By – Chitraj Singh

Depression and Anxiety are not life sentences

“We all get depressed and anxious. But we move on.” I have lost count of the number of times I have heard that from someone, especially when I introduce MindHug. They are wrong but they are also not. Language can be so unsympathetic when it comes to mental health. The historic hushed tones and stigma related to mental illness have meant that not many have felt the need to correct the euphemisms that are depression, anxiety, and mood disorders. We all know what it means to have a heart attack cause we have all had heartburn at some point. Ridiculous!? I rest my case. While I do not necessarily agree fully with the used terminology, for the sake of simplicity, I shall use it in this article.

The question is how do you make people understand something that is often beyond description? Symptoms of clinical depression, depressive disorders, and anxiety disorders rely on language. And we know how incomplete language is, particularly to describe unrest related to moods and emotions. To people who find it hard to grasp, I lend that paralysis is incapacitation, often with a healthy mind. Depression and anxiety disorders are incapacitation with an often healthy body. Simple tasks can become a chore, people are deprived of the ability to feel or control emotions, cognitive functioning is compromised, thoughts can become disruptively intrusive, relationships become hard to maintain, and individuals lose pleasure in activities that most people take for granted. Daily life and everyday activities for someone impacted are considerably harder than for someone who is not. While Depression and Anxiety Disorders are distinct from each other, I use them both here given the extent of their comorbidity — 65% by some estimates (Groen et al, 2020). Someone with paralysis cannot just snap out of it, neither can people with depression and anxiety disorders.

But people may not be wrong about the fact that depression and anxiety disorders can get better and an individual can move on to a fulfilling life, often with a better understanding of themselves and the world around them. A “cure” has generally tended to mean getting back to a state prior to an illness. Because people with depression and anxiety can come out of it, discovering a way of life that is in many ways preferable to their previous state, “cure” is perhaps not an entirely accurate word to use. The important point is to not lose hope. It gets better. I am living proof of this.

Mental Illnesses are medical conditions and need to be treated as such. For the individual in the midst of crisis, it is often difficult to understand this because the mind is what can rationalise this, and it is the mind that is compromised.

Having been through psychosis, depression, anxiety, and obsessive tendencies, I remember in the midst of crisis, how I could not see a light at the end of the tunnel. But in retrospect, that’s because I was in the middle of a 100-mile tunnel in the dark of night!

There are some great doctors, psychiatrists, psychologists, and mental health professionals. Medicines, therapies, and treatments may take time and experimentation but they do work. Psychiatry and Psychology are finally beginning to get the respect that they have always deserved. Medical research is also progressing at an unprecedented rate. There is better research being carried out, increased funding, and new and improved treatments for depression and anxiety emerging.

Having said that, it is true that we are just scratching the surface and have a lot of ground to make up. While the brain is a biological organ, it also has a significant role to play in our psychological and social makeup, including how we have responded to circumstances and trauma in our lives. Mental health conditions are therefore often a complex interplay between biological, chemical, psychological, and social factors, that vary from person to person.

Unlike many other biological illnesses, this makes a one size fits all approach to the treatment of mental disorders more challenging. This is precisely the reason why the road to recovery and treatment for depression and treatment for anxiety disorders can sometimes take longer than for other medical conditions. It takes time to find the medication, treatment, and/or therapy that works for a particular individual. It then takes to time for them to feel better. It certainly did in my case.

To illustrate this point, Selective Serotonin Reuptake Inhibitors (SSRIs), counselling and Talk therapy — Cognitive Behavioural Therapy (CBT) in particular — are considered the “gold standards” in the treatment of depression. Similarly, Anxiolytics and CBT are used to treat anxiety disorders. However, there is research to indicate that up to 33% of individuals may not respond to CBT and/or medication, at least immediately. Some people will respond to certain types of antidepressants while others will respond to different types. It’s easy to understand this when you realise that the chemical makeup of my brain is different from someone else’s, and hence the chemical(s) making up a particular antidepressant will react and influence the chemical, serotonin, in my brain differently than someone else. It is precisely why some people have allergies and side effects while others do not. Similarly, given my unique psychological and social makeup, I am likely to respond differently to CBT and/or forms of psychotherapy than to someone else.

There are strides being made in using biological and genetic markers to try and determine what medications, mental health treatments, and therapies are likely to have the greatest effect on an individual with a mental health condition. At MindHug, we are exploring Ethical Artificial Intelligence (AI) to help individuals discover what treatment works for them. However, largely, the process still relies on trial and error under the supervision of a trained health care provider.

It can therefore be helpful for an individual to work with a Doctor, Psychiatrist and/or healthcare professional to find an effective treatment for them. There is also now a greater push by the NHS (in the UK) and other medical professionals globally towards the use of a wider range of evidence-based clinical therapies. These could include Art Therapy, Music Therapy, and Animal Assisted therapy. These are able to cater to a wider range of psychological and social profiles. Hence our focus on these therapies at MindHug. In addition, there is also promising evidence around the use of mindfulness meditation, yoga, breathwork, and relaxation techniques in managing symptoms of depression and anxiety, and are therefore treatments we also offer at MindHug.

To some extent, the choice of treatment will also be determined by the severity/types of depression and anxiety individuals face, the duration of an episode, and/or if an episode is a relapse. For example, someone with mild to moderate depression and/or anxiety may not need antidepressants and/or anxiolytics to the extent that someone with Recurrent or Major Depression or a more severe form of anxiety disorder including severe Post Traumatic Stress Disorder (PTSD) and/or Obsessive Compulsive Disorder (OCD). Given the prevalence of co-morbidity of depression and anxiety disorders with bipolar disorder and psychotic disorders (including schizophrenia), an individual may also require treatment of those other conditions, including with the use of prescription medication such as antipsychotics.

The important thing for any individual suffering is to reach out to their GP, psychiatrist, and someone they trust. It is important to access the support that is becoming increasingly available. It is a sign of strength to reach out. Just remember that anyone would want a friend, family, or loved one to reach out if they were going through a difficult time.

Baby steps add up. Making small goals, simple goals, like making the bed or spending time with friends and family can go a long way. Get the right sleep and eat right. Avoid alcohol and recreational drugs as these are high risk factors and can make anxiety and depression worse. The brain is an organ in the body, so there is a link between the mind and the body. Thus focussing on a healthy body through exercise and nutrition can have a knock-on impact on the mind. Engage with one’s healthcare team and loved ones. Most of all make self-care a priority. Being kind to oneself and others through practicing compassion and forgiveness can have enormous benefits for an individual’s mental health. And know that “you are not Depression” and “you are not Anxiety”.

It is also useful to remember that recovery from mental health issues is not linear. There will be good days and weeks followed by blips. Journaling on good days can help remind individuals that things do get better. Over time, the good days and weeks will get longer. While it can indeed get demotivating when symptoms of depression and symptoms of anxiety continue to impact the quality of life, it is useful to know that things will get better. There is an abundance of examples to demonstrate that with the right support and tools, management of depression and anxiety is achievable.

If you are currently going through a mental wellbeing struggle, know you are not alone. The journey may seem long and difficult, but you can conquer it and it will be worth it in the end.

Sending you a MindHug!

References:

Groen, R.N., Ryan, O., Wigman, J.T.W. et al. Comorbidity between depression and anxiety: assessing the role of bridge mental states in dynamic psychological networks. BMC Med 18, 308 (2020). https://doi.org/10.1186/s12916-020-01738-z

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