Anxiety: The Secret Stumbling Block in Depression Therapy
Depression ranges in severity from mild and transient to severe and persistent. The most severe form of depression is called Major Depressive Disorder and may be difficult to treat and resolve. It poses a number of severe risks, not the least of which is that of possible suicide. Depression is also associated with significant medical problems such as heart disease and pain syndromes, to name a few. For this and other reasons, successful treatment is crucial.
There are several theories as to what causes this debilitating mental illness. Life stress, anxiety and a predisposing vulnerability are thought to be contributing factors. An additional component is the biochemical changes in the brain, particularly changes in neurotransmitters such as serotonin. Serotonin depletion and its reversal is the rationale for the use of SSRI class of medications.
An important component in the origin and course of depression is anxiety. Anxiety is reported by patients on a routine basis but is easily and commonly overlooked. In practice, this component of depression must be addressed if treatment is to succeed. I often wonder how many treatment failures are due to this oversight. An indicator that this oversight is common is the number of patients who are placed on antidepressants such as Prozac or Effexor for treatment of depression. These medications are known to be energizing; they can act like several cups of very strong coffee, not a welcome effect for someone who is already anxious. These two medications in particular are usually more appropriate for someone with a low-energy depression rather than an anxious depression.
The anxiety component of depression is often not recognized, or even if recognized, is not taken into account in treatment. Resolution of anxiety can often be an essential component of treatment before depression can be resolved.