weeks, months, or years. Especially if left untreated.
To have clinical depression means you are either uninterested in things you used to enjoy, and/or have had a depressed mood – for at least two weeks.
Common symptoms in addition to lack of interest and/or feeling down include:
- Sleep or appetite changes
- Loss of energy
- Poor concentration
- Feeling worthless
It’s important to seek help for these symptoms since they can cause significant distress and affect your relationships at home, school, work, and in other important areas.
The treatment options discussed above for anxiety are the same for depression.
Whether or not medication is the best treatment for you depends on a lot of factors. Some considerations include the severity of depression and its history, your age, and personal preferences for treatment.
Most people do best with a combination of antidepressants and psychotherapy.
It is possible to have depression without anxiety, anxiety without depression, or both at the same time.
How Antidepressants Work
Most antidepressants slow down the removal of certain chemicals in the brain. The chemicals are called neurotransmitters. We need neurotransmitters for normal brain function. Serotonin is an example of a neurotransmitter. Selective serotonin reuptake inhibitors (SSRIs) is a common group of antidepressant medication. Another is serotonin-norepinephrine reuptake inhibitors (SNRIs).
Antidepressants are often used to treat anxiety, especially when depression and anxiety occur together.
How Anti-anxiety Medications Work
The symptoms of anxiety vary depending on the type of anxiety a person has. Proper diagnosis is useful so the medication with the best chance of being helpful is the first medication to try.
Many SSRIs and SNRIs are also used to treat anxiety. This is because these medications to treat depression can also help with anxiety. Both groups of medications target mood and stress.
Medication to Treat Anxiety and Depression
Anti-anxiety and anti-depressants are legitimate prescription drugs and not simply “happy pills.” The medications have risks and benefits, and are taken under a doctor’s supervision.
People of all ages vary in their comfort level with taking medication. Side effects are often a concern. So is the belief that taking medication indicates weakness or defeat.
Some people are uncomfortable talking candidly with their doctor about mental health. Acknowledging out loud the pain of depression or crippling effects of anxiety can be a lot more difficult than acknowledging the pain of a broken limb.
Here are the most common reasons people give for why they do not want to discuss medication:
- “I shouldn’t need medication. I should be able to manage without it.”
- “What if I take it and become numb, and lose touch with who I really am?”
- “Medication will cause me to gain weight.”
- “Medication causes suicide.”
- “I don’t want to become dependent on medication.”
There is no shame in taking medication for anxiety and/or depression.
Medication is definitely NOT a magic bullet to feeling better, but it can help. Especially when it is part of a comprehensive plan that includes psychotherapy.
Regarding the notion that you ‘should’ be able to manage without medication: Says whom? Where did you hear that? Is the same thing true for other people, or does it just apply to you?
Taking medication is not a sign of weakness. It is treating a disorder. Or helping to reduce symptoms.
The idea that you could lose touch with who you are is ironic. When depressed and anxious, people are prevented from being who they are. Their true selves are held hostage by depression and anxiety.
Concerns about weight gain are common. Some medications for depression and anxiety are associated with weight loss, some with weight gain, and some with weight neutrality (meaning no effect on weight).
Medication does not cause suicide.
The medications for depression are NOT from a family of medications that are associated with addiction/dependence. Certain anti anxiety medications are, however, which is why it is important to take these medications under the supervision of a prescriber, and to also meet regularly with a therapist.
When To Seek Treatment for Anxiety/or Depression
Overall, the sooner you recognize you have depression or anxiety and get treatment, the better the chances for recovery.
The first thing to do is to acknowledge how negatively depression and/or anxiety affect your life, and that you really could benefit from getting help.
Examples of signs that it is time to consider medication for treating depression and/or anxiety include:
- Length of time suffering
Has it been for two weeks or more? The longer you wait, the worse your symptoms can get, and the longer it will take to feel better.
- Effect on your work
If you start to miss work, or continue to arrive late it is time to get help. Another sign is if you fall behind and can’t catch up.
- Affecting physical health
The mind and body are connected. Changes in physical health are common and understandable. Depression or anxiety can cause changes in weight, problems sleeping, and lowered immune system.
- Self-medicating with drugs or alcohol
Using alcohol to ‘take the edge off’ depression and/or anxiety leads to more problems.
While treatment of any kind can be scary, people are usually relieved after starting on a treatment plan. They are typically happier and more hopeful. To treat anxiety and/or depression, many options are available. Medication can be one approach, utilized either alone or in combination with psychotherapy. There are many types of medication and of psychotherapy. What you try first may not be effective. Many people have to try several medications for example before they find the one that works well for them.
I am a clinical psychologist in MA who specializes in providing treatment for people with mood or anxiety disorders, body image concerns, and eating disorders. I have a particular interest in supporting people who are Highly Sensitive.
One reason stress gets a bad rap is because it can trigger physical and mental health problems, including eating disorders and depression. Knowing how stress can “cause” eating disorders and depression may help prevent you or someone you love from suffering.
To be clear, stress is not always a bad thing. Especially in the short term, when it may help you feel energized to meet challenges.
In and of itself, then, stress doesn’t mean you’re destined to develop an eating disorder or depression.
But, when demands in life are greater than your coping skills, mind and body are impacted. And usually in a negative way. As in possibly leading to eating disorders and/or depression.
Stress can trigger psychological or physical problems, or both. Makes sense. After all, the mind and body are connected.
Many factors are involved in how stress impacts mind and body. Some of these factors are family history, genetics, emotional support, race, peer relations, education, social constructs, trauma history, temperament, coping skills, finances, among others.
Some factors are a buffer, and others worsen stress’ impact.
Can stress cause eating disorders ?
National surveys estimate that 20 million women and 10 million men in America will have an eating disorder at some point in their lives. That’s a lot of people. We don’t need a national survey to tell us that 100% of people experience stress in their life.
If stress caused eating disorders, the rate of eating disorders would be 100%, or somewhere close to it.
So the next time you hear people wonder if stress causes eating disorders (and depression), you’ll know what to say: “Not exactly.”
But stress can be and often is the straw that breaks the camel’s back.
Stress does not CAUSE eating disorders (or depression) but is a variable in the equation.
There’s a handful of ways stress and eating disorders are linked.
1. Stress can trigger — and seem to cause — eating disorders (and depression).
Worrying about food and weight is central to all eating disorders, regardless of the type of eating disorder. The clear message from social media, peers, and diet culture is that thinner is better, and that what you eat defines your worth as a human. Being a part of diet culture and adopting its belief system create stress (and a $70 billion/year industry).
So, in people with other risk factors, stress can easily lead to problematic coping. Coping by dieting is socially suggested, approved, and even sanctioned.
Staying on a calorically restricted diet is stressful. Even, or especially, when the diet is camouflaged as wellness, clean eating, or a lifestyle change.
Weight loss compliments and admiration from others is a source of stress as well. In 95% of cases, weight loss will be replaced by weight gain. And no more compliments or admiration.
Dieting is one of the main risk factors for eating disorders.
Stated in another way, eating disorders begin with an “innocent” diet.
Stress is part of the perfect storm.
2. Eating disorders create (more) stress.
Having a poor relationship with your body and an unhealthy relationship with food is stressful. (Thank you, diet culture, said no one ever.) Worrying constantly about food and weight causes anxiety. It’s like a 24/7 internal battle that affects everything – your relationships, mental health, physical well being, and self worth. Your fundamental sense of who are you is at stake.
Another way eating disorders create more stress is physically. Put simply: Having an eating disorder is exhausting.
Eating disorders involve harmful behaviors in the name of achieving a cultural aesthetic. Restriction, poor nutrition, purging methods, and other eating disorder behaviors place stress on your body, including your organs. (That includes your heart.)
Eating disorders create a stress fest. But festive it is not.
3. People who develop eating disorders are often prone to stress.
The impact of stress on eating disorders is likely mediated by temperament (e.g. overly controlled; perfectionistic in the case of anorexia; impulsive, outgoing in the case of bulimia).
And certainly mediated by diet culture. Social media has intensified diet culture’s harmful impact. Even Instagram acknowledges the harmful effects of filtered selfies on body image. (“Compare and despair”)
For an eating disorder and depression to develop takes more than stress alone. When other risk factors are in place, and a stressful event occurs, an eating disorder can become activated. Without the stressful event, the eating disorder may not be triggered.
The ‘why now’ question of the timing of an eating disorder usually involves a triggering event. Examples of the kinds of triggering events include a loss of a pet or other loved one, a divorce, an injury or other medical event, or teasing. In other words, some form of stress.
4. The relationship between stress and eating disorders is a vicious cycle.
Stress does not cause eating disorders, but the two combine to create a vicious cycle.
Here is how that happens.
In general, two main eating disorder symptoms are negative body image and a problematic relationship with food.
Having a poor body image and relationship with food is stressful! And that stress in and of itself worsens body image and triggers eating disorder thinking and behaviors.
Hello, vicious cycle.
Stress occurs, and you feel overwhelmed. To cope, you turn to eating disorder behaviors. Then, ongoing negative body image and self talk associated with eating disorders increase stress.
It is a hard trap to get out of. Once you see it, though, you are in a position to make some changes to stop the cycle from continuing.
Stress and Binge Eating Disorder
The most common eating disorder is called Binge Eating Disorder (BED).
BED is characterized by eating large quantities of food (binges) and feeling a loss of control during the binge episodes. Eating is often rapid, and to the point of discomfort. Often the person feels a sense of shame or guilt afterwards. The person does not have compensatory behavior, such as purging, to offset the binge eating. The person will often deliberately restrict intake between binges.
In their lifetime, 3.5% of women and 2.0% of men will have BED.
To put this in perspective: BED is more than three times more common than anorexia and bulimia combined. BED is also more common than breast cancer or HIV.
The good news is that BED is treatable. (And preventable.)
The stress of following diets or other rules contributes to the stress that fuels BED. (Hello again, diet culture.) People with BED in larger bodies face additional stress from weight stigma and discrimination.
To cope with stress, binge eating becomes the relied upon method to manage feelings that would otherwise be overwhelming. Bingeing can provide immediate comfort. The bingeing itself, though, then causes more stress and overwhelm and causes you to feel bad about yourself.
Then, there is the stress associated with fearing weight gain. And of actual weight gain. There is also the stress associated with replacing the food you’ve binged on so no one knows about the binge.
Even physicians are guilty of shaming people with diagnosed or undiagnosed BED. Especially when people are in larger bodies. If that isn’t stressful, what is?
Stress and Bulimia nervosa
Bulimia nervosa is a serious, potentially life-threatening eating disorder. It is characterized by cycles of bingeing, and self-induced purging to undo the effects of bingeing.
Three in 100 American women suffers from bulimia.
It’s common for people with bulimia nervosa to use food and purging to manage feelings they’d rather not feel — including sadness, shame, anger, stress and boredom.
So the person with bulimia feels stressed, binges (for comfort) and purges (for relief) to alleviate the stress. What then replaces the original stress is the stress of being secretive, of cleaning up the ‘evidence’ of the binge or the purge, and of shame.
The physical impact of bingeing and of purging is another form of stress caused by the eating disorder. The list of short term and long term physical effects of bulimia is extensive.
Stress and Anorexia nervosa
Anorexia nervosa is an eating disorder characterized by weight loss, refusal to maintain a medically appropriate body weight, and distorted body image.
People with anorexia tend to restrict calories and good tasting food. Some people with anorexia also exercise compulsively, purge via vomiting and laxatives, and/or binge eat.
Anorexia can affect people of all ages, genders, sexual orientations, races, and ethnicities. One in 200 American women suffers from anorexia.
Although anorexia nervosa most often begins during adolescence, an increasing number of children and older adults are being diagnosed.
You cannot tell if a person is struggling with anorexia by looking at her. A person does not need to be emaciated or underweight to be struggling. Studies have found that larger-bodied individuals can also have anorexia, although they may be less likely to be diagnosed due to cultural prejudice against fat and obesity (yep, diet culture’s effects again).
Anorexia nervosa numbs emotion and creates preoccupation with food, weight, calories, and exercise. The preoccupation is the body’s response to restriction and starvation (both of which are stressful to mind and body).
Simply put, the preoccupation is stressful. It is all the person with anorexia can think of. It is the last thing she thinks of before bed, and the first thing that comes to mind upon awakening. Even dreams are often about food and body size.
Sleep is usually poor, which creates stress in and of itself.
Anorexia is an attempt to feel more of a sense of control in life, and therefore less stress.
However, a ton of stress is created by the symptoms of anorexia. The stress anorexia creates affects both the mind and body. In fact, anorexia has a higher mortality rate of any psych illness. That is stressful.
Can stress cause depression?
Does stress cause depression? Yes and no.
Depression is a mood disorder. Its symptoms include sadness, and/or a lack of interest or motivation in things you used to enjoy. Additional symptoms include lethargy, fatigue, low motivation, poor concentration, sleep problems, or changes in appetite. Depression may include physical symptoms that don’t respond to treatment, such as headaches or gastrointestinal problems. Having any of these symptoms is stressful.
Depression affects about one in 15 adults (6.7%) per year. One in six adults (16.6%) experience depression at some time in their life. Depression can occur at any time. Typically it first appears during the late teens to mid-20s.
Stress affects 100% of adults, yet 100% of adults do not develop depression.
1. Stress can trigger depression
Stress can (seem to) cause depression in a few different ways.
When people don’t cope effectively with stress, they may become depressed. They may feel defeated, ill-equipped, or overwhelmed by the stress. A “why bother” attitude could develop, which is a depression response to stress called learned helplessness.
What happens in learned helplessness is people eventually stop trying to manage the stress because nothing has worked in the past. Not trying leads apathy. All-or-nothing thinking comes next. The person’s self talk is based in distorted thinking. It may be something like, “Nothing I do matters. I suck”.
Chronic stress is especially problematic. It can derail your natural physiological stress response, which means you are not able to manage stress as well. Depression sets in.
Generally, when people feel stressed, their problem solving skills aren’t optimal. Without the stress, the person’s coping and problem solving skills may be effective enough.
Stress can also lead to people neglecting self-care. Or to engaging in behaviors that harm their health, such as smoking or drinking alcohol.
2. Depression creates more stress
The effects of depression can create or intensify stress.
Being depressed is stressful for a bunch of reasons..
Depression disrupts life. It’s often associated with withdrawing from people and instead isolating yourself. And not doing things you usually enjoy doing.
Depression and stress can lead to a vicious cycle
The relationship between depression and stress is bidirectional. Depression can cause stress, and stress can cause depression. Stress makes depression worse, and depression makes stress worse.
3. So how does stress cause eating disorders and depression?
Stress in and of itself does not CAUSE eating disorders or depression.
Rather, stress triggers or intensifies eating disorders or depression. Stress is bidirectional in the case of eating disorders and depression.
At their core, eating disorders and depression are disorders of disconnection.
Feeling disconnected from others or from yourself is stressful.
One way to address disconnection and social isolation is to connect with someone you trust. Let that person (or those people) support you.
Often it’s better for a supportive person to ask an open ended question rather than to tell you what to do or not to do.
The disconnection at the core of eating disorders and depression can be from yourself. And that stress has the biggest potential impact of all.
If talking to friends or family is not helpful or comfortable, please speak with a trained professional.
Learning effective methods to cope with stress decreases risk for eating disorders and depression. And makes for a more meaningful life.
There will always be stress. But it need not be harmful to your well being or quality of life.
Dr Elayne Daniels is a Massachusetts based clinical psychologist specializing in the treatment of eating disorders, body image and associated concerns. She also works with people who identify as Highly Sensitive.. Contact her here to get in touch.
Never in the history of managing depression and anxiety has anyone benefitted from being told to ‘just snap out of it.” Or “just relax!”
Depression and anxiety can spiral to the point where they feel unbearable. But to expect a person to be able to “snap out of it” is not realistic. Or helpful. If the person could, she would. Depression and anxiety thoughts and feelings are just too intense.
The good news is there ARE effective ways of managing depression or anxiety if you experience a flare up.
Before we discuss tips for managing depression and anxiety, first let’s define depression and anxiety.
What is depression?
Depression is common. Being depressed is like walking around wearing whatever color is the opposite of rose colored glasses. Life is gloomy.
Depression negatively affects how you feel, the way you think, and how you behave. It causes sadness and/or a loss of interest in things you used to enjoy. You may feel bummed, blue, or irritable. Feeling tired and unmotivated are common too.
What is anxiety?
Anxiety is an emotion that everyone feels, to varying degrees. For some people anxiety can be intense, persistent, and very hard to cope with. Physical symptoms (e.g. sweaty palms, increased heart rate) are often part of anxiety.
There are effective ways to manage anxiety.
The goal is not necessarily to get rid of all anxiety forever. Rather, the goal is to strengthen the ability to cope with anxiety.
Tips for managing depression and anxiety if you have a flare up:
Flare ups happen. They don’t mean you’re back at square one. In fact, a flare up can be an opportunity to practice and strengthen techniques from your coping repertoire.
DO EXPERIMENTS to manage depression and anxiety.
Rather than committing to a definitive resolution or plan, use a different approach. I call it the ‘let me see what happens if’ technique.
Think of what you’re going to do to manage the flare up as if you are conducting an experiment For example, let’s say it’s night time, and you’re planning for the next day. You say to yourself, “let me see what happens if I get up in the morning, shower, and then eat breakfast.” As opposed to saying something like, ” I SHOULD or HAVE TO get up early tomorrow, shower and then eat breakfast. Even though I’ll probably be groggy, in a bad mood, and keep pressing snooze.”
In the first case, there is a sense of hope and opportunity. The latter case sounds like a mixture of a guilt induced mandate and pessimism.
With the ‘let me see what happens if‘ approach, you agree to try the thing. Just once. Just for today, as they say.
What often happens is it goes well, and the experiment continues the next day. And for the next many days.
In psychology talk, the behavior involved (conducting “experiments”) in managing depression and anxiety is reinforced (you feel accomplished) and therefore strengthened (it continues).
CREATE STRUCTURE as a way to manage depression and anxiety.
Depression and anxiety affect mood, energy, and motivation. Focusing can be super difficult. You may be tempted to stay home all day and avoid people. If you don’t know how your day will go, you may feel anxious.
A great suggestion is to find a regular routine. Do not let depression or anxiety be the boss of what you do and when you do it.
If you don’t have much structure, impose some. See what happens if you add structure to your days. (Hello, Tip #1!)
Plan out your day. Try to make your day full-ish, but not overwhelming.
Sticking to a schedule will help you to function in your daily life.
For an added boost: incorporate social connection, fun, and nature/the outdoors. All at once, or not.
ELEVATE SELF-TALK to manage depression and anxiety.
Self-defeating thoughts fuel depression and anxiety. Especially because we tend to believe what we think. Most of us often take our thoughts as fact. Even when the thoughts are not true.
Negative self-talk are thoughts like “I’ suck” or “Nothing will help me”. Or, “I’m going to freak out if ‘x’ happens.”
Your inner critic may also glom onto thoughts associated with depression or anxiety. What then happens is an onslaught of more and more and more depression or anxiety.
Negative, inner critic thoughts make it hard to see that you in fact have choices in your life. The negative self talk may mean you feel stuck.
I call automatic negative thoughts ‘ants’ for short. ‘Ants’ can appear quickly. Noticing them will help you to decrease their impact. Catching them and having a counter thought or affirmation will help you emphasize your strengths.
GENERATE SELF-COMPASSION to manage depression and anxiety.
Self-compassion gets a bad rap by those unfamiliar with the concept. With thousands of studies demonstrating its effectiveness, self compassion is a supremely useful tool. And way of relating to yourself and others. It honors your (and others’) human-ness.
With self-compassion, you’re mindful and accept that the moment is painful. You are kind and caring in response, remembering that part of the shared human experience is to be flawed. Imperfect. This reminder allows you to hold yourself in love and connection, and to give yourself the same kind of support you would provide a loved one. Self compassion creates optimal conditions for growth.
Self-compassion practices are not meant to suppress or fight against depression or anxiety.
Try any of these self-compassion practices, with the purpose of experimenting with the various practices (thank you tip #1). Another idea is incorporating self compassion practices into your day (thank you tip#2) and reassuring yourself (thank you tip #3) that an open mind is all you need.
Having a flare up of depression or anxiety may be inevitable. Flare ups are simply an opportunity to revisit techniques you know are helpful, and to experiment with new ideas.
Dr Elayne Daniels, a private practice psychologist in MA, specializing in the treatment of people with depression, anxiety, and/or eating disorders. Another specialty is working with Highly Sensitive People and people with body image challenges.
If you have depression and anxiety you’re probably looking for ways to feel less alone. While there is no magic quote that will make depression and anxiety vanish, sometimes quotes can shift your perspective enough that you start to feel better. With that in mind, these empowering and inspirational quotes for depression and anxiety can give you that emotional boost you’re looking for.
Everyone has a different response when they read a quote. Maybe, just maybe there are quotes that help you feel understood. Or that provide hope. Maybe even a shift in perspective. Or how about a smile or chuckle?
Pay attention as you read this collection of 11 empowering and inspirational quotes. Notice which ones make you feel understood or hopeful. Be mindful of any other way your perspective shifts even a smidge.
1.“The way you tell your story to yourself matters.”
– Amy Cuddy
2.”What the caterpillar calls the end, the rest of the world calls a butterfly.”
– Lao Tzu
3.“If you think you are too small to make a difference, try sleeping with a mosquito.”
4.“Mental pain is less dramatic than physical pain, but it is more common and also harder to bear. The frequent attempt to conceal mental pain increases the burden: it is easier to say “My tooth is aching” than to say ‘My heart is broken.’”
― C.S. Lewis, “The Problem of Pain”
5.“Slow breathing is like an anchor in the midst of an emotional storm: the anchor won’t make the storm goes away, but it will hold you steady until it passes.”
Take a breath. Diaphragmatic breathing is one way to feel better fast. Try it before and after repeating inspirational and empowering quotes for Depression and Anxiety.
6.”Ring the bells that still can ring. Forget your perfect offering. There is a crack, a crack in everything. That’s how the light gets in.”
7. “Imagine you’re 90 years old. You’re looking back on your life, as it is today. Finish the following sentences:
- I spent too much time worrying about…
- I spent too little time doing things such as…
- If I could go back in time, I would…”
Find inspiration and empowerment in recognizing that in this very moment, even with Depression and Anxiety, you have the power to choose.. to look back, look ahead, and/or be where you are, now.
8.“I will love the light for it shows me the way, yet I will endure the darkness for it shows me the stars.”
9. “When one door closes, another opens. But we often look so regretfully upon the closed door that we don’t see the one that has opened for us.”
—Alexander Graham Bell
Every ending also means a new beginning. The beginning may emerge by navigating Depression or Anxiety.
10. Acceptance doesn’t mean putting up with or resigning yourself to something. It (acceptance) is about embracing life, not merely tolerating it. Acceptance literally means “taking what is offered”. It doesn’t mean giving up or admitting defeat. (Nor does it) mean just gritting your teeth and bearing it.
It means fully opening yourself to your present reality – acknowledging how it is, right here and now, and letting go of of the struggle with life as it is in this moment.”
11. “No matter how hard the past, you can always begin again.”
Experiencing joy and suffering, and everything in between, is what being human means.
Along the way, there may be bumps in the road. When those bumps are in the form of depression or anxiety, remember to pause and become conscious of your breathing.
And, remember Dalai Lama’s words and be sure there is no mosquito in your bed.
I am Dr Elayne Daniels, a licensed psychologist practicing in the Boston, MA area. I integrate eastern and western tradition with traditional forms of psychotherapy to help people live a life they enjoy.
If you need immediate help, consider these resources:
Have you been diagnosed with Anxiety or Depression? If so, now you know that what you’re feeling has a name. You also know you aren’t alone. It is an actual ‘thing’. And maybe, just maybe, there is a silver lining.
A diagnosis of Anxiety and/or Depression is increasingly common. Especially post global pandemic.
But what does it really mean to be diagnosed with Anxiety or Depression?
One thing it might mean is you recognize you haven’t been feeling ‘yourself’. Or maybe family and friends have commented that you do not seem like your (regular) self.
Perhaps you’ve met with your primary care doctor and/or a mental health professional. Maybe a psychiatrist, or a social worker or psychologist. And that person has diagnosed you with Anxiety or Depression.
A diagnosis puts you one step closer to healing.
How can you ‘fix’ a problem if you don’t know what the problem is? A diagnosis can be clarifying.
Thank goodness you asked for help. That in and of itself is a win!
As the saying goes, you gotta name it to tame it.
Being diagnosed with Anxiety or Depression can be the start of actually feeling better than you have in a long time. (Hello, silver lining.)
A diagnosis helps you know what you need to feel better. Maybe more emotional support? How about therapy? Or medication? Perhaps some combination?
This video clip speaks to the value of treatment.
There are treatments available for Anxiety or Depression. And providers of a variety of disciplines are available to offer you their expertise and recommendations.
We’re definitely not talking about a “one size fits all” approach.
Some interventions target both disorders. For example, many different forms of psychotherapy are available to treat anyone diagnosed with Anxiety and/or Depression. For instance, Cognitive Behavioral Therapy (CBT) is a method of treatment with high success rates for people with both Anxiety and Depression, or with symptoms of one or the other. Certain medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs), have anti depressant and anti anxiety effects.
People diagnosed with Anxiety or Depression are more likely to have first degree relatives with mental health challenges. Whether or not those mental health problems were identified ‘back then’ is a different story. At least in modern day, people are generally more comfortable seeking help than were their predecessors.
Fortunately, stigma surrounding mental health is beginning to lessen, especially post COVID. (You’re part of a stigma reducing force, effecting change in the world.)
Bottom line: Treatment improves prognosis.
That said, sometimes successful treatment is a bit of “trial and error”. For instance, maybe the therapist you meet with is not a good match for you. The chemistry isn’t there. Or, the therapy approach doesn’t jive with your style. Maybe the therapist’s office or mannerisms make it hard for you to feel comfortable.
Medication may be another source of “trial and error”. Neurochemical advances make the selection of medication a bit less daunting. Tests are available in which you send saliva to a lab, and a report comes back indicating which medications are likely a good match for your particular brain chemistry
Regardless of the type of formal treatment, you can try lots of things on your own to help yourself. The hardest part can be to find the wherewithal to try them.
Ironically, the very things you know would help can be just too hard to motivate yourself to do. Perhaps you don’t have the motivation (in the case of depression) or are too stressed out (in the case of anxiety).
Additional suggestions beyond professional help:
- Attend to the basics: sleep, nourishment, movement, and emotional support.
- Practice doing experiments: Check in with yourself just before and then after an activity (e.g. a 10 minute walk). Chances are you will feel better afterwards than before the activity.
- Self validate: Recognize your efforts and give yourself credit. Be on your own side.
- Remind yourself you are not alone: Anxiety and Depression are part of shared humanity.
Building blocks of physical and emotional health really do matter. Depression or Anxiety can be a nudge to strengthen your self-care.
Pursuing help for an Anxiety or Depression diagnosis is an empowering form of taking charge of your life. Maybe even a wake-up call to enhance meaning and quality. Take some breaths, and just one step at a time.
I am Dr Elayne Daniels, a psychologist in the Boston area, who helps HSPS, people with an eating disorder, and/or those with Anxiety or Depression to move forward in their life and THRIVE!
Ever wonder what steps to take to heal anxiety and depression?
The kind of anxiety and depression I’m focusing on here is not the everyday type, but the kind that is diagnosable.
Let’s start with the fundamentals.
Anxiety and depression are feelings. Feelings exist in the body.
As humans, most of us believe we’re cognitive, rational beings who sometimes feel.
However, we’re more like emotional beings who on occasion think.
Feeling emotions can be uncomfortable. Even painful. For many of us, a natural reaction is to turn away from emotion.
There’s at least one problem with the turn-away method. Turning away makes things worse. It will not help heal anxiety and depression.
Even benign attempts at distraction are very limited in effectiveness. If they do help, the relief tends not to last long.
A much better option is to lean into the emotion.
In other words, feel it to heal it.
Keep in mind that emotions have a beginning, middle, and end.
Emotions are like tunnels. If you go all the way through them, you get to the end.
If you get stuck in a tunnel, you don’t reach the end. Maybe you can’t find your way out. Or you get lost.
And so it is with feelings. When you get stuck in them, they stagnate.
A “stuck” feeling doesn’ get to the end of the tunnel. It leaves you smack in the middle of the anxiety and depression. Yuck!
Anxiety and depression: They’re just feelings.
Not finding your way completely through. Getting lost. That’s one way to think about anxiety and depression.
They are normal human emotions.
Feelings are just that – feelings. They rise from chemical changes in your body, and they’re neither good nor bad. They simply are.
Certain feelings are definitely more pleasant than others. Some feelings are more comfortable to have then others. That’s different than feelings being good or bad.
Feeling anxious is a natural reaction to stress. And stress may be more about what you’re telling yourself than about what actually is.
Your perception of something easily becomes your reality. The ‘what if’s’ and other forms of catastrophizing are good examples of cognitive distortions that lead to beliefs and then anxiety and depression.
If depression and anxiety become chronic, interfere with your life and relationships, and/or cause other problems for you, consider professional help. There is nothing wrong with that! Reaching out for help is courageous and wise.
Let’s say you decide to heal everyday forms of anxiety and depression on your own. Or perhaps you want to work on healing your anxiety and depression at the same time you’re in formal treatment.
Here are 6 steps for healing anxiety and depression:
1. Validate your own feelings.
Whatever you’re feeling is valid. Even if what you’re feeling is different from what others feel (or simply what you perceive they feel). You may prefer to feel some other emotion than what you are feeling. Acknowledge what it is you do feel. You have a right to feel whatever it is you feel.
2. Name it to tame it.
Identify with specificity the emotion(s) you’re feeling. Instead of “I feel bad”, try words that are more descriptive of the actual emotion. Does feeling “bad” mean you feel like you could crawl out of your skin? Or more like a sense of hopelessness? Defeat? Some combination?
The fancy name for this technique is emotional granularity.
Examples of emotional granularity may help clarify this important point. Different aspects and levels exist for both anxiety and depression.
For example, anxiety could be described as angst, apprehension, fear, stress, uneasiness, suffering, nervousness, freaking out, panic, restlessness, uncertainty, or dread.
In fact, a Google search found close to 100 synonyms for anxiety!
Even more synonyms exist for depression (at least according to Google). Examples include melancholy, sadness, gloom, sorrow, unhappiness, defeat, down in the dumps, woe, tiredness, and weariness.
A great strategy for emotional granularity is to use an emotion wheel.
3. Create new neural pathways, and let other pathways fill in to heal anxiety and depression.
Specifically, the neural pathways that are traveled most often are the ones you’re strengthening. What the heck does this even mean?
Your old stories (“I’m not good enough,” “I suck”) are literally keeping you stuck.
Each time you think a particular thought, you deepen that thought’s circuit. So you are always practicing and deepening something.
Rick Hanson puts it succinctly when he says, “Where your attention goes, neural firing flows and neural connection grows.”
So, whatever you pay attention to, wherever you put effort — that’s what you get more of.
With your thoughts — just by thinking — you are always strengthening something.
So, think negatively, and you’ll get more automatic negative thinking including more anxiety or depression or both.
In contrast, move from a place of strength, gratitude, or competence, and you will see more of your strengths and notice more reasons to be grateful..
Even thinking neutrally can be helpful.
4. Feel the feelings that exist in your body.
Use your body as an instrument to assist with processing the feeling “through the tunnel.” Find what works for you, which may vary depending on the feeling and context.
Mindfulness, defined as nonjudgmental awareness in the present moment, with acceptance of what you feel, may be helpful. “Welcome the feelings in for tea,” some Zen masters suggest.
Notice sensations associated with different emotions, as well as where the sensations are located. Doing so is a practice. The ease of identifying feelings and their location will vary over time and situations.
5. Move it.
Because feelings are located in the body, moving your body can be very helpful in processing feelings. This doesn’t have to be intense or considered “exercise”. Rather, just move around. Doing so activates serotonin neurons.
Why not take a walk in your neighborhood? Or groove to the beat of your favorite tunes?
6. Provide self–compassion. Give yourself some grace!
You CAN heal from anxiety and depression. Be kind to yourself. Not in a woe-is-me, pity party kind of way., but in a way that reminds you of the shared humanity, the universality, of what you’re experiencing.
Practice using tools that help you personally heal anxiety and depression. If the tools work for others but not so much for you, that’s ok. Keep practicing until you find what feels helpful.
Connect with other people in whose presence you feel supported. Consider yoga,meditation, journaling –something that is you-focused and can easily be a daily practice
Remind yourself that you will not ALWAYS feel anxious or depressed. This moment isn’t all moments. It’s just right now.
You won’t always feel this way,even if it feels in the moment as if you will.
Over time you’ll learn what helps to heal your anxiety and depression.
When you start to feel early signs of anxiety and depression, you may recognize that as an opportune moment to access your tools.
Include your body in the healing of anxiety and depression. Mind-body-spirit are star players on “Team Heal”.
What’s The Cure For Depression And Anxiety?
Ever wonder about a cure for depression and anxiety? You’re in good company if so.
Depression and anxiety are often misunderstood. And both are more common than you might think.
In fact, depression affects more than 16.1 million American adults over 18 every year.
And, while struggles with depression can develop at any age, 32.5 years is the median age of onset. According to the National Center for Health Statistics, depression is most common in people ages 18 to 25.
Worldwide, 322 million people live with depression. That is according to the World Health Organization. Yikes! That’s a lot of people.
Speaking of a lot of people….
Anxiety disorders are the most common mental health problem in the U.S., affecting 40 million adults over 18.
The ways to cure depression and anxiety overlap.
What is depression?
Everyone feels sad at times.
It’s part of being human. For people with depression, though, sadness is more intense, far-reaching, and persistent. It’s so much more than “just sadness.”
Depression negatively affects how you feel, think, and act. When depressed, you may question if you’ll ever feel better. Sometimes there’s a triggering event, but not always.
Clinicians categorize depression by type. The most commonly diagnosed clinical form is Major Depressive Disorder.
Other symptoms of depression may include:
- Lack of interest in things you usually enjoy
- Feeling down or sad
- Trouble concentrating
- Low motivation
- Sleep problems (difficulty falling or staying asleep, sleeping too much and still feeling tired)
- Appetite/eating changes
- Thoughts of death – your own, someone else’s, or in general
- Feeling badly about yourself (e.g. you are a failure or disappointment)
- Walking/talking more slowly or rapidly than usual,
How about some good news? Depression is treatable.
“Treatable” means symptoms can be alleviated. Although there is no clinical cure for Depression, it can go into remission.
Definitions of remission vary, but generally have to do with no longer having symptoms. In other words, the disorder is “at rest.”
Please hear this:
Speaking clinically about depression is one thing. But how you live your life and feel is another.
Treatment options for depression include (among others):
Some treatment approaches require working with a professional. There are also many things you can do on your own.
A catch-22 with depression is that the very things you know would be helpful are the same things you have a hard time motivating yourself to do.
Start small. What can you do?
The more your lifestyle is geared toward a healthy mind and body, the better you’ll be able to cope with symptoms of depression (and with life in general).
Examples of lifestyle changes:
- Social connection
- Caring for a pet
- Meditation or yoga practice
- Time in nature
- Meaning and purpose in the everyday
- Eliminating use of alcohol, tobacco, and other ‘vices’
One of the best lifestyle changes you can make is to ditch dieting. In my experience, quality of life soars when Diet Culture rules no longer hold you hostage. Try Intuitive Eating instead.
There are many different forms of therapy and lots of experts to choose from. Providers vary in their credentials and theoretical approach.
Cognitive behavioral therapy (CBT) is a common and effective psychotherapy for treating depression, anxiety, eating disorders, and other issues.
CBT focuses on changing a person’s thoughts and beliefs. It also highlights the impact of thoughts and beliefs on mood and actions. (More information on this is below.)
Participating in a support group can be an excellent way to help you feel better.
People with depression meet as part of a psychotherapy group to talk about their experiences. Usually there is a mental health professional who is the group leader. Group members provide each other encouragement, understanding, and support.
Being in a support group is different from talking with supportive friends and family. People who have had similar experiences often have a deeper understanding of what you’re going through. They know firsthand what depression feels like.
The main benefits of joining a depression support group include:
- Ongoing social contact with people in a similar position
- Opportunities to share struggles and solutions
- Advice from mental health professionals/co-facilitators
Depression medications are grouped into categories based on how they work.
The most common antidepressant categories include select serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants.
- SSRIs work by increasing levels of serotonin in the brain. Examples: Zoloft, Paxil, Prozac
- SNRIs work by increasing levels of serotonin and norepinephrine in the brain. Examples: Cymbalta, Effexor XR, Pristiq
- Atypical antidepressants work by increasing dopamine and norepinephrine in the brain. Examples: Trazodone, Wellbutrin XL, Remeron
Every person’s body is unique and metabolizes medications differently. Trial-and-error is often needed to find a medication that works. A good place to start is with a medication that a first-degree relative has had a good response to.
People often ask about side effects with antidepressants. As with every medication, there may be some. The most common side effects are constipation, diarrhea, nausea, headache, dizziness, sexual dysfunction, difficulty sleeping, and drowsiness.
Another common question is how long a medication will take to work. If it works, you’ll know within a month or so. Even when you find the “right” medication, you might not notice an improvement in how you feel right away.
What is Anxiety?
Most people know what anxiety feels like because at some point they’ve felt anxious.
Anxiety is a natural human emotion that includes worry, tension, and changes within your body such as increased pulse. As a species, we’re wired to respond to fear (by our fight, flight, or freeze response). That’s how we’ve survived as a species.
So anxiety can be a good thing. It helps you recognize potential threats and keeps you alert.
For some people, anxious feelings quickly come and go. For other people, not so much. They may have an Anxiety Disorder, for which more formal treatment is available.
Anxiety is normal, not a flaw. However, people may get into coping patterns that make anxiety feel like something is very wrong, especially when anxiety is persistent and overwhelming. When anxiety interferes with daily activities, it’s considered a disorder.
Anxiety can take different forms. Symptoms of anxiety, for example, exist as part of several mental health conditions, such as mood disorders and eating disorders.
Anxiety Disorders are highly treatable, yet only 36.9% of those suffering receive treatment. How sad is that?
The seven most common “official” anxiety disorders include:
- Generalized Anxiety Disorder (GAD)
- Panic Disorder.
- Social Anxiety Disorder.
- Post-Traumatic Stress Disorder (PTSD)
- Obsessive-Compulsive Disorder (OCD)
- Separation Anxiety Disorder
Are there treatments for anxiety?
Yes! Treatment categories for anxiety are the same as those for depression:
The specific type of anxiety determines the best course of treatment.
There are things you can do to help manage anxiety. They are useful to consider, and many are common sense. Things like getting enough sleep, exercising regularly, having a mindfulness practice, and eating foods that benefit the brain are healthful habits regardless of anxiety. But they become game-changers for the person suffering from anxiety.
Psychotherapy is another effective way to manage different types of anxiety.
One of the best approaches to help with anxiety is Cognitive behavior therapy. The same CBT that is recommended for treating depression is helpful to treat anxiety.
Thoughts affected by depression or anxiety are often negative. You may not even realize that the way you think is problematic. Even though the negative thoughts bring you down and interfere with your daily life, you may think of them as facts.
We commonly accept our thoughts as facts. But they aren’t necessarily facts. They’re cognitive distortions, aka thinking mistakes that you can correct.
Examples of cognitive distortions include:
- All-or-nothing thinking: “I have to be perfect, or I suck.” Or “I ate a ______ so now I can’t eat the rest of the day.”
- Filtering: “No one ever compliments me” (disregarding the times people have complimented you).
- Catastrophizing: “My friends did not invite me to join them. They hate me.”
These are just a few of the several categories of cognitive distortions. When you know how to identify distortions, you can more easily recognize them in your self-talk. In other words, name it to tame it!
And, upon recognizing the distortions, you can reframe them so the thoughts are more neutral and realistic.
Reframing is not about being a Pollyanna. Nor is it toxic positivity. It’s about removing exaggerations and subconscious conclusions that aren’t based in reason or fact so you can “soften the edge” that you experience as anxiety.
Depending on the type of anxiety, medication may be prescribed.
While meds don’t cure anxiety, they can help with symptoms so you can function well and feel better in your day-to-day life.
Many types of medications are available. Because every person is different, your doctor may have to prescribe several different medications before finding the one that’s right for you.
Common medications for treating anxiety include:
SSRIs are used to help improve symptoms of depressed mood and anxiety. Examples include:
- Fluoxetine (Prozac) is used to treat OCD, Bulimia, Panic, and Depression
- Escitalopram (Lexapro) is used to treat Generalized Anxiety Disorder
- Sertraline (Zoloft) is used to treat OCD, PTSD, Social anxiety, Panic Disorder, and Depression
- Fluvoxamine (Luvox) is used to treat OCD, PTSD, Depression
- Paroxetine (Paxil) is used to treat OCD, Social Anxiety Disorder, and Depression
ANXIOLYTICS are used to relieve anxiety and promote sleep. An example is:
- Buspirone (Buspar) is used to treat anxiety. It works as well as benzodiazepines, but with fewer side effects. Also, it’s not habit-forming like benzodiazepines are and can be used in addition to an SSRI.
Benzodiazepines are used to help calm your mind. Doctors prescribe them to treat different types of Anxiety Disorders, including Panic Disorder, Generalized Anxiety Disorder, and Social Anxiety Disorder.
A downside of benzos is that they can be habit- forming. They also tend to increase drowsiness and worsen balance and memory.
- Alprazolam (Xanax)
- Clonazepam (Klonopin)
- Diazepam (Valium)/
- Lorazepam (Ativan)/
Other resources for learning more about depression and anxiety:
Mental Health America (MHA) is a community-based nonprofit that helps people living with mental illness. Its mission is to promote overall mental health.
The Depression and Bipolar Support Alliance (DBSA) is a national peer-oriented mental health organization. Their mission is to provide support and education.
Anxiety and Depression Association of America is geared toward improving quality of life for people with anxiety, depression, OCD, and PTSD through education.
Chances are you or someone you love has been or will be affected by depression and anxiety. So learning more is important. Awareness and knowledge are empowering and provide a solid base for getting help, whether for you a friend, a loved one, or a colleague.
Depression and anxiety can (and do) happen to anyone. Sometimes it’s obvious when someone is struggling with depression or anxiety. However, many people hide it well. They may deny anything is wrong, even though their struggles are beyond what other people deal with. Stigma can make it harder for people to be honest about feeling depressed or anxious.
While there is still no permanent clinical cure, the way you deal with depression and anxiety is its own type of “cure.” And, even as you read this, clinicians are working to find a permanent clinical cure. It’s just a matter of time.
In the meantime, you have resources within you to help you through.
If you are feeling unsafe, contact the National Suicide Prevention Lifeline at 1‑800‑273‑TALK (8255). It’s available 24 hours a day, 7 days a week, and all calls are confidential.
How To Avoid Burnout If You Have High-Functioning Anxiety And Depression
Anxiety, depression, and burnout zap the joy out of life. Sometimes they co-occur and can be difficult to distinguish from each other. Avoiding burnout if you have high-functioning (or not-so-high-functioning) anxiety or depression can be extra tricky, especially with overlapping signs and symptoms.
Because anxiety and depression lower your resistance to stress, your threshold for staying engaged in life is also diminished. This becomes the perfect storm for burnout.
What is burnout? How do you know if you are burned out?
This is a good question. You need to know what you’re looking for in order to identify it and do something about it.
Burnout can happen to anyone and goes deeper than merely feeling tired and stressed. When burned out, people feel mentally, physically, and emotionally exhausted. Drained. They tend to be pessimistic and feel like they have nothing left to give. Dealing with everyday responsibilities becomes too much. Even getting out of bed is daunting.
Burnout happens as a result of chronic stress.
A common example is caretaking while juggling other home and work demands. Exposure to negative health or political news day after day can also take a cumulative toll.
The recent political climate surrounding the 2020 election led to burnout for many, as has living through the coronavirus pandemic.
Along with an increase in burnout rates, anxiety and depression rates have also increased during this time.
Burnout tends not to go away on its own.
Signs of burnout include exhaustion, isolation, anxiety, depression, and feeling numb. The emotional, physical, and mental exhaustion of burnout worsens the symptoms of depression and anxiety.
When a battery loses its charge, it must be recharged in order to function. Burnout creates the same scenario for us humans.
What is high-functioning anxiety?
The term “high-functioning” anxiety is not a real thing in the world of official diagnoses. There are no objective criteria. But we all kind of know what the phrase is referring to.
For some people, high-functioning anxiety may refer to a person who worries, stresses out, and has episodes of physical signs of anxiety. Physical indications include symptoms like increased heart rate, headaches, and racing thoughts — all effects that are undetected by the outside world.
For others it may mean periodic anxiety symptoms that do not last long enough or become intense enough to interfere with their day-to-day lives.
Let’s say a person with high-functioning anxiety does not appear anxious on the outside. In fact, she appears to have her act together. She is kind, friendly, productive, and organized. This hypothetical high-functioning person with anxiety does not appear anxious. However, on the inside she overthinks everything and often believes she can’t measure up. She’s filled with self-doubt and has difficulty saying ‘no’ to requests.
What is high-functioning depression?
The term “high-functioning” depression, just like “high-functioning” anxiety, is neither clinically valid nor diagnostically existent. In other words, it has no standard definition. Different people may mean different things by the phrase “high-functioning”.
For some, it may suggest having symptoms of depression, such as sadness, low energy, appetite changes, and insomnia. However, that person purposely doesn’t display any outward signs of depression. Instead, on the outside, the person appears to be functioning well in life – at work, home, and with friends and family.
High-functioning depression could also refer to people who have bouts of depression that are short-lived, relatively mild, and not conducive to much derailment in their lives.
While anxiety and depression are considered psychiatric conditions, burnout is a reaction to stress.
There are treatments for anxiety and depression. The usual ‘treatment’ for burnout is to take time off or ‘recharge your battery’ in some other restful, restorative way. Unfortunately, that’s not always possible. The majority of people don’t have the kind of finances, job security, or back-up contingencies to enable that kind of elective time off.
The emotional, physical, and mental exhaustion of burnout worsens the symptoms of depression and anxiety.
The ways to avoid burnout are similar, whether you have high-functioning anxiety and depression or not.
How can you avoid burnout if you have high-functioning anxiety and depression?
If you’re already anxious and depressed, you’re more prone to burnout. Recognizing and addressing anxiety and depression before they are worsened by burnout is difficult but certainly ideal. If your stress tolerance is low due to anxiety and depression, going below that bar into the burnout zone doesn’t take much.
Self-awareness is key to avoiding burnout. So is self-care.
You decrease the likelihood of burnout by prioritizing self-care. Maybe that means going for more walks, talking more often with friends, or saying ‘no’ more consistently to requests at work. Maybe it’s even that Netflix series you watch while your puppy is snuggled up next to you. Whatever it is that helps you to replenish.
My favorite form of restoration? Getting out into nature.
Go outside and get a few breaths of fresh air. Look around at the trees, smell the flowers, feel the breeze on your cheeks.
Self-care is often more of a mindset than a prescription for pedicures and bubble baths. (But those are ok, too!)
Self-care is about being on your own side and treating yourself as you would a loved one.
The likelihood of burnout decreases when self-care is part of your daily routine — even if you’re working long hours or taking care of elderly parents. Your obligation is to add moments of joy and/or peace into each day.
Small self-care gestures can stop stress from taking over and causing burnout. And those same gestures – talking with loved ones for support, being playful, finding things to laugh about, being outside in nature – are also helpful for your general well-being.
When approached with moment-by-moment loving choices, self-care becomes a mindset, not a destination. And burnout falls by the wayside.
I am a Massachusetts-licensed psychologist in private practice. If you’re struggling with anxiety and depression and would like to learn more about working with me, please contact me here.
Anxiety and Eating Disorders often co-occur. Anxiety can begin before an Eating Disorder, around the same time, or after the onset of an Eating Disorder. This chronology has led many to wonder about the real relationship between anxiety and Eating Disorders.
So, let’s unpack this. First, anxiety.
Think of anxiety as on a continuum.
On one end is minimal anxiety. On the other end is severe anxiety. As anxiety approaches the ‘severe’ end of the continuum, it becomes an Anxiety Disorder. To be a disorder means symptoms interfere with daily life and impair functioning.
There are many different kinds of Anxiety Disorders.
They include: Obsessive Compulsive Disorder, Generalized Anxiety Disorder, Simple Phobia, Panic Disorder, Social Anxiety Disorder, and Post-traumatic Stress Disorder.
To have an official disorder of any type means you meet specific criteria outlined by the Diagnostic and Statistical Manual (DSM). This is true for Anxiety Disorders and Eating Disorders. The DSM is THE official handbook that outlines and describes all psychiatric conditions.
In the DSM category of Eating Disorders, three main types include Anorexia nervosa, Bulimia nervosa, and Binge Eating Disorder.
Eating Disorder symptoms are challenging to treat. Plus, people with an Eating Disorder often have other psychological conditions too.
Guess which DSM diagnosis occurs most frequently among people with a DSM diagnosed Eating Disorder?
You guessed it: Anxiety!
Anxiety is the most common condition people with an eating disorder have.
In fact, 48-51% of people with anorexia nervosa, 54-81% of people with bulimia nervosa, and 55-65% of people with binge eating disorder are also diagnosed with an Anxiety Disorder.
Far more people with an Eating Disorder have anxiety, but to a lesser degree than someone with a DSM Anxiety Disorder.
By the way, there is little research on the prevalence of Eating Disorders among people with an Anxiety Disorder.
One of the most common forms of anxiety that co-occurs with Eating Disorders is Obsessive Compulsive Disorder (OCD). In fact, OCD usually occurs first and is considered by some a risk factor for developing an Eating Disorder.
Anorexia nervosa is the Eating Disorder than most often overlaps with OCD.
Actually, Social Anxiety Disorder is the anxiety disorder that occurs most often among people with any type of Eating Disorder (not only Anorexia.).
Think about the implications of co-occurring Social Anxiety Disorder and Eating Disorders.
When someone has Social Anxiety Disorder, they may be that much more reluctant to seek treatment. Having Social Anxiety makes getting help for an Eating Disorder (and the for Anxiety Disorder for that matter) that much harder. And less likely.
Delaying or avoiding treatment worsens the prognosis for someone with an Eating Disorder. Or with an Anxiety Disorder. Or with both.
Let’s put the pieces together: Anxiety Disorders seem to occur more often in people with an Eating Disorder than in the general population. We also have evidence that Anxiety Disorders likely emerge before an Eating Disorder.
What does this mean?
The sequence suggests that early onset anxiety may increase the risk of developing an Eating Disorder. This is especially true of Social Anxiety Disorder.
The research on the relationship between Eating Disorders and anxiety is difficult to interpret. One reason is because of all the combinations of different Eating Disorder and Anxiety Disorder diagnoses. (As outlined in the beginning of this article.) There are methodological problems in some of the research that also makes it tough to evaluate.
So the inconsistencies complicate the understanding of co-occurring anxiety and Eating Disorders.
Regardless, though, treatment for one often benefits the other.
For example, Cognitive Behavior Therapy (CBT) is one of the treatments of choice for Eating Disorders and Anxiety Disorders.
CBT is based on the idea that psychological problems are the result of distorted ways of thinking and unhelpful behavior. Through the use of specific techniques, CBT helps people learn to cope better with everyday kinds of things. Improved coping decreases their need to use Eating Disorder behaviors. The same sort of techniques are useful in treating Social Anxiety Disorder.
Another plus to mention is that certain medications called Selective Serotonin Reuptake Inhibitors (SSRIs) can be helpful. They are often part of an effective treatment plan for Anxiety and Eating Disorders. SSRI’s were originally developed to treat depression. (They help treat depression too!)
So what is the REAL relationship between Anxiety and Eating Disorders? It depends on which research findings you read.
My professional experience is that anxiety is practically always present before an Eating Disorder develops.
Anxiety can be one of the reasons why an Eating Disorder develops in the first place.
How so? Well, in an attempt not to feel anxious, a person turns to Eating Disorder symptoms. Usually this is not conscious.
Anxiety may then decrease, but only artificially. It is still there. An Eating Disorder masks it. But, the person no longer feels as anxious. The more she relies on Eating Disorder symptoms, the less anxiety she feels. An entrenched cycle has begun.
Anxiety also occurs during an Eating Disorder. Maybe because of sneaky behaviors that are involved. Or due to malnourishment.
Anxiety also occurs after an Eating Disorder and as part of recovery. Why? Well, change can be scary. Feelings are no longer numbed by an Eating Disorder. Instead, CBT and medication provide more skillful ways to be in the world. But learning and changing take time. There is no quick fix.
Both Anxiety and Eating Disorders are treatable. To be you, without symptoms of Anxiety or of an Eating Disorder is possible. Whichever type of Anxiety Disorder or Eating Disorder you have, seek treatment that addresses both. Doing so will be one of the best investments you will ever make.
Dr Elayne Daniels is a private practice psychologist in Massachusetts, specializing in providing treatment to people with eating disorders and co-occurring conditions.
Anxiety and Depression are common and treatable. But how do you determine your best treatment for anxiety and depression? It is definitely not a one-size-fits-all kind of thing. And, there is no reliable blood test. (But, there will be one day soon.)
At least initially, anxiety and depression often present as physical ailments rather than as classic mood symptoms. No surprise that many patients turn to their primary care physicians for care. Primary care doctors really do need to be well versed in recognizing how mental health conditions manifest– and in making appropriate treatment recommendations.
Treatment absolutely can improve quality of life. But, success of treatment varies…widely. So does the length of time before you feel better. And, of course, what is helpful for you may not be for your friend.
Let’s talk about the good news and then the less than good news.
The good news in the treatment world for anxiety and depression:
1. Treatment for anxiety and depression can be similar.
Cognitive Behavior Therapy (CBT) is a highly effective therapy for both conditions. CBT has considerable scientific evidence that its methods actually lead to improvement in mood and functioning. Its core principles have to do with changing thinking patterns. CBT tends to be short- to moderate-term. Its focus is on the present.
Psychopharmacology (medication) is another common treatment, and often the same medication (e.g. a Selective Serotonin Reuptake Inhibitor or SSRI, or a Selective Norepinephrine Reuptake Inhibitor or SRNI) is helpful for anxiety and depression. Examples of SSRIs include Prozac, Zoloft, and Paxil. Effexor and Cymbalta are examples of SNRIs.
There are other types of medications to treat depression alone, or anxiety alone.
There is some evidence that combining psychotherapy and medication works best for treatment of depression.
For anxiety disorders, CBT, antidepressant medications and anti-anxiety medications (e.g. Buspar) are helpful. Some research suggests psychotherapy is more effective than medications to treat anxiety, and that adding medications does not significantly improve outcomes from psychotherapy alone.
2. Many people find treatment helpful.
The benefits of therapy vary. For both disorders, CBT is the most effective form of psychotherapy.
The benefit of medication depends on lots of factors. One is the severity of the depression or anxiety. In general, the more severe the symptoms, the more likely the medication will help. In other words, antidepressants are more effective in treating chronic, moderate and severe depression. They don’t help much in mild depression.
Keep in mind…
3. If one treatment does not help, there are many other treatment options.
Lots of research on evidence based treatments is available. We know that sticking with the approach(es) is necessary to evaluate if what you are doing is helpful.
4. Techniques you can do on your own will help.
The kinds of things you can do are helpful throughout life, even when not suffering from anxiety or depression. These include journaling, exercising, meditating, doing yoga, doing a hobby, or playing an instrument.
The less good news:
- Trial and error are often required to find the best medication for you.
This can be time consuming, especially when you are not feeling yourself. Finding a therapist who is a good fit for you can also be challenging. The ‘chemistry’ and expertise have to feel right.
- Insurance companies sometimes encourage medication over psychotherapy.
Why? Because it is less expensive. This may be appropriate at times, but often psychotherapy is clearly indicated.
3. If you’re like many people, and you seek help from your primary care physician for anxiety and depression, know that treating mental health problems in a primary care setting can be less than ideal.
Primary care clinicians have time pressures and lots of conditions that warrant attention in every patient interaction. Their evaluation and treatment of mental health disorders may fall short of the ideal.
As with most health conditions, finding and accessing treatment is not necessarily easy. In the case of feeling anxious and depressed, pursuit of care can be extra difficult.
If you have no improvement after 4-6 weeks of treatment, discuss other options with your provider. Also, be sure to disclose any alcohol or other drug use. Both are linked to anxiety and depression, and are important to mention – especially if you are on medication.
How to determine your best course of action for anxiety and depression is specific to each individual.
In general, concrete steps to consider include:
- Contact therapists and psychopharmacologists who are on your insurance plan. Check out their website. Ask about their services. Consider looking at referral sites for names of providers who may be helpful.
- Consult your PCP for referral to a therapist and/or psychopharmacologist
- Consider using telehealth services if available.
- Read reputable articles to help you assess your symptoms, your needs, and the next best steps FOR YOU.
- Get moving! Whether cardiovascular, or strength training, exercise helps. Make it fun by dancing to music. Taking a Zumba class. Or how about yoga?
Suffering from anxiety and depression is not uncommon, especially in this post-Covid world.
There is no one-size-fits-all recommendation for how to approach treatment, or for which treatment to land on.
The two basic options are therapy and/or medication. For therapy, CBT is the treatment of choice. For meds, the treatment of choice is typically an SSRI. (There are lots of factors that determine specific treatment recommendations.)
CBT is often considered better than medication at preventing relapse. It is tends to be short term, and empowering to the person who learns it. As a psychologist, I love teaching CBT an do have a lot of respect for how helpful anti-depressants can be. If they help, it is because they are remedying a chemical deficit in your brain.
I am a MA licensed psychologist in private practice. If you’re struggling with anxiety and depression, and would like to learn more about working with me, please contact me here.