Anxiety and Depression are common and treatable. But how do you determine your best treatment for anxiety and depression? It is definitely not a one-size-fits-all kind of thing. And, there is no reliable blood test. (But, there will be one day soon.)
At least initially, anxiety and depression often present as physical ailments rather than as classic mood symptoms. No surprise that many patients turn to their primary care physicians for care. Primary care doctors really do need to be well versed in recognizing how mental health conditions manifest– and in making appropriate treatment recommendations.
Treatment absolutely can improve quality of life. But, success of treatment varies…widely. So does the length of time before you feel better. And, of course, what is helpful for you may not be for your friend.
Let’s talk about the good news and then the less than good news.
The good news in the treatment world for anxiety and depression:
1. Treatment for anxiety and depression can be similar.
Cognitive Behavior Therapy (CBT) is a highly effective therapy for both conditions. CBT has considerable scientific evidence that its methods actually lead to improvement in mood and functioning. Its core principles have to do with changing thinking patterns. CBT tends to be short- to moderate-term. Its focus is on the present.
Psychopharmacology (medication) is another common treatment, and often the same medication (e.g. a Selective Serotonin Reuptake Inhibitor or SSRI, or a Selective Norepinephrine Reuptake Inhibitor or SRNI) is helpful for anxiety and depression. Examples of SSRIs include Prozac, Zoloft, and Paxil. Effexor and Cymbalta are examples of SNRIs.
There are other types of medications to treat depression alone, or anxiety alone.
There is some evidence that combining psychotherapy and medication works best for treatment of depression.
For anxiety disorders, CBT, antidepressant medications and anti-anxiety medications (e.g. Buspar) are helpful. Some research suggests psychotherapy is more effective than medications to treat anxiety, and that adding medications does not significantly improve outcomes from psychotherapy alone.
2. Many people find treatment helpful.
The benefits of therapy vary. For both disorders, CBT is the most effective form of psychotherapy.
The benefit of medication depends on lots of factors. One is the severity of the depression or anxiety. In general, the more severe the symptoms, the more likely the medication will help. In other words, antidepressants are more effective in treating chronic, moderate and severe depression. They don’t help much in mild depression.
Keep in mind…
3. If one treatment does not help, there are many other treatment options.
Lots of research on evidence based treatments is available. We know that sticking with the approach(es) is necessary to evaluate if what you are doing is helpful.
4. Techniques you can do on your own will help.
The kinds of things you can do are helpful throughout life, even when not suffering from anxiety or depression. These include journaling, exercising, meditating, doing yoga, doing a hobby, or playing an instrument.
5. Support groups are helpful, and exist in many local communities as well as nationally. Just make sure the groups are led responsibly by a licensed mental health provider.
The less good news:
- Trial and error are often required to find the best medication for you.
This can be time consuming, especially when you are not feeling yourself. Finding a therapist who is a good fit for you can also be challenging. The ‘chemistry’ and expertise have to feel right. - Insurance companies sometimes encourage medication over psychotherapy.
Why? Because it is less expensive. This may be appropriate at times, but often psychotherapy is clearly indicated.
3. If you’re like many people, and you seek help from your primary care physician for anxiety and depression, know that treating mental health problems in a primary care setting can be less than ideal.
Primary care clinicians have time pressures and lots of conditions that warrant attention in every patient interaction. Their evaluation and treatment of mental health disorders may fall short of the ideal.
As with most health conditions, finding and accessing treatment is not necessarily easy. In the case of feeling anxious and depressed, pursuit of care can be extra difficult.
If you have no improvement after 4-6 weeks of treatment, discuss other options with your provider. Also, be sure to disclose any alcohol or other drug use. Both are linked to anxiety and depression, and are important to mention – especially if you are on medication.
How to determine your best course of action for anxiety and depression is specific to each individual.
In general, concrete steps to consider include:
- Contact therapists and psychopharmacologists who are on your insurance plan. Check out their website. Ask about their services. Consider looking at referral sites for names of providers who may be helpful.
- Consult your PCP for referral to a therapist and/or psychopharmacologist
- Consider using telehealth services if available.
- Read reputable articles to help you assess your symptoms, your needs, and the next best steps FOR YOU.
- Get moving! Whether cardiovascular, or strength training, exercise helps. Make it fun by dancing to music. Taking a Zumba class. Or how about yoga?
Suffering from anxiety and depression is not uncommon, especially in this post-Covid world.
There is no one-size-fits-all recommendation for how to approach treatment, or for which treatment to land on.
The two basic options are therapy and/or medication. For therapy, CBT is the treatment of choice. For meds, the treatment of choice is typically an SSRI. (There are lots of factors that determine specific treatment recommendations.)
CBT is often considered better than medication at preventing relapse. It is tends to be short term, and empowering to the person who learns it. As a psychologist, I love teaching CBT an do have a lot of respect for how helpful anti-depressants can be. If they help, it is because they are remedying a chemical deficit in your brain.
I am a MA licensed psychologist in private practice. If you’re struggling with anxiety and depression, and would like to learn more about working with me, please contact me here.
