Anxiety and Depression

General Facts:

Anxiety and Depression are both very common, yet highly treatable, medical illnesses that can affect anyone. Anxiety disorders are the most common mood disorder in the U.S. More than 1 in 20 Americans get depressed every year. One half of those diagnosed with depression are also diagnosed with an anxiety disorder. These are medical disorders (just like diabetes and high blood pressure) that affect your thoughts, feelings, physical health and behaviors.

Depression Symptoms Include: 

• Feeling sad or unhappy 
• Loss of interest in things you usually enjoy 
• Feeling slowed down or restless 
• Having trouble sleeping or sleeping too much 
• Loss of energy or feeling tired all the time 
• Having an increase or decrease in appetite or weight 
• Having problems concentrating, thinking, remembering or making decisions 
• Feeling worthless or guilty 
• Having thoughts of death or suicide 

Anxiety Symptoms Include: 

• Restlessness
• Easily Fatigued 
• Difficulty Concentrating 
• Irritability
• Muscle Tension
• Sleep Problems 
• Chest Pain 
• Palpitations 
• Shortness of Breath 
• Numbness/Tingling

Causes & Risk Factors: 

It appears to be a variety of factors including: 

• Imbalance of neurochemicals in the brain 
• Family history of depression/anxiety 
• Stressful life events 
• History of alcohol/substance abuse 
• Early childhood trauma 
• Personal past history of depression/anxiety 
• Certain medications 
• Personality 

Treatment

The good news is that treatment works. Treatment can involve medications, counseling or both. There are also some lifestyle measures that may help as well, see the following recommendations. 

Lifestyle Measures:

• Take good care of yourself - Eat well and try to get at least 7 hours of sleep. 
• Stay physically active – Make sure you make time to address your basic physical needs, for example, walking for a certain amount of time each day.
• Make time for pleasurable activities – Even though you may not feel as motivated, or get the same amount of pleasure as you used to, commit to scheduling some fun activity each day – for example, doing a hobby, listening to music or watching a video. 
• Spend time with people who can support you – It’s easy to avoid contact with people when you’re depressed, but you need the support of friends and loved ones. Explain to them how you feel, if you can. If you can’t talk about it, that’s OK – just ask them to be with you, maybe accompanying you on one of your activities.
• Practice relaxing – For many people, the changes that come with depression – no longer keeping up with our usual activities and responsibilities, feeling increasingly sad and hopeless – leads to anxiety. Since physical relaxation can lead to mental relaxation, practicing relaxation is another way to help yourself. Try deep breathing, or a warm bath, or just finding a quiet, comfortable, peaceful place and saying comforting things to yourself (like “it’s OK”).
• Simple goals and small steps – It’s easy to feel overwhelmed when you’re depressed. Some problems and decisions can be delayed, but others cannot. It can be hard to deal with them when you’re feeling sad, have little energy, and not thinking clearly. Try breaking things down into small steps. Give yourself credit for each step you accomplish.
• Avoid self-medicating – Using alcohol or drugs not prescribed for you.

Medications:

Selective serotonin reuptake inhibitors (SSRIs)

Many doctors start depression treatment by prescribing an SSRI. These medications are safer and generally cause fewer bothersome side effects than other types of antidepressants. SSRIs include fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft), citalopram (Celexa) and escitalopram (Lexapro) and others. 

• The most common side effects include jitteriness, restlessness, agitation, headache, diarrhea and nausea and insomnia. Some side effects may go away as your body adjusts to the medication. 
• Sexual side effects (loss of sexual desire, diminished arousal, and difficulty having an orgasm) may also occur with prolonged use of the SSRIs; however, adding another drug (such as bupropion [Wellbutrin®] or buspirone [BuSpar®] can sometimes relieve these sexual side effects. 
• Serotonin syndrome. Rarely, an SSRI can cause dangerously high levels of serotonin. This is known as serotonin syndrome. It most often occurs when two medications that raise serotonin are combined. These include other antidepressants, medications for certain health conditions and the herbal supplement St. John’s wort. Signs and symptoms of serotonin syndrome include confusion, rapid or irregular heart rate, dilated pupils, fever, and unconsciousness. Seek immediate medical attention if you have any of these signs or symptoms. 

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

These medications include duloxetine (Cymbalta), venlafaxine (Effexor XR) and desvenlafaxine (Pristiq).

• Common side effects include nausea, dizziness, insomnia, sedation, and constipation. Rarely, these drugs also cause increased sweating. People taking venlafaxine should have regular blood pressure checks, since it may cause blood pressure to rise. 

Norepinephrine and dopamine reuptake inhibitors (NDRIs)

Bupropion (Wellbutrin) is in this category. Bupropion has few side effects, but it has been associated with seizures in people with eating disorders; it is not recommended for people who have bulimia or anorexia. The drug carries a small risk of seizures in other people as well. Other side effects of bupropion may include mild anxiety or insomnia and decreased appetite with weight loss. Unlike other antidepressants, bupropion does not have sexual side effects. It is sometimes used at low doses to help counter the sexual side effects of other antidepressants. 

Other medication strategies

Your doctor may suggest other medications to treat your depression. In some cases, your doctor may recommend combining two or more antidepressants or other medications for better effect. 

Important Medication Facts: 

• The Food and Drug Administration (FDA) requires that all antidepressants and some anti-anxiety medications carry a warning that some children, adolescents, and young adults may be at increased risk of suicide when taking them. Anyone taking these medications should be watched closely for worsening depression or unusual behavior – especially in the first few weeks after starting the medication. Keep in mind, these medications are more likely to reduce suicide risk in the long run by improving mood.
  • Take medications as prescribed.
  • Antidepressants are not addictive.
  • Benefits from certain medication appear slowly. Full effects are not usually seen until 4-6 weeks of treatment are complete. 
  • Continue medications even after you feel better.
  • Most medications are taken for at least 6-12 months.
  • Mild side effects are common and usually improve with time. 
  • If you’re thinking about stopping the medication, call your clinician first. Some medications may cause a discontinuation syndrome if not tapered slowly. Symptoms may include dizziness, nausea, headache, fatigue, muscle aches, chills, anxiety, and irritability.
  • The goal of treatment is complete remission. Sometimes it takes a few different medications to find the best one.

Emergencies

In an emergency go to Mount Nittany Medical Center or call 911 for an ambulance.

PSU Crisis: 24/7 877-229-6400

Crisis Text: Text LIONS to 741741

SUICIDE and CRISIS LIFELINE: 988

CAN HELP: 1-800-643-5432 is the community’s 24-hour crisis service.

Test Results and Advice Nurse

Send a secure message to the advice nurse via myUHS or call 814-865-4UHS (4847) (Press 3). 

Appointments 

Schedule an appointment online or by calling the UHS.  

This content is reviewed periodically and is subject to change as new health information becomes available. This information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis, or treatment by a healthcare professional.

Approved by the UHS Patient Education Committee Revised 01/2023