Anxiety & Depression
The moniker of “Mood Disorders” reads as if we are talking about the ebb and flow of emotions. The title stems from the fact that we are talking about disorders that hold emotional symptoms. For example, Generalized Anxiety Disorder is diagnosed when an individual feels a sense of impending doom almost all the time from almost any circumstance. It can be a debilitating disorder although its name makes it sound like a general discomfort.
Mood Disorders include:
- Bi-Polar Disorder
- Generalized Anxiety Disorder
- Panic Attacks
- Obsessive Compulsive Disorder
- Post-traumatic Stress Disorder [PTSD]
- Attentional Issues such as ADD and ADHD
Treatment for mood disorders includes but is not limited to:
- Accurate assessment
- Cognitive Behavioral therapy
- EMDR: Eye Movement Desensitization Reprocessing
- Dialectical Behavioral therapy [DBT]; DBT enhanced therapy
- Mindfulness strategies
- Analytic techniques
- Gestalt therapy
- Existential therapy
Why should I talk with a psychologist when I can talk with my friends about my worries and sadness?
Supportive friends and family are a fabulous resource whether one has a mood disorder or not. While they can often offer support, advice and a willing ear, we have found that, WebMD and Wikipedia aside, family and friends do not always understand the specific issues that need to be addressed. Further, family and friends, despite their best intentions can offer advice that does not better the situation but can sometimes worsen one’s symptoms. As we all know, there is only so far we can go when relying on family and friends. Eventually people stop wanting to hear about our troubles and want to see that we have moved on.
Mood disorders do not give way easily. Advice and support do not have much weight in the face of specific symptoms of mood disorders. To address your depressive symptoms, I can tell you to get out of bed every morning and exercise briskly in order to give your system a natural short-lived increase in endorphins, adrenaline and neurotransmitters. However, exercise will not remove your symptoms. It may momentarily decrease your malaise but the underlying sense of feeling burdened, overwhelmed and existential questioning will not be managed. In fact, most people who have depressive symptoms know to get out of bed and exercise but they are unable to move. Those who can get out of bed to exercise will often climb right back in when the task in done.
Trained clinicians understand that the disorder itself is not transient and will not pay attention to advice and support. Treatment is necessary to understand the physiology and neurochemistry at work, the triggers, automatic thoughts, stressors and dynamics that exacerbate the disorder and keep it in charge. This involves sustained focus on you as an individual, working toward understanding how best to address your specific issues as they pertain to your disorder.
Do I need to take medication?
Medication is not indicated for every case of depression or anxiety. The medical and psychological communities understand that depression is a physical illness, just like diabetes or shingles. Both are uncomfortable and respond to medication but medication is not always necessary. Some forms of diabetes require medication in order to be managed on a daily level. The same is true for mood disorders. Not every episode of depression or anxiety needs medication but there are some forms of depression or anxiety that require medication to manage symptoms before working to shift psychologically.
The use of medication, for some individuals, is similar to caring for our car engines by changing our oil or adding oil to older engines. Neurotransmitters operate in much the same way. Some individuals need to add neurotransmitters in order to keep ahead of depression and anxiety. They do not manufacture enough or the brain uses too much. Medication boosts the brain’s ability to manufacture enough neurotransmitters or to discard what isn’t needed.
I work very closely with psychiatrists and other medical doctors to monitor the health of my clients. I do not believe that everyone needs medication and err on the side of less is more. However, I know that when the need for medication is indicated it is necessary to work toward that. When the physiological aspect of depression and anxiety is managed, the individual is more capable of bringing about psychological change necessary to keep the symptoms managed or gone.
I work a 12 Step program and my sponsor says that if I work the program hard enough I won’t need to take medication. Is this true?
The 12 steps and 12 traditions are an organic treatment for anxious and depressive symptoms. Many who work this program rigorously do indeed experience a dramatic shift from feelings of dread, impending doom and a sense that nothing will work out to calm anticipation, satisfaction and hope. Those who do not experience this relief of symptoms are probably in need of medication and, in some cases, on-going medication.
We know that many addicts and alcoholics use their compulsive behavior and drugs of choice in order to manage pre-existing mood disorders. Mood disorders are often the result of chemical imbalances or simply not manufacturing enough specific neurotransmitters. Twelve step programs, as good as they can be, are not capable of resolving mood disorders.
A word, briefly about the 12 traditions: the traditions state that [Alcoholics Anonymous] has no investment in outside issues, that each recovering alcoholic focus solely on how they got and stay sober, and that paid professionals [such as doctors] should be consulted with for anything that 12 step programs does not address.
All of which means that your sponsor and program friends will appropriately counsel you on how to get and stay sober. They do this by telling you how they did that and referring you to others in the program. Twleve step programs do not have any knowledge or authority about medication. It is an outside issue and therefore is outside of your sponsor’s ability to discuss your medication and whether or not you should be on it. This is true even if your sponsor is an M.D.
If you want to be off of your medication, be sure to speak with your psychiatrist about this issue. If you feel that your psychiatrist is not fully aware of your situation and/or you disagree, be sure to get a second opinion from another psychiatrist.