Anxiety & Depression
Symptoms of Anxiety & Depression
Anxiety may have psychological symptoms such as: fearful
anticipation, irritability, a feeling of restlessness, sensitivity to
noise, repetitive worrying thoughts, difficulty in concentration and
poor memory. Physical symptoms may involve: breathing difficulties with
difficulty in inhaling, a feeling of constriction in the chest and over
breathing which can lead to a feeling of weakness, faintness, numbness,
tinnitus, tingling in the hands, feet and face, headache and spasms;
palpitations and awareness of missed heart beats; dry mouth, wind, swallowing
difficulty, abdominal discomfort, frequent or loose motions; frequency
or urgency of the bladder, menstrual discomfort, erection problems and
lack of libido; tinnitus, dizziness, prickling sensations, blurring of
vision; aching and stiffness – especially in the shoulders and
back, trembling hands – impairs fine movements, headache; sleep
disturbance.
Depression is associated with sleep disturbance, characteristically
causing waking 2 – 3 hours early and sleep is unrefreshing. The
patient may lay awake with depressive thoughts. There may be difficulty
in getting off to sleep or even excessive sleepiness during the day but
no feeling of refreshment from sleep at night. Appetite may be
poor or, occasionally increased. Similarly weight loss can be a feature
but also weight gain. The patient slows down generally but can also be
agitated. Mood is typically worse in the morning but can also be worse
in the evening. There may be loss of interest in work and pleasure
activities, loss of energy and fatigue as well as loss of libido. There
may also be constipation and lack of periods. Appearance may show a lack
of care in dress and hygiene with reduced rate of blinking, reduced gestures
with bent shoulders and head leaning forwards. Some people may smile
on the outside but be unhappy on the inside. Speech may be minimal with
hesitancy in response to questions. The mood may be miserable, unreactive
and associated with anxiety and irritability. There may be morbid thoughts,
dwelling on past events, guilt and self-blame. There may be a feeling
of failure, lack of confidence and hopelessness about the future. Life
may seem not worth living with suicidal thoughts. In severe cases there
may be psychotic features such as delusions or hallucinations. Attention
and memory may be impaired. There may also be physical symptoms such
as generalised aching and complaints about pre-existing disorders. Other
features may include phobias, obsessional or hysterical symptoms, hypochondriasis
and depersonalisation.
Some people have bipolar disorder (formerly known as manic depression) where
the above symptoms may alternate with hypomanic symptoms such as reduced sleep
without fatigue, increased activity generally, increased appetite with weight
loss and the patient is generally “speeded up”. There may be increased
energy without fatigue, increased libido and uninhibited behaviour generally.
Clothing may be bright and inappropriate. Risk taking behaviour and excessive
activity may predominate with socially indiscrete behaviour.
Diagnosis of Anxiety & Depression
Anxiety must be differentiated from ‘organic’ (having
an underlying physical cause) conditions that are associated with anxiety
symptoms. These include presenile and senile dementia, alcohol and drug
abuse, overactivity of the thyroid gland, tumour of the adrenal gland
(incredibly rare) and low blood sugar associated with overtreated diabetes
or food intolerance. Other, more severe psychiatric illnesses can also
be associated with anxiety symptoms and include depression and schizophrenia.
Usually a careful history and blood tests will exclude these conditions.
Depression can be associated with conditions associated
with low energy states such as underactivity of the thyroid gland,
Cushing’s disease, chronic fatigue states and diabetes, dementia,
syphilis, brain tumour and drug abuse. Diagnosis is made from the history
and other conditions can be excluded by suitable blood tests or brain
scans.
