Anxiety and Depression and Anger...Oh, My!

Let's think about anxiety and depression...and anger:

  • When do you get angry?
  • When do you get sad?
  • When do you get anxious?

        So, "Why am I depressed?", "Why am I anxious?", "Why am I angry?" The common theme with anxiety and depression is that there's a perception of something or someone being out of our control If we felt in control at all moments, we'd never experience these emotions.

       Our bodies respond very similarly when our mind becomes anxious, sad, or angry. The real difference among these three emotions is our internal messaging. That's why they seem so different. You can think of depression as anger turned inward.

So, when does stress become anxiety? When does sadness become depression? There are two main factors to look for in determining whether or not this is anxiety and depression:

1. How long have you felt stressed or sad?

2. How bad is it?

Everyone feels sad or blue sometimes. Everyone gets stressed out sometimes. It’s a natural part of life. But, when the sadness and worry persist and interfere with everyday life, it may be anxiety and depression.

Depression Explained: A Short Video

Anxiety and Depression:
To Diagnose or Not to Diagnose?

  • Classified according to the DSM-5.

  • Although imperfect, the DSM-5 reflects an improvement from the past, when there was no common language in talking about what was, or was not a mental condition.

  • Each version of the DSM gives us a greater understanding of mental conditions, including anxiety and depression.

Gives us a common language.
Allows people to learn and get support about their condition or problems.

Being “labeled” may carry a stigma. (Perhaps stigma is the true problem?)
People may misuse a diagnosis of anxiety and depression to avoid responsibility for a problem. “Depression is the leading cause of disability among nonfatal medical conditions in the United States.” Beth Laurence, JD

Here are the official diagnoses for the anxiety and depression disorders. Again, keep in mind these are all variations on a theme - the perception of something being out of our control. It's important to not pigeon hole yourself or anyone else in any one category. Each person's experience  with anxiety and depression is unique.

Depressive Disorders in the DSM-5: An Umbrella

  • Major Depressive Disorder (Bereavement exclusion is no longer in place)

  • Persistent Depressive Disorder

  • Depressive Disorder due to another medical condition

  • Premenstrual Dysphoric Disorder

  • Disruptive Mood Dysregulation Disorder (DMDD) (first diagnosis between ages 6 and 18)

Anxiety Disorders in the DSM-5: An Umbrella

  • Separation Anxiety Disorder
  • Selective Mutism
  • Specific Phobia
  • Social Anxiety Disorder (Social Phobia)
  • Panic Disorder Panic Attack (Specifier)
  • Agoraphobia
  • Generalized Anxiety Disorder
  • Substance/Medication-Induced Anxiety Disorder
  • Anxiety Disorder Due to Another Medical Condition
  • Other Specified Anxiety Disorder
  • Unspecified Anxiety Disorder

Diagnoses Related to Anxiety in the DSM-5: Trauma- and Stressor-Related Disorders

  • Reactive Attachment Disorder
  • Disinhibited Social Engagement Disorder
  • Post-traumatic Stress Disorder
  • Acute Stress Disorder
  • Adjustment Disorders
  • Other Specified Trauma- and Stressor-Related Disorder
  • Unspecified Trauma- and Stressor-Related Disorder

Diagnoses Related to Anxiety in the DSM-5:
Obsessive-Compulsive and Related Disorders

  • Obsessive-Compulsive Disorder
  • Body Dysmorphic Disorder
  • Hoarding Disorder
  • Trichotillomania (Hair-Pulling Disorder)
  • Excoriation (Skin-Picking) Disorder
  • Substance/Medication-Induced Obsessive-Compulsive and Related Disorder
  • Obsessive-Compulsive and Related Disorder Due to Another Medical Condition
  • Other Specified Obsessive-Compulsive and Related Disorder
  • Unspecified Obsessive-Compulsive and Related Disorder

Diagnoses Related to Anxiety in the DSM-5:
Somatic Symptom and Related Disorders

  • Illness Anxiety Disorder

Symptoms of Depression

SIG E CAPS: The daily presence of five or more of the following symptoms, lasting at least two weeks, indicates that the person is suffering from a depressive disorder.

S: Sleep disturbance
I:  Interest decreased in activities that used to be enjoyed
G: Guilt feelings and/or feelings of worthlessness

E: Energy lower than usual

C: Concentration poor
A: Appetite changes (usually loss of appetite and weight loss in the elderly. Complaints of poor digestion or constipation.)
P: Psychomotor changes (agitation or slowing)
S: Suicidal ideation

Clues that someone has anxiety and depression

  • Stooped posture
  • Slowed speech and movement
  • Lack of interest in self care
  • Aggressive behavior
  • Unrealistic fears
  • Repetitive verbalizations (calling for help)
  • Agitated shouting, yelling, screaming
  • Repeated questions, health related concerns

Common Symptoms of Anxiety

  • Rapid heart beat, pounding heart
  • Sweating
  • Trembling or shaking
  • Shortness of Breath
  • Dry mouth or feeling of choking
  • Chest pain
  • Nausea
  • Cold chills, hot flashes
  • Dizziness
  • Feeling detached from oneself
  • Numbness, tingling sensation
  • Visual changes (light seems too bright, spots)
  • Blushing
  • Muscle tension, twitching
  • Mind going blank
  • Difficulty sleeping
  • Disturbing dreams
  • Unwanted thoughts
  • Feeling urge to escape

Anxiety and Depression: Untreated

Can lead to conditions such as:
Heart disease
Irritable bowel syndrome
The list goes on and on…

Can make conditions worse:
Longer healing times from injury
Suppressed immunity = more colds, etc.

Can lead to suicide

Brain Effects: There is less neural activity in a depressed brain…   

Insights on effective treatment

My colleague, Andrew Richardson sheds some light on the essentials for the treatment of anxiety and depression in these excerpt from his articles.

Talking about your problems is the last thing for depression recovery

If you are full to bursting, then it makes sense begin talking  and to let it all out . Who could argue with that?  If you are depressed and your head is going round and round with all kinds of theories and explanations as to why you are feeling so bad and if you have urgent problems to sort out – money worries, jobs, relationships etc. etc. – then surely you need to talk to someone about it and quickly too? It seems so obvious doesn’t it?  That you should talk to friends or family or even horror of horrors to one of the legion of counselors out there who are trained to listen.

Talking is the last thing depressed people should do

It is really very simple and follows as night follows day from understanding what a depression is.  A depression is the exhaustion caused by worrying and ruminating too much.  Depression is an exhausted brain that is dreaming too much in a failing attempt to clear all of the exhaustion and over worrying.

Depression people are trapped in their thoughts and emotions and quite naturally they want to begin talking – to unload to any who might listen. But this will only give short-term relief and could in fact just feed the rumination as fuel feeds a flame.  Yes there will be real problems to sort out – but before even attempting to sort them out, your head needs to be in a much better shape.

why recovery from depression need be no harder than from a twisted ankle.  Imagine someone who twisted their ankle and, being desperately concerned that she might never walk again, keeps walking and walking, even though this was making her ankle even worse.  What would you say to her? It would surely be to say to her that she should rest it and to only begin walking again when the ankle was stronger.  The same applies to depression.  Calm you mind, worry less and only tackle your problems when your mind is fitter.

Practical Firefighting for Depression: Self Help

Set your alarm.
During tiring times like this, using an alarm clock can be most helpful. Set your alarm in the morning so you don’t end up staying in bed all day long. If you have an important meeting to attend, or an appointment, set your alarm as well. A constant reminder of your daily tasks can keep you motivated to do what you have to do.

Dress up.
Take a long, cold shower, brush your teeth, apply makeup, and wear a pretty dress. Even if you just work from home, dress up! Doing this decreases your urge to lounge because again, you are reinforcing in your brain that you are getting ready for something.

Move around.
Sweating it out is one way to boost your motivation and get your body going. Choose an exercise that works for you. You don’t have to force yourself to do an intense workout. You simply go with walking, swimming, running, or gardening.

Schedule your tasks/activities.
Schedule your tasks according to your energy levels. If you think you have more energy in the morning, you may want to do tougher jobs and reserve the lighter ones in the afternoon. For bigger projects, consider creating a timeline of at least one or two weeks (more if necessary). Break a big task to smaller ones. And don’t forget to incorporate activities that give you pleasure, such as your hobbies and passion.

Connect with people you love.
Being with people you love, including your friends and family is one way to boost your mood. And when you’re feeling good, you are more likely to motivate yourself to hit your daily goals. Remember that the more you remove yourself from the environment of depression, the better your chance of recovery.

Go out.
Leaving the house can be one of the most difficult challenges people with depression face. One reason for this is not having a place to go. When your depressed, even the most entertaining places can be boring and less amusing. But you don’t have to be somewhere far, different or extraordinary to reap the benefit of going out. Just take a short walk around the neighborhood or invite a friend for a cup of coffee, go to the mall and shop, or walk your dog in the park.

Depression Symptoms - The Cycle of Depression

This is what happens when depression symptoms and signs of depression takes hold?

    •    Something happens in your life that pushes you off balance... and you quite naturally and healthily begin to worry about it, looking for a solution that will calm you and bring you back to equilibrium.

    •    But this does not happen and as the problem persists, it becomes harder and harder to deal with. And you are aware of those rigid thinking habits that arise whenever you are under pressure and maybe also the emotion of bad past memories - and as these impose themselves, it is even more difficult to get your life back on track.

    •    Then you’re sleeping begins to deteriorate and in particular you are increasingly tired and exhausted in the morning when you wake up. You may also be dimly aware that you are dreaming much more.

A downward spiral really gets underway - the classic depression symptoms...

    •    Your problems become harder and harder to deal with and seem to be multiplying and as motivation and energy disappear, you worry more and more, introspecting and blaming yourself.
What is happening is you are locking into a depression trance, focusing internally and negatively, losing hope and as good deep wave sleep becomes pushed out by excessive dreaming, you may finally be finding that physical aches and pains add to your sense of hopelessness and "stuckness" - another of the signs of depression.

This used to be called a state of nervous exhaustion and you can see why. If very severe, this can even transmute into psychotic experiences.

This is depression symptoms formulated as a simple depression cycle.

-The simple explanation of depression symptoms

Depression is the mental and physical exhaustion caused by the body’s need to dream more than it is capable of, in order to deal with a situation that appears increasingly impossible.

And why is there the need to engage in high energy dreaming? It is the attempt to clear the excessive levels of arousal, worrying and exhaustion, which caused the problem in the first place.

And so we have a self-feeding vicious circle where symptoms and signs of depression multiply.

Depression Symptoms - what you will read from pretty well all sources:

You can read many lists of depression symptoms and indeed for many lists, this is all they offer as they have no coherent explanation. Such as:
    •    Feeling miserable and sad, being exhausted, finding the smallest tasks impossible
    •    Losing any sense of enjoyment
    •    Feeling a failure, guilty and a burden and that life is not worth living or passing you by
    •    Avoiding people, losing self confidence
    •    Being tense and irritable all the time
    •    Having difficulty sleeping, dreaming all night long
    •    Enduring physical aches and pains which appear to have no physical cause.

It is easy to see how these symptoms fit into the explanation above.

Common misconceptions about Depression symptoms

Depression symptoms are caused by a chemical imbalance.
Low serotonin is the result not the cause of depression – and this is why anti-depressants are rarely the answer. Anti-depressants treat symptoms and not underlying causes and seem to work by suppressing REM (or dream) sleep.

Depression symptoms are hereditary
The fact that family members may all suffer from depression is better explained by their common environments than their common genes. That it is learned – in terms of thinking styles and coping mechanisms.

Depression symptoms reflect a disease
It is not a biological disorder – there is no chemical test available or possible or yet devised that can mark a depression.

    •    How else but through environmental factors can the tenfold increase in depression symptoms amongst those born after 1945 be explained? Surely, it is that society has changed – family breakdown, greater materialism and focus on self, a reduced sense of obligation and duty, an increasing dependence on the state – how is that for starters as the environmental factors that create worry and dis-empowerment – all of which make it more difficult to get our essential human needs met.

Everyone needs a healthy body, mind, spirit

Body (Physical, Biological Self)
Mind (Psychological, Emotional Self)
Spirit (Spiritual Self)

Note: Overlap, e.g.  psychological interventions can cause biological changes, and vice versa

Ensure healthy amounts of
Individual exercise
Group / social exercise
Yoga / Martial Arts
Sunlight (especially in the case of winter depression)
Medications may be a helpful “body” or physical intervention in certain circumstances.
For anxiety and depression, in general:
Non-medication strategies are tried first.
Medications are used if non-medication strategies are unsuccessful.

Common types of “self-medication” - some good, some not so good!
Sweets, carbohydrates, chocolates
May possibly be a way of getting serotonin

May be a way of getting adrenaline/dopamine to cope with anxiety and depression

May be a way of getting adrenaline/dopamine

Street drugs

Hypnotherapy can help calm the mind and visualize positive outcomes.
Psychotherapy such as cognitive behavior therapy
Anxiety and depression is caused by cognitive distortions.
Fixing cognitive distortions will overcome the anxiety or depression.

Ensure good coping strategies and ways to deal with stress.
Relaxation techniques
Reframing thoughts

Figure out what gives meaning to your life.
Ensure those things are in the your life.
If you're not sure what gives you meaning, try exploring new activities. You're bound to find something to pique your interest.

Overcome emotional insecurity - YOU are enough!

How to Make Your Mind Still: A Quick Exercise

Take a moment to gain control of anxiety and depression with this simple exercise. If you think of your body as a house, most of us spend the majority of our time living right under the roof, in the attic.

We identify ourselves as our thoughts and emotions, our anxiety and depression, letting the constant “mind chatter” take over.

An easy way to slow down the mind chatter is by bringing your attention to the rest of your body. Start by taking in some deep breaths. Simply notice your breath. It’s nearly impossible to pay attention to anything else when you’re breathing in this mindful way.

Realize that you are not your thoughts or emotions. You are not anxiety and depression. You are this awareness or mindfulness behind them. When you practice mindfulness, it becomes easier to be an observer of your thoughts, rather than a follower.