July 1, 2011
|Sanjay Mathew, M.D., the medical director of the Comprehensive Mental Health Program, talks with Army Veteran John Campbell. Mathew is listed as one of the best doctors in the nation in the field of psychiatry by the medical knowledge company, Best Doctors, Inc.
photo: Bobbi Gruner, PAO
The connection between depression and anxiety is stronger than what it was previously thought to be. However, an expert at the Michael E. DeBakey VA Medical Center (MEDVAMC) cautions that medications for the two cannot necessarily be used interchangeably.
“There is an overlap between depression and anxiety, but the medications for the two are not the same,” said Sanjay Mathew, M.D., the medical director of the Comprehensive Mental Health Program at the MEDVAMC and also listed as one of the best doctors in the nation in the field of psychiatry by the medical knowledge company, Best Doctors, Inc. “It’s important to recognize how the two are related and treated.”
The first step is to determine a diagnosis. Anxiety is defined as an excessive, future-oriented worry about outcomes. There is intolerance for uncertainty and ambiguity. Physical symptoms of anxiety can include muscle tension, poor sleep, fatigue, headaches and several gastrointestinal symptoms such as irritable bowel or irritable bladder. Anxiety can result in a panic attack, which is a sudden and unexpected event during which physical symptoms include a racing heart, dizziness and shortness of breath.
Depression symptoms include a sad mood and a loss for zest in life and can cause impairment in sleep and appetite, guilty ruminations and even thoughts of suicide. However, many people view anxiety as a subtype of depression, said Mathew, who is also an associate professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine.
“If you look at a lifetime of someone with depression, more than 50 percent of them will suffer some kind of anxiety disorder,” he said. “The two tend to run together more often than not. When we treat depression, we want to address symptoms of residual or persistent anxiety and vice versa.”
Anxiety in childhood is a well established risk factor for depression in adulthood, said Mathew.
If a patient is being treated for worry, fear, post-traumatic stress disorder or any other anxiety disorder, the possibility of a mood disorder such as depression should also be addressed.
After a diagnosis is made, physicians look at the severity of the problem and to what extent it is disrupting a patient’s daily life.
For mild depression or anxiety, psychotherapy is recommended for the initial treatment. This can include cognitive behavioral therapy in which patients learn to manage their anxiety through relaxation, facing fears and regulating emotions during stressful situations.
Medication can be helpful at this point, but therapy has a better long-term outcome for preventing a relapse. Benzodiazepines are the most commonly prescribed medications for treating anxiety and can be taken on an as-needed or daily basis. These cannot be used as antidepressants, however.
Selective serotonin reuptake inhibitors, or SSRIs, are commonly used to treat depression. However, since it takes about one month to feel the effects of SSRIs, a patient who is acutely depressed and anxious can start out with a short course of benzodiazepines and then slowly taper off of them.
Although anti-anxiety medications do not treat depression symptoms, all antidepressant medications have benefits for anxiety disorders. The recommended course of action is to treat depression and anxiety with therapy along with medication, said Mathew. The learning and adaptation skills taught in therapy will have good durability throughout the years.
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