2016 March, Understanding and Remedy: Anxiety and Depression, by Emdad Khan

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Introduction: Anxiety and depression are two most common health issues many of us or our near and dear ones are experiencing in life. It affects emotional and physical well-being of the person and the relatives.
The science of mind-body medicine helps us understand the ongoing connection between the mind and body and see how anxiety and depression may be triggered by a variety of factors [1]. These can include nutritional, psychological, physical, emotional, environmental, social, and spiritual factors, as well as genetic tendencies or brain disease.
Anxiety and depression are not same, but they often occur together. People with depression may experience anxiety and people with anxiety may become depressed.
Depression: Depression is a common disorder, affecting over 350 million people worldwide. It is a disabling condition that adversely affects a person’s family, work, or school life; sleeping and eating habits; and general health [1]. Depression is typically characterized by low energy and mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Inability to have pleasure in positive aspects of life, a sense of hopelessness or worthlessness, and lack of hope for future are key symptoms of depression.
Symptoms of depression [1]:
– Sleep disorders (too much or too little)
– Shifts in appetite and weight (too much or too little)
– Anxiety
– Chronic physical symptoms, including pain, gastrointestinal disturbances, headaches, etc.
– Loss of energy and fatigue
– Feelings of persistent sadness, guilt, hopelessness, or loss of self-worth
– Thinking difficulties, such as memory loss, challenges concentrating or making decisions
– Thoughts of death or suicide
Men and women experience depression differently — while women tend to experience sadness and guilt, men often feel restless or angry and are more likely to turn to alcohol and drugs to cope.
Only 50% of people actively seek conventional treatment for depression, although a majority of people do find some relief through treatment. Women and adults between the ages of 45 and 64 are most likely to meet the criteria for major depression [1].
Anxiety: Anxiety may be a normal reaction to stress, and it can serve as a prompt to deal with difficult situations. However, when anxiety becomes excessive, it may fall under the classification of an anxiety disorder [1]. It is estimated one out of five people suffer from an anxiety disorder in USA and Canada and it is most common mental disorder in the developed world.
Symptoms of Anxiety disorder is characterized by emotional, physical, and behavioral symptoms that create an unpleasant feeling that is typically described as uneasiness, fear, or worry.
The worry is frequently accompanied by physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes. Emotional symptoms include fear, racing thoughts, and a feeling of impending doom. People suffering from anxiety often withdraw and seek to avoid people or certain places [1].
Treatment: Anxiety and depression can be treated: a) Life style changes, b) Types of therapy, and c) Active medication by Health Care Provider. Here we focus on easy one of life style changes and briefly touch on therapies and leave the medication with health care providers.
Life Style Changes [3] are simple but powerful tools in treating depression and anxiety; and they are an essential component of an integrated approach to treatment. In some cases, lifestyle changes alone can lift depression or relieve anxiety, so start with them right away. But if one is suffering from moderate to severe depression or anxiety, better to seek professional help right away.

– Exercise: Numerous well-designed studies have found exercise to be effective in elevating mood and reducing symptoms of depression. As for anxiety, many research studies have also found an improvement in anxiety symptoms with increased physical activity.

Exercise stimulates the body to produce serotonin and endorphins, which are chemicals in the brain (neurotransmitters) that alleviate depression. But that only partially explains the positive impacts of exercise on depression.

Participating in an exercise program can increase self-esteem, self-confidence, and sense of empowerment, as well as improve social connection and enhance relationships. All of these things have a positive impact on a depressed or anxious individual.

– Diet: What we eat and when we eat are important factors in our day to day well-being. The brain is one of the most metabolically active parts of the body and needs a steady stream of nutrients to function. A poor diet may not provide the nutrients necessary to produce neurotransmitters and may provoke symptoms of anxiety or depression. The science of Functional Medicine provides specific guidelines on foods for brain health.

In addition to eating a healthy diet that provides adequate nutrients, it is also important to make sure our gut is healthy so we can absorb those nutrients. This means paying attention to the health of our intestinal flora—the bacteria that break down foods. Taking supplemental probiotics with two or more live cultures (for example Lactobacillus and Bifidobacterium) and eating fermented foods, such as yogurt and miso, help support a healthy digestive system.

– Sweetened beverages, such as sweetened tea, soda, and fruit punch may also contribute to depression. A recent study found that people who drink four or more cups or cans of soda every day are 30% more likely to be depressed than people who did not drink soda. The same study reported that those who drank unsweetened coffee each day (either regular or decaf) reported less depression than non-coffee drinkers. Because other studies show that long-term use of caffeine has been linked with anxiety, decaffeinated coffee may be the best choice for some.
Minimizing refined sugars and caffeine is currently an easy and logical recommendation. If one is a regular caffeine user, cutting back gradually will be best tolerated.
– Alcohol: Depressed populations have more problems with alcohol use even though alcohol itself is a depressant. Alcohol use may be a way that individuals ‘self-medicate,’ trying to numb the pain of their depression. People suffering from depression should stop drinking alcohol. If alcohol abuse underlies the depression, it is critical that it be addressed directly..

– Poor sleep has a strong effect on mood, in part because the neurotransmitters needed to support mood are replenished with sleep. Thus we need restorative sleep to maintain a balanced brain and mental health..

People who don’t get adequate sleep, in length or quality, each night are more likely to develop major depression than those who sleep through the night. In addition, research shows that sleep-deprived people have a much stronger tendency to classify neutral images as “negative,” so that even everyday items can seem more menacing and contribute to anxiety.

Getting the amount of good quality sleep  is a priority. Everyday sleeping same time and getting up same time, may stimulate body to be in sleep mood or get a sleep disorder test..

– Life Purpose: Extensive research has found that people with a strong sense of life purpose are better able to handle the ups and downs of life. Purpose can offer a psychological buffer against obstacles — thus, a person with a strong sense of purpose remains satisfied with life even while experiencing a difficult day.
– Spirituality and faith also helps us to meet challenges and continue. Having a strong spiritual outlook help us find meaning in life’s difficult circumstances. Accept destiny, not in our control.

– Thoughts & Emotions: Negative attitudes and feelings of helplessness and hopelessness can upset the body’s hormone balance and deplete the brain chemicals required for feelings of happiness or calm, as well as have a damaging impact on the immune system and other parts of our body.

– Positive Thinking: We tend to believe that our emotions are part of who we are and can’t be changed. Research has shown that this isn’t so: emotions can be changed by altering the situation (leaving a depleting job), shifting our attention (noticing the beauty of the day instead of the traffic or snow), and by re-framing our perspective (“that person is under stress,” rather than “he doesn’t like me”)

– Life Attitudes: How we choose to live our lives impacts the way we feel every day. Certain types of mental training, such as meditation or positive thinking, can affect our perceptions of the world and make us feel calmer, more resilient, and happier.

– Forgiveness, gratitude, and kindness, have identified by researches as helpful attitudes as have positive impact that can be developed with practice. Let us forgive and let it go.

– Stress Reduction: Too much stress exacerbates depression and anxiety. Begin by identifying what creates stress for us and see if we can make changes in our life to reduce these stressors. Learn relaxation techniques to help reduce our reaction to stressors, and cultivate intentional, helpful responses. Cultivate resilience so that we can best handle life stressors that are not avoidable.

– Event Handling, an actual event I sonly10, how we control or handle it is 90%.

– Support Network: Strong relationships and social support networks reduce isolation and loneliness, both key risk factors for depression.

– Reach out to Friends & Families: Anxiety can also cause us to avoid other people and become isolated. But reaching out to friends and family can help us deal with our anxiety. Our friends can help us make realistic assessments of threat and their support can bolster our confidence in dealing with issues.

– Volunteering in community organization or hospital is a wonderful way to get social support and help others while also helping ourselves.

– Pets can also be wonderful for helping us to feel support and companionship.  Physically, having a loved one (two or four-legged) close calms us and reduces the fight or flight

Types of Therapy [2]: Therapy may help one to develop an awareness of what one feels, why he/she feels that way, what the triggers are, and how one might change the reaction to them. Some types of therapy teach practical techniques to reframe negative thinking and change behaviours.
Three of the more traditional methods used in depression include cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. Often, a blended approach is used.
– Interpersonal therapists focus on the patient’s disturbed personal relationships that both cause and exacerbate the depression.
– Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving that are often associated with depression. In addition, people suffering from anxiety disorders often participate in cognitive-behavioral therapy, which focuses on recognizing and changing thought patterns and behaviors that lead to troublesome feelings. This type of therapy helps limit distorted thinking by looking at worries more realistically.
– Psychodynamic therapies are sometimes used to treat depression. They focus on resolving the patient’s internal psychological conflicts that are typically thought to be rooted in childhood. Long-term psychodynamic therapies may be useful if there is a lifelong history and pattern of inadequate ways of coping (maladaptive coping mechanisms) in negative or self-injurious behaviour.
– Integrated Approach for Remedy: The relatively new field of integrative mental health is a holistic model that provides a useful perspective on brain health and the treatment of depression and anxiety. Integrative mental health looks at the physical, psychological, social, and spiritual health of the individual and uses evidence-based treatments from both traditional healing systems and modern scientific practices. [1]
– Optimizing Brain Health: While depression and anxiety are usually categorized as mental illnesses, we find it more useful to think of them as disruptions in brain health, which is directly related to the physical makeup and mechanisms of the brain, as well as emotional and relational issues.
This perspective highlights the need to take care of the brain, which, like other organs in the body, is impacted by our lifestyle. As such, what we eat, how we move, and the quality of our sleep impact the functioning of our brain. In addition, how we handle stress and other emotions, the quality of our relationships, and our sense of purpose all play a role in brain/mental health [1].
A new concept of the brain is emerging. Instead of being a static organ that doesn’t change after adolescence, the brain is now seen as having a lifelong dynamic ability to change in response to its environment. Neuroplasticity is the term used to explain the brain’s ability to change (from small cellular changes to complete remapping) in response to new learning, experience, or injury. This new understanding underlines the importance of paying attention to our brain health and development. The brain as an organ (like heart) needs to experience a “brain-healthy” lifestyle [1].
– How to take Care of Brain Health [1]: Ways to take care of our brain.
– Breathe………..slow exhalation helps relax the body
– Move the body
– Spend time in nature
– Get regular, replenishing sleep
– Spend time with supportive friends/family members
– Accept imperfection, no one is perfect, some short comings will be there in real life
– Eat real/functional foods and drink lots of water
– Meditate or do faith based prayers or practice regular self-awareness
– Learn to forgive, as the Creator loves who forgives and seek forgiveness
– Express gratitude daily. The Creator increases bounty, who thankful to Him & human being

Health Care Provider: When suffering from moderate to severe symptoms of depression or anxiety, it is critical to have a working relationship with a health care provider, or team of providers, who can help us choose our treatment approach and evaluate its effectiveness. An integrative approach includes psychosocial therapies and the judicious use of medication, as well as evidence-based complementary therapies and health-promoting lifestyle changes. The providers may include a primary care physician, nurse practitioner, psychotherapist, or other professional who is philosophically aligned with us, as well as integrative therapy providers [1].
Disclaimer: The information in this article is not to be used in place of medical treatment by a health or mental health provider.
References:
1) http://www.takingcharge.csh.umn.edu/conditions/anxiety-depression
2) http://www.takingcharge.csh.umn.edu/manage-health-conditions/anxiety-depression/what-types-psychotherapy-are-helpful-anxiety-and-depress
3) http://www.takingcharge.csh.umn.edu/manage-health-conditions/anxiety-depression/what-lifestyle-changes-are-recommended-anxiety-and-depre

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