Category Archives: #ANXIETY


What causes Headaches?

Headache was one of the first symptoms recorded by man, and today it is the most common of all medical complaints. More than 70% of people get headaches, ranging from an occasional aggravation to chronic, crushing head pain. Headaches cost society a large fortune each year in lost productivity.

There are many structures in the head which may become inflamed, compressed or irritated, leading to headache pain. These include nerves, blood vessels and muscles of the face, scalp and neck, teeth, the lining of the brain, sinuses, joints and other soft tissues. A number of chemicals released by arteries and nerves may set up “vicious cycles” in these structures or tissues causing a headache to become long lasting or continuous.

Investigating a Headache

Many types of headaches have a recognizable pattern. For this reason, a detailed clinical history is essential in making a diagnosis. Occasionally, additional tests may be necessary. Blood tests may screen for thyroid disease, anaemia, or infections. X-rays may be taken to rule out bony abnormalities or sinus infection. Occasionally patients with unusual headaches may require a computed tomographic (CT) scan or magnetic resonance imaging (MRI) which demonstrate internal brain structures or biochemistry of the brain. An eye examination may be done to check for weakness in the eye muscle or poor eyesight. In certain cases an angiogram may be undertaken to reveal any abnormalities in the blood vessels in the brain. If meningitis is suspected, a Lumbar Puncture may be performed.

Types of Headache

Headaches without underlying disease are termed “primary”, and include tension, migraine and cluster headaches. About 95% of all headaches are primary. Less than 5% of headaches signal a serious medical condition.


90% of primary headaches are tension-type, affecting men and women about equally. They are usually diffuse with pain over the top of the head or back of the neck. It may feel like fullness or pressure, as if a constricting band is surrounding your head. Neck and shoulder muscles may be tense. The pain may go away after an hour, may last several days, or may become chronic. The headache pain waxes and wanes. They are most often caused by anxiety or stress and occur more commonly in people with poor posture, those who strain their neck and shoulders a lot and people who work at stationary, repetitive tasks.


These are relatively uncommon, but very severe, affecting men far more often than women. Sufferers are typically heavy smokers. They have an abrupt onset and can occur at any time, but they most commonly occur 2 to 3 hours after you fall asleep. They are characterized by intense burning, boring pain frequently located in or around one eye and temple or in a cheek or jaw. The affected eye may be bloodshot and teary. The nostril on that side may be blocked or run profusely. Other features may be reduced pupil size on the painful side, a drooping eyelid, a flushed face and a sweaty brow. The pain intensifies within 5 – 10 minutes to a peak that persists for up to 2 hours. They can occur daily for days, weeks, or months, before a remission period.


About 6% of primary headaches are migraine. It has a strong genetic component, and is about 3 times more common in women than men. Most often the disorder begins between the ages of 5 and 35 years old.

Migraine headaches are characterized by intense, throbbing head pain, worsened by physical activity. It is felt in the forehead, temple, ear, jaw, or around the eye. Most migraines are one-sided. They are long lasting (from 4 to about 72 hours), and often associated with nausea, vomiting, and sensitivity to light and/or sound. Aura. About 10-20% of migraine patients have auras. These are neurological symptoms that usually precede the headache and include visual disturbances, tingling, numbness or weakness on one side of the face or body, speech problems or confusion.

What causes Migraine?

Migraine sufferers appear to have blood vessels that over react to various triggers. These cause spasm and constriction of the nerve-rich arteries in the brain followed by dilation of certain arteries within the brain, neck and scalp. Pain-producing substances called prostaglandins and a chemical called serotonin are involved. The release of these chemicals and the dilation of arteries stimulate pain receptors in the head, resulting in a throbbing headache pain.

Migraine Triggers

These activate an already existing imbalance of chemicals in the brain. Common triggers include hormone changes, diet (alcohol, especially red wine or beer; aged cheeses; chocolate; pickled foods; monosodium glutamate; aspartame and caffeine), stress, weather changes, season, altitude, time zone, sleep patterns or meal times. Bright lights, unusual odours, medications or polluted air may also trigger migraines.


Some headaches, called “secondary” headaches, result from a medical condition. These conditions include sinus infections, abnormalities of the Temporomandibular joint (TMJ) connecting the jaw to the skull, brain tumours, middle ear infection, head trauma, eyestrain or eye infections, arteritis (inflammation of arteries), meningitis (inflammation of the brain’s outer covering) and head or neck neuralgia (inflammation of nerves).

Treatment of Headache & Migraine

Rest, heat or ice packs alone may relieve an occasional headache. If not, try an over-the-counter pain reliever. Take the minimal dose needed to relieve pain. Overuse may cause chronic daily headaches (“rebound” headaches). If these measures fail to control the headache, other medication may be necessary. Migraine medications fall into two broad categories: abortive drugs to stop or reduce pain after a headache starts and prophylactic drugs to prevent headaches. Abortive medications include “Serotonin agonists,” which work by influencing the behaviour of serotonin; vasoconstrictors, which prevent blood vessel swelling; anaesthetic nasal drops; anaelgesics and Non Steroidal Anti-Inflammatories. Prophylactic medications include antidepressants, Serotonin antagonists, Beta-blockers, calcium channel blockers and anti-seizure drugs. Inhalation of 100% oxygen has been shown to be effective for cluster headaches.

Other measures

Over the long-term, combat headaches by controlling triggers, careful use of pain relievers to avoid “rebound” headaches, stopping smoking and avoiding alcohol during a headache, (especially cluster headaches). Manage stress and exercise regularly. Treatments such as physiotherapy or biofeedback may be effective.

Danger Signs

Headaches may signal a serious medical condition. Contact your doctor if your headache:

  • is accompanied by confusion, unconsciousness or convulsions
  • involves pain in the eye or ear
  • is accompanied by fever or nausea
  • occurs after a blow to the head
  • is persistent in someone previously free of headaches
  • is recurrent, especially in children
  • interferes with normal life.

Dealing with headache takes determination combined with a well-rounded approach. It means balancing use of medications with exercise, regular and nutritious meals, and adequate rest. Your goal is to attack headache pain from all sides. Together with advances in understanding headache, the reward is that you control your pain so that the pain doesn’t control you.


Having sufficient restful sleep is a critical human requirement. It is vital to emotional and physical well being. Most adults sleep between 6 and 8 hours per day, without interruption. A few nights of poor sleep do no harm, but prolonged sleep disturbances can have serious consequences.

The Physiology of Sleep

People function according to a natural cycle that repeats itself about every 24 hours. This is known as the circadian rhythm, and it governs our sleep-wake cycles. As it gets dark, the cells in the retina of the eye send a message directly to a part of the brain called the hypothalamus, which then signals the pineal gland located in the hypothalamus to produce the hormone melatonin, which causes a drop in body temperature and sleepiness. At the same time there is a reduction in the chemicals responsible for arousal, like histamine, noradrenalin, and serotonin. In a normal person, this sequence brings on sleep. There are two types of sleep: rapid eye movement (REM) and nonrapid eye movement (NREM). NREM has four stages, with stage 1 being transitional sleep, stage 2 light sleep and stages 3 and 4 deep (delta) sleep. Delta sleep is the most restful kind. During NREM sleep, brain activity and body functions slow. During REM there is increased activity – body functions speed up and a person dreams. A person moves from one phase of sleep to another during the night.


What is Insomnia?

Insomnia is a sleeping problem in which there is either inadequate sleeping time, or poor quality sleep, occurring on a regular or frequent basis, often for no apparent reason. A person with insomnia may have difficulty falling asleep, may wake up too early, wake up intermittently during the night, or may wake feeling unrefreshed.

During the day a person with insomnia may suffer from general tiredness, lack of energy, difficulty concentrating, and irritability. Sleep deprivation also impairs memory, reaction time and alertness. Tired people are less productive at work, less patient with others, and less interactive in relationships. Sleep deprivation can also be dangerous for people who have to drive. When people are deprived of sleep over long periods, the body’s immune system becomes depressed, lowering resistance to disease and infections.

Insomnia is very common – between 20% and 30% of adults suffer insomnia to some degree, and about 10% to 15% of people have insomnia which is chronic or severe. Insomnia is more of a problem in the elderly, and is more common in women. Sleeping pills are amongst the most prescribed medicines in the world.

Types of Insomnia

Transient insomnia is a temporary disturbance of the normal sleep pattern. It generally lasts no more than several nights, and usually disappears on returning to a regular sleep pattern. Travel or relocation may cause it.

Short-term insomnia lasts for 2 – 3 weeks and can accompany worry or stress. It often disappears if the cause is resolved.

Chronic insomnia disrupts sleep for extended periods of time – sleeping problems occur for at least 3 nights a week for one month or more. It is a complicated disorder with potentially serious effects.

What causes Insomnia?

Insomnia is usually the result of an underlying condition. Discovering the cause is the most important step in relieving insomnia.

Lifestyle factors are common causes of insomnia, particularly transient or short term insomnia. These include factors like high stress or anxiety, an uncomfortable sleeping environment, eating a heavy meal or drinking alcohol or caffeine-containing drinks before bedtime, exercising just before bedtime and cigarette smoking.

Medical conditions may cause chronic insomnia. These include chronic illnesses like kidney disease, heart failure or asthma, painful illnesses like arthritis or cancer, and hormone imbalances like hyperthyroidism, menopause or pregnancy.

Psychiatric conditions like depression, anxiety disorders or schizophrenia may be associated with chronic insomnia.

Medications are a common cause of insomnia. Some antidepressants, high blood pressure and steroid medications can interfere with sleep. Many painkillers, decongestants and weight loss products contain caffeine and other stimulants which will keep a person awake. Reducing or stopping your regular dose of sleeping pills may also cause insomnia.

Certain sleep disorders may result in insomnia. Restless leg syndrome is a condition where a person experiences unpleasant sensations in the legs or feet, preventing sleep. Periodic limb movement disorder is where uncontrollable twitching of the legs or arms prevent refreshing sleep. Obstructive sleep apnoea is a condition in which people intermittently stop breathing for short periods during sleep, causing them to wake frequently. Circadian rhythm disorders develop due to time zone changes (jet lag), or in people who do shift work.

Psycho Physiological Insomnia is one of the commonest causes of insomnia affecting about 5% of people. It develops when a person experiences a poor night’s sleep and then has increased anxiety the next night, which again prevents him from falling asleep. This “vicious cycle” is repeated night after night, leading to chronic insomnia.

How Is Insomnia Diagnosed?

The many potential causes of insomnia mentioned above can be determined by assessing lifestyle factors, by reviewing physical or psychiatric symptoms and by performing a physical examination. Certain laboratory tests and special investigations may be necessary. A sleep diary, which provides a record of how long and when you sleep, may also be helpful. In some patients an assessment at a sleep clinic may be necessary.

Treatment of Insomnia

Chronic or severe insomnia should be discussed with a doctor to rule out any medical or psychiatric condition.

Lifestyle changes: Regular moderate exercise, a balanced diet and avoiding excessive alcohol or caffeine will improve health and sleep. Reduce tension, promoting better sleep.

Behavioural therapies may also be used to treat some patients with insomnia. Relaxation therapy uses special techniques to calm the person and relax the muscles. Sleep restriction is a program that initially permits only a few hours of sleep per night, then gradually increases the nightly sleeping time. Reconditioning teaches the person to associate a bed with sleeping (and sexual activity), not daytime naps.

Drug treatment: If insomnia is transient or short-term, and sleep hygiene (see below) or non-medical treatments are not helpful, medication may be effective to prevent psycho physiological insomnia. In chronic insomnia, it is important to diagnose any underlying medical or psychiatric condition, and treat this effectively. Prolonged use of pills, without addressing the root cause may result in dependency. Hypnotic (sleep-inducing) medications, like the benzodiazepines, should be used for a few days at a time, to try to break a pattern of sleeplessness, while addressing any underlying problem. They should be used for short periods only, as they may become addictive. Antidepressants are effective in patients in whom depression has been diagnosed. Some Antihistamines have sedative effects and may be effective in the short-term. Melatonin may help insomnia by shifting the phases of the circadian rhythms, but is still undergoing further studies.

Sleep Hygiene is a holistic approach to sleeping. Good sleep hygiene prevents or relieves insomnia, and makes sleep more restful and pleasurable.

  • Establish a regular time for going to bed and waking up.
  • Use the bed for sleep or sexual activity only, not for reading, TV, or work.
  • Avoid naps, especially in the evening.
  • Exercise before dinner – exercising close to bedtime, however, may increase alertness.
  • Take a hot bath about an hour and a half before bedtime.
  • Do something relaxing in the half-hour before bed like reading or a walk.
  • Keep the bedroom cool and ventilated.
  • Do not look at the clock. Worrying about the time and “forcing” yourself to sleep makes it more difficult to sleep.
  • A light snack before bed can help sleep. A large meal may do the opposite.
  • Avoid fluids just before bedtime to reduce the need to urinate.
  • Avoid caffeine in the hours before sleep.
  • Quitting smoking eliminates the effects of nicotine on sleep loss.
  • People who can’t sleep after 15 or 20 minutes should get up and go into another room, read or do a quiet activity using dim lighting until sleepy again.
  • If a person with insomnia is distracted by a sleeping bed partner, a couple of nights apart may be useful.

Tips to beneficial sleep and feeling energized day after day: While many strategies are available, it is important to experiment and discover what works for you, what works for one person may not work for another!

  1. Take control of the stressors in your life.
  2. Focus on what’s really important in life.
  3. Make time for two or three quiet moments during the day and before retiring for the night.
  4. Fitness through exercising.
  5. Exercise will lower anxiety and tension.
  6. Heart and lung fitness, a direct result of exercise, promote healthy sleep.
  7. Easy stretching should precede all exercise.
  8. Exercises such as walking, dancing and aerobic work outs should be done in the late afternoon.
  9. Stay alert during the day.
  10. Keep yourself busy and involved during your daytime activities.
  11. Involvement with other people allows you to reduce stress by focusing on issues other than your own.
  12. Eat balanced meals.
  13. Make this part of the total, personal health plan.
  14. Strive for a balance between vegetables, protein and carbohydrates.
  15. Avoid a large meal within four hours of going to bed.
  16. Alcohol and bedtime do not mix.
  17. The effects of alcohol are greatly magnified by sleep deprivation.
  18. Sleep apnoea can be aggravated by drinking at bedtime.
  19. Avoid alcohol within three hours of bedtime.
  20. Develop a bedtime ritual.
  21. Read for pleasure.
  22. Gradually dim the lights.
  23. As your mind clears and you become drowsy, turn off the light.
  24. Cleanse the mind.
  25. Commit your worried thoughts to an index card on the night stand.
  26. Add some points about the potential solution.
  27. Leave the card there in case you awaken during the night.
  28. Relaxation at bedtime
  29. Play mind games with yourself.
  30. Mental imagery.
  31. Deep breathing.
  32. Time in bed: Only as long as is necessary
  33. You may go to bed earlier than usual due to stress and worries.
  34. Stay in bed only for the period that you usually need for sleep.
  35. Sleep until you are refreshed.
  36. Consult a sleep specialist if needed.
  37. Always share your sleep problems with your doctor.
  38. He/she may give you valuable advice or refer you to a sleep specialist.
  39. Awaking with shortness of breath or chest pain requires prompt attention.
  40. Your doctor must be told if you are falling asleep at inappropriate times.

Reference: Maas J.B. (1999): Power Sleep, New York: Harper Perennial p84-99

Courtesy of Medical Essentials, Health Information

The Comorbidity of Major Depression and Anxiety Disorders

Recognition and Management in Primary Care
Robert M. A. Hirschfeld, M.D.

Depression and anxiety frequently co-occur, especially in primary care settings. These co-occurrences manifest themselves in several ways and have different clinical courses. This review was written to help the clinician to identify what is and is not important in the diagnosis and treatment of patients with comorbid depression and anxiety in the primary care setting. The scope of this review is limited to major depression and not other forms of depression such as bipolar depression or dysthymic disorder. Literature was reviewed by 2 methods:

(1) a MEDLINE search (1980–2001) using key words depression, depressive disorders, and anxiety disorders; comorbidity was also searched with individual anxiety diagnoses; and
(2) direct search of psychiatry, primary care, and internal medicine journals over the past 5 years.

The scope and impact of depression and anxiety disorders worldwide are overwhelming. The watershed Global Burden of Disease study found that major depression ranked fourth among all medical illnesses in terms of its disabling impact on the world population. 1,2 The authors
estimated that by the year 2020 depression would be second only to ischemic heart disease. Anxiety disorders rank close behind major depression, contributing additional disability.

The prevalence of depressive and anxiety disorders in primary care settings is high. Between 10% and 20% of adults in any given 12-month period will visit their primary care physician during an episode of mental illness (although frequently not because of the episode). Depression and anxiety disorders contribute to the majority of those visits. If unrecognized and undiagnosed, depression and anxiety disorders contribute to high medical utilization in the primary care setting. Twenty-four percent of high utilizers (the top 10%) have been found to suffer from current major depression and 22%, from an anxiety disorder.

In primary care, presenting complaints for behavioral problems are more likely to be somatic than psychological. Back pain, chest pain, shortness of breath, heart palpitations, problems with sleep or appetite, and fatigue are among the most frequent presenting symptoms.

Although much work still needs to be done to increase awareness of depression and anxiety, the last decade has witnessed enormous progress in both the recognition and management of these disorders, especially in the primary care setting, which has long been recognized as the she is a bad wife and mother. She is no longer interested in sex. Lately, the patient admits that she does not really care that much about anything she has lost all of her interests.



When discussing depression as a symptom, a feeling of hopelessness is the most often described sensation. Depression is a common psychiatric disorder in the modern world and a growing cause of concern for health agencies worldwide due to the high social and economic costs involved. Symptoms of depression, like the disorder itself, vary in degree of severity, and contribute to mild to severe mood disturbances. Mood disturbances may range from a sudden transitory decrease in motivation and concentration to gloomy moods and irritation, or to severe, chronic prostration.

With treatment, more than 80% of people with depression respond favorably to medications, and the feeling of hopelessness subsides. With treatment, most people are able to resume their normal work and social activities.

Depression may occur at almost any stage of life, from childhood to middle or old age, as a result of a number of different factors that lead to chemical changes in the brain. Traumatic experiences, chronic stress, emotional loss, dysfunctional interpersonal relationships, social isolation, biological changes, aging, and inherited predisposition are common triggers for the symptoms of depression. Depression is classified according to the symptoms displayed and patterns of occurrence. Types of depression include major depressive disorder, bipolar depressive disorder, psychotic depressive disorder, postpartum depression, premenstrual dysphoric disorder, and seasonal disorder. Additional types of depression are included under the label of atypical depressive disorder. Many symptoms overlap among the types of depression, and not all people with depression experience all the symptoms associated with their particular type of the disorder.


Symptoms of a depressive disorder include at least five of the following changes in the individual’s previous characteristics: loss of motivation and inability to feel pleasure; deep chronic sadness or distress; changes in sleep patterns; lack of physical energy (apathy); feelings of hopelessness and worthlessness; difficulty with concentration; overeating or loss of appetite; withdrawal from interpersonal interactions or avoidance of others; death wishes, or belief in his/her own premature death. In children, the first signs of depression may be irritation and loss of concentration, apathy and distractibility during classes, and social withdrawal. Some adults initially complain of constant fatigue, even after long hours of sleep, digestive disorders, headaches, anxiety, recurrent memory lapses, and insomnia or excessive sleeping. An episode of maression may be preceded by a period of dysthymia, a mild but persistent low mood state, usually accompanied by diminished sexual drive, decreased affective response, and loss of interest in normal social activities and hobbies.

Most individuals with depression have difficulty in dealing with the challenges of daily life, and even minor obstacles or difficulties may trigger exaggerated emotional responses. Frustrating situations are frequently met with feelings of despair, dejection, resentment, and worthlessness, with people easily desisting from their goals. People with depression may try to avoid social situations and interpersonal interactions. Some people with depression overeat, while others show a sharp loss of appetite (anorexia). In some individuals, medical treatments for some other existing illness may also cause depression as an adverse reaction. For instance, antihypertensive drugs, steroids, muscle relaxants, anticancer drugs, and opioids, as well as extensive surgery such as a coronary bypass, may lead to depression. Cancer and other degenerative diseases, chronic painful conditions, metabolic diseases or hormonal changes during adolescence, or after childbirth, menopause, or old age may be potential triggers for depression. When the first onset of depression occurs after the age of 60, there is a greater possibility that the causative factor is a cerebrovascular (blood vessels in the brain) degeneration.

Molecular genetics research has recently shown that mutations in a gene coding for a protein that transports serotonin (a neurotransmitter) to neurons may determine how an individual will cope with stressful situations. A two-decade study involving 847 people of both sexes has shown that those who inherited two copies of the long version of the gene 5-HTT have a 17% risk of suffering a major depressive episode due to exposure to four or more identified stressful situations in their lives, whereas those with one long and one short version of the gene had the risk increased to 33%. The study has also shown that individuals with two short copies of the gene have a 43% probability of a major depressive episode when exposed to four or more stressful life events. The shorter version of the gene 5-HTT does not directly causes depression, but offers less protection against the harmful effects of traumatic or stressful situations to the brain. Studies of population genetics have also shown that about 50% of the world’s Caucasian population carry one short and one long version of 5-HTT genes.

Depressive episodes may be associated with additional psychiatric disorders. Neurotic depression is often triggered by one or more adverse life events or traumatic experiences that have historically caused anxiety in the life of the person experiencing depression. For example, loss of social or economical status, chronic failure in living up to the expectations of parents, teachers, or bosses, death of a close relation, work-related competitive pressures, and other stressful situations such as accidents, urban violence, wars, and catastrophic events may lead to a depressive episode. Conversely, anxiety disorders such as panic syndrome, phobias, generalized anxiety, and post-traumatic stress disorder may trigger a major depressive crisis. Psychotic depressive disorders are likely to be associated with other psychiatric diseases or caused by them. Eating disorders such as bulimia, anorexia nervosa, and binge-eating disorder are generally accompanied by depression or may be caused by an existing depressive state. Neurodegenerative diseases such as Alzheimer’s, Huntington’s, and Parkinson’s diseases frequently have depression among their symptoms.

Dysthymia is a mild but chronic depressed state, characterized by melancholic moods, low motivation, poor affective responsiveness, and a tendency for self isolation. A dysthymic state lasting two years or longer is a risk factor for the onset of a major depressive episode. However, many dysthymic individuals experience a chronic low mood state throughout their daily lives. Dysthymia is a frequent occurrence in individuals involved in chronic dysfunctional marriages or unsatisfying work conditions. Such chronic stressful situations alter the brain’s neurochemistry, thus the opportunity arises for symptoms of depression to develop.

Psychotic depression is a particularly serious illness and possesses biological and cognitive (thought) components. Psychotic depression involves disturbances in brain neurochemistry as a consequence of either a congenital (from birth) condition or due to prolonged exposure to stress or abuse during early childhood. Prolonged exposure to severe stress or abuse in the first decade of life induces both neurochemical and structural permanent changes in the developing brain with a direct impact on emotional aspects of personality. Normal patterns of perception and reaction give way to flawed mechanisms in order for a person to cope with chronic fear, abuse, and danger. Perception becomes fear-oriented and conditioned to constantly scan the environment for danger, with the flight-or-fight impulse underlying the individual’s reactions. Delusions, misinterpretation of interpersonal signals, and a pervading feeling of worthlessness may impair the individual’s ability to deal with even minor frustrations or obstacles, precipitating deep and prolonged episodes of depression, often with a high risk of suicide. Hallucinations may also occur, such as hearing voices or experiencing visions, as part of depression with psychosis.

A major depressive disorder (MDD) or clinical depression may consist of a single episode of severe depression requiring treatment or constitute the initial sign of a more complex disorder such as bipolar disorder. MDD may last for several months or even years if untreated and is associated with a high risk of suicide. In bipolar disorder, manic (hyper-excited and busy) periods alternate with deep depressive episodes, and are characterized by abnormal euphoria (an exaggerated feeling of happiness and well-being) and reckless behavior, followed by deep distress and prostration, often requiring hospitalization.

Major episodes of depression may last for one or more years if not treated, leading to a deep physical and emotional prostration. The person with major depression often moves very slowly and reports a sensation of heaviness in the arms and legs, with simple walking requiring an overwhelming effort. Personal hygiene is neglected and the person often desires to stay secluded or in bed for days or weeks. Suicidal thoughts may frequently occupy the mind or become recurrent patterns of thinking. Painful or unsettling memories are often recalled, and contribute to feelings of helplessness.

Atypical depression causes a cyclic behavior, alternating periods of severe and mild depressive states, punctuated by mood swings, hypersensitivity, oversleeping, overeating, with or without intermittent panic attacks. This depressive disorder is more common in women, with the onset usually occurring during adolescence.

Premenstrual dysphoric disorder (PDD) is not premenstrual stress. It is a more severe mood disorder that can cause deep depression or episodes of heightened irritation and aggressiveness, starting one or two weeks before menstruation and usually persisting during the entire period. Premenstrual dysphoric disorder is associated with abnormal changes in levels of hormones that affect brain neurochemistry.

Seasonal affective disorder (SAD) is caused by disturbances in the circadian cycle, a mechanism that controls conversion of serotonin into melatonin in the evening and mid-afternoon, and the conversion of melatonin into serotonin during daytime. Serotonin is the neurotransmitter responsible for sensations of satiety and emotional stability, which is converted at nighttime into melatonin, the hormone that regulates sleep and other functions. Some people are especially susceptible to the decreased exposure to daylight during long winter months and become depressed and irritable. Overeating and oversleeping during the winter season are common signs of seasonal affective disorder, along with irritation and depressed moods. However, as the amount of light increases during the spring and summer seasons, the symptoms disappear.

Postpartum depression is a severe and long-lasting depressive state also associated with abnormal changesmone levels affecting brain neurochemistry. If untreated, postpartum depression may last for months or even years, and is highly disruptive to family and maternal-child relations.

Without treatment, the risk of suicide as a consequence of depression should not be underestimated. Suicide accounts for approximately 15% of deaths among people with significant depression, and half of all suicide attempts in the United States are associated with depression. Persistent and recurrent depressive episodes are important contributors to other diseases alike such as myocardial infarction, hypertension, and other cardiovascular disorders.



Klein, Donald F., MD. Understanding Depression: A Complete Guide to Its Diagnosis and Treatment. New York: Oxford Press, 1995.

Solomon, Andrew. The Noonday Demon: An Atlas of Depression. New York: Scribners, 2002.


Manji, H. K., W. C. Drevets, and D. S. Charney. “The Cellular Neurobiology of Depression.” Nature Medicine (May 2001) 7: 541–546.

Teicher, Martin H. “Wounds That Won’t Heal–The Neurobiology of Child Abuse.” Scientific American (March 2002): 68–75.


National Institute of Mental Health: Depression. February 12, 2004 (March 31, 2004).


National Institute of Mental Health (NIMH). Office of Communications, 6001 Executive Boulevard, Room 8184, MSC 9663, Bethesda, MD 20892-9663. (301) 443-4513 or (800) 615-NIMH (6464); Fax: (301) 443-4279.

Sandra Galeotti

Info Supplied by – depression


Anxiety is a feeling of uneasiness, uncertainty or fear, in response to a real or imagined danger. The body responds to anxiety by releasing a number of “stress” hormones, like adrenaline and cortisol, which have an effect on almost every organ in the body.

What are Anxiety Disorders?

Mild forms of anxiety caused by emotional conflict or life stress are common and unproblematic. Anxiety disorders are a group of conditions in which the feelings of anxiety are not associated with a real or appropriate threat, or are much more intense and long lasting than they should be. People feel frightened and distressed for no apparent reason. This condition can paralyze the individual into inactivity or withdrawal, and can dramatically reduce productivity and significantly diminish a person’s quality of life.

Anxiety disorders are common – nearly 25% of people will experience anxiety disorders at some time in their lives.

Symptoms of Anxiety Disorders

Physical symptoms of anxiety disorders are due to released stress hormones. These may increase blood pressure, cause heart palpitations, chest pain, rapid breathing or breathlessness, sweating, increased muscle tension or irritability. Intestinal blood flow decreases, resulting in nausea or diarrhoea. There is often a decreased sex drive. Children may also have a fear of being away from the family, a refusal to go to school, a fear of strangers, a fear of falling asleep or have recurrent nightmares.

Anxiety disorders

Specific anxiety disorders each have their own particular pattern of symptoms and additional behavioural characteristics.

Depression and Anxiety

The simultaneous occurrence of depression and anxiety is very common. Figures show that between 60% and 90% of people with depression also have symptoms of anxiety. The combination is well recognized and can significantly increase the disability and disruption of normal function suffered by the patient. The anxiety associated with depression can take many forms including panic attacks, obsessive compulsive disorder, post-traumatic stress disorder, social anxiety disorder or a generalized anxiety disorder. Fortunately medication is available which can effectively relieve both depression and anxiety. If symptoms of depression and anxiety are a problem to you, you should discuss them with your doctor. Appropriate treatment can then be prescribed.

Types of Anxiety Disorders

A number of anxiety disorders have been classified. It is common for one anxiety disorder to accompany another anxiety disorder, depression, eating disorders orsubstance abuse.

Panic Disorder

People with panic disorder experience recurrent, unexpected attacks of intense anxiety or terror usually lasting 15 to 30 minutes. These attacks reach peak intensity within seconds and then subside over 5 to 20 minutes. Episodes of terror are accompanied by shortness of breath, rapid heart beat (palpitations), chest pain, hot flushes or chills, nausea, dizziness, abdominal cramps, sweating, shakiness, a choking feeling, feelings of unreality, and fears of dying or going insane. Frequency of attacks can vary widely, and may occur spontaneously or in response to a particular situation.


Phobias are persistent, irrational fears of certain objects or situations. These people are so overwhelmed by anxiety that they avoid the feared objects or situations.

Social Phobia/Social Anxiety Disorder is an extreme fear of embarrassment or humiliation in social situations. Social phobias disrupt normal life, interfering with work, social relationships and career choices, especially when they develop during adolescence which they commonly do. People give up many pleasurable and meaningful activities due to these fears.

Agoraphobia is a paralyzing fear of being in places or situations from which a person feels there is no escape or help in case of an attack. These people confine themselves to places in which they feel safe, usually at home, which may have very damaging effects on work and social interaction. It occurs typically together with panic disorder.

Post-Traumatic Stress Disorder (PTSD)

PTSD is an extremely debilitating condition that occurs after exposure to intensely frightening events or experiences in which severe physical harm was threatened or occurred. These events include violent personal assaults such as rape, mugging, disasters, car accidents or military combat. These people repeatedly re-live the ordeal in the form of mental flash backs, nightmares or disturbing thoughts or memories, especially when reminded of the trauma. Symptoms can occur weeks, months or even years after the traumatic event. Symptoms of PTSD include emotional numbness or withdrawal, hopelessness, mood swings, sleep disturbances, depression, irritability, outbursts of anger, feelings of intense guilt, inability to concentrate and an excessive startle response to noise.

Obsessive-Compulsive Disorder (OCD)

People with OCD suffer from repeated, unwanted thoughts or mental images (obsessions) which may result in compulsive behaviour – repetitive, uncontrollable routines performed in the hope of preventing the obsessive thoughts or making them go away. Rituals such as hand washing, counting or checking are common. These rituals, however, provide only temporary relief, and not performing them markedly increases anxiety. OCD is time-consuming, distressing, and can disrupt normal functioning. Read more on OCD…

Generalised Anxiety Disorder (GAD)

People with GAD suffer from an almost constant state of tension and anxiety lasting more than 6 months, without an obvious cause for the anxiety. They usually expect the worst, worrying uncontrollably about money, health, family or work. They are constantly on edge, have difficulty concentrating and typically have physical symptoms such as fatigue, sleep disturbances, trembling, muscle tension, headaches, irritability or hot flushes. They may interpret other people’s intentions or events in a negative way, and therefore feel unsafe in the world. These symptoms cause much distress and impair normal functioning.

What Causes Anxiety Disorders?

Genetic factors, environmental influences, family and childhood experiences and biochemical disorders make certain people more susceptible to stress stimuli than the normal population. Alcohol or substance abuse, other psychological problems like depression and medical conditions like thyroid disease may also play a role.

How are Anxiety Disorders Treated?

Most anxiety disorders respond well to treatment even if two or more anxiety disorders exist simultaneously. An effective approach is a combination of cognitive-behaviour therapy (CBT) and medication.

Drug Therapy will most likely be required for prolonged periods. Anti-anxiety drugs, antidepressants like the selective serotonin-reuptake inhibitors (SSRI’s), tricyclic antidepressants (TCA’s) or Monoamine Oxidase Inhibitors (MAOI’s) may be used. Drug interactions and side effects must always be monitored.

Cognitive-Behavioural Therapy teaches a patient to control their reactions to stress and stimuli, thus reducing the feeling of anxiety. Some therapies teach patients to understand their thinking patterns so they can react differently to the situations that cause them anxiety.


Therapies may use techniques which either gradually or rapidly expose the patient to the anxiety- producing stimulus. Breathing exercises to prevent hyperventilation may also help.

Healthy Lifestyle. Regular exercise, adequate rest, and good nutrition can help reduce the impact of anxiety attacks. Rhythmic aerobic programs may also help to reduce the effects of anxiety.

It is important to remember that these conditions are treatable. Your length of therapy will be based on your personal needs. It is important to continue taking your medication for as long as your doctor advises, even if you are feeling better.

Helping someone with Anxiety Disorder
  • Don’t make assumptions about what the affected person needs – ask him or her.
  • Be predictable – don’t surprise them.
  • Let the person with the disorder set the pace for recovery. Be patient, but don’t allow self-pity to develop.
  • Never criticise or trivialise the condition.
  • Find something positive in every experience. Don’t allow the patient to avoid the anxiety.
  • Encourage the patient to take even a small step forward.

Courtesy of Medical Essentials, Health Information