Anxiety and depression

Release date:2020-01-10 Source:This site Browse times:174
In the busy modern life, everyone has all kinds of stress, and the words anxiety and depression appear more and more in our lives. Although each of us has talked more or less about anxiety and depression, do we really understand anxiety and depression?

What is anxiety? Anxiety and anxiety concept




Anxiety refers to the irrational anxiety or fear that is caused by the internal conflicts that occur emotionally or psychologically. The main cause of anxiety is that the shock given by the external environment and the ability to resist stress can not form a certain balance. Anxiety may be a temporary feeling. Anxiety disappears after a certain situation, but it may also become a long-term feeling that cannot be suppressed, making life difficult.
There are many forms of anxiety, social anxiety, self-compulsion, stress after trauma, and even phobia. In addition to internal anxiety, anxiety can have a great negative impact on the body, shortness of breath, headaches, palpitations, weakness in limbs, and so on.


Anxiety is a common mental illness that is mainly unpleasant and painful and often accompanied by physical discomfort. 3.6% to 28.8% of people suffer from this disease for life, and more than 90% of patients are before the age of 35. Onset, women tend to have more anxiety disorders than men.

What is depression? Depression and depression concept


Depression is a state of low mood and aversive activity, which has certain influence on people's thinking, behavior, feeling and physical health. Depressed people may feel depressed, anxious, empty, hopeless, sinful, irritable, and upset. They may no longer be interested in their usual hobbies, lose appetite or overeating, become uncommunicative, experience problems such as decreased memory, difficulty concentrating, and indecision. Depression is also accompanied by insomnia, lethargy, fatigue and other symptoms, which may induce suicide. Depression may be a normal response to a traumatic event, or it may be caused by a disease or a side effect of a drug. Emotional depression is also a common major symptom of emotional disorders.



Depression is a common mental illness with chronic depression as its main clinical feature.Most of the clinical manifestations are depressed,often accompanied by loss of interest,depression,blame,guilt,unconfidence,energy decline,poor sleep.And decreased appetite.Once the onset of depression,it is easy to recur.Depression can be relieved in most cases,but in some cases it may leave sequelae or turn into a chronic course.

At least 10%of depression patients will experience manic episodes,the so-called bipolar disorder.Some patients have significant anxiety and motor agitation,and severe patients will develop hallucinations such as hallucinations.In addition to emotional torture,suicide threatens the lives of depression patients all the time.According to statistics,2/3 of depression patients have suicidal thoughts.The suicide rate of severe depression patients is as high as 10%to 15%,and suicides die.0%to 70%of patients are associated with depression.

Epidemiology of anxiety and depression comorbidity

Currently,depression and anxiety are classified into two different types of mental illness in diagnosis.However,it is found in clinical practice that these two diseases often appear at the same time.The symptom of depression and anxiety refers to the simultaneous occurrence of depression and anxiety.

In the early 1990s,the United States conducted the first large-scale National Comorbidity Survey(NSC).This survey collected data from 1990 to 1992 on people aged 15 to 54 who were diagnosed with mental illness by DSM-III-R.Population information for 8098 patients.The survey results show that among young people,the comorbidity rate of anxiety disorder and depression disorder at 12 months was 56.1%;among the lifetime comorbidity rate of patients with depression disorder,generalized anxiety disorder was 17.2%,and panic disorder was 9.9%,Plague horror disorder was 16.3%,pure horror disorder was 24.3%,social anxiety disorder was 27.1%,and post-traumatic stress disorder was 18.5%.At the same time,a large-scale primary healthcare survey also found that the comorbidity rate in primary health care is much higher than in the community.More than 75%of patients with depression in primary care suffer from different types of anxiety disorders.





The results of the second national comorbidity survey from 2001 to 2003 in the United States showed that the lifetime comorbidity rate of depression and anxiety disorder and the comorbidity rate at 12 months were as high as 59.2% and 57.5%. In the same period, they carried out their own national surveys in European countries, Australia and other countries, and assessed the lifetime comorbidity rate at different time points. Although the research data from different countries are slightly different, they generally show that depression and anxiety disorders mostly occur in the form of comorbidities, and the proportion of simple disease forms is small.
Stein research reports: Only 1/3 of “simple” anxiety disorders that do not co-exist with other mental disorders are only 1/3. In 2002, the Dutch Mental Health Survey showed that only 39.5% of emotional disorders and 59.3% of anxiety disorders were purely one. This form of mental disorder appears. In summary, anxiety and depression comorbidities are common forms of diseases in psychiatry and should be taken seriously by us.

Clinical characteristics of anxiety and depression

① The comorbid group was older and had a later onset than the simple group, with acute onset as the main group, while the simple depression group and anxiety group were mainly intermittent and chronic.

② Complicated patients have complicated clinical manifestations, more complaints from patients, subjective feelings of pain, more severe clinical symptoms, and self-evaluated symptoms are significantly higher than their actual conditions.

③ The main symptom groups in the comorbid group are similar to those in the depression group, but various somatization symptoms are particularly prominent and have the characteristics of the anxiety group; the anxiety and depression emotions seem to be more expressed as concerns about their physical disorders.



④Some symptoms in the comorbidity group are serious, such as social discomfort, avoidance, suspected illness, self-blame; some symptoms are more frequent, such as waking up early, lack of pleasure, suicide, fatigue, and inattention; Some symptoms are mild, such as psychomotor retardation, psychotic symptoms; most patients show pessimism, depression, fatigue, and are accompanied by more obvious anxiety, anxiety, fear, sadness, doubt, etc., and they are prone to suffering and repetition.


⑤ The medical condition of comorbid patients is more complicated, there are more clinical departments to visit, too many medical examination items, frequent use of medicines, and many patients take a variety of anti-anxiety drugs for a long time. There is often tolerance and dependence on anxiolytic drugs Sex, poor adherence to treatment, easy to produce iatrogenic mental burden.



⑥ The course of the disease is often chronic, easy to relapse or intensify, the effect is not stable enough, it is often difficult to heal without standard treatment, and some patients will fluctuate even during maintenance medication.

Anxiety and Depression Treatment

medical treatement




The treatment of depression and anxiety comorbidities is different from that of single diseases. Studies have shown that venlafaxine and its slow-release agents are an effective drug to treat the co-morbidities of depression and anxiety disorders. Selective 5-HT reuptake inhibitors are the first-line medications for treating social anxiety, and they can also be used as a drug choice for social anxiety and depression. If they are not effective, you can choose drugs such as phenelzine or tranylcypromine. Studies have also reported that the treatment of comorbid patients with nefazodone has effectively improved the symptoms of depression and anxiety after 12 weeks; in the case of depression and general anxiety, mirtazapine can be used for treatment, which has a certain effect. Generally, the disability rate and functional impairment of patients with such comorbidities will increase significantly. In addition, paroxetine can treat depression and anxiety disorders at the same time, so it also has the effect of treating depression and anxiety comorbidities.

Psychotherapy

Psychotherapy should also be considered when treating patients with anxiety and depression. Although drug treatment is often the first choice clinically, psychotherapy still occupies a certain position. Whether it is applied alone or in combination with drugs is very much needed. SSRI and SNRI drugs combined with cognitive behavioral psychotherapy (Cgnitive behavior therapy (CBT)) in the treatment of anxiety spectrum such as depression and generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, social horror disorder, post-traumatic stress disorder or plague horror disorder The co-morbidity of the disease is positive. Lenze et al. Found that the use of CBT alone in elderly patients with anxiety and depression comorbidities with cognitive impairment may not be effective. Residual symptoms in elderly patients with anxiety and depression may lead to relapse if they have residual symptoms after treatment. Therefore, it is recommended that elderly patients with comorbidities should continue to maintain drug therapy after psychotherapy and / or combined antidepressant treatment, instead of just Receive individual psychotherapy.

references:

[1] Liu Xiaolin, Cao Wei, Wei Haiyan, Cheng Chunrong.Summary of comorbidities between anxiety and depression [J] .Medical Herald, 2004 (10): 730-732.

[2] He Jianhua, Zhang Na, Gong Yuntao.Summarization of research on anxiety and depression comorbidity [J] .Journal of Psychiatry, 2010,23 (06): 468-471.

[3] Yue Lili, Bai Guangguang.Research Status of Depression and Anxiety Disorder [J] .Medical Recapitulate, 2013,19 (06): 1069-1072.
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