Chapter 26
Professional Treatments for Anxiety and Depression
In This Chapter
• Serious depressions and anxiety disorders are very common
• Am I just “down” or is it really major depression?
• Biochemical imbalances in the brain or hormonal changes (especially in women)
• Bipolar (manic-depressive) illness is more common than you might think
• Psychological and medical treatments are very effective
Many people experience significant struggles with anxiety and depression. These common emotional problems affect people from all walks of life. Effective medical and psychological treatments have been developed, and yet most people in our country never seek treatment. In this final chapter, we will take a look at these common psychological problems and briefly discuss professional treatment options.
Normal Folks and Serious Disorders
It must be emphasized from the outset that many people who have had very difficult or tragic lives fall prey to depression and other types of serious mood disorders. At the same time, it is very often the case that entirely psychologically healthy, emotionally mature individuals can also develop certain types of depressions or bipolar illness. Many, many thousands of successful, competent people and those often considered to be the “worried well” get hit by serious depression. Most of the time these serious mood disorders have little to do with weaknesses of character; in part this is due to the fact that many depressions and anxiety disorders are due, at least in part, to biological changes in the brain.
Depression
Many people occasionally will say that they feel depressed. This can refer to a host of unpleasant emotions such as feeling “blue,” moodiness, feelings of sadness, disappointment, discouragement, being unmotivated, or just feeling “out of sorts.” For most of us, feeling down in the dumps occasionally or being saddened temporarily is a normal part of human life. These are understandable reactions to a myriad of difficult life experiences.
In the United States, however, every year 10 percent of the population experiences a much more devastating mood disorder, referred to these days as either major depression or clinical depression. Over the life span of the average American, the prevalence of major depression is even higher, affecting 17 percent—one out of six Americans will at some point in their lives suffer with this form of severe emotional disorder. With such a high incidence, it is hard to imagine that anyone has not either experienced depression personally or known close friends or relatives who have had episodes of clinical depression. The bottom line—major depression is an extremely common experience.
Some people may be at greater risk for developing depression. Depression is, to some degree, influenced by genetics and can run in families. But it is important to state that depression can happen to anyone, under certain circumstances. It occurs in people from all cultures around the world. Depression is, however, about twice as likely to occur in females than in males.
Major Depression Versus the “Blues”
Major depression differs from minor bouts of sadness in a number of ways that are discussed in detail later in this chapter. However, its main characteristics are as follows:
1. It is extremely severe.
2. If not treated, it generally lasts for months or even years.
3. It often results in significant disability. (In addition to tremendous personal suffering, during episodes of major depression, otherwise capable people often cannot function well at work or in school, marriages may fall apart, and loving parents may find it nearly impossible to really interact with, love, and guide their children.)
4. Rates of alcohol and other types of substance abuse are higher during episodes of depression.
5. For untreated or inappropriately treated people, there is a risk of suicide (the lifetime mortality risk from suicide is 10 percent).
6. Chronic depression contributes to poor physical health, especially to increased risks of heart disease, osteoporosis, infectious diseases, and, possibly, an increased risk for Alzheimer’s disease.
Clinical depression is obviously much more than a mere case of the blues. It is a common and often devastating emotional illness. The real tragedy is that only one third of those experiencing a major depression ever receive treatment. Most of these people somehow grit their teeth and suffer for months and months (the average length of an episode of depression is from 9 to 15 months, unless treated). Yet, according to the National Institute of Mental Health, 80 percent or more of those experiencing major depression can be successfully treated, and in many cases, symptom relief can occur in a matter of weeks. Dr. David Burns, author of the popular book Feeling Good says, “Depression feels hopeless even though the prognosis is excellent.”
This high rate of treatment success is due to the development of several effective types of therapy, including some types of psychotherapy, medication treatment (antidepressant medications), and exercise, which have a remarkably good impact on reducing depression.
A Recurring Illness
For half of people experiencing a major depression, the current episode will be a once-in-a-lifetime event. However, for the other 50 percent of people experiencing serious depression, unfortunately, the disorder will recur. In this group, many will experience ongoing, chronic depression, while most will be plagued with recurring episodes of the illness. Although this may sound bleak, the good news is that psychological and medical treatments for depression also have been shown to be very effective in preventing relapse. Thus, when considering treatment for depression, it is important to focus not only on resolving the current episode but also on taking steps to prevent recurrence of the disorder.
Not Everyone Will Understand
It is a very common experience for those going through a depression to hear comments from concerned friends or family revealing that the concerned person does not truly understand the nature of clinical depression. For example, people make statements like these: “You just need to look on the bright side.” “Just try to snap yourself out of it.” “You need to try harder—you need to pull yourself up by your bootstraps.” They may even say, “Don’t worry—be happy.” Their intentions may be good, but they simply do not understand. An old saying is “Good advice is free and it’s worth the price.”
True clinical depression drags people into a kind of emotional paralysis from which it is difficult to escape, despite considerable effort.
Signs and Symptoms of Depression
A brief list of symptoms was presented in Chapter 7. Here we’ll look at depressive symptoms in more detail. It is useful to consider two main sets of depressive symptoms. The first set is referred to as Core Symptoms, which are symptoms that are seen in nearly all types of depression.
The following are core symptoms common to all depressions:
• Mood of sadness, despair, emptiness
• Loss of interest in most normal life activities and an inability to feel a sense of vitality, pleasure, or aliveness (the psychiatric term for this is anhedonia)
• Low self-esteem, lack of self-confidence
• Apathy, low motivation, and social withdrawal
• Excessive emotional sensitivity
• Negative, pessimistic thinking
• A tendency to take things personally
• Irritability
• Indecisiveness
• Suicidal ideas
def•i•ni•tion
Anhedonia is a common symptom of serious depression. It is a loss of a sense of aliveness and vitality. Regardless of what happens in a person’s life, nothing evokes happiness, interest, or enthusiasm. When anhedonia is present, life loses all meaning—people can no longer experience the beauty of a sunset, a funny movie, the laughter of their grandchildren, the inspiration of a favorite hymn, or the pleasure of good food or physical intimacy. And when nothing matters, then people invariably withdraw from life. The sadness and discouragement of depression is enough suffering, but add anhedonia to this and depression feels even worse. Fortunately, anhedonia is a symptom of serious depression that typically responds well to professional treatment.
A second group of symptoms are the biological or physical symptoms of depression. These symptoms are associated with chemical malfunctions in the brain that can occur in many types of depression.
The following are biological symptoms of depression:
• Appetite disturbance—decreased or increased, with accompanying weight loss or weight gain
• Fatigue
• Decreased sex drive
• Restlessness, agitation, or conversely, a loss of energy
• Impaired concentration and forgetfulness
• Pronounced anhedonia—total loss of the ability to experience pleasure
• Sleep disturbance—early-morning awakening, frequent awakenings throughout the night, and occasional hypersomnia (excessive sleeping)
When a person is being evaluated for possible depression, the mental-health professional (or primary-care physician) should ask specifically about the presence or absence of these symptoms (both core symptoms and biological symptoms). Not all depressed people will have all of these symptoms, but they usually will have several. In general, for a diagnosis of depression to be made, such symptoms must be present for a period lasting at least two weeks.
Biochemical Imbalance
Some types of depression appear to be associated with an underlying biological cause (a neurochemical disorder). The presence of one or more of the physical symptoms of depression strongly suggests that at least a part of the problem can be traced to a biochemical disturbance. The biological changes in brain functioning can seem to come out of the blue (i.e. may occur in the absence of major, difficult life events). Such depressions are called endogenous depressions, meaning to “arise from within.” They also can be set in motion by the medical illnesses or drugs mentioned in Chapter 8 and outlined in detail in Appendix B. However, most commonly depressions are caused by stress. Here life stressors provoke not only emotional responses, but also begin to significantly derail brain chemical functioning.
There are also genetic factors that influence the emergence of biological depressions. Some depressions tend to run in families. Consequently, obtaining a family history (to see if there are blood relatives who have had mood disorders) may provide important clues to the diagnosis.
The reason it is important to determine if there is some form of underlying chemical imbalance is that for those individuals, antidepressant medications may be quite effective.
Dysthymia
Dysthymia is a very long-lasting type of low-grade depression. It is not as severe as major depression, but can be experienced almost every day for a period of at least two years, and often longer. It is believed that this disorder affects about 6 percent of the population. Those suffering from dysthymia are burdened by an almost-constant low-grade depression. This usually manifests in the following symptoms:
• Moodiness
• Low self-esteem
• Persistent lack of enthusiasm
• Fatigue
• No zest for life
• Irritability
• A strong tendency for negative, pessimistic thinking
• Often seen by other people is being boring, pessimistic, cranky, or just miserable people
People with dysthymia can be treated by psychotherapy, and some recent studies have shown that a number of people with dysthymia also respond well to antidepressant medications. The response rate to medication treatments is about 66 percent.
When medication treatments are successful for people with dysthymia, these patients often make comments like, “I have never felt this good in my entire life.” This kind of very positive result has led many investigators to conclude that probably some forms of dysthymia are caused by a chronic neurochemical malfunction.
def•i•ni•tion
Dysthymia is a low-grade, chronically depressed mood that is experienced almost every day over a long period of time. People suffering from dysthymia tend to see the world in a pervasively negative way.
Hormone-Driven Depressions
About 75 percent of all women notice some changes in their emotions when they are premenstrual. For most, the changes are very slight. However, as previously discussed in Chapter 8, it has been estimated that about 5 percent of women experience intense mood symptoms during this part of their menstrual cycle. This is technically referred to as premenstrual dysphoria. The emotional changes can include depression, anxiety, and/or irritability. In recent years many psychiatric specialists have noted that the serotonin-specific antidepressants medications (referred to as SSRIs: Prozac, Paxil, Zoloft, Celexa, and Lexapro) appear to be effective in reducing these mood symptoms (and are more effective in accomplishing this than other classes of antidepressants). The emotional brain is packed with estrogen-sensitive receptors, and it makes sense that significant fluctuations in female hormones (especially estrogen) may destabilize the chemical functioning in the emotional brain.
It should be noted that exercise, exposure to bright light (sunlight), and some dietary changes (e.g., reducing caffeine) also may play an important role in the treatment of premenstrual dysphoria.
Other Hormone-Related Depressions
In approximately 10-14 percent of women giving birth to a baby, within four to eight weeks, a severe depression can occur: post-partum depression. Hormonal changes associated with childbirth play a role, but it is also very important to note that sleep deprivation during the weeks following delivery is another key factor increasing the risk of post-partum depression.
Some women also develop severe depressions in the peri-menopausal period of life (in the years leading up to and including entry into menopause). Most of the time these depressions occur in women who have had previous depressions associated with various changes in female hormones. It is that same group of women who have had premenstrual depression and/or post-partum depression who are most at risk.
Atypical Depression
It has been estimated that between 15 and 20 percent of people experiencing clinical depression suffer from a particular subtype of major depression called Atypical Depression (atypical meaning not typical). The symptoms of atypical depression include the following:
• Severe fatigue
• Appetite increase and weight gain
• Excessive sleeping (technically referred to as hyper-somnia)
One reason for listing this disorder separately is that the presence of atypical depressive symptoms is a warning sign for possible bipolar (manic-depressive) disorder. Three fourths of people who suffer with atypical depression have a form of bipolar disorder. The medical treatments for major depression and for depression seen as a part of bipolar disorder are very different, and that is why this distinction is so important. Also, if a person actually has bipolar disorder, over a period of time the use of antidepressant medications may actually make the disorder more severe.
Treatments for Depression
Most depressions can be successfully treated. Anyone with significant depressive symptoms should seriously consider getting professional treatment … and do not delay. The longer depression goes untreated, the harder it is to treat. A comprehensive discussion of treatments for depression is beyond the scope of this book. However, I’d like to briefly summarize those treatments that have documented success in the treatment of depression:
• Psychotherapy (including a version of psychotherapy called cognitive-behavioral therapy).
• Antidepressant medications are effective in many types of depression (as noted previously, this is especially so if the depression is severe and if it is accompanied by the physical symptoms of depression). One significant problem, however, is that most people treated with antidepressants are prescribed medications by primary-care doctors, and often there is a lack of follow-up. The results are that the majority of times the outcomes are inadequate. Antidepressants are discussed in Appendix D.
• Exercise has been shown to be quite effective in treating depression. The trick is getting a depressed person to exercise. (Let’s face it, it’s hard to get most people to exercise.) However, the research on exercise therapy for depression is very promising.
• High-intensity light therapy can be a successful treatment for some forms of depression (especially those that are seasonal depression, i.e. winter depression).
• For very severe depression, ECT (electro-convulsive therapy, often called “shock therapy”) continues to be a highly effective treatment. This is generally only offered if the depression is extraordinarily severe and/or if antidepressant medication treatment has not been successful.
Possible Meltdown
Seventy-five percent of prescriptions for antidepressants and 90 percent of prescriptions for antianxiety drugs are written by primary-care doctors. Due to a lack of close follow-up in primary care, as little as 15 percent of those who are treated actually experience a good response to medications. Treatments with these medications warrant close follow-up to ensure adequate dosing and to monitor for side effects.
Bipolar Disorders
Bipolar disorder, which is also known as manic-depressive illness, is characterized by wide swings in mood that alternate between mania and depression. These two emotional states can be viewed as opposite ends, or “poles,” of a continuum, hence the term bipolar (“bi” is the Latin term for two). During an episode of mania, a person’s mood is abnormally elevated, euphoric, or accompanied by pronounced irritability. The depressions associated with bipolar disorder can be equal in severity to those seen in major depression.
The following are core symptoms of mania:
• Excessive euphoric or high feelings
• Irritability
• Distractibility
• Unrealistic and inflated beliefs in one’s abilities—called grandiosity
• Dramatic mannerisms
• Racing thoughts, technically referred to as flight of ideas
• Loud, pressured, and rapid speech—difficult to interrupt and subject to changing topics, often unrelated
• Increased energy, activity, restlessness
• Decreased need for sleep; requiring only four to five hours of sleep a night without daytime fatigue the next day
• Increased sex drive—provocative behavior, can be promiscuous
• Poor judgment
def•i•ni•tion
Mania is a severe mood episode associated with bipolar disorder. It is most noticeable by the presence of an upbeat mood, elation and/or extreme irritability, and impulsive behavior. Hypomania is a less severe form of mania.
• Abuse of substances, particularly stimulants and alcohol
• Spending sprees or excessive gambling
Some people experience what is called dysphoric mania. This is an especially severe form of mania where there is agitation, marked insomnia, extreme irritability, and depression (not euphoria).
On average, 5 percent of the U.S. adult population is afflicted with bipolar disorder. It often first appears in adolescence or early adulthood (usually before the age of 30) and is considered a long-term illness, characterized by patterns of multiple episodes (recently it has been discovered that up to one third of cases of bipolar disorder begin in late childhood).
def•i•ni•tion
Dysphoric mania is an especially severe form of mania where there are classic manic symptoms accompanied by extreme irritability and depression.
Bipolar disorder can strike even very competent and emotionally mature people. It has nothing to do with one’s ego strength, level of intelligence, or track record of effective coping. Stress can play a role in provoking episodes, however, bipolar disorder is considered primarily to be a medical/neurological illness.
For the majority of people with the disorder, the symptoms of bipolar disorder can be treated effectively with psychiatric medications (mood stabilizers). However, up to one third of people suffering from bipolar disorder go for years misdiagnosed. Treatment with psychiatric medications is often very challenging owing to numerous side effects associated with mood stabilizers. If bipolar disorder is suspected, please consult with a psychiatrist. This is not a disorder that should be treated by primary-care doctors.
A comprehensive discussion of medical treatments for bipolar disorders is beyond the scope of this book. It is, however, important to state emphatically that medical treatment is absolutely essential. Untreated bipolar disorder always gets worse and failure to treat can often have disastrous consequences. Aside from the enormous personal suffering, the divorce rates are about twice the national average, careers are ruined, health problems abound, and the suicide rate can be as high as 15 percent.
Anxiety Disorders
Anxiety is a part of life. Indeed, it is hardwired into our brains. As we’ve seen when people feel anxious or threatened, they are likely to respond with an increase in tension and physiological arousal, called the “fight-or-flight response.”
For all people, distressing life events can provoke anxiety. However, people with anxiety disorders can experience the full set of these biological reactions without an actual threat being present. Or they may experience severe anxiety reactions to relatively minor stressors.
There are several types of anxiety disorders, including situational anxiety, social phobia, panic disorder, generalized anxiety disorder, and obsessive-compulsive disorder. Of these, panic disorder and obsessive-compulsive disorder (OCD) are at least somewhat influenced by genetic transmission. Also both have the notable abnormalities in brain functioning that account for a good deal of the symptoms. The distinctions between these various types of anxiety depend on whether the anxiety is brief or constant, and whether it is generalized (i.e. experienced in all situations) or specific to a particular situation.
1. Situational anxiety refers to what is often simply called “stress.” It is an overly anxious reaction to a distressing situation.
2. Panic disorder is distinguished as sudden attacks of very severe anxiety that last for only a few minutes. Often, after several such attacks, people may also begin to develop phobias (e.g. if they have had a panic attack while driving, they may become very afraid to drive).
3. Generalized anxiety disorder manifests as a near-constant anxiety primarily characterized by constant tension and worry.
4. Obsessive-compulsive disorder (OCD) is distinguished by compulsive, ritualistic behaviors such as repeated hand-washing or checking and rechecking to make sure the oven has been turned off or the doors have been locked, and/or frightening thoughts (e.g. fears regarding dirt, germs, disease, and contamination).
5. Social anxiety disorder is characterized by very intense anxiety felt only in social situations, such as dating, applying for a job, or interactions with strangers, such as while standing in line at the grocery store, and public speaking.
6. Post-traumatic stress disorder (was discussed in detail in Chapter 22).
Altogether, these disorders affect between 10 and 20 percent of the population at any given time, and some 20-25 percent of people over their lifespan. In their more severe forms, anxiety disorders cause tremendous suffering, are very disabling, and are sometimes associated with increased risks of health problems. Often some of the symptoms begin in childhood, so that the person has a life-long struggle with anxiety. In this chapter, we will take a separate look at panic disorder, generalized anxiety, OCD, and social anxiety disorder.
Medical Causes of Anxiety
As we saw in Chapter 8, sometimes anxiety can be caused by an underlying medical illness (also see Appendix B).
In addition, as we have seen, many drugs can cause anxiety. Among them are amphetamines, asthma medications, caffeine, central nervous system depressants (such as withdrawal from alcohol), cocaine, nasal decongestants, steroids, and appetite suppressants.
In the initial evaluation of an anxiety disorder, it is always a good idea to have a physical examination, including appropriate laboratory tests, and to give a thorough drug history, including prescription, over-the-counter, and recreational drugs. If a medical condition or drug usage is found, it is important to first treat the underlying disorder that may be causing the anxiety or to address the drug use. Then, if necessary, treatment targeted specifically at anxiety can begin.
Panic Disorder
Panic disorder is characterized by acute attacks of anxiety, which are so severe that sufferers often fear they will go crazy or die (many people are afraid that they are having a heart attack). These episodes come on very suddenly, are very intense, generally lasting last from a 1 to 15 minutes. The attacks are accompanied by any or all of the symptoms of a fight-or-flight reaction (see Chapter 3).
Typically, panic disorder will begin with a single, isolated panic attack. This attack is often so frightening that the person often becomes anxious and fearful about having another attack. She develops significant anticipatory anxiety about having another attack and may begin, therefore, to experience at least some degree of anxiety most of the time, re-experiencing full panic attacks periodically.
People suffering from panic disorder often come to feel more secure at home and develop phobias about traveling any distance away from home. They are uncomfortable especially when they feel trapped and are unable to go home immediately, as when caught in heavy traffic or in a crowd. Thus, people with panic disorder go from having discrete, severe anxiety attacks, to having near-constant anxiety and phobias of specific activities, punctuated by periodic full-blown panic attacks. This can progress to agoraphobia, a condition where the fears are so pervasive and intense that people essentially becomes housebound.
def•i•ni•tion
Agoraphobia is a fear of being in public places such as the grocery store or shopping mall.
Panic disorder can be aggravated by stress, but there is rather convincing evidence to suggest that it is largely a biochemical problem in the brain.
Also, it must be noted that certain cardiac and respiratory diseases can produce what appear to be panic symptoms, thus it is vital to be checked out medically if you experience panic attacks.
Two types of treatment for panic disorder have been developed; both are generally very effective in reducing or eliminating panic symptoms. Exposure-based cognitive therapy for panic disorder is the psychological treatment of choice. Medical treatments for panic include the use of either tranquilizers, (e.g. Xanax, Ativan, Klonopin) or antidepressants. The advantage of tranquilizers is their fast action. Assuming that the dose is adequate, tranquilizers can reduce panic symptoms generally within a few days. The down side of tranquilizers is that they are habit-forming. Antidepressants (all antidepressants with the exception of Wellbutrin) can successfully treat panic disorder. However, you must take medications daily for three to four weeks before symptoms begin to subside. Unlike tranquilizers, antidepressants are not habit-forming.
Think About It
Exposure-based cognitive therapy is a specific type of psychotherapy that has been found to be highly effective in treating most anxiety disorders. It generally includes three features. The first is teaching the therapy client effective anxiety management techniques that enable him to have greater control over the intensity of anxiety symptoms. Second, the cognitive aspect is helping the client to use particular thinking that reduces the perception of impending catastrophe; for instance, during a panic attack, to say to oneself, “This is a panic attack. It is unpleasant, but is not dangerous … these attacks usually only last five minutes … just hang on, it will be over very soon.” The final piece is exposure. Once a person has mastered various anxiety-reduction techniques, then he is instructed to gradually face things he fears. For instance, if he has a fear of driving, he would begin by just sitting in the car in his driveway … and gradually progress, over a period of weeks, to doing things that are more challenging, such as actually driving the car. This gradual approach is monitored so as to result in experiences of mastery at each step of the way.
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) is seen in individuals who feel quite anxious and tense most of the time. It is not associated with exposure to specific stressful events. Normal, everyday life events cause excessive anxiety, especially worry. It has sometimes been called “what ifing” disease. People are constantly worried about “What if … something bad happens?” Many of us worry, but with GAD it can become so severe as to dominate a person’s life. GAD responds well to typical “talk therapy” (as described in Chapter 25), to exposure-based cognitive therapy, to exercise (actually a very good treatment for GAD), and to three classes of psychiatric medications: BuSpar (a non-habit-forming tranquilizer), standard tranquilizers (e.g. Xanax, Ativan, Valium, and Klonopin—but remember, these are habit-forming), and to antidepressants (all except Wellbutrin).
Obsessive-Compulsive Disorder
Obsessive-Compulsive Disorder (OCD) is characterized by obsessional thoughts and/ or compulsive behaviors. Obsessional thoughts are intrusive thoughts that are very distressing to the person thinking them. They evoke a great deal of fearful anxiety, such as fears about oneself or loved ones becoming ill, infected with deadly viruses, or dying.
Compulsive behaviors are ritualistic behaviors that the person feels compelled to perform to ward off some impending calamity, or to reduce the feeling of intense anxiety. Examples include repeatedly checking locks, compulsive counting, tapping a certain number of times, positioning objects in specific ways, or excessive hand-washing.
When the disorder is severe, much of the OCD person’s time is occupied by the symptoms, so that performing even a simple task can become very time-consuming.
Obsessive-Compulsive Disorder may be aggravated by stress, but it is considered to be a biological illness due to abnormalities in the brain chemical serotonin. Interestingly, these abnormalities tend to normalize during treatment, whether treatment is exposure-based cognitive-behavioral therapy or medication treatment. The drugs used to treat OCD are antidepressants that increase brain levels of serotonin: Prozac, Zoloft, Paxil, Lexapro, Celexa, and Anafranil.
Social Anxiety Disorder
Lots of us feel at least somewhat uneasy in some social situations. However, in those plagued with social anxiety disorder, the anxiety can be overwhelming. One of the main results of social anxiety disorder is that people are so inhibited about interacting with others that they are very likely to find it difficult to meet people and develop intimate relationships. Many such people often suffer from significant loneliness and may become quite depressed. The best treatments for social anxiety include exposure-based cognitive therapy, group therapy, and some medications, primarily antidepressants (again, with the exception of Wellbutrin).
Why Treat Anxiety Disorders?
Except for situational stress, most anxiety disorders we have addressed in this chapter can become very chronic if not treated. Not only does this result in prolonged suffering, but many people thus affected will also turn to alcohol to quell some of their anxiety, and may eventually become addicted to alcohol. In addition, very chronic anxiety has been associated with an increased risk of heart disease. Treatments for anxiety disorder are often very successful. If medications are used, they should always be accompanied by psychotherapy. And keep in mind that exercise is very effective in the treatment of anxiety. Generally, for it to be helpful, you’ll need to be involved in regular exercise (e.g. three times a week for 20 minutes) for at least three months to reap the positive benefits.
The Least You Need to Know
• Significant anxiety and depressive disorders affect a very large number of people.
• Professional treatment for depression and anxiety is often very successful.
• Most prescriptions for antidepressants and antianxiety medications are written by primary-care physicians. Successful treatment outcomes in these settings are disappointingly low due to two factors: lack of close follow-up and neglecting psychotherapy.
• Specific types of psychotherapy have been developed for treating anxiety and depression. If you are considering professional therapy, be sure to ask your potential therapist if she offers these particular forms of psychotherapy.
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