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Could anxiety and depression be two sides of the same coin. Over the past couple of years, clinicians and researchers alike have been moving towards the conclusion that depression and anxiety are two aspects of one disorder.
What does this look like from a Biblical model of the person? Remember the creation story? God shapes Adam from mud and breathes life into this clay model. God's breath is what we call "spirit." Every people uses a word from this family for the energy inside man. Don't you get it? Every people has been given godly intuition that the core of man is God's being, God's life, God's Spirit. We all are given a divine intuition that at the core our inner being shares in the essence or nature of God. The inner core of our person is not mind or matter. It is spirit (soul, chi).
Psychologists and researchers will not use that language. Here we can talk like that. We can stretch our imagination and reconsider what we have been taught about the human person. If the Bible is right then God sustains our inner being. According to Ecclesiastes 12:7 when we die or in the words of Ecclesiastes 'the dust returns to the ground it came from,' and 'the spirit (our spirit) returns to God who gave it.' According to Job, "The Spirit of God has made me; the breath of the Almighty gives me life." Job 33:4.
If at core we are spirit and we run on 'spiritual energy' then depression can be caused by something interfering with our energy supply. A simple way to understand depression is that it is a shortage of core energy. Simply put there is not enough life getting from the Source (God) to our core (human spirit).
Your counsellor is there to help uncover some of the specific internal causes of this lack of energy. This often means looking at what you say to yourself, how you see life and what is in your core beliefs. The effectiveness of therapeutic approaches that focus on core beliefs is evidence that core beliefs are part of this blockage of God's life. Fair enough because Jesus was always concerned with people's faith, Faith - expectations based on core beliefs - was one of the most important issues that Jesus kept raising both with people wanting healing and with His disciples. After caling a storm on the Sea of Galilee, Jesus turns to his awestruch disciples and asked, "Where is your faith?"
Cognitive-behavioral therapy (CBT) is effective with both conditions. Core belief therapy, "Journey Work," and Listening Prayer Theapy are search and destroy theraeutic tools against an array of anxiety disorders, from social phobia to panic and post-traumatic stress disorder (PTSD).
The nature of the anxiety disorder has an influence. Obsessive-compulsive disorder, panic disorder and social phobia are particularly associated with depression. Specific phobias are less so.
Usually, anxiety precedes depression, typically by several years. Currently, the average age of onset of any anxiety disorder is late childhood/early adolescence. Psychologist Michael Yapko, Ph.D., contends that presents a huge opportunity for the prevention of depression, as the average age of first onset is now mid-20s. "A young person is not likely to outgrow anxiety unless treated and taught cognitive skills," he says. "But aggressive treatment of the anxiety when it appears can prevent the subsequent development of depression."
"The shared cornerstone of anxiety and depression is the perceptual process of overestimating the risk in a situation and underestimating personal resources for coping." Those vulnerable see lots of risk in everyday things--applying for a job, asking for a favor, asking for a date. These perceptions are rooted in early experience and one's chosen personality style.
Further, anxiety and depression share an avoidant coping style. Sufferers avoid what they fear instead of developing the skills to handle the kinds of situations that make them uncomfortable. Sometimes gaining social skills, such as assetiveness, will help.
In fact, says Jerilyn Ross, LICSW, president of the Anxiety Disorders Association of America, the link between social phobia and depression is "dramatic. It often affects young people who can't go out, can't date, don't have friends. They're very isolated, all alone, and feel cut off."
Sometimes anxiety is transmitted to children by parental overconcern. "The largest group of depression/anxiety sufferers is Baby Boomers," says Yapko. "The fastest growing group is their children. They can't teach kids what they don't know. Plus their desire to raise perfect children puts tremendous pressures on the kids. They're creating a bumper crop of anxious/depressed children."
Treatment seldom hinges on which disorder came first. "In many cases," says Ross, "the depression exists because the anxiety is so draining. Once you treat the anxiety, the depression lifts."
In practice, treatment is targeted at depression and anxiety simultaneously. "There's increasing interest in treating both disorders at the same time," reports Himle. "Cognitive behavioral therapy is particularly attractive because it has applications to both." The enhanced affectiveness of targetted core belief therapies such as George Hartwell's Listening Prayer Therapy make them an ideal choice.
Core Belief Therapies are equally effective in reducing anxiety/depression. Cognitive therapies are better at preventing relapse, and create greater patient satisfaction. "It's more empowering," says Yapko. "Patients like feeling responsible for their own success." Skills are learned, perceptions changed and personality styles can even be shifted in Journey work and Listening Prayer Therapy.
Treatment averages 12 to 15 weeks, and patients can expect to see significant improvement by six weeks. Focused cognitive, belief and core identity therapies don't involve years and years of talk therapy. Beyond that these people gain tools they can use for the next life crisis.
For information about counselling services including phone sessions and retreats phone (416) 234-1850 in Toronto, Ontario, Cananda or 1 877 854-3990 in Canada or United States. Also see: Counseling services on www.healmylife.com.
Related Topic: Are Antidepressants Addictive?
When withdrawal leads to illness.
A key to the definition of an addictive drug is the experience of withdrawal. The pain and nausea some people feel when they stop taking certain antidepressants suggests these drugs should carry explicit warning labels about addiction and withdrawal.
Jamé Tierney was 14 years old when she started taking Effexor, a serotonin norepinephrine reuptake inhibitor (SNRI), for her migraines. When she slowly tapered off the drug, Jamé experienced vomiting, suicidal impulses, electric shock-like sensations and fatigue. She likened her confusion of time and space to special effects in the movie "The Matrix."
Such withdrawal has often been mistaken for depression relapse. However, mounting testimony from people like Jamé, who were prescribed serotonin reuptake inhibitors (SSRIs), such as Prozac or Zoloft, for nonpsychiatric conditions could publicize what doctors say is a phenomenon recognized since the late 1990s. Patients using Paxil and Effexor report the most severe problems because those drugs have the shortest half-lives, which make them the quickest to exit the system.
Some experts estimate as many as 80 percent of patients experience withdrawal from Paxil when they go cold turkey. On the other hand, David L. Dunner, M.D., director of the Center for Anxiety and Depression at the University of Washington, says studies show less than 25 percent of patients who quit Paxil experience symptoms.
Though Paxil and Effexor labels now warn of "discontinuation," some say the labels aren't adequate. Lawyer Karen Barth, who represents 35 patients in a California lawsuit, says her firm has heard from some 10,000 Paxil patients.
Joseph Glenmullen, M.D., author of Prozac Backlash, sees a potential crisis should withdrawal become widely recognized. "Thousands and thousands of people have tried to go off SSRIs, and their doctors have mistaken it for a relapse [into depression]," says Glenmullen, who advocates therapy in addition to tapering off the medication in order to distinguish a relapse should one occur.
risk of suicidal thoughts and attempts
As 2004 gets underway, antidepressant medications are on the pharmacologic equivalent of orange alert. Safety concerns raised anew in mid-2003 shadow the skyrocketing use of selective serotonin reuptake inhibitors in children and adolescents.
Last June, the Food and Drug Administration advised U.S. physicians that America's most prescribed antidepressant, the SSRI Paxil, should not be used in children and adolescents under age 18 due to a possible increased risk of suicidal thoughts and attempts. The agency recommendation followed close on the heels of a similar action in Britain.
A preliminary review of 20 placebo-controlled trials of the drugs in over 4,000 children found no completed suicides, although case reports of suicide attempts have appeared in medical journals and the press. The FDA finds such reports "difficult to interpret in the absence of a control group, as these events also occur in untreated patients with depression."
Specialists around the country believe that in contrast to a ban imposed by British regulators, the FDA is already charting a nuanced approach to medication availability, one that grapples with the difficult realities of depression and its treatment at a stage in life when impulsive behavior is at its height.
Suicide is the eleventh leading cause of death for all Americans. It is the third leading cause of death for those aged 15 to 24. "And the number one cause of suicide in young adults is untreated depression," emphasizes John Greden, M.D., chairman of psychiatry at the University of Michigan and head of its depression center, the nation's first. According to the National Institute of Mental Health, depression affects up to 2.5% of children and about 8% of adolescents in the U.S.
In the year ending September 2003, some $10.6 billion worth of prescriptions were written for the SSRI antidepressants. An unknown but growing number of those were for youngsters between the ages of 12 and 18.
In January 2003, Prozac became the only SSRI approved by the FDA for use in children 8 to 18 with major depression; psychopharmacologists believe, however, that all the serotonin reuptake inhibitors act similarly enough that safety and effectiveness proved for one can be presumed of all. Many of the SSRIs have been studied and approved for use in children with obsessive-compulsive disorder and other anxiety conditions.
The latest concerns with SSRIs stem less from clear evidence of risk than a paucity of placebo-controlled studies proving benefit against depression in children. In strong contrast to the situation with adult depression, the number of studies of antidepressants in children can be counted on one's fingers. It took an act of Congress in 1997, with the provision of financial incentives to pharmaceutical manufacturers, to encourage them to study their own drugs in children.
Studies failed to demonstrate any benefit of Paxil in depressed children
The current alarm was tripped when three unpublished studies failed to demonstrate any benefit of Paxil versus placebo in depressed children. Child psychiatrists are quick to put that in perspective. "Ten years ago, we were still debating whether kids could be depressed," says Robert Kowatch, M.D., professor of psychiatry and pediatrics at Cincinnati Children's Hospital and Medical Center. "The early studies we did were not well designed."
Timothy Wilens, M.D., associate professor of pediatric psychiatry at Harvard, elaborates. "Only recently have psychiatrists become familiar with ways to assess childhood depression."
What's more, many observers believe that a variety of responses "got lumped into the 'adverse reaction' category." According to Wilens, the primary problem is the emergence of "fleeting suicidal ideation." He emphasizes that no actual suicide "events" have been tied to such reactions.
What is clear is that a number of people have transient reaction to medications. It could be manic activation. It could be activation of some psychotic features. In his own study, Wilens says, "we didn't find any de novo suicidal ideation. The drugs are probably triggering panic and other reactions interpreted as suicidal ideation."
Clinically, Kowatch says, there a 2% risk of any adverse effect. "Most of the time a kid who shows up in a psychiatrist's office with depression has been through psychotherapy. He or she is failing in school and is suicidal. We're willing to take that risk. Nine out of ten will do well with an antidepressant, though not necessarily the initial one tried. I may have to switch to find the right one."
Kowatch contends that American psychiatrists are more comfortable with SSRIs and medications in general than are their British counterparts. "There is a cultural difference; they are still debating whether depression appears in children."
For Michigan's Greden, the most persuasive argument for the drug's continued availability is the nature of depression. "Suicidal thinking and occasional attempts are to depression as fever is to untreated pneumonia. Untreated depression leads to suicidal thinking and attempts."
Psychiatrists say they are always cautious about treating young people with drugs. They emphasize the need for complete evaluation. "Are they really depressed?" says Kowatch, explaining his chain of thinking. "Is anything else going on, in school or in the family? Does the child have a learning disability?"
Who gets treated with antidepressants in childhood? Says Greden: "It's the most severely depressed, the ones who struggle most with impulsivity and suicide."
Evidence now demonstrates that depression is most likely to begin in the young, those between ages 15 and 24. "If you can't treat it, then the syndrome gets a running start," says Greden. "Not making drugs available dooms young people to more severe disease that is harder to treat. That's a heavy burden when we have treatments that work."
The solution, many psychiatrists agree, is to start drugs slowly and watch patients carefully. The most dangerous time for suicide is just after treatment is started. "We don't fully understand this yet," Greden confides. "If you treat moderate to severe depression it's like shaking a glass of water. You see a flare-up of suicidal ideation. No one is sure why." The SSRIs raise serotonin levels; impulsivity is associated with low serotonin levels, not increased levels.
His best guess is that the drugs increase fear conditioning in the acute phase. The issue is not whether, but how, to use the drugs. "Clinicians should start with low doses and closely monitor children. The families should monitor them, too."
In the long run, treatment lowers the rates of suicide. Columbia University psychiatrist John Mann, M.D., an expert on suicide, is one of many specialists to call attention to suicide statistics. As the use of SSRIs has increased four-fold, there has been a decline in suicides in the U.S. Although the correlational data do not establish a direct cause-and-effect relationship, they so suggest that the drugs aid suicide prevention.
If clinicians have a beef with Paxil, the drug that stimulated suicide concern, it is that it poses a problem of withdrawal reactions. "People have difficulty when they stop the medicine abruptly," says Richard Kadison, M.D., director of student health services at Harvard University. This is a concern because "adolescents are, in general, not the most reliable folks when it comes to taking medications."
Still, schools and colleges are generally reaping a "Prozac payoff." Taking SSRIs to reverse depression has enabled many young people to stay in the academic system who in earlier times might have been forced by illness to drop out of school.
Whether in the longest run drugs are the best way to deal with depression in young people is a legitimate question now getting serious attention. At least two studies funded by the National Institute of Mental Health are exploring whether developmental approaches, alone or in combination with medication, can combat depression. One is a study of cognitive therapy versus drugs, the other looks at whether instruction in specific coping skills, can head off depression in stressed teens with a family history of the disorder. It's too soon to know.
How Christian Prayer relieves depression
By: Douglas Bloch
From Publication: Psychology Today Magazine, Date: Nov/Dec 2000
Summary: A personal narrative on the power of prayer and social support.
When you've hit a dark, bleak point in your life, you become willing to try almost anything to overcome your feelings of hopelessness and despair. In the fall of 1996, a painful divorce, a bad case of writer's block and an adverse reaction to an antidepressant medication hurled me into a major depression. For the next 10 months, I was assailed by out-of-control anxiety attacks that alternated with suicidal thoughts. Each day felt like a painful eternity.
My depression was deemed "treatment-resistant" (a condition that applies to 10% to 20% of those who suffer from a depressive disorder), and for good reason. Antidepressants, the mainstay of conventional depression treatment, simply did not work for me. Drugs, such as Prozac, Paxil and Zoloft, made me agitated; others, such as lithium, made me even more depressed. Others did nothing at all. As the emotional pain became unbearable, I began to contemplate suicide as the only way to escape from my ongoing nightmare. In desperation, I agreed to be evaluated for ECT (electroconvulsive therapy), but was told that I was not a good candidate because of my high state of agitation. Having run out of options, I felt as if I was trapped in a dark runnel in which both ends were labeled "No Exit."
It was then that I received a phone call from Eddy, the pastoral counselor at the church I was attending. "When a member of our congregation was dying of cancer," he explained, "we decided to bring all of her support--her family, friends, minister, physicians and social worker--together in one room. Their combined prayers created a powerful healing energy that allowed Carol to live far longer than anyone expected. I think that the same principle might work for you. Our senior minister, myself and members of the prayer ministry would like to schedule a prayer meeting with you in two weeks. We would like you to attend and bring members of your personal support team with you."
It may have sounded like a doubtful approach to treating depression. But in his book Prayer Is Good Medicine: How to Reap the Healing Benefits of Prayer (HarperCollins, 1997), physician and researcher Larry Dossey, M.D., maintains that praying for oneself or others can make a scientifically measurable difference in recovery from illness or trauma. Furthermore, I respected Eddy highly, and was so beaten down by my mental condition that I agreed to the meeting.
When I arrived, I described the history of my illness and my feelings of despair. Then, the 12-person group shifted the focus away from my symptoms and asked me to imagine what wellness would look like for me. Although I could not remember a time when I was not anxious or depressed, I described in as much detail as I could the thoughts, feelings and behaviors I might experience if I were healed of my affliction. The group then affirmed that my desire was already a reality and agreed to hold in their consciousness my vision of wellness over the next 30 days, until we met again (a total of six monthly support meetings were held). Seventy-two hours after this prayer support began, the black cloud of depression began to lift. Within 90 days, I was completely free of my symptoms.
If there is a moral to this story, it is that no matter how sophisticated brain science and technology become, there is no substitute for human love and caring. Scientific studies (such as David Siegel, Ph.D.'s work with breast cancer survivors at Stanford University) repeatedly reveal that strong social bonds strengthen the immune system and ward off the harmful effects of stress on the cardiovascular system. If social support can affect a physical organ like the heart, then it's not a far leap to believe that it could also treat the brain.
Every day, I am grateful that a committed group of loving people took a few hours from their busy schedules to give their love and support. Whether I recovered thanks to the power of prayer, or simply because of their unfailing encouragement, my struggles with depression are finally over.
Does Prozac help or harm?
Another view: Talking back to Prozac
Psychology Today, Publication Date: Jul/Aug 94
By: Peter Breggin
Summary: Presents the views of the author, co-author with Ginger Breggin of 'Talking Back to Prozac,' on whether Prozac really improves depression. His investigation of FDA documents on its approval of Prozac; Prozac as a stimulant-like drug; The contention that Prozac remains unproven.
The Declaration of Independence affirms our right to the pursuit ofhappiness, but the Founding Fathers did not anticipate that laboratory-de-signed drugs such as Prozac would become the preferred path for so many. Prozac has become the most widely prescribed psychiatric drug in America.
Does it really improve depression? Long a skeptic about claims for new psychiatric wonder drugs, I decided to undertake a comprehensive analysis of the drug and its effects. Making extensive use of the Freedom of Information Act to obtain FDA documents pertaining to the approval of Prozac, what I found was more dismaying than my initial skepticism suggested. The full results are published in a new book, Talking Back to Prozac (St. Martin's) I co-wrote with Ginger Breggin.
Contrary to widespread public belief, the FDA does not conduct any of the studies used for drug approval; they are financed, constructed, and supervised by drug companies using doctors they hire. While it may take a decade for a drug to get through the FDA bureaucracy, the actual controlled scientific studies last--as in the case of Prozac--just four to six weeks. Anecdotal material is collected on longer-term patients, but for Prozac, only 63 patients were followed for more than two years before the drug's approval.
For starters, seriously suicidal patients and hospitalized patients were excluded. Of the included patients, many were allowed to take sedatives and minor tranquilizers to overcome Prozac's stimulant-like side effects, vastly compromising data interpretation.
After weeding out the most badly flawed studies, the FDA found only four that were adequate enough to consider. One of these showed that Prozac was no better than placebo. Three others supposedly showed Prozac to be somewhat superior to the sugar pill, but not as good as older antidepressants. However, due to adverse drug effects and lack of drug effectiveness, the dropout rates in most of these studies was very high.
While the gross number of patients receiving Prozac in all the trials was more than 5,000, the actual number finishing the trials used for approval was very small. When I counted the actual number of patients who completed the four- to six-week trials used for the approval of Prozac, it turned out to be a grand total of 286. It bears restating--only 286 patients finished the four- to six-week trials used to determine Prozac's efficacy.
Because of the high dropout rates and because Prozac was often no better than place-bo in many trials, many statistical maneuvers were required to make the studies look positive. In one of the key studies, involving six different sites around the country, results at five sites showed Prozac to have no benefit. One site--representing 25 percent of the patients who finished the trials--was discarded. Then the data from the remaining sites were pooled. This is such a scientifically unacceptable practice that the FDA prohibits drug companies from doing it in the studies used to support advertising claims. Yet the FDA allowed it in this case. Otherwise Prozac could not have been approved.
If Prozac was largely ineffective in the FDA studies, how and why has it become so popular? Controlled studies routinely show that placebo is highly effective in relieving depression. When a drug becomes a social fad, placebo can gain miraculous powers.
There is, however, another, more disquieting reason for Prozac's popularity. The FDA's own analysis--expunged from its published conclusions--originally determined that Prozac is a stimulant-like drug. Nearly all of Prozac's clearly established effects are indistinguishable from those of classic stimulants such as the amphetamines and cocaine: activation or energizing, nervousness, anxiety, agitation, insomnia, nightmares, sweating, anorexia, weight loss, and in the extreme, hypomania and mania. There is also evidence that Prozac can produce behavioral abnormalities consistent with stimulants including paranoia and violence, and crashing, with depression and suicidality.
Americans have always loved stimulants. During the 1960s, amphetamines were prescribed in even greater numbers than Prozac, and they were touted for the same disorders, including depression and fatigue. Cosmetic psychopharmacology, presented as a unique Prozac phenomenon, has a long history in association with stimulants. Sigmund Freud, as he became hooked on cocaine, wrote glowingly about how it transformed his personality entirely for the better without any negative side effects.
Prozac's seemingly good effects are probably based on a combination of placebo and stimulation, with no specific "antidepressant" effect. Being artifically jazzed up can be tempting for meeting the demands of our high-stress, high-production lifestyles.
Many people do not feel high or euphoric on Prozac, but react with a narrowing of their emotional spectrum. They lose touch with themselves and others, and may perceive this as a kind of relief. Commonly, Prozac--like other stimulants--acts as an "anti-empathy" agent. It disconnects a person from the rest of the world and from his or her own real-life issues.
Sometimes it dulls the perception of emotional despair. Other times it produces an artificial euphoria that can progress toward mania. At best, people who use Prozac may become "better adjusted" to circumstances that do not truly meet their needs or fulfill their ideals. Worse, an individual can develop drug-induced apathy or euphoria.
Since recorded time, humankind has suffered from depression. Many individuals can recall periods in their lives when they were depressed (try remembering adolescence, for instance). Usually through the personal evolution of one's life, the sadness passes. Sometimes therapy, a spiritual awakening, or life changes help restore or initiate a more enthusiastic, hopeful outlook. Depression--and its mirror image, enthusiastic involvement in life--are the result of a complex interrelationship of environmental, social, spiritual, psychological, and sometimes physical factors.
Despite the enthusiasm with which the psychiatric community has embraced the biological theory of depression, it remains unproven. No genetic factors have been proven in depression or in the severe mood swings of manic depression despite 200 years of claims. At times, depression is produced by a recognized hormonal flaw such as hypothyroidism, which should be treated medically.
The emotional factors in depression are well known. From chimpanzees in the wild to human children enduring institutional care, it has been shown that most higher animals respond to the loss of love, liberty, or hope with degrees of depression that can become life-threatening. When so many Americans feel depressed and hopeless, we are dealing with a social phenomenon. The very idea that drugs are the answer suggests a moral, psychological, or spiritual vacuum.
That the specific causes of depression in our own lives often seem mysterious to as is no surprise. At the root of depression is a feeling of helplessness in the face of life--a sense that nothing can be done to make life worth living. If the causes of despair were known to us, we might feel frightened, but not be as like lapse into hopelessness.
Depression tells us that something is the matter with our lives. It can be a signal for personal transformation. In therapy as well as in other approaches to life improvement, overcoming depression often means finding greater appreciation for oneself and all other aspects of life, plus increased determination to live in a more self-fulfilling and loving way.
Is Prozac a short-cut to happiness? There can be no quick fixes of the human spirit. With or without drugs happiness can not be directly sought It comes, if at all, as a bonus for living a principled, rational, and loving life. The frailty and elusiveness of happiness is a tragic reality. Even wisdom, ethics, and courage cannot guarantee it.
Golda Meir once said, "Those who do not know how to weep with their whole heart don't know how to laugh either." Today we view depression and all distress in a medicalized way, divorced from our personal histories and family background, our ongoing conflicts and circumstances, and the values of the society in which we live. Instead of doing the tough work of self-transformation, we blame biochemistry.
When mental health professionals point to spurious genetic and biochemical causes, they encourage psychological helplessness and discourage personal and social growth. Even if we feel "better adjusted; we have not faced what life is all about--finding our own ethical and spiritual path, the one that brings enthusiasm and hope to all we do.