When anxiety and depression combine

Anxiety and depression are two different conditions with some similar symptoms which often occur together.

Anxiety can be summarised as a state of perpetual fear, worry and hypervigilance. Sufferers experience a range of physical symptoms including tension, heart palpitations, shortness of breath, trembling and nausea. Sometimes this anxiety can be attributed to a particular phobia, social situation or stressful experience. Sometimes there is no specific trigger, a condition known as Generalised Anxiety Disorder. Anxiety is characterised by avoidance of situations which might trigger the overwhelming feelings of fear leading sufferers to lead an increasingly isolated life.

Depression is a state of hopelessness, melancholy and despair with feelings of apathy, loss of life satisfaction, feelings of worthlessness and loss of interest in activities previously enjoyed. The physical symptoms include sleep disturbance, decreased appetite, aches, pains and digestive problems. Depression is characterised by a withdrawal from the world and, as in the case of anxiety, leading an increasingly isolated life.

It follows that if you are avoiding situations and becoming isolated, you may also become depressed. Or that if you are depressed enough to separate yourself from others, you may become anxious at the thought of interacting with others. It is thought that 85% of patients with depression also experience anxiety and up to 90% of patient with a diagnosed anxiety disorder develop depression.

Cognitive Behavioural Therapy (CBT) is the recommended talking therapy for both anxiety and depressive disorders, but when occurring together, the best results occur when undertaken in conjunction with psychiatric medication. The use of SSRIs (Selective Serotonin Reuptake Inhibitors), a type of anti-depressant prescribed for both conditions, can be combined with a mood stabiliser such as lithium when the patient does not respond to SSRIs alone.

Case Study

A male patient of 48 years was referred with considerable job stress. He worked long hours, as a banker in London and felt under constant pressure, with strict deadlines to complete work. He started to under-function at work, with poor concentration and was frequently weepy. His sleep pattern was disturbed, with early morning wakening at 4am and he felt worse in the morning. He found it difficult to attend work and would have panic attacks when he saw his office in the City.

He was diagnosed as having a mixed anxiety/depression and was prescribed Citalopram 20mg in the morning (This is an SSRI). He also received 12 sessions of individual cognitive behavioural therapy.

There was a marked improvement in his mental state and he was able to function well again at work.

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