Anxiety is a normal part of living. It’s a biological reaction—the body’s way of telling us something isn’t right. It keeps us from harm’s way and prepares us to act quickly in the face of danger. But if your anxiety becomes overwhelming and persistent, or if it interferes with your regular daily activities, or even makes them impossible, you may have an anxiety disorder.

Researchers are learning that anxiety disorders run in families, and that they have a biological basis, much like allergies or diabetes and other disorders. Anxiety disorders may develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events.

Success of treatment varies, but most people with an anxiety disorder can be helped with professional care. Benefits of CBT are usually seen in 12 to 16 weeks. Medication may be a short-term or long-term treatment option, depending on severity of symptoms, other medical conditions and individual circumstances. It often takes time and patience to find the drug that works best for you. Treatment may be complicated if you have more than one anxiety disorder or if they suffer from depression, substance abuse, or other coexisting conditions. This is why treatment must be tailored specifically for each person.

Four major classes of medications are used in the treatment of anxiety disorders:

1. SSRIs (selective serotonin reuptake inhibitors)
2. SNRIs (serotonin-norepinephrine reuptake inhibitors)
3. Benzodiazepines
4. Tricyclic antidepressants

Contact your physician if you experience side effects, even if you are not sure a symptom is caused by a medication. Do not stop taking a medication without consulting with the prescribing physician; abrupt discontinuation may cause other health risks.

Medications will work only if they are taken according to the explicit instructions of your physician, but they may not resolve all symptoms of an anxiety disorder.

Any treatment plan has risks and benefits, and for pregnant women, the risks are of particular concern. The effectiveness and safety of treating symptoms for anxiety disorders and depression differs for every woman. Talk to your doctor before beginning or changing any treatment plan.

Cognitive-behavioral therapy (CBT) and medication are effective in treating children with anxiety disorders. Recent research found that a combination of CBT and an antidepressant worked better for children ages 7-17 than either treatment alone.

Because one child may respond better, or sooner, to a particular treatment than another child with the same diagnosis, it’s important to discuss with your doctor or therapist how to decide which treatment works best for your child and family lifestyle.

The U.S. Food and Drug Administration (FDA) issued a warning in October 2004 that antidepressant medications, including SSRIs, may increase suicidal thoughts and behavior in a small number of children and adolescents. However, the FDA has not prohibited or removed these medications, and no suicides were reported in the studies that led to the warning.

You should not necessarily refuse to give your child medication, but you should watch for signs of depression and talk to your child’s doctor or therapist about any concerns. Untreated anxiety disorders in children increases the risk for depression, social isolation, substance abuse, and suicide.

Find out about resources that offer assistance in paying for treatment. Family physicians also may have information about low-cost treatment resources.

For Singaporeans please click HERE to find out more.

• There are several possible causes of depression, and they often interplay with each other. Generally, biological or genetic, psychological and/or environmental factors, or a combination of these, are thought to underlie depression.
  
  
• Depression can be a result of a primary psychiatric condition, or it can be secondary to a medical condition. Depression may be caused by use of certain substances, such as alcohol.

   

• Some of the medical conditions which can cause depression are hypothyroidism, certain types of cancer such as pancreatic cancer, Parkinson’s disease, and others.

• Depression can affect anyone.
  
  
• Females are more likely to suffer from depression than males, however, depression affects males as well.
  
  
• Some of the risk factors that increase the likelihood of developing depression:
  
  • Having a family member with depression
  • Stressful life events 
  • Adverse childhood experiences 
  • Certain medical conditions may increase risk for depression, for example, stroke, multiple sclerosis, HIV .

Experiencing sadness at one time or another is part of the normal human experience. However, depression is more than the occasional sadness that people experience. When an individual suffers from depression, the sadness tends to be more pervasive or long lasting, and can be accompanied by one or more of the following: decreased interest in pleasurable activities, feelings of hopelessness, low self-worth, excessive guilt, decrease in energy, concentration difficulties, appetite changes, sleep difficulty or excessive sleep, headaches, body aches and pains, and/or thoughts of suicide.

• Mental health and physical health are closely interrelated. Depression is linked with changes in the brain. Additionally, depression can increase risk for medical conditions such as cardiovascular disease, stroke, Type 2 diabetes, Alzheimer’s disease, osteoporosis, migraine (NIMH, Steffan et al 2020). Chronic depression can also increase the risk of obesity.
  
  
• Studies show that major depressive disorder may increase risk for cardiovascular disease (Van der Kooy et al 2007). On the other hand, depression may emerge after a myocardial infarction, as a first episode or as a recurrent one (Spijkerman et al 2005).
  
  
• Similarly, studies show that depression may increase risk for diabetes, and diabetes may increase the risk of depression (Mezuk et al 2008, Katon 2011, Oladeji and Gureje 2013). Depressive disorders in people who have diabetes, can lower adherence to diabetes treatment, and can increase the likelihood of ‘poor glycemic control’ and complications from diabetes (Oladeji and Gureje 2013).

Depression can affect the elderly as well. In fact, it is often missed in the elderly. Elderly with chronic health conditions and related impairment in functioning may be at greater risk of depression. According to the CDC, depression among elderly ranges from 1% to 5% for those living in the community, and is about 11.5% & 13.5% among elderly who are hospitalized and elderly requiring home health care respectively (CDC).

Just like adults, children can suffer from depression that significantly impairs their social, academic and/or other domains of functioning. For more information on childhood depression

When feelings of sadness, low mood, or emptiness after the birth of the baby are significant and persists for 2 weeks or longer, postpartum depression may be present. It may be accompanied by hopelessness, crying spells, decrease in interest or motivation, worthlessness, decreased energy, thoughts of suicide, thoughts of hurting the baby, lack of interest in the baby, sleep difficulty or excessive sleep, appetite increase or decrease, and/or concentration, memory difficulties. Postpartum depression can affect both the mother and the baby in various, significant ways. Timely treatment is important.

There are effective treatments for depression which have been established through research; many treatments for depression have been around for years. Many people ignore signs of depression despite experiencing significant suffering. This may be due to stigma, lack of awareness, and/or barriers to accessing care. Untreated depression confers several risks. Discussing your concerns about depression with your doctor can often be the first step in getting professional help.

Untreated depression can increase risk of depressive episodes becoming more frequent, prolonged and/or severe over time and increase risk of suicide. It can significantly interfere with one’s functioning at work, school, and/or in interpersonal relationships. Depression can also increase risk of alcohol and/or substance use disorders. Additionally, depression can worsen the course and outcome of chronic medical conditions, such as diabetes, cardiovascular disease, and others.

Psychotherapy and medications are the most commonly used treatments for depressive disorders. For mild to moderate depression, psychotherapy is generally thought to be the first line treatment. For moderate to severe depression, a combination of medications and psychotherapy is often considered. For severe depression that has not responded to multiple trials of medications and psychotherapy, electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS) may be some of the treatment options. The type of treatment that is suitable for an individual depends on an individual’s specific clinical situation.

Anxiety disorders and substance use disorders are some of the psychiatric conditions commonly found co-existing with major depressive disorder (Hasin et al 2018, Steffan et al 2020). Other psychiatric conditions too, such as posttraumatic stress disorder (PTSD), eating disorders, can co-occur with depression.