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Major Depressive Disorder Generalized Anxiety Disorder

Depression And Generalized Anxiety Respond Well To The Same Types Of Medications

Major Depressive Disorder (MDD) & Generalized Anxiety Disorder (GAD)

Antidepressants take their name from their ability to reduce the intensity of symptoms associated with depressive disorders. What many dont realize is that these medications are also frequently given to people who have anxiety disorders, and in fact certain classes of antidepressants are the most widely prescribed medications for men and women with generalized anxiety disorder.

Selective serotonin reuptake inhibitors and serotonin and norepinephrine reuptake inhibitors are the specific classes of medication most often recommended for individuals who are struggling with the symptoms of GAD. No one who develops either major depression or generalized anxiety should rely exclusively on medication to achieve wellness, but should instead use them as supplements to weekly or daily psychotherapy sessions, which may be delivered in either outpatient or inpatient settings.

Effects Of Missing Doses And Abrupt Treatment Discontinuation

One of the practical aspects of medication treatment with SSRIs and other antidepressants is the fact that patients, for various reasons, may not take their medication for several days. This form of temporary noncompliance leads to unplanned visits to the emergency room or to night or weekend calls to a physician’s answering service. Such abrupt medication discontinuation may also occur when there is some medical reason for rapidly stopping treatment.

Several studies have directly compared the effect of abruptly discontinuing SSRI treatment. As might be expected on the basis of its very long half-life, fluoxetine had no discontinuation effects whatsoever . Even though paroxetine and sertraline have similar elimination half-lives, sertraline was found to have milder withdrawal effects after abrupt discontinuation of treatment than paroxetine, possibly because of the anticholinergic effects associated with the latter drug. The potential for a withdrawal syndrome after discontinuing paroxetine has recently been added to its product labeling.

Effect of Abrupt Selective Serotonin Reuptake Inhibitor Discontinuation on Occurrence of Withdrawal Symptomsa

Digital Therapeutic For Major Depressive Disorder And Generalized Anxiety Disorder

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government.Know the risks and potential benefits of clinical studies and talk to your health care provider before participating. Read our disclaimer for details.
First Posted : August 23, 2021Last Update Posted : August 23, 2021
Condition or disease
Major Depressive DisorderGeneralized Anxiety Disorder Device: HPDT-DA-013 Not Applicable
Layout table for study information

Study Type :
Treatment
Official Title: A Real-World Evidence, Single-Arm, Open-Label Study Evaluating the Safety and Efficacy of HPDT-DA-013 Digital Therapeutic in the Treatment of Major Depressive Disorderand Generalized Anxiety Disorder
Actual Study Start Date :
Use HPDT-DA-013 digital therapeutic for a period of 8-10 weeks. Device: HPDT-DA-013Digital program with therapeutic interventions based on Cognitive Behavioral Therapy .
  • Patient Health Questionnaire-9 A 9-item self-report measure to assess symptoms of depression
  • Generalized Anxiety Disorder-7 A 7-item self-report measure to assess symptoms of anxiety
  • PHQ-9 A 9-item self-report measure to assess symptoms of depression
  • GAD-7 A 7-item self-report measure to assess symptoms of anxiety
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    Health Intervention Under Review

    Three common types of psychotherapy for the treatment of major depressive disorder and generalized anxiety disorder are cognitive behavioural therapy , interpersonal therapy, and supportive therapy.

    The Royal Australian and New Zealand College of Psychiatrists defines structured psychotherapy as the treatment of mental or emotional illness by using defined psychological techniques, pre-planned with clear goals and employed within a specific timeframe. According to the College, patients must be seen by their treatment provider, either individually or in a small group, on at least a monthly basis. CBT and interpersonal therapy are considered structured psychotherapies, but supportive therapy is not.

    Cognitive behavioural therapy focuses on helping patients become aware of how certain negative automatic thoughts, attitudes, expectations, and beliefs contribute to feelings of sadness and anxiety. Patients learn how these thinking patterns, which may have developed in the past to deal with difficult or painful experiences, can be identified and changed to reduce unhappiness.

    Interpersonal therapy focuses on identifying and resolving problems in establishing and maintaining satisfying relationships. Such problems may include dealing with loss, life changes, conflicts, and increasing ease in social situations.

    Symptoms Of Anxiety And Depression

    Ppt Generalized Anxiety Disorder Powerpoint Presentation

    According to the current Diagnostic and Statistical Manual of Mental Disorders , the standard classification of mental disorders used by mental health professionals in the United States, anxiety and depression can share several common symptoms, including, but not limited to:

    • Being easily fatigued
    • Sleep disturbance

    Other signs that a person may suffer from both anxiety disorder and depression include:

    • Constant, irrational fear and worry
    • Physical symptoms like rapid heartbeat, headaches, hot flashes, sweating, abdominal pain, and/or difficulty breathing
    • Changes in eating, either too much or too little
    • Persistent feelings of sadness or worthlessness
    • Loss of interest in hobbies and activities
    • Inability to relax
    • Panic attacks

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    Those Who Develop Both Conditions Can Benefit From Inpatient Care

    Many people are able to recover from major depression and generalized anxiety disorder with outpatient care. But when these conditions occur together, intensive residential carel that facilitates a full-time focus on wellness is more likely to produce transformative and sustainable results.

    Recovery regimens for a dual diagnosis of MDD and GAD will include a full menu of therapeutic services and complementary healing methodologies appropriate for all symptoms that are being experienced. Blended recovery plans can be highly effective for men and women who are determined to heal and recover, and are prepared to tackle all the challenges associated with overcoming multiple mental or behavioral health disorders.

    Major depressive disorder and generalized anxiety disorder are a potent combination. But a well-rounded, evidence-based recovery program can provide a powerful and effective antidote to these persistent conditions.

    Can Anxiety And Depression Be Treated Together

    Yes. No one has to suffer from anxiety disorder or depression, and certainly not both. People with anxiety disorder should speak with a psychiatrist, therapist, or other healthcare professional about their symptoms and start treatment as soon as possible. If you suspect you have both anxiety and depression, Connolly recommends getting a thorough evaluation from a psychiatrist as a first step. “It’s really crucial for people with both to have a good assessment to rule out bipolar disorder,” she says.

    Important: If you or someone you know needs help coping with anxiety or depression, call the National Suicide Prevention Lifeline at 800-273-TALK . The Crisis Text Line also provides free, 24/7, confidential support via text message to people in crisis when they text to 741741.

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    Major Depression And Generalized Anxiety Share The Same Hereditary Risk Factors

    Having a close member of your family who has experienced either major depression or generalized anxiety disorder will put you at increased risk for having both conditions. To clarify, this means that if you had a parent or grandparent who was diagnosed with clinical depression, youll have a greater chance of developing either MDD or GAD .

    Many mental health experts speculate that this is because major depression and GAD are at least partially caused by shared genetic factors, and indeed research indicates that this association is quite strong. Studies have been carefully structured to eliminate the possibility that environmental causes might mimic genetic effects, which allows scientists to confirm that heredity is a major contributing factor in many observed cases of comorbidity.

    Major Depression And Generalized Anxiety Disorder Cause Chronic Physical Pain

    Chelsey talks to her younger self about depression, anxiety, PTSD and an eating disorder

    A notable percentage of people who have major depression or generalized anxiety disorder will report a variety of mysterious aches and pains. Especially common are discomfort in the neck, back, and facial areas, and in some instances the pain can become chronic or severe.

    Those who experience these pains will often seek out the services of a physician, convinced theyre suffering from some type of physical malady. In reality, these pains are mainly caused by persistent muscle tension, which is a predictable side effect of frequent anxiety or depressed moods. Once the depression and anxiety are treated, the pains will tend to gradually disappear.

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    E Demoralization Secondary To Anxiety Disorder

    Demoralization is a feeling state characterized by a patients perception of impotence and inability to deal/cope with pressing problems and receive adequate support from others . A feeling of having failed to meet their own or other expectations and lack of hope that problems will be solved are also present . It can be encountered with anxiety disorders , particularly in agoraphobia and panic . It can be associated with major depression or occur independently, as in the case here illustrated.

    Clinical Presentation

    Liza is a 45-year-old, single, architect. She has suffered from generalized anxiety since she was 20 years old the family doctor managed anxiety by prescribing alprazolam 0.25 mg, when needed. In the last 2 months, she perceived to be unable to cope with pressing problems at work, when she had tight deadlines and inadequate support from others. In addition, she had the feeling of having failed to meet her own expectations and believed there were no solutions for these problems and difficulties.

    Assessment and Diagnosis

    Macroanalysis. The patient satisfied DSM-5 criteria for generalized anxiety disorder she also suffered from demoralization, according to the Diagnostic Criteria for Psychosomatic Research . Due to demoralization, Liza tended to avoid social situations and spent her spare time on the sofa taking naps or watching TV, although she felt highly dissatisfied by her lifestyle.

    Fig. 5.

    For additional information:

    Exposure To Trauma And Abuse In Childhood Predicts Major Depression And Generalized Anxiety

    Many serious mental health issues have their roots in past trauma. Often the trauma will have occurred in childhood, and will involve exposure to some kind of abuse or extreme neglect. These exposures interfere with normal development, and if left unresolved will almost certainly cause mental, emotional, and behavioral health issues later in life.

    In one 2015 study, more than 75 percent of chronically depressed individuals reported exposure to childhood trauma. Research into the link between childhood trauma and GAD has been more limited, but one 2013 research project found that people whod been traumatized as children experienced developmental changes in areas of the brain known to be overly active in people who have generalized anxiety.

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    B Depression In Patients With Anxiety Disorders Under Treatment

    If the patient with an anxiety disorder is under treatment , the potential iatrogenic role of therapy needs to be evaluated . Demoralization and mood disturbances may occur during treatment of agoraphobia and panic with CBT . Depression may also ensue during antidepressant treatment . The overall situation may be complicated, as this case illustrates.

    Clinical Presentation

    Thomas is a 35-year-old, single, white-collar worker. He has been taking citalopram for social anxiety for 2 years and reported a mild improvement in anxiety. Citalopram had been prescribed by the family doctor. Recently, however, he started feeling sad, had late insomnia, loss of interest in life, and reported a decrease in appetite and energy. His anxiety considerably increased, especially when he tried to approach women, and a panic attack occurred. The family doctor increased citalopram to 40 mg per day with no results.

    Assessment and Diagnosis

    Macroanalysis. The patient met DSM-5 criteria for a major depressive episode and social anxiety disorder. He also reported one isolated panic attack. The loss of clinical effect after 2 years of treatment with citalopram, as well as the refractoriness to dose increase, are well documented in the literature . The patient de facto did not respond to the first course of treatment. Thomass macroanalysis is illustrated in Figure 2.

    Fig. 2.

    Macroanalysis of Thomas clinical case.

    Treatment Options

    Psychotherapy And Relaxation Therapies

    (PDF) POST

    Psychotherapy includes many different approaches, such as cognitive behavior therapy and applied relaxation .33,34 CBT may use applied relaxation, exposure therapy, breathing, cognitive restructuring, or education. Psychotherapy is as effective as medication for GAD and PD.11 Although existing evidence is insufficient to draw conclusions about many psychotherapeutic interventions, structured CBT interventions have consistently proven effective for the treatment of anxiety in the primary care setting.3436 Psychotherapy may be used alone or combined with medication as first-line treatment for PD37 and GAD,11 based on patient preference. Psychotherapy should be performed weekly for at least eight weeks to assess its effect.

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    Symptoms Of Major Depressive Disorder

    The essential feature of major depressive disorder is a period of two weeks during which there is either depressed mood most of the day nearly every day or loss of interest or pleasure in nearly all activities. Other potential symptoms include:

    • Significant weight loss when not dieting or weight gain and changes in appetite
    • Insomnia or hypersomnia nearly every day
    • Psychomotor agitation or retardation nearly every day
    • Fatigue or loss of energy nearly every day
    • Feelings of worthlessness or excessive guilt
    • Impaired ability to think or concentrate, and/or indecisiveness
    • Recurrent thoughts of death, recurrent suicidal ideation without a plan, or a suicide attempt or suicide plan

    The symptoms of major depressive disorder cause significant distress or impairment in social, occupational, or other areas of functioning.

    Neuroimaging And Gene Function

    Neuroimaging has also seemed to offer a further advantage: access to measures of brain function that might be intermediate to and more sensitive than illness phenotypes to genetic analysis. The early observation of a possible link between genetic variation of the 5-HTTLPR gene and neuroticism suggested the hypothesis that there might be a more detectable effect of polymorphism in this gene and amygdala function. This has proved controversial and again highlights general problems for the field. Thus, a recent meta-analysis has indicated that there is a statistically significant but small effect of 5-HTTLPR on amygdala activity. However, perhaps more striking was the between-study heterogeneity and the evidence for excess statistical significance. In summary, all the individual published studies have been considerably underpowered to detect the size of effect that is likely to be present, which is smaller than originally thought. In addition, the retreat to a very small or no effect for genetic variation exactly parallels what was summarized previously for this gene and its association with neuroticism. Therefore the claimed advantage of intermediate phenotypes may also be wrong. Measures of systems level neurocognition with fMRI may be no more or less helpful than the behavioral phenotypes like neuroticism or DSM diagnosis for genetic analysis.

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    Epidemiology Etiology And Pathophysiology

    The 12-month prevalence for GAD and PD among U.S. adults 18 to 64 years of age is 2.9% and 3.1%, respectively. In this population, the lifetime prevalence is 7.7% in women and 4.6% in men for GAD, and is 7.0% in women and 3.3% in men for PD.1

    The etiology of GAD is not well understood. There are several theoretical models, each with varying degrees of empirical support. An underlying theme to several models is the dysregulation of worry. Emerging evidence suggests that patients with GAD may experience persistent activation of areas of the brain associated with mental activity and introspective thinking following worry-inducing stimuli.2 Twin studies suggest that environmental and genetic factors are likely involved.3

    The etiology of PD is also not well understood. The neuroanatomical hypothesis suggests that a genetic-environment interaction is likely responsible. Patients with PD may exhibit irregularities in specific brain structures, altered neuronal processes, and dysfunctional corticolimbic interaction during emotional processing.4

    Generalized Anxiety Disorder And Major Depressive Disorder In Pregnant And Postpartum Women: Maternal Quality Of Life And Treatment Outcomes

    Clinical Results for Major Depressive Disorder and Generalized Anxiety Disorder
    • Reproductive Mental Health Program, BC Childrens and Womens Hospital, Vancouver BCDepartment of Obstetrics and Gynaecology, University of British Columbia, Vancouver BCDepartment of Psychiatry, University of British Columbia, Vancouver BCBC Mental Health and Addiction Services, Provincial Health Services Authority, Vancouver BC
    • Reproductive Mental Health Program, BC Childrens and Womens Hospital, Vancouver BCDepartment of Psychiatry, University of British Columbia, Vancouver BC

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    The Personality Trait Of Neuroticism Is Associated With Both Conditions

    Neuroticism refers to a tendency to see the world as threatening, hostile, or unfriendly. Those who demonstrate this personality trait are prone to anxiety, often struggle with self-esteem, and have a habit of overreacting to setbacks both big and small.

    Research has revealed that individuals with major depression and/or generalized anxiety are likely to manifest the telltale symptoms of neuroticism. Their emotions can be unstable and unpredictable in even the best of times, and if their neuroticism remains untreated it can lead to more serious mental health issues.

    Distinguishing Gad From Other Mental Health Issues

    Anxiety is a common symptom of many mental health conditions, like depression and various phobias. GAD is different from these conditions in several ways.

    People with depression may occasionally feel anxious, and people who have a phobia may worry about one particular thing. People with GAD worry about a number of different topics over a long period of time , or they may not be able to identify the source of their worry.

    both environmental and genetic factors, such as:

    • a family history of anxiety
    • recent or prolonged exposure to stressful situations, including personal or family illnesses
    • excessive use of caffeine or tobacco, which can make existing anxiety worse
    • childhood abuse or bullying
    • certain health conditions such as thyroid problems or heart arrhythmias

    Some 2015 evidence suggests that those living with GAD may experience certain activation in areas of the brain associated with mental activity and introspective thinking when they encounter situations that could cause worry.

    Studies show that the prevalence of GAD is likely about 7.7 percent in women and 4.6 percent in men over their lifetime.

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