I have been diagnosed with depression and anxiety. How is the combination of conditions treated?

Anne's comment:

One of my children was treated with antidepressants for 9 months before revealing that he had been experiencing anxiety for a long time and had hoped that the antidepressant medication, which improved his depression, would also assuage his anxiety. In fact, his anxiety had become acute, and he experienced tremendous relief with the addition of anti-anxiety medication to his medication regimen.

Anxiety is a condition that commonly occurs with depression. Some anxiety conditions, such as social phobia, panic disorder, and generalized anxiety disorder, may predispose someone for the development of a depressive disorder because of the significant impact that severe anxiety can have on a person's functioning. Likewise, depression can also trigger the onset of an anxiety disorder. The treatment for both conditions is often very similar, and both conditions can often be addressed with the same medication or type of therapy. The SSRIs are a very useful treatment for many anxiety disorders and thus are ideal in persons who suffer from both anxiety and depression. As in the treatment of depression, the SSRIs can take a few weeks to have their full benefit for anxiety. Also, higher dosing of SSRIs is often needed to address anxiety, even after depressive symptoms have remitted on a given dosage. Because of the delayed onset of relief, short-term treatment of anxiety is sometimes necessary, particularly in cases of severe anxiety that results in significant impairment. In the short term, anxiety is better treated with benzodiazepines[1], which typically provide rapid relief of anxious symptoms , but benzodiazepines are controlled substances that can be habit forming and thus are not generally recommended for long-term use. Buspirone is a nonaddictive antianxiety medication that is used for generalized anxiety. It may be a better choice in persons with substance abuse histories or active substance abuse. Buspirone does not offer immediate relief of anxiety. It also requires 4 to 6 weeks before a full effect is seen. Concurrent anxiety can result in refractory depression, and thus it is important that untreated anxious symptoms are addressed if there seems to be little response to an antidepressant.

Psychotherapy is a very important treatment for anxiety. Cognitive-behavioral therapy in particular has been demonstrated in studies to have beneficial results for a variety of anxiety conditions. Although medications are very effective in reducing severe anxiety, significant residual symptoms are often left, and therapy helps to reduce these further. A combination of therapy and medication is typically the best treatment approach for a variety of anxiety disorders, such as generalized anxiety disorder, panic disorder, social anxiety disorder, and obsessive-compulsive disorder.

My husband is drinking a lot of alcohol lately. My friend believes he might be self-medicating. What does that mean?

Individuals with depression may abuse alcohol or drugs in a misguided effort to feel better. Alcohol can initially give the impression of improving one's mood, but in actuality alcohol is a depressant. Likewise, the use of drugs to get "high" is usually followed by a "crash," during which the mood becomes sad or despondent.

Depression is sometimes caused by the alcohol or drug abuse itself and remits when abstinence is achieved. Often, depression precedes the alcohol or drug use, and people turn to these substances in an effort to feel better. Typically, however, feeling better really just means being "numb" or deadened to the depressed feelings. Treatment of the depression rarely may result in achievement of abstinence, which depends on the stage of substance abuse. If the individual has become dependent (addicted) to the alcohol or drugs, then concordant substance abuse treatment will likely be necessary as well. As long as the person is addicted to alcohol or drugs, recovery from depression will be limited. In fact, substance abuse is a problem that needs to be considered if someone is refractory to treatments for depression. Seeing a person who specializes in treatment of addictions is also helpful, because there are different forms of therapeutic interventions often needed in persons who have addictions. In addition, there are specialized treatment programs for persons with both depression and substance abuse.

  • [1] a drug that is part of a class of medication with sedative and anxiolytic effects. Drugs in this class share a common chemical structure and mechanism of action.
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