The Anxious and The Depressed

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Treatment is challenging when pain overlaps with anxiety or depression. Focus on pain can mask both the clinician's and patient's awareness that a psychiatric disorder is also present. Even when both types of problems are correctly diagnosed, they can be difficult to treat. In patients with depression or anxiety, various psychotherapies can be used on their own to treat pain or may be combined with drug treatment. Cognitive behavioral therapy.

Effect on Illness Course and Outcomes

Pain is demoralizing as well as hurtful. Cognitive behavioral therapy CBT is not only an established treatment for anxiety and depression, it is also the best studied psychotherapy for treating pain. CBT is based on the premise that thoughts, feelings, and sensations are all related. Therapists use CBT to help patients learn coping skills so that they can manage, rather than be victimized by, their pain.

Relaxation training. Various techniques can help people to relax and reduce the stress response. Stress tends to exacerbate pain as well as symptoms of anxiety and depression. Techniques include progressive muscle relaxation, yoga, and mindfulness training. During this therapy, a clinician helps a patient achieve a trance-like state and then provides positive suggestions — for instance, that pain will improve.

Some patients can also learn self-hypnosis. There's an abundance of research that regular physical activity boosts mood and alleviates anxiety, but less evidence about its impact on pain. The Cochrane Collaboration reviewed 34 studies that compared exercise interventions with various control conditions in the treatment of fibromyalgia. The reviewers concluded that aerobic exercise, performed at the intensity recommended for maintaining heart and respiratory fitness, improved overall well-being and physical function in patients with fibromyalgia, and might alleviate pain.

More limited evidence suggests that exercises designed to build muscle strength, such as lifting weights, might also improve pain, overall functioning, and mood. Patients with anxiety or depression sometimes find that combining psychotherapy with medication offers the most complete relief.

A randomized controlled trial, the Stepped Care for Affective Disorders and Musculoskeletal Pain SCAMP study, suggests that a combination approach might also work for people suffering pain in addition to a psychiatric disorder. Some psychiatric medications also work as pain relievers, thereby addressing two problems at once.

Why Do Depression and Anxiety Go Together?

Just remember that pharmaceutical companies have a financial interest in promoting as many uses as possible for their products — so it is wise to check that evidence exists to support any "off label" not FDA approved uses for medications. Patients may prefer to take one medication for the psychiatric disorder and another for pain. In this case, it's important to avoid drug interactions that can increase side effects or reduce the effectiveness of either drug.

Talk to your doctor if you are taking multiple medications. So I am here today to tell anyone who can hear me: if you suspect that you have a mental illness, there is no reason to be ashamed, or embarrassed, and most importantly, you do not need to be afraid. You do not need to suffer.

There is nothing noble in suffering, and there is nothing shameful or weak in asking for help. I missed out on a lot of things, during what are supposed to be the best years of my life, because I was paralyzed by What If-ing anxiety. I wanted to go do things with my friends, but my anxiety always found a way to stop me. Traffic would just be too stressful, it would tell me. What if the plane crashes? What if I sit next to someone who freaks me out? What if they laugh at me? What if I get lost? What if I get robbed?

What if I get locked out of my hotel room? What if what if what if what if…. I have to tell you a painful truth: I missed out on a lot of things, during what are supposed to be the best years of my life, because I was paralyzed by What If-ing anxiety. All the things that people do when they are living their lives … all those experiences that make up a life, my anxiety got in between me and doing them.

I was just existing. And through it all, I never stopped to ask myself if this was normal, or healthy, or even if it was my fault. I just knew that I was nervous about stuff, and I worried a lot. Like I said, I had suspected for years that I was clinically depressed, but I was afraid to admit it, until the most important person in my life told me without shame or judgment that she could see that I was suffering.

I think it was then, at about 34 years-old, that I realized that Mental Illness is not weakness. So I let my doctor help me. I started a low dose of an antidepressant, and I waited to see if anything was going to change. At that moment, I realized that I had lived my life in a room that was so loud, all I could do every day was deal with how loud it was.

But with the help of my wife, my doctor, and medical science, I found a doorway out of that room. I had taken that walk with my wife almost every day for nearly ten years, before I ever noticed the birds or the flowers, or how loved I felt when I noticed that her hand was holding mine. Ten years — all of my twenties — that I can never get back.

Anxiety and Depression in Children

Ten years of suffering and feeling weak and worthless and afraid all the time, because of the stigma that surrounds mental illness. Thank God for her love and support. I started talking in public about my mental illness in , and ever since then, people reach out to me online every day, and they ask me about living with depression and anxiety. They share their stories, and ask me how I get through a bad day, or a bad week. Physically, it weighs heavier on me in some places than it does in others.

I feel it tugging at the corners of my eyes, and pressing down on the center of my chest. Emotionally, it covers me completely, separating me from my motivation, my focus, and everything that brings me joy in my life. When it drops that lead apron over us, we have to remind ourselves that one of the things Depression does, to keep itself strong and in charge, is tell us lies, like: I am the worst at everything.

Nobody really likes me.


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This will never end. And so on and so on. We can know, in our rational minds, that this is a giant bunch of bullshit and we can look at all these times in our lives when were WERE good at a thing, when we genuinely felt happy, when we felt awful but got through it, etc. So another step in our self care is to be gentle with ourselves. Some of those things are:. It will get better.

It always gets better.

You are not alone in this fight, and you are OK. We have all the money in the world for weapons and corporate tax cuts, so I know that we can afford to prioritize not just health care in general, but mental health care, specifically.

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The pain-anxiety-depression connection - Harvard Health

But there are also people everywhere who are picking up the phone and making an appointment. I spent the first thirty years of my life trapped in that dark, loud room, and I know how hopeless and suffocating it feels to be in there, so I do everything I can to help others find their way out. I do that by telling my story, so that my privilege and success does more than enrich my own life. I can live by example for someone else the way Jenny Lawson lives by example for me. We can start by demanding that our elected officials fully fund mental health programs.

And until our elected officials get their acts together, we can support organizations like NAMI, that offer low and no-cost assistance to anyone who asks for it. We can support organizations like Project UROK, that work tirelessly to end stigmatization and remind us that we are sick, not weak. We can remember, and we can remind each other, that there is no finish line when it comes to mental illness. Finally, we who live with mental illness need to talk about it, because our friends and neighbors know us and trust us.


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