How Anxiety & Depression Are Similar

Anxiety & Depression Treatment

If you’ve ever experienced anxiety and depression in the clinical sense, you’ll know that they can feel really different. With anxiety, you’re all ramped up…and with depression, you’re very, very down. Yet they tend to go together. And a lot of medications, especially certain types of antidepressants, can be used to treat both. We still don’t know a ton about how exactly anxiety and depression work in the brain or how antidepressants work to treat them. But over time, psychologists have come to realize that the two types of conditions are surprisingly similar. They may feel very different in the moment but they actually have a lot of symptoms in common and involve some very similar thought patterns.

They might even involve similar brain chemistry responses. If you’re looking to understand a little more about how anxiety and depression manifest themselves, whether for yourself or for someone else in your life, those connections are a good place to start. Depression and anxiety aren’t really specific disorders, they’re generic terms for types of disorders. The most common, and most closely linked, are major depressive disorder, or MDD, and generalized anxiety disorder, or GAD. In any given year in the U. S. about 7% of the population will have MDD and about 3% will have GAD. Lots of those people have both: About 2/3 of people with major depression also have some kind of anxiety disorder, and about 2/3 of people with generalized anxiety disorder also have major depression. And whether you have one or the other or both, the same medications are often at the top of the list to help treat it — usually antidepressants.

Unsurprisingly, psychologists have noticed these statistics. For a long time, we’ve thought of generalized anxiety and major depression as very different things and understandably so. Probably the most noticeable symptom of anxiety is arousal, which in psychology is a technical, non-sexual term. It basically just means being on high alert — whether psychologically, with increased awareness, or physically, with things like a racing heart and sweaty palms. Arousal isn’t part of major depression, though. There’s a key symptom of MDD that doesn’t usually show up in generalized anxiety: low positive affect, which is the technical term for not getting much pleasure out of life and feeling lethargic, just kind of … blah.

So there are important differences between anxiety and depression, which is part of why they’re still considered separate classes of disorders. When you look at the other symptoms, you start to realize that major depression and generalized anxiety have almost everything else in common. There’s restlessness, fatigue, irritability, problems with concentration, sleep disturbances … the list goes on. That’s just in the official diagnostic criteria. For decades, psychologists have been examining the models they use to describe anxiety and depression in the brain to see if they point to a similar source for both types of disorders. They’ve come up with lots of different ideas, as researchers do, but the most common ones tend to center around the fight or flight response to stress.

Fight or flight kicks in when you’re confronted with something your mind sees as a threat, and it automatically prepares you to either fight or run away. When you think about it, anxiety and depression are just different types of flight. Psychologists often characterize anxiety as a sense of helplessness, at its core, and depression as a sense of hopelessness. Anxiety might feel like you’re looking for ways to fight back. Part of what makes it a disorder is that it’s not a short-lived feeling that’s easily resolved once you have a plan.

Of course, as with all things mental health, anxiety disorders can be deeply personal and won’t feel the same for everybody. But clinical anxiety does tend to be more pervasive. The worry sticks around and starts to take over your life because it doesn’t feel like something you can conquer. So anxiety and depression might just be slightly different ways of expressing the same flight response: helplessness or hopelessness.  Maybe that’s part of why they so often go together.

This connection also shows up on the biochemical side of the stress response. There are a lot of hormones involved in this response, and their effects interact in super-complex ways that scientists still don’t fully understand. Both depressive and panic disorders are closely associated with an oversensitive stress response system. Researchers think that’s one reason both of these types of disorders are so much more common in people who’ve experienced major stresses like trauma or childhood abuse. Those stressors could make their stress response system more sensitive. The main hormones involved aren’t always the same, but the changes can cause some ofthe same symptoms — problems with sleep, for example. So anxiety and depression seem to be two sides of a similar reaction to stress, in terms of both thought processes and hormones.

This doesn’t really explain why some anti-depressants can treat both disorders. These medications primarily affect neurotransmitters, the molecules your brain cells use to send messages to each other. If you thought we had a lot left to learn about how the stress response works, we know even less about what the brain chemistry of anxiety and depression looks like, or how antidepressants help. However, if the thought processes and physical responses that go along with these disorders aren’t quite as different as they seem on the surface, it makes sense that the brain chemistry would be similar, too. And that’s exactly what scientists have found.

Several studies have pointed to lower levels of the neurotransmitter known as serotonin as a major factor in both anxiety and depression. Researchers have even identified some more specific cellular receptors that seem to be involved in both. There’s also some evidence that the way the brain handles another neurotransmitter, norepinephrine, can be similar in both anxiety and depression. Since most antidepressants work by increasing serotonin levels, and some of them also affect norepinephrine, that could explain why they’re so helpful for both anxiety and depression.  Although again, there’s a lot we don’t know about their exact mechanism of action.

Ultimately, there’s no denying that in the moment, anxiety and depression can seem like very different feelings. If someone has both types of disorders, it’s easy to see how that could feel overwhelming. It’s hard enough treating generalized anxiety or major depression on their own. It is also true that it is often harder to treat these conditions when someone has both. Perhaps though, not twice as hard. After all, anxiety and depressive disorders have a lot in common, from their symptoms to the basic brain chemistry behind them, to some of the treatments that can help. The fact that they often go together can be really tough. Understanding more about why this is has also pointed us toward better treatments and more effective therapies which really can help.

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Anhedonia: Not Feeling Pleasure In Sobriety


One of the major reasons why people relapse, especially in early recovery, is due to anhedonia and therefore a subsequent lack of knowledge of this issue . The best way to describe anhedonia is a state of ‘blah’.  A current dissatisfaction with sobriety or somebody’s current reality.  Anhedonia consists of two primary factors: The first is biochemical and the second is psychological.

First let’s focus on the biochemical.  When somebody ingest drugs or alcohol they release dopamine into the brain and this continues over a period of time, for years sometimes, and every time they put a drug in their body dopamine is released in the brain. What eventually happens is the brain says, ‘that’s it I’m done, I don’t need to produce this naturally any more’. Now dopamine is responsible for a lot of things, it’s responsible for a reward that keeps us safe and alive and keeps us moving forward as individuals. If we don’t have dopamine or a natural production of dopamine, we’re gonna feel that ‘blah’ feeling.

When somebody enters a recovery center or any kind of treatment environment and they are no longer having a chemically altered amount of dopamine going off in their brain throughout the day, whenever they put the drug in their body, what will happen is as they go through everyday activities during that initial phase of sobriety they’re not going to feel very good.  They’re not going to feel that reward.  That’s the biochemical reason of why somebody’s going to feel anhedonia.  The second thing to discuss when really understanding anhedonia is the psychological effects that somebody’s going to be experiencing while in early sobriety.

To really understand, let’s take a look at somebody while in active addiction. This is usually a pretty exciting lifestyle, now it’s negative excitement a majority of the time, but excitement nonetheless.  This is somebody who might be participating in illegal activity, somebody who’s probably putting themselves in pretty dangerous situations.  They may be dealing with some pretty shady people or running from the police or maybe even just the excitement provided from being dishonest to the people around them, trying to hide their stash or just get away with the substance use or anything involved in the substance use.

One thing all of these types of behaviors do is get the heart beating and it can start to produce adrenaline, all of these behaviors will create excitement.  But what about that individual when they decide to go into treatment? They’re not going to be receiving that same kind of excitement and what this can do is lead to a comparison: ‘I understand those were negative behaviors but the way I interpreted it while in active addiction was, ‘that was very exciting!  Now that I’m in treatment, I have a schedule, I have a routine, and I’m not receiving that same kind of adrenaline pumping excitement that I’m used to.’

This can often lead to other psychological set-up behaviors.  A person may now awful-ize sobriety or even romanticize past using. So, with both the biochemical and the psychological effects, somebody can have anhedonia.  Anhedonia can be consistent during somebody’s recovery process, at least the initial phase, it can also spike during different months of their process.  It can get elevated during activities that maybe somebody has formerly had a relationship with. 

If somebody grew up surfing and they loved surfing, every time they go out surfing they get that dopamine reward — if that same individual later on in life, decides to get sober and they go out surfing, there’s a good chance they’re not going to get the same reward they used to. That dopamine deficit can easily lead somebody to ‘awful-ize’ their sobriety or even hyper-focus on things from their past that would produce that dopamine, like substance abuse.

Here we see where a lot of people tend to relapse.  You may have someone in treatment waking up at the crack of dawn, going out to the ocean and experiencing that joy, that excitement, getting the heart beating, getting the adrenaline going as they’re out there, they’re riding the waves, etc.  Now they’re doing this sobriety thing  and it’s a structured, controlled environment but they’re still creating a new relationship with that excitement. For a lot of people who were bad addicts and may still very much crave drugs, they then go from the beach, then they’re going to the gym, and they’re participating in intense workouts. So when they’re doing that, it’s going to kickstart that natural dopamine production.

In treatment, we have the ability to assist somebody through that initial phase in this way, without the use of any kind of medications, at least anything that’s actually gonna do more harm than good. Ultimately what’s going to happen is, we can help somebody get through that initial physical phase of anhedonia. Then on the clinical side, someone in treatment is going to come into the office or group and they’re going to get lessons from clinical staff or peers and they’re going to learn about things like anhedonia. They’re going to learn in real time how to use coping skills.

All of this works together well, but anhedonia is gonna act as a one-two punch as far as the biochemical factors and the psychological factors.  We use the same kind of recipe combating it: address the physical and the psychological aspects.  The problem often seen however, is people making permanent or life-threatening decisions based on temporary uncomfortability or boredom, and that’s why people will relapse from anhedonia.  From this prospective, it becomes necessary for the addict to enter an environment where they’re given the opportunity to promote brain healing, along with gaining the knowledge of why they’re acting or feeling a certain way, which can set somebody up with an ability to maintain long-term, sustainable sobriety.

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Fentanyl Facts

fentanyl treatment

Fentanyl is a synthetic opioid painkiller.  It’s one of the most potent narcotics on the market and highly addictive. The fast-acting painkiller is prescribed for severe and chronic pain.  Prescription Fentanyl comes in the form of tablets, a nasal spray and lozenges.

The most popular form of Fentanyl is a patch that releases the drug slowly over three days. These patches can be abused by scraping out the gel contents and eating or smoking the entire dose all at once to get high.  Fentanyl’s potency is so deadly, it can be up to 100 times more toxic than the same amount of morphine and up to 50 times more toxic than heroin.

As little as 2 mg of powdered Fentanyl can cause an overdose and death. That’s about the same amount as two grains of salt. This highly dangerous chemical owes its rise to the legacy of Oxycontin. The popular brand-name prescription painkiller was taken off the market in 2012 after reports of addiction and overdoses exploded.  According to police, it’s the rise of illicit Fentanyl, often manufactured by chemists in China and processed by dealers for street sale in Canada, that is increasingly leading to overdose deaths.

As illicit production of this drug is swiftly taking the place of Oxycontin, it is often cut into other drugs like heroin or pressed into fake oxy tablets. When it’s cut into other drugs, it’s easy to get the dosages wrong. Imagine a batch of cookies with an uneven number of chocolate chips in one cookie, versus the rest. Sometimes the Fentanyl is mixed into other drugs secretly to make them more powerful which also significantly raises the risk of overdose or death.

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Signs of Bipolar Disorder

bipolar treatment

Bipolar disorder is a serious condition where a person’s mood can swing from feeling veryhappy or “up” to very sad and “down.” The “up” mood is known as a manic episode and the “down” mood is called a depressive episode. The fluctuation between the two of these moods can cause a child to be hyper productive one moment and show signs of depression the next. While it can be diagnosed in children, it is usually developed later during the teen years or early adulthood.

Bipolar usually lasts a lifetime. There is no known cause for bipolar disorder. Children with bipolar disorder can also have other problems including: substance abuse problems, ADHD and Anxiety disorders.  Suicidal thoughts can also be a problem.

Only a professional therapist or physican can officially diagnose bipolar disorder. However, here are some signs: Severe temper outbursts that are verbal, or aggressive behavior toward others and things. The temper outbursts occur three or more times a week and are inconsistent with a child or teens age. Irritable mood that changes without warning. Extreme sadness or lack of interest in things. Rapidly changing moods that can last for long periods of time. Rage. Hyperactivity, agitation, and distractibility. Sleep problems. Impaired judgment, impulsivity, racing thoughts, and pressure to keep talking. Poor decision making skills and impaired judgment with reckless behavior. Possible promiscuous behavior may be a signal as well.

In the event the preceeding symptoms should be observed in a child or teen, a medical professional should be consulted. They will be able to assess whether these symptoms are possibly due to a different cause. Remember, children are still growing and developing and this may cause some of these symptoms. It’s also important to understand there are different kinds of bipolar.  A medical professional will help determine what treatment would be best suited. Treatment for bipolar disorder can be done with medicine and therapy.  Usually a skills based approach with the parent and child will be helpful as well.

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Exercise and the Brain

Exercise treat addiction

Apart from fitness, physical exercise also has beneficial effects on the brain. A regular routine of aerobic exercise can improve memory, thinking, skills, moods and have protective effects against aging, injuries and neurodegenerative disorders. It is noteworthy that these effects are specific to aerobic exercise, the kind of exercise that accelerates heart and respiratory rate such as running, cycling, swimming, etc. Non aerobic activities such as stretching or muscle building do not have the same effect.

The positive effects of aerobic excercise appear to result from increased blood flow to the brain and subsequent increase in energy metabolism. It is worth noting that a certain degree of intensity in these activities is required to achieve the beneficial outcomes described. Aerobic exercise increases the production of several growth factors of the nervous tissue known as neurotrophins. Among these are BDNF, for brain-derived neurotrophic factor. BDNF exerts a protective effect on existing neurons and stimulates formation of new neurons from neural stem cells in a process called neurogenesis.

BDNF appears to coordinate its action with at least two other growth factors: insulin-like growth factor or IGF and vascular endothelial growth factor or EGF. EGF levels also increase following aerobic exercise, BDNF then interacts with IGF to induce neurogenesis while EGF stimulates growth of new blood vessels, a process known as angiogenesis. Together these processes improve survival of existing neurons produce new brain tissue and constitute the brain’s enhanced plasticity.

These factors underlie the exercise-induced protective effect against degenerative diseases and injuries. Changes in BDNF levels ar eobserved throughout the brain but are most remarkable in the hippocampus, the area that is responsible for memory retention and learning. In fact, regular exercise has been shown to increase the size of the hippocampus and improve cognitive functions, while even a single workout can produce significant changes in BDNF levels and subsequent improvements in learning performance.

A regular exercise program progressively increases BDNF baseline level and makes it respond steadier over time. However, it also appears that some cognitive functions are enhanced immediately after a single workout, while others only improve following a consistent exercise routine. A single aerobic session can promote positive emotions, suppress negative feelings, reduce the body’s response to stress and sometimes, after intense exercise, induce a euphoric state known as runner’s high.

These effects may persist for up to 24 hours and are thought to result from exercise induced up-regulation of several neurotransmitters involved in mood modulation these include dopamine, a neurotransmitter of the brain reward pathways, as well as serotonin, commonly known as the substance of well-being and happiness, whose low levels in the brain have been associated with depressive disorders. Also, the consequent production/release of beta endorphin or endogenous morphine, an endogenous opioid which is related to psychoactive chemicals involved in pain modulation, stress and anxiety reduction may be helpful for those who suffer from accompanying disorders.

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How PTSD and Substance Abuse are Connected

Addiction Trauma PTSD

Traumatic events can leave a person feeling unstable long after the event has passed. Sometimes trauma can cause post-traumatic stress disorder or PTSD.  PTSD occurs when trauma and associated feelings are not resolved. Symptoms of PTSD include sleep disturbance, nightmares, flashbacks, anxiety and depression, excessive fears, impulsivity and addictive behaviors. People with unresolved trauma often turn to alcohol and other drugs as a means to self-medicate. While this may alleviate their stress temporarily, it is never a long-term solution and eventually substance abuse becomes yet another source of pain and trouble for an already suffering person.

Poor lifestyle choices can also put a substance abuser at greater risk for re-traumatization or PTSD.  Impaired driving, being in dangerous situations to get drugs or alcohol and drugs effects on a person’s judgment or alertness can lead to an increased risk of re-experiencing traumatic events. Whatever the cause for the correlation, the fact is that people suffering addiction very often have the additional problem of unresolved trauma. In these cases it is always best to treat the drug and alcohol addiction first but not to stop there.

The trauma survivor may work very hard to get and stay sober only to find other compulsions replacing drugs and alcohol, but once recovery from addiction is underway a person suffering from unresolved trauma will benefit greatly from trauma-focused therapies like PTSD intervention, body psychotherapy, which targets physiological responses, art and equine therapy or medications for depression and anxiety.

A licensed therapist can help find the best treatment plan for each individual. The bottom line is that resolving past trauma may require professional help but it is essential to living a truly healthy and gratifying sober life. For more information or to get help, contact Oceanside Malibu.