Anxiety and Depression

Should I be worried about side effects from long-term use of SSRIs?

DEAR DOCTOR K: I'm nearing 60, and I've been on SSRI medicines for nearly 30 years, for depression. They work for me, but should I be worried about side effects from using them for so long?

DEAR READER: You've asked an important question -- one that should be asked of any medicine used for many months or years. All medicines can have side effects, and SSRIs are no exception. And some medicines can have side effects that become apparent only after long-term use.

Are heart palpitations dangerous?

DEAR DOCTOR K: I often experience heart palpitations -- almost every time I'm excited, angry or scared. Is this dangerous to my health?

DEAR READER: The word "palpitations" is used differently by different people. To me, palpitations are simply an awareness of your heart beating. People aren't usually aware of their heart beating. But when it beats unusually forcefully, irregularly or rapidly, you notice the heartbeat.

Is it safe to take an antidepressant during pregnancy?

DEAR DOCTOR K: I have been on SSRI medicines for depression for five years. I'm trying to get pregnant, and I hear that SSRIs might be dangerous. What do I need to know?

DEAR READER: I love to receive questions that I can answer confidently. Yours is not one of them. The evidence from different studies is conflicting. Here's my best attempt to weigh the risks against the benefits.

Could I have PTSD?

DEAR DOCTOR K: Last year, a truck ran a red light, totaled my car and nearly totaled me. I spent several weeks in the hospital. Since then my body has healed, but I'm not myself. I'm very irritable, easily angered and sleeping poorly. A friend says I have PTSD, but I thought that occurred to people -- soldiers, for instance -- exposed to repeated threats.

DEAR READER: Your friend is astute. Post-traumatic stress disorder -- PTSD -- is a condition in which distressing symptoms occur after a major trauma. While the media often talk about PTSD in soldiers who have seen active combat, you don't have to be in battle to get PTSD. A single horrible event, like a bad auto accident, can surely do it.

Is online cognitive behavioral therapy effective?

DEAR DOCTOR K: I've been looking into cognitive behavioral therapy to help with my anxiety. It would be convenient to do this therapy from home and, surprisingly, there seem to be many online CBT options. But would the therapy be less effective if I didn't have a personal connection with an actual therapist?

DEAR READER: Cognitive behavioral therapy (CBT) attempts to correct ingrained patterns of negative thoughts and behaviors. It's an effective treatment for depression, anxiety and other behavioral health problems. It also is widely used to help people with chronic diseases cope with that burden.

What is body dysmorphic disorder?

DEAR DOCTOR K: The doctor says my 14-year-old daughter has something called "body dysmorphic disorder." What is it, and can it be treated?

DEAR READER: I've had questions about this condition before and have consulted with my colleague Dr. Michael Miller, assistant professor of psychiatry at Harvard Medical School.

What is cognitive restructuring?

DEAR DOCTOR K: In your column you've mentioned something called cognitive restructuring. Can you explain this in more detail?

DEAR READER: Cognitive restructuring is one part of cognitive behavioral therapy (CBT), a type of "talk therapy" that attempts to correct ingrained patterns of negative thoughts and behaviors. CBT is the leading therapy for anxiety. It is also used to treat stress, depression, eating disorders and many other problems.

Is it possible to treat depression caused by a stroke?

DEAR DOCTOR K: My mother had a stroke that weakened one side of her body. But the bigger problem right now is her depression. Can that be treated, or is it caused by irreversible brain damage from the stroke?

DEAR READER: Strokes can cause significant problems. People can have difficulty moving (like your mother). They can have trouble speaking or understanding speech. They can have trouble thinking. Being suddenly hit with any or all of those losses would depress anyone -- including people who never suffered from depression before.

What is the treatment for social phobia?

DEAR DOCTOR K: I've always thought of myself as shy. But my partner thinks I may have social phobia. Could he be right?

DEAR READER: "Social phobia" goes well beyond shyness. People with social phobia feel a constant and powerful discomfort, self-consciousness and fear of humiliation in ordinary social situations. They feel as though all eyes are turned on them. Social phobia often leads people to avoid parties and other gatherings.

Is dysthymia a form of depression?

DEAR DOCTOR K: My doctor says I suffer from "dysthymia." A friend says this is just a nice word for depression. What is dysthymia?

DEAR READER: Dysthymia is a type of depression. Periods of dysthymia tend to last longer than periods of depression. In fact, many people with dysthymia describe having been depressed as long as they can remember. Dysthymia typically is less severe than major depression; however, people with dysthymia are more likely to develop major depression in the future. Dysthymia is not quite as common as full-blown depression. During the course of a year, about two people out of every 100 will suffer from dysthymia. It is about twice as common in women as in men.