Depression and Anxiety

Social anxiety and depression are two of the most common health conditions worldwide.

In the UK alone, 19.7% of people aged 16 and above bear symptoms of depression or anxiety. And according to the Mental Health Foundation, these statistics are steadily increasing.

Gender-wise, cases are more prevalent in women (22.5%) than in men (16.8%).

Here, we are going to explore these 2 conditions – including their symptoms, causes, treatments, and healthy lifestyle tips.

What is Depression?

Depression is more than just being ‘sad’ or ‘fed up’.

It’s about having a sad mood for a long time – so much so that it gets in the way of your normal, day-to-day functioning.

In the report Fundamental Facts About Mental Health, surveys showed depression affects about 3% of UK men and a little below 4% of UK women.

Depression often occurs with other mental health conditions, the most common of which is anxiety.

Classification

Depression may be classified as mild, moderate, or severe (major).

Mild symptoms come with ‘temporary symptoms’. They can last for days and may be crippling enough to affect your day-to-day activity.

Moderate depression has the same symptoms as mild depression (more of these below). Additionally, these symptoms may cause reduced productivity, excessive worrying, increased sensitivity, low self-esteem, and a feeling of worthlessness.

Severe or major depression also comes with the same symptoms, though they are fairly noticeable to your family and friends. It can last an average of 6 months (or longer).

In some cases, major depression may lead to hallucinations, delusions, stupor, and suicidal ideations.

What are the Symptoms of Depression?

You may be depressed if you have the following signs and symptoms:

• You feel sad or anxious most/all of the time
• You often feel irritated, restless, and frustrated
• You refuse to do activities that you used to enjoy
• You feel helpless, worthless, or guilty
• You have a hard time concentrating, recollecting details, or making decisions 
• You find it hard to go to sleep or stay asleep
• You either wake up early or sleep too long
• You feel tired even after sleeping for several hours
• You have no appetite – or you eat more/less than usual
• You suffer from headaches, aches, pains, and stomach issues that don’t resolve with the usual treatments
• You want to hurt yourself

Remember: these symptoms are mere guides. As always, it’s best to see your doctor for comprehensive diagnosis and treatment.

What Causes Depression?

What exactly causes depression remains unknown. Experts believe it to be a combination of psychological, biological, genetic, and environmental factors.

Although this is the case, your risks of developing depression can be increased by the following factors:

• You have relatives who suffered from depression
• You have experienced traumatic events such as physical/sexual abuse, financial problems, or the demise of a loved one
• You underwent a big life event (planned or unplanned)
• You have a serious medical condition, i.e. chronic pain, stroke, or cancer
• You habitually drink alcohol or use illicit drugs
• You’re taking medications that can make you feel depressed

How is Depression Treated?

Many treatments can help minimize symptoms and reduce the duration of depression.

1. Cognitive Behavioural Therapy for Depression

 CBT is one of the most recommended treatments to help with depression and anxiety. Add to that, this evidence-backed treatment may also be used to help people suffering from stress, marital problems, even substance abuse disorders.

The general course of treatment is as follows:

1. Defining the problem – which is done by both the patient and the therapist
2. Setting goals
3. Explaining the 5-area model of CBT to the patient
4. Improving the understanding and awareness of the patient’s behaviour and cognition
5. Modifying thoughts and behaviour through Socratic dialogue, guided discovery, exposure exercise, and/or behavioural experiments
6. Applying and consolidating new skills to real-life situations
7. Preventing relapse

The duration of a CBT session may range anywhere from 30 minutes to 1 hour, at a frequency of once or twice a week. It may be done on an outpatient or inpatient basis.

Each session follows this structure:

1. Start of the session – includes mood check, agenda-setting, and homework review
2. Discussion of problems or agendas, i.e. problems and their interventions
3. Feedback to the therapist

2. Medications

Apart from therapy, your doctor may prescribe you any of the following medications to treat your depressive symptoms:

a) Selective Serotonin Reuptake Inhibitors

Also known as SSRIs, this is the first line of pharmaceutical treatment for depressive individuals. They work by increasing the levels of serotonin, a neurotransmitter that positively influences mood, emotion, and sleeping patterns.

Common SSRIs include:

• Sertraline
• Paroxetine
• Fluoxetine
• Citalopram
• Escitalopram

It is important to know that the effects of SSRIs are not immediate. Changes in mood and behaviour may only be obvious 2-4 weeks after the start of treatment.

Common side effects of SSRIs include nausea, tremors, nervousness, agitation, tiredness, sweating, sleep issues, and sexual dysfunction.

b) Serotonin-Noradrenaline Reuptake Inhibitors

Known as SNRIs, they work like SSRIs. However, they are touted to be more effective.

Common SNRIs include Venlafaxine and Duloxetine.

SNRI Side effects include nausea, vomiting, fatigue, drowsiness, constipation, and dry mouth, to name a few.

c) Noradrenaline and Specific Serotonergic Antidepressants

Known as NASSAs, they are given to people who don’t respond to SSRIs. Its side effects are similar to SSRIs, though they are said to bring lesser sexually related side effects.

The most common NASSA prescribed by doctors in the UK is Mirtazapine.

d) Tricyclic Antidepressants

TCAs are older types of drugs that used to be the first line of treatment for depression. But because of their severe side effects and potential for overdose, they are now only given to those with severe depression.

TCAs are also prescribed to people who fail to respond to the above-mentioned medications.

Examples include Amitriptyline, Clomipramine, Lofepramine, Imipramine, and Nortriptyline.

e) Monoamine Oxidase Inhibitors

MAOIs are another type of ‘older’ antidepressants.

These drugs, which include Phenelzine, Tranylcypromine, and Isocarboxazid, should not be taken with tyramine-containing food sources. These include wine or cheese.

3. Natural Depression Remedies

There are a handful of natural remedies for anxiety and depression. But since they may interact with any of your current medications, you should consult with your doctor before you try any of these:

a) St. John’s Wort

St. John’s Wort or Hypericum perforatum is one of the most prominent natural depression remedies. According to a study, they are similarly effective to traditional antidepressants – but with lesser major side effects.

Dosages vary from 150 mg to as much as 900 mg a day.

b) Omega-3 fatty acids

Apart from eating omega-3 fatty acid-rich food (such as salmon or herring), taking this supplement may help with your depressive episodes as well.

That’s because studies show that people with such a condition usually have low levels of fatty acids in their systems.

The same study results show that omega-3 fatty acids help reduce depressive-like symptoms in women.

That said, some experts recommend taking this supplement – especially formulations made with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). 

c) Saffron

Saffron or Crocus sativus is popular for being a spice and medicinal herb. According to a study, it contains substances crocin and safranal – both of which have anti-depressant effects.

Results show that people with mild-moderate depression – who took a 30 mg capsule of saffron thrice a day – enjoyed benefits similar to Imipramine. This comparator antidepressant was taken at a dose of 100 mg a day.

The same can be said with a 15 mg dose of Saffron, which was taken by participants twice a day. Results show that it is just as beneficial as Fluoxetine (taken 10 mg twice a day) for people with mild-moderate depression. 

d) Rhodiola rosea

Rhodiola rosea is a herb used in traditional medicine. While research has shown it to be less effective than the antidepressant Sertraline, it does come with fewer side effects. 

Additionally, research shows that it may help patients with a history of chronic stress. Practice shows that it may help minimize the body’s negative responses to severe stress.

e) L-5-hydroxytryptophan

5-HTP is the precursor of serotonin, a neurotransmitter that affects your mood, emotions, and sleeping patterns.

According to a study, 5-HTP, in conjunction with other treatment (Carbidopa in this case), may help patients who are resistant to common therapies and treatments.

f) Dehydroepiandrosterone

Popularly known as DHEA, this is a hormone that the body naturally makes. People with depression, however, are said to have low amounts of DHEA in their bodies.

A study has shown that DHEA is more effective than placebo. Given these findings, the researchers conclude that it may be a good alternative for antidepressant medications.

Healthy Lifestyle Tips for Depression

Apart from therapy and taking certain medications, the doctor may recommend lifestyle changes to people living with depression and anxiety.

Here are some lifestyle tips on how to cope with depression:

1. Follow a routine. Depression can take away your life’s structure, so setting a routine can help you get back on track.
2. Set goals. Depression can make you feel worthless. By setting goals – no matter how small – you may break away from despair.
3. Exercise. Working out brings a rush of feel-good hormones called endorphins. It may also help the brain ‘rewire’ itself for the better.
4. Eat healthily. Apart from eating healthy food (in the right portions), adding viands rich in omega-3 fatty acids and folic acid may help stem depression.
5. Sleep well. Sleeplessness can worsen depression, so make sure to improve your slumber habits by improving your sleep hygiene.

What is Anxiety?

Anxiety is a condition wherein people feel intense worry, fear, and/or panic. Like depression, these feelings can get in the way of normal day-to-day living.

Anxiety can be a symptom of many mental conditions. As mentioned, many people may be suffering from depression and anxiety – all at the same time.

1. Generalized Anxiety Disorder

One of the major types of anxiety is GAD. This long-term problem may make you feel anxious about a variety of events, instead of 1 particular issue.

So even if you manage to resolve your anxiety over 1 issue, you may end up feeling anxious about another event.

According to the NHS, GAD affects about 5% of the UK population. It’s more common in women, especially those from the age of 35 to 39. 

a) What are the Symptoms of GAD?

GAD comes with both physical and mental symptoms lasting for about 6 months.

You may feel restless, worried, wound-up, or on edge. You may feel irritated as well.

Physically, you may constantly feel fatigued. You may experience trouble sleeping or concentrating too.

People with GAD may also feel dizzy. Some have tensed muscles – while some have heart palpitations from time to time.

b) What Causes GAD?

While the exact reason behind GAD remains unclear, experts believe that these factors play a crucial role in its development:

• Increased activity in brain areas controlling behaviour and emotion
• Imbalanced levels of serotonin and norepinephrine, neurotransmitters that govern mood control/regulation
• Family history – you are 5 times more likely to suffer from GAD if you have a blood relative with the same condition
• History of traumatic or stressful life events, such as bullying, abuse, or domestic violence
• History of a chronic pain condition such as arthritis
• History of alcohol or drug abuse

2. Social Anxiety Disorder

Another common anxiety disorder is social phobia. This is characterized by overwhelming anxiety and self-consciousness in daily social events.

It can be limited to a certain situation, i.e. talking in front of large groups of people.

As for the case of severe social anxiety disorder, the person may experience symptoms whenever he/she is around other people. That said, socially anxious people may find it hard to deal with these common social events:

• Going to school or work
• Attending parties or gatherings
• Eating in front of other people
• Using a public restroom
• Dating

Unfortunately, social phobias can lead to complications such as hypersensitivity to criticism, negative self-talk, poor social skills, isolation, low self-esteem, and depression. Worse, it may lead to substance abuse – even several suicide attempts.

a) What are the Symptoms of Social Anxiety?

A socially phobic individual may manifest any (or all) of the following:

• The fear of being judged or embarrassing yourself
• The fear of talking/interacting with strangers
• Anxiety over an upcoming social event
• Expecting the worst consequences after a certain social interaction

Like GAD, social anxiety also comes with physical manifestations. They include sweating, trembling, blushing, and shakiness. Muscle tension and stomach problems may occur as well.

b) What Causes Social Anxiety?

As with GAD, social phobia may stem from a variety of factors:

• Inherited traits. Social phobia may run in families. Whether it’s a genetic or learned environment issue is still unknown.
• Brain structure. Socially anxious individuals may have an overactive amygdala, which is the part of the brain that governs fear response.
• Environment. Social phobia may be a learned situation – i.e. a person becomes anxious after experiencing an embarrassing situation.

The risk of developing social anxiety is also heightened in people with:

• Family members (parents or siblings) with anxiety disorders
• Negative childhood experiences such as bullying, rejection, teasing, humiliation, or ridicule
• Childhood temperament – shyness, timidity, withdrawal, or restraint
• A visually obvious condition such as tremors, stuttering, or disfigurement
• Social or work demands, i.e. the need to meet new people, deliver speeches in front of an audience

How is Anxiety Treated?

GAD and social phobia may be treated in a variety of ways:

1. CBT

Just like cognitive behavioural therapy for depression, CBT may work with anxious individuals as well.

This form of talk therapy is designed to alter the way you think and/or behave.

There are many benefits to having CBT for your depression and anxiety symptoms:

• It can be completed in a short time
• It’s structured enough to be delivered in various formats, including groups, self-help books, and online apps
• It teaches strategies you can easily use in your daily life
• It may help in people whose anxiety medicines did not work

Tip: You don’t need a referral from a GP (though you may get one) to avail of the NHS’ Psychological Therapies. You only need to refer yourself to the IAPT service in your area.

Should you go for a private consult, be prepared to pay a fee of £40 to £100 per session.

2. Medications

a) GAD

People with GAD are often given SSRI antidepressants, including Citalopram, Escitalopram, Fluoxetine, Sertraline, and Paroxetine.

SNRIs such as Duloxetine and Venlafaxine – as well as the TCA Imipramine – may be prescribed as well.

In some cases, the newer antidepressant Mirtazapine has been given.

b) Social Anxiety

People with social phobia are often prescribed SSRIs such as Paroxetine and Sertraline.

The doctor may also prescribe you the SNRI drug Venlafaxine.

Other medications for social anxiety include:

• Benzodiazepines, which work to minimize your anxiety
• Antihistamines and/or Beta-blockers, which help control heart rate, blood pressure, heart palpitations, and shaky voice/limbs

How To Overcome Anxiety

If you suffer from signs of depression and anxiety, you may reduce them by following these self-help tips.

1. Reduce Stress

Whether you have GAD or social phobia, you may feel stress (and eventually, anxiety) without any warning. And should you feel this creep up, you may overcome them by doing certain stress reduction techniques.

An easy technique to try is a shallow or deep breathing exercise. A yoga breathing exercise may help as well.

Progressive relaxation is another beneficial method. It’s done by tensing one part of the body – and relaxing the other one.

You can also try a technique known as relaxing visualization. Here, you ‘imagine’ relaxing sights and sounds.

2. Exercise

Working out can help relieve stress and tension. It also improves both physical and mental wellness.

As mentioned previously, exercise is a good pick-me-upper since it floods the body with feel-good hormones.

3. Sleep Well

Lack of sleep may be harmful to your mental health. In fact, a report has shown that sleepless nights can lead to a 30% increase in anxiety.

The same report also shows that sleeplessness deactivates the medial prefrontal cortex. This is the portion of the brain that helps reduce feelings of stress and anxiety.

Apart from restoring the prefrontal mechanism, deep sleep may help regulate your emotions. This can lead to minimized emotional reactivity – which could trigger or heighten your anxiety.

4. Eat Healthily

You are what you eat. That said, what you eat (or not) may help with depression and anxiety symptoms.

It’s good to consume complex carbohydrate food sources such as quinoa, oatmeal, and whole-grain bread/cereals. Any of these may help increase the amount of serotonin – a neurotransmitter that has a calming effect on the brain.

It’s also good to increase your water intake, as dehydration can pretty much ruin your mood.

While there are food and beverages that you need to consume more, you should cut down on these things:

• Alcohol. Although it may be calming in the short term, alcohol can actually make you edgy. It can also interfere with your sleep, which, as mentioned, can affect the anxiety-attenuating part of the brain.
• Caffeinated beverages. Coffee, chocolate, or tea, although delicious, may make you feel jittery and nervous. Like alcohol, it can worsen sleep quality as well.

Conclusion

Depression and anxiety are two of the most prevalent mental health conditions in the UK – and the world.

Depression is feeling sad for a long time – so severely that it affects your day-to-day functioning.

Anxiety, on the other hand, is an intense feeling of fear, worry, or panic. There are several anxiety disorders, the common conditions being generalized anxiety disorder and social phobia.

There are many physical and psychological causes of depression and anxiety. Both CBT and medications may help deal with them.

Apart from these treatments, a person living with depression and anxiety may benefit from certain lifestyle changes. They include reducing stress, exercising, sleeping well, and eating healthy.