You’re not crazy, there really is something wrong with you!

You’re not crazy, there really is something wrong with you! 

In a 2007 study in the Journal of Clinical Psychiatry, over 900 patients who came to primary care visits were questioned about anxiety and depression.  Amazingly 30-40% of the patients questioned reported symptoms of anxiety and depression and more importantly these patients reported more impairment in their daily lives than people with diseases such as diabetes and heart failure. 

“When compared with patients with congestive heart failure, patients with moderate to severe anxiety or depressive symptoms reported worse bodily pain, vitality, social functioning, role limitations due to emotional problems, and mental health. Furthermore, patients with depressive symptoms also reported worse general health. The only area in which congestive heart failure patients reported worse functioning was in the physical functioning domain.”

These statistics are congruent with what I see in my office and people are always surprised when I ask them if their anxiety is limiting their social, work, and family functioning. When questioned, most people who I suspect have anxiety and depression report that their lives are significanty impacted by their depression and anxiety, but they are reluctant to seek therapy either medical or psychological for a variety of reasons. Most commonly, people state that they don’t believe that a psychologist can help them and even more commonly people are afraid that if start medications they will be on the for the remainder of their lives. When I tell people they have diabetes or early congestive heart failure, people very rarely decline therapy or testing despite the fact that most of them do not have physical or emotional limitations secondary to their disease. 

Before I treat people for anxiety and depression in my practice I try and identify whether or not it is present by asking a few questions at the annual exam. Only in he most severe cases do I offer medications at the initial diagnosis. More often when I suspect depression or anxiety and even Premenstrual Dsyphoric Disorder (PMS), I try and address lifestyle changes that have been proven to decrease anxiety and depressive symptoms. 

For all patients who I suspect may be suffering from anxiety and depression I recommend a few very basic lifestyle changes

1. A minimum of 30 minutes of cardiovascular exercise or yoga daily
2. Regular sleep of 7-9 hours nightly
3. 30 minutes of sun exposure twice daily if possible. 
4. Low fat low carbohydrate diet

These lifestyle changes typically will help with emotional stability and overall mood. When I see patients back in my office almost everyone who has adhered to these recommendations feels better. However, when I see people back for anxiety and depression, most people will report feeling better but continue to have daily symptoms that limit their overall function. For this population I usually recommend psychologic therapy and the addition of SSRI medications such as Prozac, Paxil,  or Lexapro with little reservation because I understand the severe impact that depression and anxiety can have on peoples lives and further feel that side effects of these medications are minimal compared to the lifetime impact of untreated depression and anxiety.