Disease of the Month: Depression and anxiety disorders

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One in four Britons will experience mental health problems within a given year writes Fergus Bescoby.

Most people experience ups and downs in their life, and can feel unhappy, depressed, stressed or anxious during difficult times. This is a normal part of life.

The word depressed is a common everyday word and we often hear people say "I'm depressed" when in fact they mean "I'm fed up because I've had a row, or lost my job" These ups and downs of life are common with most people recovering quite quickly.

Statistics show that one in four Britons will suffer from a mental health problem within a given year, with anxiety and depression being the most common combination of mental health disorders in the UK.

Depression and anxiety disorders are not the same, although at first glance they seem similar and commonly occur together. Not everybody who is anxious is depressed, but most depressed patients have some symptoms of anxiety.

Depression generates emotions such as hopelessness, despair and anger. Energy levels are generally low and depressed people often feel overwhelmed by the day to day tasks and personal relationships which are so important to life.

A person with anxiety disorders however, experiences fear, panic or anxiety in situations where most people would not feel threatened or pressured. The sufferer may experience sudden panic or anxiety attacks without any recognised trigger and often lives with a constant nagging worry or anxiousness.

Both anxiety and depression are frequently treated in much the same manner, which may explain why the two disorders are so often confused. Anti-depressant medication is often used for depression while behavioural therapy frequently helps people overcome both conditions.

Depression

Depression affects people in different ways and can cause a wide variety of symptoms ranging from lasting feelings of sadness, tearfulness and hopelessness, to losing interest in the things previously enjoyed. There can be physical symptoms too, such as feeling constantly tired, sleeping badly, having no appetite or sex drive, and complaining of various aches and pains.

The severity of the symptoms can vary from simply feeling persistently low in spirit to feeling suicidal.

Although not fully understood, it is felt that a chemical imbalance in the brain might be a factor. However, an alteration in some chemicals in the brain is thought to be the reason why antidepressants work in treating depression.

Depression can run in families. If there is one parent who has become severely depressed, there is about eight times more likelihood of a sibling also becoming depressed.

Women tend to develop depression more often than men, particularly after childbirth (post-natal depression) and the menopause.

Doctors normally describe depression based on the severity of the condition:

• Mild depression has some impact on your daily life.
• Moderate depression has a significant impact on your daily life.
• Severe depression makes the activities of daily life nearly impossible. A small proportion of people with severe depression may have psychotic symptoms.

Anxiety disorders
These are amongst the most common mental disorders with about 10% of the population suffering from anxiety to such a degree that treatment is required. Women are more frequently affected than men. The onset of the disorder is rarely after the age of 45.

Anxiety is a normal response to stress or danger. At times it is helpful because it can help prepare the body for action, and it can improve performance in a range of situations. Anxiety becomes a problem when it is experienced intensely and it persistently interferes with a person's daily life.

Anxiety can be experienced in a number of different ways, both psychological and physical and symptoms can include irritability, inner tension, fear of losing control, chest pain and tightness, palpitations and sweating.

Specific types of depression and mental health disorders

 Obsessive-compulsive disorder (OCD)
OCD is a serious anxiety related condition where a person experiences frequent intrusive and unwelcome obsessional thoughts, often followed by repetitive compulsions, impulses or urges. OCD is a relatively rare disorder, occurring in less than 1 in 1000 people with both men and women being equally affected.

 Post-traumatic stress disorder (PTSD)
Symptoms tend to commence weeks, or even months, after a stressful event that was of an exceptionally threatening or catastrophic nature, which would cause distress in almost anyone. It can persist for years. Symptoms include flashbacks, nightmares, avoiding anything associated with the stressful event and being on edge.

 Bipolar disorder (manic depression)
This form of depression can be defined as an emotional disorder characterized by changing mood shifts from depression to mania which can sometimes be quite rapid. People who suffer from manic depression have an extremely high rate of suicide. It affects the same number of men and women and tends to run in families

 Endogenous Depression
Endogenous means from within the body. This type of depression is defined as feeling depressed for no apparent reason.

 Reactive depression or adjustment disorder
Depressive symptoms developing in response to a specific stressful situation or event (e.g. job loss, death of family member). These symptoms occur within three months of the stressor and lasts no longer than six months after the stressor (or its consequences) has ended.

 Psychotic Depression
Major depressive episode with psychotic symptoms such as hallucinations (e.g. hearing voices) and delusions (false beliefs).

 Postpartum Depression
Pregnancy brings about many hormonal shifts. These dramatic shifts can sometimes affect mood. This is commonly known as the "baby blues." Postpartum depression can be more than just a case of the blues, however. It can range from mild symptoms that go away without treatment all the way up to postpartum psychosis.

Treatment

Depending on the severity, treatment usually involves a combination of drugs, talking therapies and self help. Hardly anyone with depression is admitted to a psychiatric hospital. Most get treatment from their GP and make a good recovery.

 Cognitive behavioural therapy (CBT)
This normally consists of a fixed number of sessions - usually six to eight sessions over 10-12 weeks. Some GP practices have counsellors specifically to help patients with depression. CBT teaches the patient to behave in ways that challenge negative thoughts - for example, being active to challenge feelings of hopelessness.

 Antidepressant drugs
SSRIs (selective serotonin reuptake inhibitor) are as effective as the older TCAs (tricyclic antidepressants) and have fewer side effects. Fluoxetine, citalopram and sertraline are all examples of SSRIs. The drug increases the level of a natural chemical in the brain called serotonin, which helps lift the mood. There may be some side effects when taking SSRIs, such as nausea, headache, sleep problems and anxiety, however, these tend to improve over time.

 Interpersonal therapy (IPT)
This focuses on relationships with other people and on problems, such as difficulties with communication or coping with bereavement. There is some evidence that IPT can be as effective as medication or CBT, but more research is needed.

 Counselling
This form of therapy helps the patient think about the problems they are experiencing in there life, in order to find new ways of dealing with them. Counsellor's offer support in finding solutions to problems, but do not tell you what to do.

Associated diseases

There are several associated diseases, including the following:
 Eating disorders: anorexia nervosa and bulimia nervosa
 Substance misuse is frequently associated with depression
 Other psychiatric conditions may co-exist with depression (e.g., generalised anxiety disorder, panic disorder, obsessive-compulsive disorder, personality disorders)

Some medical conditions have known associations with depression:

o Parkinson's disease.
o Chronic diseases such as diabetes and cardiac disease.
o Cerebrovascular disease.
o Endocrine disorders such as hyperthyroidism, Cushing's syndrome, Addison's disease and hyperparathyroidism.
o Cancer, especially pancreatic.
o Autoimmune conditions.

Underwriting

For the majority of disclosures of mild anxiety or depression, additional information will be requested in the form of a med-tele interview. This should ascertain the following:

Type of disorder or symptoms, date of onset, cause, number of episodes, treatment, amount of time off work, any suicide attempts, suicidal thoughts or self harm and current mental state.

A GPR may be required if the information on the med-tele interview indicates a more severe psychiatric condition.

Terms will vary depending on the severity of the condition and the type of cover being applied for.

Fergus Bescoby is underwriitng development manager at VitalityLife. 

Further reading 

Disease of the Month: Chronic kidney disease (CKD)

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