Depression/Anxiety

iVillage Member
Registered: 01-07-2007
Depression/Anxiety
32
Wed, 07-11-2007 - 7:59am

Since it's been a little quiet in here and the topic was brought up in one of the threads here not too long ago I thought I'd share some information I stumbled upon this morning.

I also wanted to include some information I myself found a bit disturbing. On my expecting board, a woman who is 37-38 weeks into her pregnancy was just prescribed Zoloft by her OB for her depression. From the information available online regarding Zoloft, it's still one of those that takes 4-6 weeks to take effect, anything before that is simply placebo. Maybe the doc feels a placebo effect is better than nothing at all and feels the drug is not going to harm her pregnancy?

*I* believe it's indicative of our desire as a 'fix it now' society to pop a pill...whenever.

"How to Fight Depression and Anxiety

Most people with major depression also suffer an anxiety disorder.
By Hara Estroff Marano for MSN Health & Fitness


Q: What is the best way to deal with depression and anxiety?

A: Quickly and definitively. Whatever kicks them off, depression and anxiety both are maintained by styles of thinking that magnify the initial insult and alter the workings of the brain in such a way that the longer an episode exists, the less it takes to set off future episodes.

Anxiety and depression are probably two faces of the same coin. Surveys have long shown that 60 percent to 70 percent of people with major depression also have an anxiety disorder, and half of those suffering anxiety also exhibit clinical depression symptoms.

The stress response system is overactive in both disorders. Excess activity of the stress response system sends emotional centers of the brain into overdrive so that negative events make a disproportionate impact and hijack rational response systems. You literally can’t think straight. You ruminate over and over about the difficulties and disappointments you encounter until that’s all you can focus on.

Researchers believe that some people react with anxiety to stressful life events, seeing danger lurking ahead everywhere—in applying for a job, asking for a favor, asking for a date. And some go beyond anxiety to become depressed, a kind of shutdown in response to anticipated danger.

People who have either condition typically overestimate the risk in a situation and underestimate their own resources for coping. Rather than developing the skills to handle situations that make them uncomfortable, sufferers merely avoid what they fear. Often enough, a lack of social skills is at the root. Some types of anxiety—panic disorder, obsessive-compulsive disorder, and social phobia—are particularly associated with depression.

The fact that anxiety usually precedes the development of depression presents a huge opportunity for the prevention of depression. Young people especially are not likely to outgrow anxiety on their own; they need to be taught specific mental skills.

Cognitive-behavioral therapy (CBT) gets at response patterns central to both conditions. And the drugs most commonly used against depression have also been proven effective against an array of anxiety disorders.

Although medication and CBT are equally effective in reducing anxiety/depression, CBT is better at preventing return of the disorder. Patients like it better, too, because it allows them to feel responsible for their own success. What’s more, the active coping that CBT encourages creates new brain circuits that circumvent the dysfunctional response pathways.

Cognitive-behavioral therapy teaches people to monitor the environment for the troubling emotional land mines that seem to set them off. That actually changes metabolic activity in the cortex, the thinking brain, to modulate mood states. It works from the top down. Drugs, by contrast, work from the bottom up, modulating neurotransmitters in the brainstem, which drive basic emotional behaviors.

Treatment with CBT averages 12 to 15 weeks, and patients can expect to see significant improvement by six weeks. Drug therapy is typically recommended for months, if not years.

Exercise is an important adjunct to any therapy. Exercise directly alters levels of neurohormones involved in circuits of emotion. It calms the hyperactivity of the nervous system and improves function of the brain's emotion-sensing network. It also improves the ability of the body to tolerate stress. What’s more, it reduces negative thinking and changes people’s perception of themselves, providing a sense of personal mastery and positive self-regard.

However, just telling a distressed person to exercise is futile, as depression destroys initiative. The best thing a loved one can do is to simply announce: “Let’s go for a walk.” Then accompany the person out the door."

http://health.msn.com/centers/depression/articlepage.aspx?cp-documentid=100165580&GT1=10201

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iVillage Member
Registered: 04-26-2005
Wed, 07-11-2007 - 11:15am

Wow....this is the same answer I would give to a regular abortion debate....I think that decision is best made by a woman and her doctor...and unless you are that woman or a doctor...perhaps your opinion on her mental health treatment is rather shortsighted.

I "popped" my metformin today to treat my diabetes. I didn't get up and excercise or down a slimfast...even though we all know diet and excercise to promote weight loss would be a great course of action...in the meantime I let a little pill work it's magic.

I would hate to have my medical treatment debated on a debate board that I did not sign up to be a part of and by people who are not MD's.

iVillage Member
Registered: 01-07-2007
Wed, 07-11-2007 - 12:08pm

You are more than welcome to not participate. As I said, the issue was brought up in another thread and there hasn't been much going on here. I though the article was interesting so I shared.

If you took personal offense to what I said it probably has more to do with you and your choices than something an anonymous person said on a message board. No one debated your particular medical condition on a debate board, you brought that up. The person whose situation I did mention isn't on this board and I would not address her about her situation as I agree it's something between her and her doctor. That doesn't mean I can't disagree with the doctor's choice to prescribe the pills and her decision to take them.

Again, you are more than welcome to pick and choose what you participate in, on any board. I prefaced my post with the fact it was not related to abortion but rather a specific issue that came up in another thread here. You were more than welcome to leave the thread at that point.

You don't have to be an MD to have an opinion. :)

iVillage Member
Registered: 03-08-2007
Wed, 07-11-2007 - 12:17pm

I do agree with you about how many people turn to meds too easily in many situations. That's why I'm not planning on taking the epidural during labor--I don't really need it. My body will manage, although it will be painful and I don't want to put an unnecessary drug in my body. But with mental illness I think it depends on the condition and severity.

I have two examples. As I mentioned before my husband has schizophrenia. Sometimes he'll go periods of time without taking his medicine, and he doesn't function well. He won't go into work and he'll argue about everything. He'll have hallucinations and start thinking about suicide. But his wellness is contingent on more than just pills. He needs mine and his family's emotional and finanical support at times. It's a combination, including drugs, of factors that keep him well.

But in high school I had some issues of fighting with my parents and experimenting with drugs. The first step in my treatment was drugs. I was given many different types over the years and nothing worked. Eventually I stopped taking them and grew out of my rebellious stage. I believe there was never anything wrong with me, other than the fact that I didn't want to listen to my parents and thought pot was cool. I should've never been medicated.

Bottom line--I think medicine can be really good for many people but they also need more than pills. They need suppot and therapy as well. And many people like myself they should take a closer look and determine if it's mental illness or a corrupt lifestyle that needs to be adjusted.

Ella Grayce

Lilypie1st Birthday Ticker
iVillage Member
Registered: 01-07-2007
Wed, 07-11-2007 - 12:37pm

I'm with you on no drugs for my labor and delivery. I don't want anything that isn't absolutely necessary and I am going to *try my best* to go without. All my OB asks is that if the pain is simply too much and the birth and baby are in danger then I allow him to do his job and that I NOT feel like a failure. I'm good with that! :)

ITA with you, I do not at all mean to imply that ALL cases of depression and anxiety or other mental illness only need exercise and diet and I completely agree that meds alone are the best answer. My problem is that doctors are simply too quick to prescribe a pill and go no further with treatment. I've had first hand experience with this and with multiple doctors.

I mentioned the one woman on my expecting board because it seemed dangerous and useless simply because by the time the meds start to work she'll probably have already delivered. She's at the end of her pregnancy, she miserable as I am too, lol! On the surface, her issues seem typical. There may be more there that only her doctor can see but from the information the poster provided it doesn't seem that way. She's just ready to not be pregnant anymore, just like the rest of us in her shoes.

I think the article touched on some VERY good points about disassociation and avoidance. Like I've said before, for some people finding out the root of the depression/anxiety is key and I just don't think the patient or the doctor go far enough to determine these things.

iVillage Member
Registered: 03-08-2007
Wed, 07-11-2007 - 1:11pm
During pregnancy hormones change so much that many women might start to resemble signs of a mental illness, but that doesn't mean much. Pregnancy changes every part of your body. Maybe wobit will have a comment on this, since she probably knows the most about medicine, but I would think the doctor should wait until she delivers and if she continues to have problems with depression or anxiety than turn to the pills. No one acts like themselves in the final weeks, but I would never think of going on medicine until I knew it was going to be a long term problem.

Ella Grayce

Lilypie1st Birthday Ticker
iVillage Member
Registered: 04-26-2005
Wed, 07-11-2007 - 2:34pm

Of course you don't need to be an MD....I'm just always amused at those that feel that they have such an important perspective that they are justified in questioning what goes on between a woman and her doctor. It's amusing..hence my interjection.

No offense taken....sorry you mistook my point...which was, sometimes "pill popping" is actually a real medical solution.

I have a friend that had horrible PPD. She was normally on anti-depressants...and began taking them late in the pregnancy so that AFTER delivery they would be in her system..to help ward off another round of, for her, almost life ending PPD.

iVillage Member
Registered: 10-14-2003
Wed, 07-11-2007 - 4:04pm


I find it sad that so many think pills are the easy way out of things and do so not having direct experience with the health issues they opine over. Truth be told, it was pills that enabled me to exercise, enabled me to make better lifestyle choices and do all of these without the hypervigilance to potential risks/harm. If not for these pills, I wouldn't have had the chance to make better lifestyle choices and would've continued to be crippled by fear. They very well were the answer to my medical dilemma, and I DO have an anxiety disorder called Complex Post Traumatic Stress Disorder from repeated trama I was subjected to. I had and have apt social skills. My disorder is a result of traumatic experiences, and a normal response from a normal brain to such stimuli. My disorder is not a personality disorder, meaning that it is not due to genetics. Rather, it is a "psychological injury". Prior to this, I had no known mental health issues, and the current issues stem directly from the trauma, not "poor social skills" that I can chalk up to bad parenting or faulty genes.

Depression, anxiety, and other anxiety-based disorders are not simple mind over matter illnesses. Combination therapy with medication and CBT is proven to be the most successful. One can't just get over it. I wish it weren't so.

In short, I found this article to be incredibly short-sighted and limited in scope.

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iVillage Member
Registered: 01-07-2007
Wed, 07-11-2007 - 4:19pm

And I'm amused at those who take an opinion and make the supposition that it's regarding all involved, meaning- I know there are people who need to resort to 'pill popping'(since you like that phrase so much) yet I believe there are a lot of people who are overmedicated because doctors are in the business of selling medication, not exercise and diet plans.

The position I took with the situation I presented (the woman late in her pregnancy prescribed Zoloft) is a first time mom and BASED ON THE INFORMATION SHE PROVIDED seems to be suffering from the same thing all of us who are late in our pregnancies are dealing with. Maybe in her case there is more going on, maybe there isn't. It's one situation I portrayed among many and yes, I do feel my perspective is important enough to have an opinion on it yet not important enough to address the particular person which is why I posted it HERE. I do not feel justified questioning her or her doctor but if I want to question it elsewhere I do absolutely feel justified and you can be just as amused as you'd like to be.

I understand PPD is very serious and if this womans doctor feels she might suffer from that AFTER delivery then she is certainly justified in prescribing an anti-depressant. However, there are more advanced SSRI's on the market that take 7-10 days to take affect instead of the standard 4-6 weeks and have less side affects.

IT IS MY OPINION that if her doctor is trying a pre-emptive strike to thwart PPD and is using an anti-depressant while her patient is still pregnant then she is taking a huge risk AND the patient, being in a depressed state might not be thinking clearly enough to factor all the risks to her unborn.

iVillage Member
Registered: 01-07-2007
Wed, 07-11-2007 - 4:30pm

I find it sad that some people don't recognize there is an over medicating problem in this country and just because someone suggests pills are not the answer for everyone someone ALWAYS seems to think it's being directed at them. In your particular case, pills worked for you so therefore we can suppose you aren't one of those who would have benefitted from ONLY the ideas in this article.

"Depression, anxiety, and other anxiety-based disorders are not simple mind over matter illnesses. Combination therapy with medication and CBT is proven to be the most successful. One can't just get over it. I wish it weren't so."

Not true in every case. You're making absolute statements about everyone who suffers from depression, anxiety and other anxiety based disorders, which is not what I'm doing. SOME CAN just get over it and learn to deal with the issues that are causing the depression and anxiety and they CAN use diet and exercise to do so making medication unnecessary.

iVillage Member
Registered: 06-03-2007
Wed, 07-11-2007 - 6:17pm

Lots of thoughtful comments - and perfect illustrations of how varied and complex every case really is. Can I agree with everyone? :)

I actually do mean that seriously. It's entirely possible for a large proportion of all anxiety and depression to be most successfully treated with CBT, while at the same time there is a significant population for whom that is insufficient and inappropriate treatment. The only ones who can sort it out are the patients in conjunction with their physicians.

Unfortunately, it's a lot easier for people and for insurance companies and for physicians to try to think of it as though there were one "right answer" for all depression or anxiety patients . CBT is more expensive than pills. I think it's really worth it, but it also requires that the patient be in a place where they can really participate, so they need to be at least a little bit okay and in full agreement to start.

In this suggested case with the woman in the end of her pregnancy, perhaps she and her doctor had been on the fence about her needing this drug for the last year, and held off while they tried other things (which she may have been embarrassed to report didn't work) until now. Who can know?

I think it is appropriate to have a societal dialog about these kinds of grey-scale choices, in order to ensure that people are aware of their options and thinking about their consequences. Everyone here agrees that these kinds of societal dialogs are always trumped by personal circumstance, I think. At least in this kind of case. :)

I think it's clear we are sometimes medicating inappropriately. I wouldn't exactly say "too much" so much as the wrong people. There are many people walking around who could benefit from a little pharmaceutical help, probably just as many as are taking needless or contradictory prescriptions.

Articles like the one that Sandi posted can increase the dialog about the variety of treatment modalities available, so that people who are suffering know they can do more than ask for a pill. Hopefully we will overhaul the system with the next presidency and weed out some of the weight and misinformation of the pharmaceutical advertisements.

Until we have a perfect world in which everyone already knows their options and no one is ever under- or over-medicated or interfered with, this dialog will step on peoples toes and make people uncomfortable, as they advocate for themselves and their loved ones and the ways in which they were poorly served. These viewpoints need to continue to be heard.

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