Anxiety and Depression

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.

Could childhood trauma cause anxiety as an adult?

DEAR DOCTOR K: I endured some physical and emotional abuse as a child. Could this explain why I struggle with anxiety as an adult?

DEAR READER: Sigmund Freud and many other psychiatrists surely thought so. Indeed, exploring the experiences of childhood is an important part of psychoanalysis. This view did not think that childhood experiences could actually make physical changes in brain chemistry, however. Instead, it imagined an unchanged brain that simply was given unusually difficult experiences to cope with.

How long do I need to take my antidepressant?

DEAR DOCTOR K: I've been on an SSRI antidepressant for a few months, and it has really helped improve my depression. How long do I need to take this medication?

DEAR READER: If you're fortunate enough to find an antidepressant that lifts your dark mood, and you aren't too troubled by its side effects, your doctor likely will renew the prescription indefinitely. As long as you continue taking the medication, you are unlikely to suffer a relapse of your depression. But perhaps you're having bothersome side effects. Selective serotonin reuptake inhibitor (SSRI) drugs, like fluoxetine (Prozac) or sertraline (Zoloft), sometimes cause side effects.

How can I get over my fear of flying?

DEAR DOCTOR K: When I am forced to fly, I sweat and shake and feel like I'm going to faint. I've been avoiding work-related travel, and I'm holding my family back from taking long-distance vacations. What can I do to get over my fear?

DEAR READER: You suffer from a type of anxiety disorder called flight phobia or, in medicalese, "aviophobia." A phobia is an extreme fear of something that poses little or no real danger. Fear of flying, heights, animals, insects and the like are all phobias.

Restore sex drive by changing dose or kind of depression medication.

DEAR DOCTOR K: Last year I started taking an SSRI for depression. It has done wonders for my mood -- but it has really dampened my sex drive. Any suggestions?

DEAR READER: Since depression is so common, and since SSRIs are often used to treat depression, I've known many people who share your problem. Fortunately, there are several options that often help people restore their sexual desire and function. Selective serotonin reuptake inhibitors (SSRIs) are currently the most commonly prescribed antidepressants.

Is it just fear or an actual phobia?

DEAR DOCTOR K: I have a terrible fear of heights, dogs and public speaking. My sister calls them "phobias" and says I should seek help. How do I know if my fears are normal, or if I need treatment?

DEAR READER: We all have things we worry about or are afraid of. And with most of them, we're right to be fearful. But in people with a phobia, the fear is persistent, excessive and unrealistic. As many as one in 10 people suffer from phobias at some time during their lives.

Can depression increase my craving for sweets?

DEAR DOCTOR K: I am a 50-year-old woman with a history of depression. I recently developed an uncontrollable craving for sweets, which has increased my weight. Is it my depression or my medicine?

DEAR READER: You are right to wonder about the cause of your craving. It could be triggered by your depression or by the medicine you are taking to manage it. Or by something else entirely.

Could something other than depression be affecting my mood?

DEAR DOCTOR K: I've been feeling down and moody lately, but nothing out of the ordinary has happened in my life. And I've always been a happy and positive person. Could something other than depression be affecting my mood?

DEAR READER: Depression is a common problem, and it often is not recognized by either the person suffering from it or that person's doctor. In fact, I think undiagnosed and untreated depression is one of the most important health problems in the developed nations. It generates enormous emotional suffering -- on the part of the depressed person, and that person's family, friends and co-workers. It also leads to lost productivity.

Does anxiety medication cause dementia?

DEAR DOCTOR K: I'm an older woman who sometimes takes Valium or Xanax for anxiety or if I'm unable to fall asleep. I recently heard that this type of medication may cause dementia. Should I stop using it?

DEAR READER: Valium and Xanax are benzodiazepines, a type of anti-anxiety drug. Like you, many people take these drugs to calm their nerves or help them sleep. And as you've heard, a recent study raised the possibility that benzodiazepine use may lead to dementia.

Do antidepressants cause weight gain?

DEAR DOCTOR K: My doctor thinks I could benefit from an antidepressant. But I've heard that antidepressants cause weight gain and I'm already overweight. Do any antidepressants cause less weight gain than others?

DEAR READER: Many of my patients have asked me that question. Like you, they were hesitating to take antidepressants because of the possibility they would gain weight. And they're right: Many antidepressants do cause weight gain in some people. The question has been how much weight gain they cause.