Anxiety, depression and feeling blue

The white lab coats are back. This MSNBC article discusses information from the National Mental Health Association which says that 100K patients a year undergo ECT (electroconvulsive therapy). The articles discusses that for the vast majority of depression sufferers that are not helped by anti-depressants, ECT is still the most effective treatment. The side effects are still quite severe. A good article overall and superior to the Time Magazine article from 2005, which only discussed the downsides and stigma and worth a read.

Patients with agoraphobia, in time, tend to multiply various places or situations avoided. Situations and places avoided may differ in great deal from patient to patient. Some places or situations have to be avoided at all cost by some patients. Professional reports are showing cases when places where patients had their first encounter with panic attacks and places where their public embarrassing was so big are the certain must avoid places.

Despite that reports, there are patients that do not avoid public places at all cost. They can use public transport or public places in periods when there is no crowd. They can come first at work and left last just to avoid crowd. Their deviant behavior sometimes can be masked with presence of agoraphobic friend or presence of some family member or friend with whom they feel safe. In such cases agoraphobic patients can work and travel with years. Question of availability of such companions is always open. Such companion is not available at all time and sure not available on longer period of time. In such case fear from panic attacks becomes apparent.

Most of the patients suffering from anxiety are pointing to their first encounter with panic attacks like not expected and sudden experience and they don’t express some previous events or symptoms preceding panic attacks. Despite that fact, very often there are quite many symptoms showing that something is going on. In some cases that is constant worry about something, present anxiety and discomfort. Many situations can lead to first panic attack. It can be some conflict on work or at home, some medical dysfunction, excitement, intoxication from amphetamine, cannabis, caffeine, alcohol, some traumatic moments, physical sexual contact and so on.

Fact where and how first panic attack showed, will determine patient response to the following attacks. Patient can develop some fear of future attacks and need of avoidance of such places and situations reminding him/her of their first panic attack.

Agoraphobia is avoidance and fear of such situations where escape is really embarrassing or difficult. Agoraphobia can be in mild cases where with successful treatment will permanently go away, or it can be in stage where immediate severe treatment should be started.
There are two situations that patients with agoraphobia avoid and fear. First one is fear of entrapment where they will not have opportunity to escape in case if panic attack shows. Urge for escaping is very strong, because they believe that attacks will be gone if they are sure that have open road to escape. If they cannot escape they are terrified and that’s why great deal of agoraphobic patients doesn’t like to travel by plane.

Second situation related to agoraphobic fears is need of patients to have doctor in near vicinity so they can get instant help in case of panic attack strike. They would like to be near medical persons or institutions where they can get help needed. That’s why these patients very often have need to know where hospitals or institutions are located before they go to travel or go on unknown places.
These situations enlighten the facts why agoraphobic patients don’t like to be alone, don’t like to travel alone and don’t like to be outside of their imaginative zone of safety in which they can escape not being embarrassed in case of panic attack. Such problematic zones for agoraphobic patients are public crowded places, public transport (buses, trains, subway, boats), planes flying, elevators, bridges, underground facilities, cinemas, theaters, great shopping centers, restaurants, standing in line facilities, public meetings and so on.

When we are talking about depression, it’s only natural to know some basic facts about it. In our modern society near 15 % of whole population got or reported or manifested some kind of depressive symptoms. Density of symptoms showing may differ regard to age and sex. Women tend to express their problem more often than men. Women are known to report and ask help for their emotional problems, and maybe that is one of the facts why reports showing women are more depressed than men. Depressive symptoms are increasing with age, although there are lots of examples of younger people with depressive symptoms in recent time. Depression is prevailing in adolescents than in smaller children. There is common believe that anxiety and depression are showing together. Almost 2/3 of people suffering depression have reported some additional symptoms characterizing some form of anxiety. Despite that fact, there is lack in depression diagnostics in primary health care. Reasons should be generalized and summarized as soon as possible. Sometimes patients ignore depression because of fear of mental illness. They are worried about their image and public life. However, sometimes even doctors cannot separate depression from present depression lead by some negative circumstances. Ignoring the problem is bad scenario for future development of depression. Sometimes separate depressive and anxiety disorders symptoms are not sufficient for diagnostic. That’s why both type of symptoms characterizing depression and anxiety should be analyzed side by side and not separately. Only then, doctor can get clearer picture about patient’s mental health. Diagnostic will be accurate and treatment will be more effective.

There are several symptoms pointing to panic attacks. Diagnostic process needs four symptoms at least, to declare panic attack at any patient. Heart pounding (tachycardia), breath shortness, pain and discomfort in chest, some point of dizziness, chocking, trembling, sweating are declared as panic symptoms from first rank. At least one of these symptoms most likely is present during presence of panic attacks. Other symptoms showing are not that common and they can be sorted as second rank symptoms. Upset stomach area, sensations like tingling, cold or hot flushes can be perfect examples.

While observing great deal of patients suffering panic attacks, some differentiation may be given toward aspect of absence or presence of some respiratory symptoms. Those panic attacks with distinct respiratory symptoms are known by chest pain, tingling sensations and dying fear. On the other hand panic attacks without distinct respiratory symptoms are also known and common to some patients. This form of distinction on panic attack is not yet main selection factor for medications.

Many researchers in anxiety and panic attacks filed have reported number of patients suffering from non fearful panic attacks. Most of the patients got frightening and most unpleasant feelings (catastrophic interpretation). In those physical attack consequences, patients got fear of sudden dying from heart stroke or chocking, or from collapsing and injuring themselves. Also patients are afraid that they will lose self-control, make unpleasant scene and will be embarrassed overall. Running aimlessly, saying senseless, screaming and acting inappropriate or aggressive are also some of the fears. Even when patients had panic attack in the past and nothing of these happened, they think that they were lucky that time, but sure next time something like that will happen. During attacks, patients concentration is diminished and they are immersed in the extreme negative experience and may have certain problems to get away from that frightening experience. In that order they cannot concentrate and think in clear manner about other live matters.