Anxiety or Depression? Sometimes it is Both!

Depression or Anxiety? Often it is Both
Many people suffer from what are called co-morbid conditions. That means that there are at least two different conditions and that an individual may suffer from both of them at the same time. This is often true of the disorders called depression and anxiety. Generally, one condition masks the other. The individual presents with identifiable symptoms of depression. The depression gets treated, or naturally improves, and what comes to the surface is anxiety. Or, conversely, the individual is treated for the different manifestations of anxiety and they improve, then the individual begins to present with depression.

Both of these conditions are believed to be caused by physiological issues and emotional/stress related issues. Depending on whom you engage regarding the origin of depressive states, you will hear that depression is caused by a neurotransmitter imbalance and is purely a bio-chemical issue. You will hear that anxiety is caused by adrenal issues and is primarily bio-chemical in nature. Both of these presume that finding the correct medical intervention will alleviate the problem and restore the balance to the individual.

My clinical experience with people suffering from depression is that anti-depressants alone are not enough to “fix” the problem. Many people need and take anti-depressants but do not feel more energized, more up-lifted or more hopeful. At best, they report feeling less despair, but not “elevated.” An argument is made that anti-depressants are not mood elevators, rather they are drugs which attempt to restore the bodies natural neurotransmitter functions. This is the presumptive cause of depression for those who focus on the “biological” issues. There are side effects to these anti-depressants, one of which is loss of libido. Many who take these drugs over an extended period will report that they no longer “think” about sex or they report that when they are engaged in sexual activity suddenly, without warning, everything just goes away. It is like a chemical switch is turned off, and so is the client. As you can imagine, this leads to very stressful relationship issues when it is not understood by the individual, or their partner!

People suffering from anxiety conditions often report being “hyper- vigilant” or having a high “startle” reaction. They sometimes report that they are constantly in a state of dread because they are “waiting” for something bad to happen, waiting for the other shoe to drop. Often, anxiety sufferers will know that if they are going to experience a situation with enhanced emotional potential, they will feel their bodies “run wild.” Their heart beat increases, they break out in a sweat, their chest hurts, they have the sense that they are going to choke, they fear a heart attack, they don’t think clearly, etc… There are drugs that they can take which will reduce these effects, or help avoid them by putting both a “floor” and a “ceiling” over the physiological “arousal” potential of the body. These are like beta blockers which prohibit the heart from going into overdrive. They are situational in nature and one takes them in anticipation or in response to an “arousal” state.

The medicines help. They help control the range of the body’s responses. They often have side effects and/or are addictive. Questions arise regarding the cost benefit ratio for taking these medicines. Sometimes people resist taking these meds, (especially men) because they are “un-manly” or indications of weakness. Sometimes they resist taking them because of the sexual side effects. Sometimes they resist because taking them does not really “fix” anything.

I believe in taking medicines when they are needed and are helpful. I encourage my clients to go to their doctor and discuss the situation with them. I often have an opportunity to discuss with the doctor the situation of the client as I understand it. Some doctors, in my experience, welcome this additional contribution of information. Some doctors see no need to look at outside information. That being said, I believe that medicine is seldom enough. There have to be behavioral interventions and behavior changes to make progress. These are most likely to come from therapy.

Working in therapy sessions with clients who are clinically depressed is a very difficult thing to do. I see more progress with people suffering from anxiety attacks. They tend to be more responsive and have more immediate relief and I am more aware of their success in overcoming it. But many clients with whom I deal do suffer from varying degrees of depression. Some of them have lives which are minimally functional and they believe they have limited options. These clients are, at best, surviving and waiting for time to pass and things to change. They feel victimized by life’s circumstances and they are hopeless to change. I remember in particular, a woman I worked with for years. She was severely depressed and went through suicidal cycles regularly. She felt powerless to change her life and cycled from quiet impotent rage, to helpless cries of despair and self pity. She would get a little better, begin to make some behavioral changes in her life, i.e. go back to school, get a dog, join a social network, go on a diet, etc., then it would just all dissolve and she would sink back into despair and have suicidal thoughts. It was very difficult to work with her week after week, month after month. I often felt that I was the only one bringing energy to the session. I would feel depleted after she left because it felt like my battery drained in order to recharge her battery. It seemed like every week we had the same conversation.

There were elemental places in her life where she was abused and victimized. She had survived much. I had so much respect for her and for her survival from the traumas of childhood and adult losses. She was a tower of strength and intelligence. Yet she could not see or experience herself as the strong, capable woman I saw and knew. She saw herself with a jaundiced eye of critical self-hatred. She was convinced it was her fault that these things happened to her. If she had been a more worthy daughter, friend, worker, then good things would happen and she would be successful, beautiful, slim, and happy. She did not deserve any of these things because she was fatally flawed. She would get angry with me when I encouraged or praised her. She hated me and called me a “paid” friend because I expected her to pay her bill and only worked with her because it was my job. She wanted me to love her for herself, not for the money she paid me. She wanted me to respect and care for her even though she was not able to do this herself.
These clients are so very challenging for a therapist. It is such an uphill battle. It is exhausting because you have to stay alert, focused, encouraged, and encouraging, against constant resistance of negative energy and refusal to hope or engage. I had to keep reminding myself that I could go home at the end of the day. I had a life filled with color and excitement. I felt good about myself. My hour with her would end honorably when I had done my best during that session. She lived in her skin and in her life every minute of every day and could not get away from her feelings by leaving my office. Keeping this in mind helped me find the energy and maintain the desire to work with and encourage her. I continued to respect her and care about the pain with which she lived, but to this day, I do not know if I made a difference in her life. I don’t know if I offered insight, help or any positive benefit from all my investment of caring and energy. But like every other therapist, I remain committed to the belief that it does matter. All I can give is my dedication, my attention and my caring. I do not know, nor do I expect to know, the ripples that occur in the lives of those with whom I work. It is not my lot to see the effects of the work with these individuals. I must be satisfied with my own sense of having done the best I could every single day. I believe it matters, that it is worthwhile and that it helps. It is an article of faith and professionalism. Otherwise I would not do this job, it is just too damn hard.

If you are a therapist, you will understand. If you are training to be a therapist, you will learn. You must go to work every day with the energy, focus and commitment to do your job in a caring, professional way. You cannot afford to ride the waves of energy that come off of your clients. Your energy must come from within you. Their success or failure is not yours, it is theirs. Your job is to do your job which is to live your life and work ethically and professionally, constantly trying to accurately and empathically attend to experiencing the client honestly. You reflect back to them your observations and encourage them to see themselves honestly. But each client has to walk their own walk, and so do you.

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8 Responses to Anxiety or Depression? Sometimes it is Both!

  1. sandy lewis says:

    I’ve researched depression/anxiety for years and never read anything like what I went though. Your’re info is more than I’ve ever heard from all the dr’s I’ve seen. I want to know if you’d heard of a case such as mine. Starting with hindsight, as a teen I required alot of sleep, in the 80’s while in my 20’s, weak, no energy, was told I had low sugar. I now know it was mono when epsteirn bar viris was in the bloodwork. I watched my every move scared of making mistakes at work. I knew for years something wasn’t right. I had jobs that not just anyone could do, yet I was scared to death inside, of messing up. Way too tired, faked it at work for years. At the start of 2000, I was at home feeling pretty good. In a drop dead moment I was too weak to stand, lost my vison for a few moments then it stayed blurry. I knew I was going to drop dead that moment. I’d eat a little just to find moments later stuff running down my leg. I stayed severly ill for 10 years, being sent to every kind of dr there is. I cried at my dr’s office, I said I have to work. Fix me or take me out back and shoot me. The allergist, with his back to me said, I think you have depression. I shot back, I’m not depressed I’m sick. family dr finally put me on a low dose depression med which worked great but didn’t last a month. Lost my job of 5 years from being out on short term disability so many times, stayed home a year but got much worse. Finally the next year I tried to work a two bit office job. I had total mental block, my legs swelled up, I could hardly walk, alot of pain all over. I was let go early on. My resume would get me a great job in a heartbeat, but I don’t see ever being able to work again. Since 2006 I’ve been a patient at county mental health, the process of trying drugs, the time it takes, the side effects from hell. Effexor, felt like I was in heart failure. I was so sick yet the actual depression didn’t hit for over a year. Everyday I begged God for death. Years later out of the blue I’d get so angry. Two years ago, I went to an outside dr who increased lamictal. He said I had a lower form of bi-polar. I thought I was hiding most of the anger but I was bouncing off walls. My brain told me to kill myself, I fought this a whole weekend calling everywhere, no help since I had no insurance. Twelve years later, I’ve been on disabibility since 2009. The depression is better than I ever imagined it would be, yet I have a very hard time making myself take a shower, or do housework. The anixity got so bad, the heart acted up, I’d feel so sick, whole body shook inside, felt like I was in flight mode. I can only see a dr every 3 months. Was on colazapam forever, told my new dr how much worst it was, when I try to sleep I have to take a deep breath and release it slowly to calm my heart. He said I was having panic attacks, I never knew they lasted almost all day & night. A state run mental health is bad, but it’s all I can afford. It has taken years because the dr’s are always leaving or they are so over worked they just don’t care. After 10 years another new dr just changed the anxiety med. to valium. I was told before there was only one med for anxiety. It’s working great but still have some break thoughs, makes me have to nap. My main trade was a police dispatcher. Can you imagine hiding anixety while responsible for every officer and detective on the street? handling armed robberies, stabbings & high speed chases? I started at rock bottom, trained and supervised shifts. Guess maybe I did a much better job because I couldn’t allow anything to distract me. Plus the anixiety wasn’t at it’s worse yet, but it was a heavy noose around my neck, living in total fear of losing my job. No one knew the hell I was going though inside and I never dreamed it would get so much worse. I worked at a dr’s office, at lunch I ran to my dr, EKG said I was fine. Why is it that family dr’s don’t see the symptoms of depression and anxiety? I feel I suffered the worst for so many years for lack of knowledge and concern, even at mental health. Depression made me deadly ill, not just depressed. Haven’t slept on my own since 1999, I take seroquel to make me sleep, which causes at times, nightmares and vivid scary dreams. No one has come up with anything else to put me to sleep. What is advertised on tv is a sugar pill to me. I have nights with no sleep, or I’ll sleep day and night. This illness has taken the word active out of my life. That along with the med’s made me blow up like a balloon. Any small action like shaking out a small rug for a minute speeds my heart and wipes me out even on the new med. Thank God the anger has only happend a few times. Recently saw my new mental health dr, I think about it later and feel like a fool, I talked so much and so fast, is this anixiety or bi-polar? Anyone else would have thought I was on speed. you’re a busy man but I’d appreicate some imput from you. I found you last night after watching a cat video on face book. In the short video, you seemed to know everything that the dr’s I”ve seen don’t. My new dr said, I’ve looked over your chart but then asks why am I depressed, was it over money? how much do you get monthly? I said, thats personal business and you said you read my chart so you should know I have clinical depression. To me clinical means a medical condition not a temp illness over say the lost of a loved one. I thought about him later, he reminded me of the show Monk and his dr asking, and how does that make you feel? I once told a dr, you have no clue what I go though. He said I’ve been depressed before so yes I do. No, he was referring to a short term depression. Every Dr needs to really listen & hear from one person with a severe case like mine, from the beginning so they have an idea of how bad the person is really suffering & this is my compressed version. All the mental health drs I’ve been though, not one really has a clue how I suffer and even with much improvment, still do. The commerical on tv says, depresson hurts. They don’t even know. Depression for me made me deadly ill, so bad I wanted to die to be free from it. I no longer want to die, I still want to work. Last year I had a week or two where I felt so good I stated job hunting. One phone call about a police dispatcher job, the lady said with my experience I needed to get in there fast, my resume would go on the top of the wait list. If I could work, I’d more than double my income. My disability is a good bit higher than what most people get, but I skip meals, during the last two weeks of the month I’m lucky to find the smallest things to eat. Not eating healthy takes it’s toil too, but I can’t afford good food and I don’t cook because I can’t stand in the kitchen that long. I knock things over all the time and just have a hard time doing things without losing my balance, get confused and forget things right away. Memory of years past are all but gone. Alot of times I can’t remember what I just did seconds ago. Everyone used to come to me to ask how to spell a word, now I fight to remember how to spell. I repeat things alot. I have to reread what I just wrote many times because it’s repetative. I’m a pretty smart person with common sence locked up where I can no longer reach it. Thanks for your time and I pray you will help many mental health workers understand what we really go though. To all my dr’s, if you can’t walk in my shoes, you need to really listen to my whole story, but no. I only get 30 minutes with the dr and then I’m rushed out. I so wish I could talk to a large room full of dr’s that treat or attempt to treat depression. If anyone knows how severe it can be, it’s me. This is my life, I’ve finally learned to deal with it, finally begging for death has now turned to hope. My life just passes me by, while I stay imprisioned in my home. A trip to get food is a strain on me, and I sure can’t afford a trip to Asheville NC which is what I really need. The heat & humidity in SC kills me. There is no going out in summer, major cabin fever. I pray all the time for the Lord to make a way for me to move to NC. With the cooler temps, I know I’d love being outside, get somewhat active again and would have something that appears more like a normal life. I’m 53 now. I just don’t see a move happening even though I consider it medically neccessary. If only the goverment had a program to help people like me with relocating for heath reason. I’d be lucky to even see NC again in my lifetime. Disability restricks what you eat, it sure won’t get me accross the state line. I think I should write a book about my experience, do you think it would stand a chance of being published? People and mental health providers need to know what I know in order to help people without it taking 11 years.

    • Brett Newcomb says:

      I am sorry for your pain and suffering. From what you write you have really been struggling. Obviously for such a complicated and enduring case no blog response can offer substantative feedback. I would encourage you to continue your journey by forcing yourself to function as much as you can. It is a hard fight but a worthy one. I wish you well, please continue to take your meds and stay in touch with your Doctors.

  2. anon says:

    I understand exactly what you are going through. Word for word is what i too feel, think and experience every day of my life.
    You are not alone. I’m 41 yrs old and on temp disability. I cried when I found out that a psychiatrist who had to review my latest assessment wrote that I did not appear depressed, that he is not convinced I am bipolar and that I lacked motivation. I wrote back to him and told him that he has NO idea how I feel or what personal hell I go through every day. What we are going through is not life….it is torture.

  3. anon says:

    FYI:
    I am compliant with taking my meds, I see my psychotherapist once weekly. I put a lot of effort into wanting to feel and function like a “normal” person. It hurts intensely when i’m told I should persevere and try harder. This makes me feel weak and pathetic my efforts are simply dismissed as me not trying to work harder. I am so exhausted, dead, empty with no energy left to do the basics. I am NOT lazy!

  4. Brett Newcomb says:

    One of the awful things about this illness is that people who suffer from it do not look like they are wounded. It is easy for others, who don’t understand, to dismiss you as being lazy or manipulative. It is so hard to find the energy to fight back against this crippling disorder and for much of the time it is a battle you fight alone.

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