There’s a decision that millions of people have to make at a time when they have the greatest difficulty making decisions. The decision is more complicated than pondering how effective anti-anxiety and depression meds are.
When anxiety and/or depression begins to slowly, pervasively suffocate the “life out of life,” people have to choose. Do I continue down this path into the dark unknown by myself…or do I get help? And what if that help involves anti-anxiety and depression meds? Do I want to go that route?
Compared to even a few decades ago, discussion of mental health has begun to step out of the shadows into the light of day. Especially after the height of the Covid pandemic. And yet, understanding, acceptance, compassion, and treatment still have so far to go.
For as common as anxiety and depressive disorders are, their negative impact on every aspect of life is largely understated.
Anxiety disorders, for example, are the most common mental illness in the U.S., affecting over 40 million people over 18 years of age every year.
And major depressive disorder (MDD) is the leading cause of disability in the U.S. for those between 15 and 44.3 years of age.
What should give you (and all of us) pause is the sheer magnitude of these forms of mental illness…and their impact.
For instance, depression and anxiety can cause memory loss if left untreated.
The person suffering with any form of anxiety or depressive disorder isn’t the only one who suffers. Everyone in theirr sphere suffers. Like the sufferer, they miss out on the full potential of life and relationships.
And the debilitating effects trickle all the way down to money.
Every year, our economy loses billions of dollars to the disabilities of anxiety and depression. Missed work, unsatisfactory job performance, inability to stay employed, choice of employment. It’s all connected.
So how do you know when worry has turned into panic? Or performance jitters become an anxiety disorder? Or the blues that have fallen over your mood have become clinical depression?
How do you even start the process of considering anti-anxiety and depression meds?
First, look at your life:
- Is your mood interfering with your normal functioning?
- Do you been feeling consistently down?
- Have you lost interest in things you used to enjoy?
- Have your eating, weight, sleep, energy changed in the past two weeks without changing back to normal?
- Is your mood affecting your work and relationships?
- Are you irritable? Obsessing? Having physical symptoms like increased heart rate or sweaty palms?
The diagnosis of major depressive disorder (MDD), for example, has strict diagnostic criteria.
This is important, in part, because anxiety and depression are not diagnosable via a blood test (someday?) or biopsy. They rely on a person’s ability (and willingness) to make an honest assessment of their mental state based on specific, clinically provided criteria.
They also rely on the knowledge, experience, and intuition of psychiatric and psychological professionals to interpret and help clarify that assessment in order to proceed with treatment.
In these ways, anxiety and depression, like mental illness in general, are subjectively diagnosed.
What does all this have to do with the efficacy of anti-anxiety and depression meds?
A lot, actually.
First, it helps you know when it’s time to see your doctor about treatment for anxiety and depression. This appointment may include discussing anti-anxiety and depression meds.
Far too much mental illness remains undiagnosed, and therefore untreated. People tend to downplay their symptoms. Sometimes they don’t recognize their symptoms.
Second, it helps to distinguish the severity of the disorder and potential overlap with other disorders.
Case in point, anxiety and depression often occur together. Many of their symptoms overlap, and many of their treatment methods overlap.
Third, the severity of anxiety and depression is related to the effectiveness of anti-anxiety and depression meds.
Let’s take a quick look at history…
It wasn’t until the 1950’s that antidepressants made their official clinical introduction.
The monoamine hypothesis laid the groundwork for the development of many antidepressant drugs in use today.
Its premise is that the underlying cause of depressive disorders is a depletion of serotonin, norepinephrine, and dopamine in the central nervous system.
The gist? Keep these monoamines from being absorbed back into their transmitting neurons, and they could make it across neural synapses to waiting neurons.
The pathway of these important mood-affecting neurotransmitters, therefore, would remain uninterrupted.
When it comes to anti-anxiety and depression meds, selective serotonin reuptake inhibitors (SSRIs) are probably the most familiar. Names like Prozac, Zoloft, Lexapro, and Paxil have become commonplace in everyday conversations.
Zoloft is the most commonly prescribed psychiatric medication. It is the usual first-line medication for the treatment of depression, anxiety, PTSD, and OCD because of its efficacy and safety.
And yet, even good news and positive results in medicine are not without controversy and conflicting research.
Anti-anxiety and depression meds are no exception.
How studies are conducted – and even by whom – can influence results.
Consider, for example, studies by pharmaceutical companies that have a vested interest in a drug. Or studies involving placebos that aren’t the sugar-pill format we normally think of for placebos.
By the time results are carefully converted to abstracts, then packaging, then advertising, and then passed to clinicians and patients, relevant information can become blurred.
Of course patients want to know if anti anxiety and antidepressant meds are safe. Are they going to work?
When dealing with a diagnosis as subjective as mood disorders, perceived effectiveness of meds can vary widely.
In general, research suggests the tricyclic antidepressants (SSRIs and selective norepinephrine reuptake inhibitors [SNRIs]) are effective in relieving depression symptoms in about 20% of people.
It’s important to note that antidepressants are more effective for chronic, moderate, and severe depression.
They don’t help as much in cases of mild depression.
And this research doesn’t take into account the melancholic subtype of depressive disorder, which may have more symptoms and be more difficult to treat than other types of depression.
These first-line antidepressants are also used with similar effectiveness for generalized anxiety disorder (GAD), although not all anti-anxiety meds are effective.
Keep in mind that what works for one person may not work for another.
If a baseline medication like Zoloft (sertraline) isn’t doing the job, a clinician will usually “move up the ladder.”
A patient could end up taking a whole cocktail of meds to achieve desired results. All while attempting to offset specific side effects.
Does this medical-speak sound somewhat “unclear?” Yes?! Well, you’re onto something.
Science (including medicine) builds upon itself. What we “knew” 40 years ago may be a window to more relevant today.
The monoamine theory is a perfect example.
The belief that depression and anxiety are caused by deficiencies in transporting serotonin, norepinephrine, and dopamine has now come up against conflicting research.
But, for the person living under a dark cloud of depression and anxiety, emerging data may be of little comfort.
At least until a more effective solution is found.
Dr Elayne Daniels is a psychologist, coach, and consultant in Massachusetts. Her areas of expertise include treatment of eating disorders, body image, and Highly Sensitive People.
Mind and behavior
Psychology may be the scientific study of the mind and behavior, but not to the exclusion of the physical seat of the mind, the brain. The interplay between physical and non-physical is as central to research and treatment as it is to everyday life. Within the seemingly isolated topics of depression, anxiety, and memory loss, for example, an important question is taking on attention: Can Depression And Anxiety Cause Memory Loss?
The human brain is a frontier under constant exploration. It’s not unlike the infinite universe that boggles the non-astronomical mind. For every discovery made, a new galaxy opens. More questions. More theories. And more research.
Take depression, for example. While contemporary psychology may employ a wide array of therapies to treat it, depression has a startling history of far-reaching diagnoses and “treatments.”
In the second millenium B.C.E., “experts” treated depression, like most illnesses, as a spiritual condition – the result of demonic possession.
Through the ages, theories have evolved. And “treatments” have run an often frightening course – from witch hunts to bloodletting to frontal lobotomies.
Today we tread with compassion and the backing of science in the quest for truth and treatment. Depression, like anxiety and other forms of mental illness, now has a voice and a spotlight for deeper understanding. Thank goodness.
One of the common complaints of those who suffer from depression and/or anxiety is memory loss, or cognitive impairment.
Specifically, the working/short-term memory is affected. Words, names, directions, executive functioning, decision-making, locating and misplacing objects – the crazy-making stuff that adds insult to injury.
The long-term memory – remembering key events and people from your life, for example – remains intact.
What’s the connection here? How is it that suffering from low mood, disinterest, irritability, hopelessness, and other symptoms of depression can wreak havoc with basic mental tasks?
With regard to depression, we know for certain it’s linked to structural and chemical changes in the brain. And these changes can begin at the onset of depression and even continue after depressive symptoms have been resolved.
Specifically, the affected areas are the prefrontal cortex, hippocampus, and amygdala. These areas are all involved in cognition and emotional processing, connected neurally via synapses and neurotransmitters. What affects one affects all.
In addition to the interconnection of these areas, there’s also overlap with the stress response systems.
In other words, your mood, cognition, and ability to handle stress are all firing off the same circuitry.
The way depression and anxiety cause memory loss has to do with stress.
The body’s stress response system is masterfully designed to engage during fight-or-flight situations. It triggers a cascade of changes that can be life-saving if you’re engaged in a staredown with a predator.
But it can also be counterproductive if it overstays its welcome or gets triggered in situations that don’t warrant it. (In that regard, one might wonder if perhaps the stress response hasn’t caught up with human evolution.)
Those who suffer from chronic anxiety, with or without depression, know the constant worry and fear, also known as are trademarks of the condition.
Everything is a perceived threat. A headache, a flat tire, something a loved one says (or doesn’t say), a message from Human Resources – it all triggers a stress response. And in flows the cortisol that, under acutely threatening situations, would sharpen the mind and give the body superhero powers.
But day in and day out? That kind of chronic stress response does more harm than good.
Add in the lack of sleep that usually accompanies anxiety, and “brainpower” spreads itself thin – or diminishes altogether.
What many people inexperienced with clinical depression don’t understand is the difference between situational sadness and chronic depression.
Everyone experiences periods of sadness, irritability, anxiety, and grief. But people who live with clinical depression don’t bounce back as quickly.
And the longer one lives with depression, the more permanent the effects become.
From a purely physical standpoint, depression related memory loss can be attributed to depression’s three startling effects on the brain:
- shrinkage (of the hippocampus, prefrontal cortex, and thalamus)
- decreased oxygen supply
When you think about the physical effects of anxiety and depression, chances are they’re effects you can actually sense. You feel your hands sweating, your heart racing, your head hurting. And you see the change in your weight from the change in your eating habits.
You also feel the frustration of not being able to complete everyday tasks. You’re distracted, preoccupied, exhausted, disinterested.
But your brain shrinking? Being inflamed? Not getting enough oxygen?
This all starts to sound like the defining brain atrophy of Alzheimer’s.
And that raises even more questions and cause for research.
If depression and anxiety cause memory loss, how do we need to change the narrative around these disorders?
And around mental health in general?
How do science, medicine, psychiatry, and psychology improve on the detection, intervention, treatment, and management of depression and anxiety?
If depression and anxiety can cause memory loss, is the reverse equally true or at least plausible? Can memory loss cause depression and anxiety in an otherwise non-depressed person?
Can we medically stop or reverse the changes to the brain caused by depression and anxiety?
If medical and psychological intervention can keep sufferers flourishing despite anxiety and depression, can memory loss be mitigated?
If depression, anxiety, and memory loss can co-occur symptomatically, can a “cure” for one hold the key to curing the others?
In the frontier of the human brain and mind, there will always be more questions than answers.
But look how far we’ve come.
Dr Elayne Daniels is a MA based psychologist and coach, specializing in eating disorders, anxiety and depression, and body image. She especially enjoys working with Highly Sensitive People.
You swear you can’t live without him. And he is faithfully sworn to your happiness. He doesn’t check a damn thing off your honey-do list, and you couldn’t care less. You’re happy to swap poop-scooping and fur on…well, everything…for the unconditional love and uncomplicated companionship. You may even have one of the best emotional support dog breeds for anxiety and depression and not know it. Lucky you!
We’ve all seen the memes – and may even own the t-shirt by now: “I love dogs, (insert other interest), and maybe three people.”
Slap a heart emoji on that one because oh, how we all understand and agree!
In fact, we understand and agree so much that the preference for dog company over human company rarely fazes us, even when we’re the competition!
Given the choice between a human and canine, plenty of people would choose to keep company with a dog. Any day. Paws down.
Dogs are, after all, less complicated to live with than most humans.
They don’t weigh down your relationship with a bunch of emotional drama. And their presence can be a natural antidote to human-created stress.
Toss in the cuteness, cuddliness, manipulative eyes, gratis entertainment, and gift of living in the moment, and the preference is understandable.
It’s no wonder humans have come to their senses, bringing their furry friends in from the doghouse and onto the furniture.
Beyond companionship and love, however, some dogs provide something extra. Something indispensable. Something potentially life-saving.
Depending on their owners’ needs, some dogs take on very specific service and support roles.
While any breed can get the part, some breeds are, in general, a more natural fit.
After distinguishing between service dogs and emotional support dogs, we’ll look at the best emotional support dog breeds for anxiety and depression.
Are service dogs the same as emotional support dogs?
Emotional support animals (ESAs) — emotional support dogs (ESDs) included — are not the same as service animals.
(For a beautiful story about service dogs and their human counterparts, check out “Pick of the Litter.”)
Service animals, most often dogs, have specific jobs to do. And they go through extensive behavior and task-specific training to meet the call.
They are responsible for helping their handlers, who may have mobility issues, medical alert needs, or a health condition such as diabetes, severe allergies, or multiple sclerosis.
The United States Department of Housing and Urban Development requires special training for service dogs, but not for emotional support dogs.
(Basic behavior and obedience training is a logical recommendation for any non-regulated, non-certified animal that serves its human in a supportive capacity. Heck, it’s just basic good sense for any dog.)
An ESD may not have the training or designated job of a service dog. But its value to its owner is equally impactful.
And the relationship between an ESD and its owner is one of deep connection and inter-reliance..
ESDs enhance quality of life in ways that are difficult to put into words.
Dogs may be the most popular emotional support animal. But they don’t own the market on assuaging the effects of anxiety and depression.
Practically any domesticated animal can qualify to provide emotional support – cats, hedgehogs, teacup pigs, miniature horses, rabbits, hedgehogs, mice, even (yes) snakes.
While any dog can be an ESD, some are consistently the best emotional support dog breeds for anxiety and depression.
What is the definition of an emotional support dog?
ESDs provide therapeutic benefits, including anxiety relief, companionship, and comfort. The intensely loving and devoted bond they have with their humans provides emotional stability their humans would otherwise struggle to maintain.
When suffering from anxiety, depression, and/or some other mental health issue, the support of an ESD can be invaluable.
There is no required training for ESDs. They are ‘prescribed’ by a licensed mental health provider as part of the process outlined here.
Even though all dogs can offer support, the best emotional support dog breeds for anxiety and depression have traits that make them well suited for the role.
These breeds tend to be gentle, laid-back, and sociable. They’re also highly trainable and are all about pleasing their human friend/owner.
Let’s explore some of the specific ways ESDs help their human beneficiaries.
Here are 4 benefits of emotional support dogs for people with anxiety and depression:
1. Improved Sleep
ESDs can help you sleep by providing a sense of security to help you fall asleep and stay asleep.
With anxiety or depression, sleep is often dysregulated. And sleep problems only worsen mental health symptoms.
2. Emotion Regulation
ESDs help their humans recognize and regulate feelings more effectively.
Emotions are less likely to take over and overwhelm the human when the ESD senses a potential upset or intervenes during an upset.
ESDs can help their humans make connections with other people, such as when taking a walk together or spending time in a dog park.
Conversations tend to be easier when dogs are involved, especially when it comes to starting conversations.
4. Daily Routine
ESDs help people be more engaged in their own lives and have a sense of purpose.
They give their humans a loving reason to wake up in the morning — “Feed me! Pet me! Walk me! Play with me!”
What size dog is best?
Any size dog can make a great ESD. After all, physical size has no bearing on the love, comfort, and support that pour out of a pure heart.
But certain breeds have a predisposition to better temperament, trainability, and obedience.
There are pros and cons to having a small or large ESD.
Small ESDs are a great choice for people who live in cramped spaces such as apartments.
They are also easier to travel with, in part because of airline and other transportation restrictions.
If you love having a perpetual lap dog, a small ESD will probably serve your needs better than, say, a Great Dane.
But then, doesn’t every dog think it’s a lap dog?
Certain traits, dispositions, and genetic tendencies will help you narrow down your options when choosing an emotional support dog breed.
Medium to large ESDs are an excellent choice for people who have more living space and maybe even a yard.
They may also be more of a deterrent to unwelcome attention (such as an intruder, bully, or thief) than a smaller dog.
Understanding your own personality, lifestyle, and needs is essential to creating this indissoluble match.
A larger, more energetic dog breed, for example, may inspire you — even out of necessity — to get back into exercise.
Scenic hikes, jogging, kayaking, even dog-oriented activities like agility, dock-diving, and flyball. The physical engagement will mean a healthier body (for both of you), with the added benefit of endorphins for a healthier mind.
Key criteria to consider include temperament, energy level, and shedding. (But seriously, isn’t dog hair just a badge of honor?)
Here are 8 small emotional support dog breeds for anxiety and depression:
1. Chihuahuas (long-haired or short-haired)
- WaWa’s are are kid-friendly.
- With enough exercise and interaction, they calm down and adapt to a new setting.
- They have a long life span (12-20 years).
- They’re confident, loyal and outgoing.
- Chihuahuas can be nippy, yappy, and feisty.
- Both short- and long-hair Chihuahuas shed, usually in the spring and fall.
2. Poodles Poodles come in 3 AKC sizes: Toy, Miniature, and Standard.
There is also a medium-sized ‘tweener, the Moyen Poodle, for your sizing convenience.
- Poodles are super intelligent and trainable.
- They respond well to learning new tricks.
- They’re active.
- And yea! they don’t shed.
- Even non-shedders need regular grooming. But then, don’t we all?
- They need space to move around and expend energy.
Also called the English Toy Spaniel, the Cavalier King Charles Spaniel has an interesting history..
- They have a sweet temperament.
- They love to cuddle in your lap and snuggle on pillows.
- They’re gentle, friendly, and playful.
- This breed is polite to people and gets along well with dogs and cats.
- They are eager to please.
- Their adorable ears and eyes provide positive vibes, especially if you’re sad.
- They shed heavily. (Your coats, couch, and sheets can attest to this!)
- They may be timid.
- As for their energy level, they love their walks and any chance to run, chase, and fetch.
These low-riders were originally bred for farming and herding sheep.
- They’re intelligent, alert, and protective of their owner. (No wonder Her Majesty collects them like crowned jewels.)
- They have a friendly, affectionate, and obedient temperament/personality.
- They’re light hearted and especially helpful for people with anxiety.
- This breed requires a lot of exercise due to their innate herding instinct.
- They shed heavily.
- Pugs have many human-like expressions, including surprise and happiness.
- They’re versatile and get along well with children and seniors.
- They adapt well to both urban and rural settings.
- They’re affectionate.
- Playful antics are a specialty.
- Pugs have a lot of energy and enjoy running outside.
- They tend to be curious about things and people.
- Yea! for very little shedding!
- Training them is important so they know how to calm down.
- Some people rule them out because of their facial features.
- They can be mischievous.
Dachshunds were bred to hunt animals that burrow, such as badgers and rabbits. Their short legs help them quickly hunt in narrow tunnels.
- “Weiner dogs” are highly trainable.
- They’re affectionate, playful, and friendly.
- Dachshunds are an excellent family companion.
- They have a lot of stamina and energy.
- Besides daily walks, they love playing outdoors with other dogs, digging holes in the yard, and hunting.
- Training your Dachshund in obedience before taking it to parks is especially important
- They need to be brushed regularly and have their ears cleaned weekly.
- Fungi, bacteria, and mites hide in their droopy ears.
- They can be stubborn at first.
- They hunt and dig holes, which can be problematic.
7. Yorkshire Terriers (“Yorkies”)
They’re small with enormous personalities!
- They’re small and portable.
- They fit into small spaces easily and are good travel companions, especially on an airplane.
- They are trainable and sensitive to dangers.
- Their coat is long and silky, but doesn’t tend to shed.
- Despite their small size, they love to chase, play, and pounce.
- They’re considered curious, affectionate, and brave.
- They yap and bark at unfamiliar and suspicious sounds.
- Their coat grows fast and requires regular trimming and constant brushing.
- They need to be walked and played with everyday.
- Their small size may make them easy to accidentally step on.
- Their fur is plushy and hypoallergenic – like a giant cotton ball!
- Bichons tend to be easy-going and intelligent.
- They’re alert to strangers and are great watchdogs.
- They are curious, confident, and warm.
- They love to stay by your side.
- Bichons shed little and should be brushed two to three times a week.
- Their fur is all white. Just a heads-up to you mud puddles out there….
- They resemble miniature poodles, which is a ‘con’ if you don’t like the poodle look.
- They’re energetic and need daily exercise.
Often the same pros and cons are consistent across many breeds. And who/what determines the pros and cons in the first place is subjective.
What are some of the best medium-large emotional support dog breeds?
- This breed is known for its friendliness, kindness, and ability to bond well.
- Golden retrievers are even-tempered and well-mannered.
- Goldens like to retrieve things. For this reason, they also make fantastic service dogs.”Bring the phone! Bring my meds!” Goldie is all about “Your wish is my command.”
- They’re very huggable! (I think loving Goldens is a criterion for being human. Just a hunch.)
- This breed expects to be treated like a family member and not ignored. (And the issue would beee…?)
- Goldens shed a lot.
- They are prone to hip problems and skin issues.
- They require considerable exercise.
- Goldens have one of the highest cancer rates in the dog world.
- The National Institute of Health identifies these dogs as particularly well-suited to contribute to happiness and reduce depression.
- Labradors are among the best dog breeds for anxiety sufferers because they’re cheerful and even-tempered.
- Labrador Retrievers are intelligent and easily trained, and they remain responsive and calm during training.
- They love consistency.
- They’re often used as guide dogs for the visually impaired because they easily pick up daily routines.
- Labs love to please their owners.
- They have a lot of energy and require daily exercise.
- Labs are highly food-motivated, so have dog treats easily accessible (for you to access, not them).
- They love to kiss you – and usually sloppily!
- They’re quite energetic.
11. Irish Wolfhounds
- Irish Wolfhounds are naturally protective and patient.
- Their sensitivity allows them to attend to and improve their human’s mood.
- Their lifespan is short (6 years or so).
- They weigh over 100 pounds.
12. Border Collies
- They’re smart (like, Mensa smart), fearless, and affectionate.
- They’re devoted to their owners.
- This breed is known to be intuitive to feelings.
- They are one of the top champion breeds in canine competitions like agility.
- Their sensitivity to sound can make them appear nervous.
- They have a high risk of eye issues and hip problems.
- They’re sometimes not great with children. (But, if herding your children into their bedrooms at night is your goal, look no further.)
13. German Shephards
- They are super intelligent, strong, and agile.
- They’re very protective and loyal.
- They adapt easily to their environment.
- They take their role as guard dog very seriously (can be a pro or con).
- They have high stamina and require a lot of outdoor time.
- They shed. A lot.
Another breed consideration? Rescued.
Rescue dogs are often mixed breeds. They can be just as loving, compassionate, loyal, and trainable as any dog breed, often without some of the “intense” identifying traits of pure breeds
Breeds to Avoid
Even though any dog breed can technically provide emotional support to a person, certain breeds are less likely to fit the role.
For instance, Shar Peis may be loyal, but not cuddly or loving.
Other breeds such as the Shiba Inu and Pekingese have independent personalities and tend not to offer affection.
Emotional support dogs provide comfort and support
Emotional support dogs, unlike service dogs, are not required to perform any specific tasks for a disability. They’re meant for emotional stability and unconditional love.
As highly affectionate animals, dogs fulfill the role of providing support and love incredibly well.
Giving and receiving affection and having companionship are parts of what makes for a meaningful, fulfilling life.
If you have anxiety or depression, consider speaking with your licensed mental health provider about an ESD. The benefits are enormous.
Imagine improving your mood, decreasing anxiety, feeling better overall, sleeping well, feeling more confident and comfortable, and improving self-esteem.
Seriously. Think about how that would change the course of your life.
And to be part of an inseparable duo with your best friend? Life is looking up just thinking about it!.
As the saying goes, “Imagine yourself to be the person your dog believes you are.”
Dr Elayne Daniels is a clinical psychologist and coach in MA, specializing in Highly Sensitive People and people struggling with eating disorders or body image concerns.
Feeling overwhelmed by life – unable to keep up, let alone meet society’s expectations for spirited ambition and perpetual “on-ness” – can be maddening, deflating, isolating. And, if you find yourself paralyzed by anxiety or slowly sinking under the weight of depression, you may begin to feel downright hopeless. You may be tempted to tough it out alone. Or you may wonder how to know when you need counseling for depression and anxiety.
No matter what you’re asking yourself, you’re in good company. Now, more than ever, people are feeling the same emotional challenges…and asking the same right questions.
One good thing that has come from the Coronavirus Pandemic is more comfort with and less shame about mental health.
Indeed, rates of depression, anxiety, trauma, and other conditions have skyrocketed due to COVID’s impact. As a result, more people recognize that addressing mental health matters doesn’t require whispering or tip-toeing. You don’t even have to use the “asking for a friend” line (unless you actually are).
Mental health challenges are nothing to be ashamed of. Fortunately, depression and anxiety are no longer taboo topics (at least in most circles).
(Recent celebrity and athlete disclosures of depression, anxiety, and other mental health challenges have also helped reduce stigma. Thank you, Simone Biles, Michael Phelps, Serena Williams, and others.)
Less stigma about mental health means it’s easier to acknowledge struggles and seek counseling. Yay!
Counseling is a great idea for just about everyone. You don’t need to qualify by having depression or anxiety.
Counseling, believe it or not, is a powerful tool for personal growth, with or without an underlying condition or glaring “issue.”
It can give you access to a healthy, objective perspective from a trained professional.
Counseling can help you push forward out of “stuck” beliefs and behaviors so that you can become more of who you know you were created to be.
It can help you cultivate clarity and courage so you can recognize (or flat-out leave) toxic situations and relationships.
And it can nurture your natural curiosity and self-exploration, giving you the ability to live a more authentic, enlightened life.
So back to how to know if you need counseling for depression and anxiety…
People often assume that if someone “looks fine,” they “feel fine.”
That assumption, however, is all myth. (Remember the proverb about not judging a book by its cover?)
It’s impossible to have certainty about other people’s degree of depression or anxiety, especially just by looking at them.
An obvious exception is in cases of someone displaying severe signs – suicidal tendencies, stage fright, or a direct admission of depression.
To help you determine if you may need (or benefit from) counseling for depression and anxiety, ask yourself some questions. (I encourage you to write down your responses, as there is power in seeing your thoughts in writing. It’s the same premise as journaling.)
Here are 10 questions to reflect upon in order to know if you need counseling for depression and anxiety:
- How often do you think about coping with depression and anxiety?
- What are the ways/habits you use to cope?
- How many of your methods do you consider good for physical and mental well-being?
- Do you feel shame about depression or anxiety, or about how you are coping?
- How do depression and anxiety affect your relationships – personally, professionally, and with yourself?
- How has the quality of your life been affected overall?
- If your close friend, sibling, or child were suffering from depression and anxiety in a similar way as you, would you encourage counseling? Why or why not?
- What are the pros and cons of you pursuing counseling for depression and anxiety?
- Is there a time frame, after which you would seek counseling if your symptoms were not improved?
- In what ways have depression and anxiety caused problems in your life, both every day and in the big picture?
When depression and anxiety affect your daily life, counseling is a great resource.
This is especially true when their negative effects close in on your relationships or cause you to lose interest in what you used to enjoy.
Difficulty working, feeling irritable, having medical problems, or questioning your worth are other telling signs that depression and/or anxiety may warrant professional help
Counseling is helpful for depression and anxiety because it helps you learn how to identify and name feelings. It also teaches you effective ways of coping.
Talking about feelings can be difficult, especially if you’re from a family where feelings weren’t discussed. The sweep-it-under-the-rug-so-it-goes-away strategy only serves to intensify feelings and is never helpful.
Being able to put words to your feelings is so important.
Unnamed and unexpressed feelings tend to accumulate and fester. They fuel depression, anxiety, and harmful coping behaviors such as alcohol use, self-harm, smoking, compulsive spending, and promiscuity.
The counseling office is a safe space to talk through challenges, be it struggles with family or romantic partners, losses, fears, or blocks to moving forward in your life.
Counseling provides a forum for talking about feelings and thoughts you might not feel safe or comfortable discussing with anyone else.
An additional benefit is that you learn skills that last after counseling ends. The strategies you practice continue to improve well-being.
As you assess whether you need counseling for depression and anxiety, ask yourself how often you feel each of the emotions listed below.
(You may also ponder how much and how severely each particular feeling interferes – if at all – in your life.)
***If any of the feelings could lead you to cause yourself or someone else harm, getting help is essential.
Overwhelm and burnout happen when you believe you have way too many things to do or deal with.
You feel unable to relax and possibly even unable to breathe.
You may notice you are unusually tired or even chronically wired. Perhaps you even feel “wired” while your body and mind are exhausted.
Because mental and physical health are linked, you may have physical symptoms (e.g. fatigue, sleep disturbance, or headaches) from depression or anxiety.
Fatigue can make even pleasant activities difficult.
A racing heart due to anxiety can create panic (and an even faster heart rate), especially if you’re convinced you’re about to have a cardiac emergency.
Feeling angry at times is normal. However, if anger sticks around or leads to harmful urges or acts, get help.
Suppressing anger leads to it coming out at inopportune times and likely in a disproportionate way.
Anxious thoughts/depressed thoughts
Worrying and feeling bummed out on occasion are normal. But when either occurs often, interferes with concentration, or causes physical symptoms, counseling could help.
If you are experiencing suicidal ideation or a suicidal emergency, please seek help immediately. And keep this number for the National Suicide Prevention Hotline on-hand at all times: 800-273-8255
Losing hope or believing there’s no point in bothering to try can be a sign of depression or avoidance/anxiety.
Spending time alone is fine. But if you’re alone because you’re chronically uncomfortable with other people, counseling may be helpful. (This is not necessarily true if you are introverted or a Highly Sensitive Person.)
Having trouble concentrating or being preoccupied by your thoughts could signal depression or anxiety.
Difficulty with concentration is nothing to be concerned about if it happens infrequently or if it’s due to not getting enough sleep the night before. (Sleeplessness as a pattern, however, could be due to depression.)
Preoccupation is concerning when you can’t help but go down a rabbit hole of thoughts – when the more you try to stop the thought spiral, the more it strengthens.
Even though you know that “what you resist, persists,” you still feel trapped in your thoughts.
Hopefully these ideas provide you with a better sense of how to gauge your need for counseling for depression and anxiety. (Or simply your potential to benefit from counseling. I have yet to meet someone who can’t.)
There are as many reasons people go to counseling as there are people. Depression and anxiety are among the most common struggles. Counseling can help us all move forward more effectively.
Give it a try, especially if you’re feeling symptoms of depression and anxiety. (In other words, if you are a human who has lived through 2020 to the present!)
Better days are coming, so hang in there.
Dr. Elayne Daniels is a psychologist specializing in eating disorders, body image, and High Sensitivity. She is passionate about helping people access their own vitality and wellness. Contact her here for more information.
What happens in Vegas may stay in Vegas; but, when it comes to anxiety and depression, there are no “secrets.” Despite their mental origins, they have far-reaching effects on the body. The physical effects of anxiety and depression provide strong evidence that your mind and body are always in communication with one another. (It may come as small consolation, but anxiety and depression are not all in your head.)
Your mind and body interconnect; so, whatever your mind thinks/feels, your body also feels.
This synergy between the mind and body allows you to fully respond to emotions, thoughts, and sensations.
It therefore makes sense that, when you feel anxious or depressed, you physically feel effects, despite their mental origin.
General information about anxiety:
Everyone knows what anxiety feels like. Because it’s the body’s natural response to stress (and everyone experiences stress), no one escapes this life “anxiety-ignorant.”
There are different forms of anxiety, including worry, fear, and nervousness.
Giving a toast at a friend’s wedding, starting a new job, or going on a first date, for example, are naturally stressful situations. They evoke a “what will happen next?”/apprehension-type of stress.
Occasional, situational anxiousness is completely normal. It’s transient in nature and doesn’t culminate in emotional derailment.
Even in these fleeting, innocuous occurrences, however, you will experience physical signals of your anxiety.
Think back to the last time you felt a bit of “stage fright” before facing an uncomfortable (or simply unfamiliar) situation. Did your heart speed up? Your legs tremble? Your mouth feel dry?
Perhaps you even felt a bit nauseous.
Did you connect the dots between your physical symptoms and your nervousness? Or were you too nervous to put two and two together?
It may surprise you to know that many of the world’s most revered celebrities have always struggled with performance anxiety (“stage fright”). This is an important point of reference because it attests to the connection between the mind and body, regardless of preparedness, perception, expectation…or fame.
Most forms of anxiety, including anxiety disorders, have overlapping symptoms. How, then, are you supposed to know if your anxiety is appropriate for the situation of the moment or is something more serious?
If anxiety significantly interferes with your life, it may be considered a disorder. Six examples of anxiety disorders include:
- social anxiety
- post traumatic stress disorder (PTSD)
- generalized anxiety disorder (GAD
- panic disorder
- obsessive compulsive disorder (OCD)
Regardless of whether a person’s anxiety is a disorder, treatments and coping strategies are available.
Panic disorder is a form of anxiety that affects over a quarter of Americans in the form of panic attacks.
Panic attacks come on suddenly and “out of the blue.” And they have major mind and body symptoms.
The symptoms of a panic attack can be so severe that you may be convinced you’re going to die.
You may experience overwhelming fear along with intense physical sensations – pounding heart, blurred vision, dizziness, an inability to hear. You may also start to feel hot or faint.
Why? Because your fight-or-flight system is temporarily going bonkers.
Even though you feel super-intense emotions on the inside, they’re usually not visible from the outside.
A good example of this is the panic attack news journalist Dan Harris had on national television in the early 2000’s. In this video clip, he gives a humble, honest, step-by-step appraisal of what was happening to him…and why.
He also shares his moment of awareness and the steps he took to gain control (in part by giving up control) of his panic disorder.
Panic attack symptoms are not dangerous.
It’s important that you repeat this to yourself because what you experience on a feeling level is incongruent with the perceived danger.
In fact, to give your body the opportunity to learn to manage anxiety, general guidance advises you to experience the symptoms and not resist them.
That doesn’t mean you should allow the panic to take over and cause a downward spiral. It does mean learning techniques for recognizing and guiding yourself through the constricting symptoms of the attack.
This coping principle applies not only to panic attacks, but to the emotional and physical effects of anxiety and depression in general.
The simplest and most effective conscious response? Breeeathe. Slowly, deeply, intentionally…breeeathe.
Typically, the more you breathe into the frightening sensations, the more your fear will diminish. (Thank you, mind-body connection!)
Physical effects of anxiety include:
- racing thoughts
- feeling like you may have diarrhea or are going crazy
- sensation of blood pulsing through your body
- increased heart rate
- blurred vision
- dry mouth
- ringing in ears
- hands shaking
Although the symptoms of panic disorder are not physically dangerous, you should still seek help as soon as possible for the condition.
Learning to recognize and respond to underlying thoughts, feelings, and behaviors will help to improve anxiety in general.
In the same way that your body experiences physical effects of anxiety (and depression) that have unconscious origins, it also responds to consciously applied coping skills.
Now let’s talk specifically about depression….
General information about depression:
Depression is so much more than feeling sad. It is not the situationally appropriate feeling of sadness or deflation in response to negative experiences or loss.
Depression is like a fog that pervades your mind and makes you feel sad, hopeless, and uninterested in things you used to enjoy.
It can also show up as irritability and crabbiness or lethargy and fatigue.
“Depression” is actually an umbrella term for many different mood issues.
As with anxiety, symptoms associated with depressive disorders overlap, despite distinguishing differences.
Because of depression’s negative emotions and thoughts, it may seem to be just “what’s going on in your head.”
However, nothing could be further from the truth.
Depression is not “just in your head.”
Again, because of the inextricable connection between the mind and body, depression is also physical.
As with anxiety, there are different forms of depression.
Feeling bummed or disappointed is not the same as feeling depressed. Neither is grief.
If depression interferes with daily life functioning, it may be considered a disorder.
If that’s the case, please consult with your primary care physician. Treatments for depression abound – from pharmaceutical and/or therapeutic protocols to behavioral and lifestyle adjustments.
Forms of depression that are considered a disorder include:
- major depression (clinical depression)
- dysthymia (persistent depressive disorder)
- seasonal affective disorder (SAD)
- adjustment disorder with depressed mood
Seasonal affective disorder (SAD) as an example of depression.
Starting in late fall or early winter, symptoms of seasonal affective disorder (SAD) start to emerge for some people. SAD occurs much more often in women than in men and is more common in the north, where winter daylight hours are shorter than further south.
The symptoms of SAD tend to begin in young adulthood and occur most often in people who have other mental health issues.
Signs and symptoms of SAD include oversleeping, overeating, and feeling very tired, emotionally drained, lethargic, and depressed during winter months.
Symptoms of SAD tend to go away in the spring and summer, when there is more daylight.
Physical effects of depression include:
- sleep interruptions (trouble falling asleep; trouble staying asleep; waking up early and not falling back to sleep)
- appetite problems (feeling less hungry or more hungry)
- increased sensitivity to pain
- lack of interest in things you used to enjoy doing
- frequent stomach aches or headaches
- restlessness or slowing down
- dry mouth
- trouble concentrating
- memory problems
Mind and body automatically interconnect through the highs, lows, and stressors of life.
Taking care of your mind and mental health means you’re simultaneously doing the same for your body and physical health.
Your mental and physical health are both important. Recognizing the mind-body connection provides you with the ability to change the way your body reacts to thoughts and feelings.
A healthy mind and healthy body go hand in hand.
May you find peace of mind and body.
“Let go of control and find refuge in the body’s immediate present sensory field. When the mind relaxes its grip, the body models sustained attention. The body leads the way. It’s a great relief for the mind…”
—Willa Blythe Baker, “The Body Is Already Mindful”
Dr. Elayne Daniels is a MA-based psychologist, specializing in eating disorders, body image, and High Sensitivity. Contact her here to learn more.
It’s a noble aspiration – a Scarlett O’Hara, “As God is my witness!,” fist-raised-to-Heaven determination – this whole notion of “pulling yourself up by your bootstraps.” “Push on!” “Get over it!” “Do whatever it takes!” And on and on the merciless cheerleading goes. But what happens when you can’t work due to anxiety and depression? What do you do? How do you rally yourself off the bench to go in for the win, even if the “win” is just another day on the clock?
Society celebrates the never-say-”die”-ers. They get guest spots on talk shows. And they “go viral” on social media. Maybe they get gold medals and big-dollar endorsements in the Olympics.
Because they push through…the pain, the inconvenience, sometimes even the common sense.
And, while these noble stories can be the stuff of inspiration, they can also be cautionary tales.
If we’re not careful, they can blind us to discernment (Your team is down 50 points with one minute left in the game. Do you keep cheering for a win?) and harden us to compassion – even unto ourselves.
Get help for anxiety and depression!
The ultimate goal if you can’t work due to anxiety and depression is to treat your symptoms and get back to work.
Whether or not that means back to the same job, however, depends on several factors.
If the job environment was the cause of anxiety and depression, consider looking elsewhere to work.
But be aware of the possibility that the job environment, instead of being the cause of your anxiety and depression, felt intolerable to you because of anxiety and depression.There is nothing wrong or bad about having anxiety or depression.
There is abundant support available, including therapy, medication, and support groups.
Some depression symptoms are mood-based. Examples include sadness, lack of interest or pleasure, and a negative outlook.
When depression symptoms are more severe, the effects become more intense.
These intensified symptoms might present as very low energy, trouble focusing, and feeling extremely unmotivated. Your appetite and sleep pattern might also be negatively affected.
Biological changes, such as changes in hormone levels, can also occur with more severe depression.
As with any other ailment or debilitating condition, the ideal approach is always to seek help before your symptoms of anxiety and depression become severe.
However, if you suffer from anxiety and/or depression, you know how insidiously their symptoms can creep up on you. And trying to determine when to get help can lead you to risk waiting too long.
There is nothing to be ashamed of when seeking help. In fact, getting help is the responsible thing to do.
If you had a cardiac or pulmonary problem, you’d probably make an appointment with your doctor. You wouldn’t stumble to your car and drive to work in the middle of a heart attack (we hope)!
It’s no different if you can’t work due to depression and anxiety.
Here are several insights and suggestions to help you navigate life when anxiety and depression are along for the ride:
- Meet with your primary care physician, who then might refer you to a psychologist for therapy and/or a psychiatrist for medication. Some primary care doctors prescribe antidepressants, but many defer to their psychiatry colleagues.
- Isolating can be so tempting when you’re depressed or anxious. Staying in bed, keeping pajamas on all day, closing the blinds.
But that just makes depression and anxiety worse.
Instead, even if it takes all your might, get out of bed. Shower. Brush your teeth. Eat something for breakfast. Go outside for some fresh air and essential vitamin D.
As counter-intuitive as it feels at first, the positive effects will be immediate.
- A technique I recommend when activities of daily living feel too hard is to conduct “mini experiments.”
Check in with how you feel prior to getting out of bed (maybe on a 1-10 scale). Once you’ve showered, check back in with yourself to assess how you feel. Compare the two ratings.
- Practice focusing on the one thing you are doing in that particular moment. This concentration on “the present” is at the heart of mindfulness practices, which can have profound benefits for people suffering from anxiety and/or depression.
Here is a simple example for getting out of bed when you really don’t want to move: First you sit up in bed. Check. Then you swing your legs around so they hang off the bed. Check. Then you put one foot on the floor. Check. Then the other. Yes! (And so on.)
You are literally taking just one step at a time. The steps add up; and yet, focusing on the one step at hand feels less overwhelming.
- Sometimes listening to music is helpful. Same with journaling.
- In my experience, professional treatment is essential in order to feel better. Anxiety and depression, depending on their severity, tend not to just go away on their own, especially if they are so intense that you can’t work.
- If you can’t work due to anxiety and depression, you may want to consider applying for Social Security Disability benefits.
Know, however, that there are strict criteria to meet, and documentation of ongoing treatment is required.
- For anxiety and depression to improve, you may need to make some lifestyle changes. Incorporating exercise, getting more social support, and/or finding a hobby are all “natural” and very doable examples.
Sometimes getting a pet can help, too – as long as having another life to care for serves as motivation to immerse yourself in a new and positive rhythm of responsibility.
If you do not know where to turn, keep in mind that there are several hotlines to reach out to.
Please keep the following two important hotline numbers where you can easily access them (in your phone, wallet, home, and car, for example). You never know when you or someone you know may need them.
- National Alliance on Mental Illness (NAMI) Helpline: 1-800-950-NAMI (6264)
The staff at NAMI are well-trained to answer questions on a wide range of mental health issues. Available Monday through Friday from 10 a.m. to 6 p.m. EST, they provide free information and referrals to treatment programs, support groups, and educational programs. NAMI also offers help for family members, information about jobs programs, and connections to legal representation in your area.
- National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
If severe anxiety is causing suicidal thoughts, call this free, 24-hour crisis intervention hotline. Counselors can help ease your anxiety. There are separate hotline numbers for Spanish speakers: 1-888-628-9454; the hard of hearing: 1-800-799-4889; and veterans: 1-800-273-8255. You can also speak with a crisis volunteer live on their website.
The bottom line: Help is available, and hope is too.
It all starts with taking just one step.
Dr Elayne Daniels is a clinical psychologist in MA. Her expertise is in the areas of eating disorders, body image, and High Sensitivity. Contact her here.
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 your life, and/or when it causes distress.
Anxiety is especially problematic when it 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’s 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’s time to talk with your doctor about medication to treat anxiety (and depression). This especially makes sense if you know a therapist with whom you feel comfortable talking.
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, however, 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, as they can cause significant distress and affect your relationships at home, school, work, and in other important areas.
The treatment options for depression are the same as those discussed above for anxiety.
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’s 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, called neurotransmitters, in the brain. You need neurotransmitters for normal brain function.
Serotonin is an example of a neurotransmitter. Selective serotonin reuptake inhibitors (SSRIs) form a common group of antidepressant medications.
Another example 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 treat both depression and anxiety. Both groups of medications target mood and stress.
Medication To Treat Anxiety And Depression
Anti-anxiety and antidepressant medications 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 levels with taking medication. Side effects are often a concern.
Unfortunately, so is the belief that taking medication indicates weakness or defeat.
Some people are uncomfortable talking candidly with their doctors about mental health. Acknowledging out loud the pain of depression or the crippling effects of anxiety can be a lot more difficult than acknowledging the pain of a broken limb.
(We may like to believe that, as a society, we have “come so far” in acknowledging, talking about, and treating mental illness. But we have so far to go before we are where we need to be.)
Here are the 5 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 for feeling better. But it can help, especially when it’s part of a comprehensive plan that includes psychotherapy.
Regarding the notion that you ‘should’ be able to manage without medication: Says who? 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 at least 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. That’s why it’s important to take these medications under the supervision of a prescriber and also to meet regularly with a therapist.
When To Seek Treatment for Anxiety and/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 acknowledge how negatively depression and/or anxiety affects your life and that you really could benefit from getting help.
Examples of signs that it’s 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’s time to get help. Another sign is falling behind and never being able to catch up.
- Effects on 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 a weakened 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 psychotherapy. What you try first may not be effective, so be patient with the process of finding what works for you.
Many people have to try several medications, for example, before finding the one (or a combination) that works well for them.
What matters is your acceptance of depression and/or anxiety as factors that affect the entirety of your life.
Treating them under the compassionate care of clinical professionals is simply an expression of the value you place on your life.
The world needs your best self, and you deserve your best life. Depression and anxiety simply need to know who’s in charge.
I am a clinical psychologist in MA who specializes in providing treatment for people with mood and/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 that 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. Think about all those times when a short-lived dose of stress gives you the incentive and energy to meet a challenge.
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 the impact is usually negative, as in possible 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 the mind and body. Some of these factors are family history, genetics, emotional support, race, peer relations, education, social constructs, trauma history, temperament, coping skills, and finances.
Some factors are a buffer, while others worsen stress’s 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 lives.
If stress caused eating disorders, everyone would have one.
So, the next time you hear people wonder if stress causes eating disorders (and depression), you’ll know what to say: “Not exactly.”
Stress does not cause eating disorders (or depression), but is a variable in the equation.
And it can be and often is the straw that breaks the camel’s back.
Stress and eating disorders are linked in a handful of ways.
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 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 you are is at stake.
Eating disorders also create physical stress. 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 and outgoing [in the case of bulimia]).
It’s also mediated by Diet Culture.
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. The eating disorder may not be triggered were it not for the stressful event.
The Why now? question of the timing of an eating disorder usually involves a triggering event.
Examples include the 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’s how it 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’s a hard trap to get out of. Once you see it, though, you’re 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, to the point of discomfort.
Often the person feels a sense of shame or guilt afterwards. Without compensatory behavior, such as purging, to offset the binge eating, the person will often deliberately restrict intake between binges.
In their lifetimes, 3.5% of women and 2.0% of men will have BED.
To put this into 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.) Larger-bodied people with BED face additional stress from weight stigma and discrimination.
To cope with stress, binge eating becomes the relied-upon method for managing 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 the fear — and reality — of weight gain.
Add to all this 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’s characterized by cycles of bingeing and self-induced purging to undo the effects of bingeing.
Three in 100 American women suffer 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.
The cycle goes like this:
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 purge, and of shame.
Another form of stress caused by the eating disorder is the physical impact of bingeing and purging. 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, more and more 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. Food (and her relationship with it) is all the person with anorexia can think of. It’s 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, anorexia’s symptoms cause a ton of stress, which affects both the mind and body.
In fact, anorexia has the highest mortality rate of any psychiatric 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%) experiences depression at some time in his/her life.
Depression can occur at any time, but typically first appears during the late teens to mid-20s.
Stress affects 100% of adults; and yet, not 100% of adults 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. This is a depression response to stress called learned helplessness.
A person who has learned helplessness eventually stops trying to manage the stress because nothing has worked in the past. Not trying leads to apathy, then all-or-nothing thinking.
The person’s self-talk is based on 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 then sets in.
Generally, when a person feels stressed, her problem-solving skills aren’t optimal. Without the stress, her coping and problem-solving skills may be effective enough.
Stress can also lead a person to neglect self-care or engage in behaviors that harm her 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 many reasons..
Depression disrupts life. It’s associated with withdrawing from people, isolating, 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.
At the core of eating disorders and depression is disconnection, often 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.
There will always be stress. But it doesn’t need to harm your quality of life.
Learning and practicing how to cope differently with stress decreases the risk for eating disorders and depression.
And makes for a more meaningful 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. To expect a person to be able to “snap out of it” is not realistic. And it’s certainly not helpful.
Actually, it’s unkind, insensitive, and uncompassionate.
If the person could switch gears on command, she would. But thoughts and feelings that rise out of depression and anxiety are just too intense.
The good news? There are effective ways to manage depression or anxiety if you experience a flare-up.
Before we discuss tips for managing depression and anxiety, let’s take care of some definitions.
What is depression?
Being depressed is like being emotionally colorblind. If you’ve ever seen videos of people putting on EnChroma colorblind glasses for the first time, you know how affecting the experience is.
A person who has viewed the world in muted, vintage-photo shades suddenly realizes what he has been missing.
Depression is the gray scale. It’s the muted, lifeless wavelength of life’s vibrancy. It negatively affects how you feel, think, and 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 is 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 isn’t to permanently exile your anxiety, but to strengthen your ability to cope with it. Tips for managing depression and anxiety if you have a flare-up:
Flare-ups happen. They don’t mean you’re back to square one. In fact, a flare-up can be an opportunity to practice and strengthen techniques from your coping repertoire.
CONDUCT EXPERIMENTS to manage depression and anxiety.
Rather than committing to a definitive resolution or plan, try the “let me see what happens if…” approach.
Think of what you’re going to do to manage the flare-up as if you’re conducting an experiment.
For example, let’s say it’s nighttime, 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.”
Nothing earth-shattering about that. People get up, shower, and eat every day.
The power and coping potential lie in the comparison to what you may be used to telling yourself. “I ‘should’/’have to’ get up early tomorrow, shower, and then eat breakfast. But I know I’ll be groggy and in a bad mood and will keep pressing snooze.”
The first case speaks to hope and opportunity.
The latter sounds like a mixture of a guilt-induced mandate and pessimism.
With the “let me see what happens if” approach, you agree to try something different. Just once. Just for today.
What often happens is the experiment goes well and continues the next day…and the next…and the next….
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 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. Don’t 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 time spent in nature. (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 take our thoughts as fact, even when the thoughts aren’t true.
Negative self-talk is stinkin’ thinkin’ — thoughts like “I suck,” “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, leading to a downward spiral of “more and worse” of the same.
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 mitigate their impact. And 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 accepting 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, feeling.
This reminder allows you to hold yourself in love and connection and to give yourself the same kind of support you would give 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 to incorporate self-compassion practices into your day (thank you, tip#2) and reassure yourself (thank you, tip #3) that an open mind is all you need.
Having a flare-up of depression or anxiety may be inevitable.
But life has a way of presenting the same challenges as opportunities for you to gain mastery of them.
Flare-ups, when accepted in this positive light, are simply opportunities to revisit techniques you know are helpful and to experiment with new ones.Dr Elayne Daniels is a private-practice psychologist in MA, specializing in the treatment of depression, anxiety, and/or eating disorders and 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 for depression and anxiety. 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.
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