— Diane, South Carolina Depression is associated with fatigue and low energy, but not actual weakness. Some people with anxiety have fluctuating feelings of numbness or weakness in their limbs, especially during intense anxiety or panic attacks. The history of such complaints, coupled with the findings of a physical examination, can help separate these kinds of physical symptoms from those associated with other conditions that cause weakness, such as multiple sclerosis. Regardless of the cause of your physical symptoms of weakness, worrying about your health can be quite disruptive and lessen your quality of life and productivity. The best remedy for this type of worry is to get a good medical evaluation and, if recommended by your doctor, a more detailed assessment by a specialist who can determine the cause of your symptoms. Q2. I’ve had a lot of things happen in the past that I should have gotten help for, and recently a lot of things have left me feeling helpless and hopeless. My husband wants to know why I want to isolate myself all the time. I have no energy, no motivation. I’m easily irritated, and I feel that I just don’t care anymore. I know I need help. All I want to do is cry, and I get so upset my body shakes. I feel as if I’m losing control, and I don’t know how to deal with the past, or any new stress that comes along. Please help. What do I need to do next? Although a diagnosis should not be made on the basis of such a short description, it sounds very much as if you may be in the midst of what is called a major depressive episode. First, you should not feel alone — at least 1 in 10 people (and maybe closer to 1 in 5) will suffer from depression in his or her lifetime; typically, the first episode develops during a period of increased stress. If you haven’t done so already, you should let your husband know just how bad you are feeling and — with or without his help — make an appointment to see your primary care physician or, if you’d rather, an experienced mental health professional. (You can also search for psychotherapists in your area on Revolution Health, an Everyday Health partner Web site.) If this seems like too big a step, try talking with a friend or another family member — you may be surprised to find out that he or she has also had experience with this common condition. The most important thing to keep in mind now is that there are many effective treatments for depression, and it is likely that with the appropriate therapy, you can begin to feel better within a matter of weeks. Moreover, if your first choice of therapy is not helpful, it’s important to continue to pursue treatment until you find one that works, because these treatments (both therapy and medications) can help most people with depression. Q3. Is it possible to be depressed and anxious at the same time? Ever since Hurricane Charley, it seems like the littlest thing will set me off. Before Charley I was the kind of person that would let things slide off my shoulders, and I never worried about anything. Now the smallest thing sets me off like a time bomb. Depression and anxiety are closely related conditions, both in terms of what’s happening in the brain and the clinical features (symptoms). Most people with depression have at least some anxiety and vice versa. Based on your description, you may have developed a particular form of anxiety known as post-traumatic stress disorder. This illness can follow traumatic events such as war, domestic abuse, rape or, as in your case, natural disasters. Symptoms can begin soon after the event, or as long as six months later. You should find a doctor or therapist who is knowledgeable about both conditions and talk about treatment options. Q4. How common is it for someone to have depression, anxiety, stress, and maybe even bipolar disorder at the same time? My default emotional state is down, but I also get very anxious at times, and I have a hard time handling stressful situations. I want to get treated, but I’ve heard that a lot of people get misdiagnosed and end up on the wrong drug(s). Thanks for any help! At least 50 percent of people who have major depressive disorder also have significant anxiety symptoms, and approximately 10 percent to 20 percent of people who are depressed also have had periods of abnormal upward mood swings (that is, mania or hypomania); stress is commonly associated with all three conditions — major depressive disorder, depression, and bipolar disorder. Anxious depressions and bipolar depressions tend to be somewhat more difficult to treat than “uncomplicated” depression. Although misdiagnosis can occur, underdiagnosis and undertreatment are more common problems. The best way to minimize the effects of misdiagnosis or to reduce the likelihood of being placed on the wrong treatment is to establish a strong collaborative relationship with your treatment provider and not be bashful about letting him or her know if something doesn’t make sense or isn’t working. Q5. Our 24-year-old son just returned from the Army and has been diagnosed with post-traumatic stress disorder (PTSD) with major depression. He served one year in Korea and one year in Iraq. He has also separated from his wife and has moved in with us. He has no job, no money, and no motivation to do anything. What can we do to help him get over this and back into his own life? — Stacy, Oaklahoma A significant proportion of soldiers returning from combat have PTSD, and depression is a very common co-occurring or complicating condition. In addition to having to adapt to the return to civilian life after several years overseas and having to cope with the distressing symptoms of PTSD (such as nightmares and heightened anxiety) and depression (such as low energy and decreased motivation), your son faces the additional challenges of unemployment and what I assume is an unwelcome marital separation. These particular stressful life events are associated with an increased risk of depression even in people who do not have PTSD. The first and most important thing that you can do is to have a heart-to-heart talk with your son to make sure that he knows that you are in his corner and will support his efforts to recover in every way that you can, which will include ensuring that he is receiving adequate treatment for PTSD and depression. Although people with PTSD and depression can sometimes recover without appropriate treatment, his chances of feeling better and getting back on track with his life will be greatly enhanced if he is receiving treatment for both of these conditions. A second way that you can help him is to ensure that he is being evaluated for eligibility for veterans’ benefits for service-related health problems. A third is to try your best to help make sure that your son is living a healthy lifestyle, including regular bedtimes and wake times, exercise, and minimizing the use of alcohol and drugs. Q6. I believe my anxiety is increasing my blood pressure, and has for some time now. My readings are 135/90. I don’t think this is “typical” high blood pressure, because I am not at all overweight and am still very young. What are your thoughts? — Amy, Georgia I am sorry to hear of your struggle with your blood pressure. Your question is a very good one, and more complicated than you might imagine. Although anxiety can cause rapid increases in blood pressure, it has not been shown to cause persistent high blood pressure. However, if episodes of anxiety occur frequently, they may cause significant damage to blood vessels and kidneys over time, increasing the chances that a person will develop high blood pressure. Your question also brings into play the effect of stress on blood pressure. The research in this area is challenging, in part because it’s difficult to establish an agreed-upon definition of stress. Nevertheless, when individuals are in a stressful situation — say, speaking publicly — the body responds by increasing the secretion of epinephrine (adrenaline) and cortisol, often referred to as stress hormones. These hormonal elevations can result in an increase in blood pressure, a faster heart rate, and a constriction of the blood vessels. When the stressful condition is over, the system gradually returns to baseline, and blood pressure returns to normal. But as mentioned above, frequent temporary spikes in blood pressure can have negative consequences that are similar to those of persistent high blood pressure. All that being said, it’s important that you manage both your high blood pressure and your anxiety. Talk to your physician to be sure that you are doing all you can to reduce your blood pressure to normal levels. At the same time, it would be helpful to work with a mental health professional trained in the treatment of anxiety disorders, someone who can help you develop the necessary skills to reduce your anxiety and stress. Learn more in the Everyday Health Depression Center.
