Anxiety & Depression: two faces of the same coin
Diagnosticians tend to be guided in their assessment of psychiatric diagnoses by the Diagnostic and Statistical Manual of Mental Disorders. The manual, published by the American Psychiatric Association, is in its fourth edition (DSM IV) but the fifth version is due sometime around May 2012.
Like many other people I'll be interested to see what emerges in the latest version. The DSM is dogged by controversy, not least by the fact that around 70 percent of those on the current task force have disclosed direct ties with drug companies or related industries. Then of course we have the proliferation of diagnoses and diagnostic sub-categories, many of which attract the development of new drugs. Will we see even more categories and sub-categories in version five? Will new ‘disorders' such as sexual addiction find a place? And will some conditions currently viewed as distinct be reconsidered? This last question forms the focus of this Sharepost and relates to the issues of anxiety and depression.
Depression comes in many different guises. It can be masked by a person's social skills, or distractions such as a heavy work load. The person who drinks too much alcohol may be viewed as alcoholic but is this just the manifestation of depression? And what do anger, sexual promiscuity, worrying, sleepless nights and risk taking have in common? Nothing? Everything? These aren't simply ramblings as the way we choose to regard psychological health has a huge bearing on the treatment prescribed and its overall effectiveness.
It has long been recognized that anxiety and depression share some kind of relationship. Increasingly, the evidence points to a far closer relationship than was previously envisaged. Around 70 percent of people with depression also suffer an anxiety disorder. In these cases it is recognized that the stress response is overactive. For example, those with panic disorder and depression tend to show a marked decrease in 5-HT1A, a receptor for serotonin. Repeated triggering of the stress response causes the hormone cortisol to affect the gene function that produces 5-HT1A.
Writing in the publication PsychologyToday, Hana Estroff Marano cites David Barlow, director of the Center for Anxiety and Related Disorders at Boston University. "They're probably two sides of the same coin. The genetics seem to be the same and the neurobiology seems to overlap. Some people with the vulnerability react with anxiety to life stressors and some, in addition, go beyond this to become depressed."
Anxiety nearly always precedes depression. Knowing this should present us with an ideal opportunity to intervene at a point where effective coping skills can be both taught and practiced. Given that anxiety frequently shows itself as a force during adolescence it stands to reason that greater emphasis in schools could be placed upon issues such as personal growth, developing resilience, self-esteem and sense of self, social skills and physical exercise. Exercise is cheap, natural and effective for mental health.