Sunday, 13 July 2014

What is the Difference Between Anxiety and Depression?

For more on Mindwork see here.
   In a nutshell, depression is caused by looking into the past with regret, and anxiety is caused by looking into the future with apprehension or fear. We tend to treat both anxiety and depression as “things”, like diseases, as if they have a life of their own, and the pharmaceutical industry encourages this medicalization because it’s good for their business. However, depression and anxiety are in fact mood states we create ourselves because of particular thinking patterns. People who create depression often also create anxiety and vice versa.

Blue Nude by Henri Matisse
What else affects mood states?

   There is a caveat to the idea that we create our own mood states from thinking patterns, however. Various drugs, both prescription and illegal, can affect the way we feel and think regardless of our thinking patterns. This is true not only when taking the drugs, but also when withdrawing from them. A classic example we are all familiar with is alcohol. Although alcohol is a depressant officially (and who wants one of those!), many of us like the way alcohol allows us to relax and enjoy ourselves, especially in a social situation. Have a glass of wine or a couple of beers and like magic, the difficulties in our lives feel less imperative and the present moment becomes more enjoyable. Cheers! Yet have a few too many drinks and you may wake up the next morning with a sore head and a grumpy demeanour—“Whadda mean the sun is shining? Work? Ugh!”

   And of course personal tragedy or grief or loss can certainly generate both depression and anxiety, and that’s a natural response. The loss of a loved one, for example, not only leaves a hole in the present but may create a sense of regret for things not said or done before in the past, and may also affect one’s future in uncertain ways. Lack of stability is great fun if you’re playing with an inner tube and waves at the beach, but becomes a lot more stressful when your home, family, health or livelihood is threatened.

Can anxiety or depression be good for you?

   Some would argue that these states are a wake-up call. Your internal sense of harmony is out of balance, and something fundamental in your life needs changing. This may be something external (maybe I need a different job...) or something internal (I need to stop thinking about that all the time...) If you harken to these undesirable mood states and accept them as a signal that something needs to change, and you take steps to make those changes, then the anxiety and/or depression is a valuable signal for you. On the other hand, if these states are not perceived as a call for action...

What can you do about anxiety and depression?

   Firstly, it’s important to accept that neither state is a significant problem on a short term basis, especially if a clear cause can be identified. If your faithful family dog passes away and you feel weepy for a few days, that’s a natural and appropriate response. If you feel anxious about going to the dentist to have a tooth pulled, that’s likewise temporary and natural. Feel the moment and accept it. You know it will pass with time.

   According to the DSM-IV[i], clinical depression can be diagnosed if at least five significant symptoms linger for more than two weeks and a medical cause is ruled out. See here for the DSM-IV definition of depression, and here for the DSM-IV definition of anxiety.

   Psychiatrists and medical doctors often provide anti-depressant medication for both depression and anxiety, and many people choose to go this route because (superficially, at least) it’s quick and easy and relatively cheap. However, anti-depressants do not address the issues that may be causing the depression or anxiety.

   In 2010 I completed my master’s thesis on antidepressant use and withdrawal, and for that I gathered information from over 500 antidepressant users, ex-users, and a control group of non-users. I found no overall increase in well-being created by antidepressant use, and problems with side effects and withdrawal were reported by the majority of study participants with antidepressant experience; in some cases these were debilitating. 

  Clinical trials of antidepressant drugs (mostly 6-8 weeks long) demonstrated minimal mood improvement with  use, which researchers Kirsch and colleagues deemed “negligible” given the placebo effect evident in their analysis of the data supplied to the US Food and Drug Administration. The placebo effect is how thinking a medication will help often means it really does help, even if the "drug" is a non-active fake. (for more on this, see their excellent book The Emperor's New Drugs: Exploding the Antidepressant Myth).  Personally, I wouldn’t choose to take anti-depressant medication—it’s like taking a pain killer for a rotten tooth: it might diminish the pain but it won’t fix the problem. I’d rather fix the problem.

   Therapy, provided the patient and therapist don’t spend a lot of time focussing on the “whys” of the problem, can be very useful in getting rid of depression and anxiety, and provides a valuable opportunity for self-discovery and personal growth. CBT (cognitive behavioural therapy) and NLP (neuro-linguistic programming) both have very good track records for dealing with depression and bringing about lasting change. Helping the client set clear goals and recognize things like his/her thinking patterns, past/present/future orientation, and the relationship between values, thoughts, behaviours, and moods enable positive changes to occur. Several NLP processes, in particular, allow clients to resolve internal conflicts and release negative emotions attached to events from the past quickly and easily, creating the opportunity to move forward into the future in more positive ways.

For more information on psychiatric drugs and alternative ways to understand and resolve anxiety and depression, see my new book Reframing Mental Illness.

[i] Manual compiled by the American Psychiatric Association that classifies mental disorders.

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