Depression Hurts*

Depression: Recognizing the Physical Symptoms

Most of us know about the emotional symptoms of depression. But you may not know that depression can cause physical symptoms, too.

In fact, many people with depression feel pain or other physical symptoms. These include:
You Don't Have to Live With Depression

Understand the symptoms of depression, from sadness to hopelessness to headache.

* Depression Myths and Facts
* What’s Causing Your Depression?
* Getting Help: Where You Can Look
* Questions to Ask Your Doctor
* 18 Positive Steps to Feel Better

2009 WebMD, LLC. All rights reserved.

* Headaches. These are fairly common in people with depression. If you already had migraine headaches, they may become worse if you're depressed.
* Back pain. If you already suffer with back pain, it may get worse if you become depressed.
* Muscle aches and joint pain. Depression can make any kind of chronic pain worse.
* Chest pain. Obviously, it's very important to get chest pain checked out by an expert right away. It can be a sign of serious heart problems. But chest pain is also associated with depression.
* Digestive problems. You might feel queasy or nauseous. You might have diarrhea or become chronically constipated.
* Exhaustion and fatigue. No matter how much you sleep, you may still feel tired or worn out. Getting out of the bed in the morning may seem very hard, even impossible.
* Sleeping problems. Many people with depression can't sleep well anymore. They wake up too early or can't fall asleep when they go to bed. Others sleep much more than normal.
* Change in appetite or weight. Some people with depression lose their appetite and lose weight. Others find they crave certain foods -- like carbohydrates -- and weigh more.
* Dizziness or lightheadedness.

Many depressed people never get help, because they don't know that their physical symptoms might be caused by depression. A lot of doctors miss the symptoms, too.

These physical symptoms aren't "all in your head." Depression can cause real changes in your body. For instance, it can slow down your digestion, which can result in stomach problems.

Depression seems to be related to an imbalance of certain chemicals in your brain. Some of these same chemicals play an important role in how you feel pain. So many experts think that depression can make you feel pain differently than other people.
Treating Physical Symptoms

In some cases, treating your depression -- with therapy or medicine or both -- will resolve your physical symptoms.

But make sure to tell your health care provider about any physical symptoms. Don't assume they'll go away on their own. They may need additional treatment. For instance, your doctor may suggest an antianxiety medicine if you have insomnia. Those drugs help you relax and may allow you to sleep better.

Since pain and depression go together, sometimes easing your pain may help with your depression. Some antidepressants, such as Cymbalta and Effexor, may help with chronic pain, too.

Other treatments can also help with painful symptoms. Certain types of focused therapy -- like cognitive behavioral -- can teach you ways to cope better with the pain.

Depression: Recognizing the Emotional Symptoms

Common symptoms of depression can make work and daily life almost impossible. Depression can skew your view of the world, making everything seem hopeless. Depression can make you feel utterly alone.

But you're not. Major depression affects about 14 million American adults or about 6.7% of the population 18 or older in any given year. And the good news is a lot of treatments work to reduce depression symptoms, and some experts claim depression can be "cured" as well. This guide will help you recognize the symptoms of depression and learn how to treat them.
Depression: Your Path to Recovery

Understand the symptoms of depression, from sadness to hopelessness to headache.

* Could You Be Depressed?
* Do You Have These Symptoms?
* Find the Right Doctor For You
* What Are Your Best Treatment Options?
* Create Your Success Plan

2009 WebMD, LLC. All rights reserved.

You may already know some of the emotional and psychological effects of depression. They include:

* Feeling sad, empty, hopeless, or numb. These feelings are with you most of the day, every day.
* Loss of interest in things you used to enjoy. You might no longer bother with hobbies that you used to love. You might not like being around friends. You might lose interest in sex.
* Irritability or anxiety. You might be short-tempered and find it hard to relax.
* Trouble making decisions. Depression can make it hard to think clearly or concentrate. Making a simple choice can seem overwhelming.
* Feeling guilty or worthless. These feelings are often exaggerated or inappropriate to the situation. You might feel guilty for things that aren't your fault or that you have no control over. Or you may feel intense guilt for minor mistakes.
* Thoughts of death and suicide. The types of thoughts vary. Some people wish that they were dead, feeling that the world would be better off without them. Others make very explicit plans to hurt themselves.

Depression: Coping With Anxiety Symptoms
Depression and anxiety often go together.
By R. Morgan Griffin
WebMD Feature
Reviewed by Brunilda Nazario, MD

Depression and anxiety might seem like opposites. We think: Depression saps you of energy; anxiety makes you keyed up and afraid. Depression makes it near impossible to get out of bed; anxiety leaves you sleepless, pacing all night.

But the truth is not so simple. In fact, depression and anxiety often go together. Mental health experts estimate that more than half of the people diagnosed with depression also have anxiety.
Depression: Your Path to Recovery

Understand the symptoms of depression, from sadness to hopelessness to headache.

* Could You Be Depressed?
* Do You Have These Symptoms?
* Find the Right Doctor For You
* What Are Your Best Treatment Options?
* Create Your Success Plan

2009 WebMD, LLC. All rights reserved.

“We know that many of the symptoms of depression and anxiety disorders overlap,” says Ian A. Cook, MD, the director of the Depression Research Program at UCLA. “And we’re learning from studies that there also appears to be a lot of overlap in the underlying brain mechanisms involved in these two conditions.”

Unfortunately, the combination of depression and anxiety can be particularly severe, and many people don’t get the correct diagnosis. The good news is that doctors have good treatments for tackling both conditions.

“When you’re in the grip of depression and anxiety, it can feel like the misery will never end, that you’ll never recover,” says Dean F. MacKinnon, MD, an associate professor at the Johns Hopkins Hospital in Baltimore. “But people do recover. You just need to find the right treatment.”
Understanding Depression and Anxiety

Although either depression or anxiety can be a disabling condition on its own, the combination can be particularly hard. “If you’re already depressed, anxiety is a multiplier of suffering,” MacKinnon says.

Depression can make feel people profoundly discouraged, helpless, and hopeless. Anxiety can make them agitated and besieged by physical symptoms -- a pounding heart, tightness in the chest, and difficulty breathing.

“People who have both depression and anxiety feel low, down in the dumps, and unmotivated,” says Jerilyn Ross, MA, LICSW, president and CEO of the Anxiety Disorders Association of America. “But their minds are also racing, they can’t concentrate, they can’t sit still. It’s a very tough combination.”

It’s also tough to control. “It’s important for people to recognize that when they have both depression and anxiety, it may be more difficult for them to get all the way well,” Cook tells WebMD. That’s not to say they won’t recover fully, but that it may take more work, he says.

People diagnosed with both depression and anxiety tend to have

* More severe symptoms
* More functional impairment
* More trouble finding the right treatment
* A higher risk of suicide

Some people who are depressed have a distinct anxiety disorder, like panic disorder, social anxiety disorder, or generalized anxiety disorder (GAD), Ross says. Many others don’t have full-fledged anxiety disorders, but more general anxiety symptoms that accompany their depression.

The fact that depression and anxiety so often co-occur has led some researchers to speculate -- controversially -- that they may not always be different conditions. “It’s possible that in time, we’ll come to see anxiety and depression together as representing a distinct illness separate from either condition by itself,” Cook says.

Depression and anxiety often go together.
(continued)
Treating Depression and Anxiety

Different experts take different approaches to treating depression with anxiety. Some try to work out which condition is causing the major problems -- the primary condition -- and try to resolve that first. Others try to deal with both at the same time. Fortunately, many treatments are good for either individual condition. They just might be used in different ways.

Here’s a rundown of five ways to treat depression and anxiety.

1. Antidepressants. Despite the name, these drugs aren’t just for depression anymore. “We’ve learned that a lot of the medications originally approved as antidepressants also relieve anxiety symptoms,” says David I. Sommers, PhD, Scientific Review Officer at the National Institute of Mental Health in Bethesda, Md. However, it’s key that you get the right medication. Some antidepressants have a reputation for being activating, which could worsen anxiety symptoms.
For depression and anxiety, many doctors first turn to an SSRI antidepressant -- like Lexapro, Paxil, and Zoloft. “I think they’re some of the safest and easiest to use,” MacKinnon says. Cymbalta and Effexor -- newer antidepressants known as SNRIs -- are other first-line anxiety and depression treatments. If those medications don’t work, your doctor may try other antidepressants like the older tricyclic medications.
2. Therapy. Although many types of talk therapy may help, the approach with the best evidence for depression and anxiety is cognitive behavioral therapy (CBT.) What is cognitive behavioral therapy? CBT is a technique that helps people identify and then change the thought and behavior patterns that add to their distress. “When you’re anxious and depressed, you’ve come to believe that the world is a much more negative and frightening place than it is,” MacKinnon says. “CBT helps expose those ways of thinking and teaches you ways to develop new ones.”
3. Anti-anxiety medicines. Although some antidepressants can help both depression and anxiety, they take some time to work. Other drugs like benzodiazepines -- Ativan or Xanax, for example -- can quickly control the symptoms of anxiety. However, many doctors are reluctant to prescribe them in the long term because of a potential risk of abuse or addiction.
4. Other medications. Depending on how a person responds to treatment, other medications might help. MacKinnon says that some people with depression and anxiety benefit from mood stabilizers like lithium, antipsychotic drugs, and antiepileptic drugs on top of their antidepressants. Medications that help with sleep – like the antidepressant trazodone – may allow people with anxiety to get the rest they need.
5. Lifestyle changes. Experts stress that you can do a lot to support your treatment for depression and anxiety. Try to eat well and get enough sleep. Don’t rely on alcohol or illicit drugs. Physical activity is key, as there’s good evidence that it can help with mood and may help people bounce back from depression. Breathing exercises, muscle relaxation, and disciplines like yoga can help too.
“Most people already know this stuff,” Sommers says. “Telling people that eating well or exercising is a good idea is often just preaching to the choir.” The key, he says, is to figure out ways of integrating better habits into your life. That’s something else that you can work on with your therapist.

Depression and anxiety often go together.
(continued)
Treating Depression and Anxiety continued...

Which approach is best to treat depression and anxiety symptoms? There’s no right answer; it all depends on the person. Sometimes, just one approach – like therapy or an antidepressant – is enough. In some people, it isn’t.

“There’s evidence that people who have both depression and anxiety tend not to do as well with just the standard treatments,” Cook says. “They may need more aggressive treatment at the outset, with more frequent appointments and closer monitoring.” People with depression and anxiety might do best with a combination of therapy and medication, he says, or a pairing of different medications at the same time.
Tips for Depression and Anxiety Treatment

Although treatment can help symptoms of depression and anxiety, it may take some time. Here are five tips to improve your odds of success.

1. Have patience. For people with depression and anxiety, it can take some trial and error to arrive at the right approach. “We have very good treatments for depression and anxiety, but we don’t necessarily know which treatment will work best in any particular person,” Ross says. The first one your doctor tries may not work. Sometimes, the second one won’t either. But with time, you and your doctor will arrive at the right approach.
2. Focus on small steps. If you’re grappling with depression and anxiety, just getting through the day can seem overwhelming. But if that’s how you’re feeling right now, how on earth are you supposed to do that and start medication, go to weekly therapy, eat healthier, exercise, enroll in a yoga class, join a support group, and sleep eight hours a night? The demands of treatment might seem so intimidating that you don’t even want to try. “Changing your behavior can seem overwhelming,” Cook says. “So I try to encourage people to make small, manageable steps in the right direction.” To get more exercise, don’t sign up for daily sessions with a trainer; just take the stairs at work instead of the elevator. Over time, small changes can give you the confidence that bigger ones are also possible, Cook tells WebMD.
3. Take your medications as prescribed. Never change the dose of your medicine without talking to your doctor. That’s true -- especially true -- if you’re feeling better. “I’ve seen so many people who go off their meds because they were feeling good,” Ross says. “But often they were feeling good because of the medications. Once they stop, they start feeling terrible again.”
4. Put some effort into therapy. The benefit you’ll get from therapy is directly related to the work you put into it. Therapists who use cognitive behavioral therapy often assign “homework” for you to work on between sessions. Try to do your part. At the very least, spend a little time thinking about what you want to focus on before you walk into a session.
5. Get a second opinion. Because of the combined symptoms, people with depression and anxiety may have a tougher time getting the right diagnosis. A doctor who only meets with you for 15 minutes might notice your depression but not your anxiety, or vice versa. Or he or she might mistake your condition for the cycles of mania and depression in bipolar disorder. As a result, you could wind up on the wrong medications. It’s crucial that you find a doctor willing to spend the time to discuss your condition. If you have any doubts about your diagnosis or treatment, see someone else. “A lot of people get worried that they will hurt a therapist’s feelings if they get a second opinion,” says Ross. “But these are real illnesses and they need the right treatment. If your doctor is telling you something about your condition that doesn’t feel right in your gut, you really need to go elsewhere.”

Depression and anxiety often go together.
(continued)
Depression and Anxiety: Recovery and Feeling Better

There are lots of different ways to treat depression and anxiety effectively. But experts say that they all hinge on one thing: a good relationship with your healthcare provider. Whether you see a general doctor, psychiatrist, psychologist, or social worker -- or a combination -- you need to work well together. Recovery will be a collaborative project.

“Really, the first treatment people with depression and anxiety need is education,” MacKinnon says. “When they come in for treatment, they’re often bewildered. But just talking to an expert who takes the time to explain the basics -- to define what depression and anxiety are and how they are treated -- can reduce a lot of the suffering right away.”

So find someone whom you trust and can work with. And stick with it.

"Depression and anxiety together can be hard to treat,” Cook says. “But the odds are very good that people with these conditions can get their lives back and feel well again. They just need to hang in there while we find the treatment that works."