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A Look at Depression and Anxiety

By: Dr. Brian Byrd


At any given moment, roughly 30% of Americans experience either anxiety or depression. If you are feeling down, disinterested, and you are struggling with concentration, energy, or sleep, you may be experiencing major depressive disorder.


Anxiety generally presents as either Generalized Anxiety Disorder in which the person experiences round the clock worry, or Panic Disorder which has symptoms that come on very quickly, last for seconds to minutes, then recede. Panic can be brought on by fears of public speaking, social events, or can occur without provocation. It is quite disabling.


In particular, depression can worsen other ailments such as heart disease. Depression exists in high rates in people who are hospitalized for heart failure, for example. The message is that we have to take these diagnoses seriously.



Diagnosis

To help with establishing a diagnosis, your physician may ask you to complete a brief questionnaire. Examples are the PHQ-9 for depression and the GAD-7 for anxiety. We offer both in our clinic.


Suffering from one of these ailments should not cause anyone to feel shame. Life is hard. Challenges are bigger than our ability to cope and very quickly any one of us can find ourselves in need of help.


Particularly among men, some of us tend to believe that these kinds of feelings are for sissies. We aspire to the John Wayne toughness believing that anger and toughness are the only acceptable emotions. But that is a mistake.


Men suffer from depression and anxiety just as much as women. The good news is that by talking about it with your physician you can climb out of the darkness that these diseases cause us to feel.

Treatment Treatment begins with what physicians call Cognitive Behavior Therapy (CBT). What is CBT? It helps us name and describe our emotions so that we fear them less and control them more.


Author and researcher Brene Brown has described 87 human emotions and she believes there are more. Healthy people take the time to identify these emotions in themselves.


One great tool for this therapy is an app called WoeBot that I commend to you. Spending just a few minutes everyday with the WoeBot app decreases depression and anxiety.


One of the basic principles of CBT is to do the things we enjoy doing and avoid doing the things we don’t enjoy. Say yes to playing a board game after dinner ( if that is your kind of thing), and say no to commitments that you don’t enjoy but feel pressured to do.


Lastly, a big part of CBT is telling ourselves the truth about our situations. Someone feeling anxiety about an upcoming social event may worsen their anxiety by believing lies such as, “I don’t have much to offer anyone in these settings,” or, “These people are not going to like me.”


When we are feeling this way, Telling Yourself the Truth, a book by William Backus, advises us to speak truth to ourselves: “I have plenty to offer by just being myself. I don’t have to be clever or funny. What these people think about me does not determine my value.”


This “cognitive reframing” of our situation is powerful! It reflects the truth that what happens to us is not as important as what we tell ourselves about what happens to us.



Treatment Continued: Medications Medications can assist in many cases of depression and anxiety though if we are doing the CBT work, we may need medications only temporarily.


Some medications are designed to help someone in the moment of a panic attack. Examples are lorazepam or alprazolam. We don’t like to use these long term because of their addictive potential.


Other meds require us to take one to two tablets everyday for 6 to 9 months. Most of the anti-depressant and anti-anxiety treatments are like this. Examples are Prozac, Lexapro, Effexor, Wellbutrin. Most treat depression and anxiety.


For treatment-resistant situations, I will sometimes prescribe more than one medication. More serious cases require less often used medications and sometimes deep brain stimulation.

Fortunately, the side effect profile for almost all of the medications we prescribe are quite mild. Most people experience no side effects. These treatments typically require at least a month before they reach their full affect.


Lastly, it is important to notify your physician or a loved one if you feel like hurting yourself. We have helped many people in deep despair find hope again. Moving Forward Once you and your physician begin a treatment plan, you will likely schedule a follow-up about a month out and periodically thereafter. Telehealth can work great for these visits.

Once you get used to spending a few minutes with a CBT tool (and/or a once weekly visit to a licensed counselor) you will notice improvement. Stay with it! It will be worth it for you and your loved ones.


Hospital and Imaging Charges If you’ve been hospitalized you’ve seen on your bill what you and your health insurance (or Medicare) were charged for services. Rarely does anyone preview or shop hospitals to see who has the lowest prices for the service they need.


In 2019, the Texas Legislature mandated that hospitals post their procedure charges on their websites, and most hospitals are doing that. But looking up your anticipated procedure and comparing that across the local hospitals is a daunting challenge.


A startup company called Turquoise Health has developed an online tool that will make it all easier. They collect prices from hospitals and imaging centers all over the country so that consumers can compare.


You can do your own search on the Turquoise Health website. Click HERE.



A Pharmacy That Delivers to Your Home

Recently, I was introduced to Alto Pharmacy which delivers medications to patients. If you want that service you can find out more at www.alto.com.


Pharmacy choice belongs to the patient so we prescribe medications to the pharmacy that you select. Sometimes, we miss medication doses because we don’t have a chance to pickup our meds. Alto Pharmacy may be a solution for that problem.


Cancer Screenings Down During the COVID Pandemic

During the prolonged 2020 quarantine a lot of patients were not able to complete their cancer screenings. Examples are mammograms for breast cancer, colonoscopy for colon cancer, and pap smears for cervical cancer.


The long term effect of these misses will be significant. Early colon cancers are small and don’t cause any symptoms, but if we detect them on a colonoscopy, we can snare them and prevent cancer spread.


If, on the other hand, we miss the screening scope, that undetected cancer will grow and spread. By the time we start showing symptoms, we are in trouble. The only options at that point are surgery, chemotherapy and radiation.


We recommend colonoscopy starting age 45, then every ten years, and mammograms annually starting age 40. Schedule a visit to determine if you are due for one of these important screening tests.








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