Depression and Anxiety have become widespread in our society today. As a matter of fact, anxiety is now the most common mental illness in the United States. According to the National Institute of Mental Health, it affects 40 million adults in the United States age 18 and older, or 18% of the population. Anxiety disorders are highly treatable, yet only about one-third of those suffering receive treatment. And anxiety cost the U.S. more than $42 billion a year, almost one-third of the country’s $148 billion total mental health bill. People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from anxiety disorders. Anxiety disorders develop from a complex set of risk factors, including genetics, brain chemistry, personality, and life events. It is also very common for those who suffer from anxiety to also suffer from some form of depression.
Depression can occur as major depressive disorder. This means that someone has at least five symptoms of depression for a two week period. An episode is disabling and will interfere with the ability to work, study, eat, and sleep. Major depressive episodes may occur once or twice in a lifetime, or they may recur frequently. Or depression can happen as persistent depressive disorder, or PDD. It is a form of depression that usually continues for at least two years. Although it is less severe than major depression, it involves the same symptoms as major depression, mainly low energy, poor appetite or overeating, and insomnia or oversleeping. It can manifest as stress, irritability, and mild anhedonia, which is the inability to derive pleasure from most activities. People with PDD might be thought of as always seeing the glass as half empty.
As we said, many people have both anxiety and depression. This was the case of Dudi, a 41 year old who moved to Israel at age 35. He had given up a steady job to come to Israel and was having a very hard time adjusting to new realities. Although he was somewhat comfortable financially, he was worried about a long term lack of income and his adjustment to a new culture was also difficult. In addition, his day lacked structure. Couple all this with the problems that the rest of his family was having during this adjustment period, and the result was that Dudi was indeed suffering from both depression and anxiety.
Dudi’s physician sent him to a psychiatrist to get an evaluation and diagnosis. The doctor told him he had GAD, generalized anxiety disorder and PDD. Dudi wanted to be completely cured and wasn’t looking for quick fixes or Band-Aids. He made it clear to the psychiatrist that he was willing to work hard to get out of his funk. It was recommended that Dudi go on two medications and seek a good Cognitive Behavioral Psychologist and the psychiatrist assured him that with the right kind of work, he could probably get off the meds. He was worried because some of the common side effects include fatigue, nausea, agitation, drowsiness, weight gain, diarrhea, insomnia, nervousness, headaches, dry mouth, increased sweating, and much, much more. Dudi began and was compliant both with his weekly visits to his therapist as well as taking his medications. Although after a month there were some points of improvement, he was feeling some side effects, including weight gain from the meds and there still seemed to be a constant low-level depression.
Dudi is unfortunately typical in his reaction to treatment. Improvement? Yes! Cured? No. Dr. Martin Seligman, the founder of the Positive Psychology movement, and former president of the American Psychological Association, says that combined research shows beyond a doubt that both medication and clinical psychology in its typical form don’t cure. Unlike an antibiotic drug, which can cure you from a bacterial infection, psychiatric drugs only suppress symptoms and relieve a person from their misery. They don’t cure. Psychotherapy is not much better. It’s what we call Palliative. That means it relieves the pain, but it doesn’t fix the underlying problem. Palliative care most certainly has its place and is often times necessary. But Seligman says that the very maximum effect of treatment is never more than a 65% relief rate. In addition, there is a very high placebo effect in these drugs. Seligman points out that the placebo effect is so high in some of these drugs that the Federal Drug Administration (FDA) when testing antidepressants for their effectiveness found that in many cases, there was little difference between the drug and the placebo at all. Based on all this research, Dr. Seligman has discovered the “65% barrier” which means two things. One, only 65% of the people who take these types of drugs gain relief from their symptoms and roughly only 65% of symptoms can be relieved in each patient. He looks at 65% as a maximum number.
What are we to do to better this unimpressive result? Can we start to look at a cure instead of a temporary reprieve? This is a tough nut to crack, but here’s what we did with Dudi. First we got him on an exercise regimen in personal training. Although a trainer might not be necessary, we wanted a methodical program where Dudi could advance in all areas of exercise, especially in his strength training. This would help him to 1) activate all the good hormones in his brain to take him out of depression, and 2) build up his self-esteem and self-efficacy and get him to really believe that he could succeed in any area. In 6 weeks there was already an appreciable change. At the same time we worked on appreciation and gratitude and concentrated a lot on helping others, because ultimately that helps ourselves. Once Dudi began focusing on all the good in his life, he started complaining less about his situation. His improved attitude rubbed off on his family as well.
It is true that there are some people who will have to be on medication for the long term, and it can take a while to get off of anxiety and depression medications. Much depends on the extent of the disorder. But instead of only going after the symptoms, just like in a physiological illness, we need to treat the problem and aim to cure it. Dudi will probably have a tendency toward depression for the rest of his life. It seems to have run in his family, but he is now managing his life better and has already cut the dosages of his drugs. He is working hard having the incentive to be rid of his drugs and all the side effects that come with them.
Proper treatment for anxiety and depression with a look towards cure instead of a quick fix can “add hours to your day, days to your year and years to your life.”