Anxiety and Depression

Could antidepressants help improve my thinking skills along with my mood?

DEAR DOCTOR K: I suffer from depression. My doctor told me that depression can cause cognitive impairment. Antidepressants improve my mood -- can they help improve my thinking skills as well?

DEAR READER: Depression is more than long bouts of intense sadness. People who suffer from depression often also experience a loss of energy and interest in things they once enjoyed.

How can I persuade my husband that he could benefit from therapy?

DEAR DOCTOR K: I'm convinced my husband is depressed, but he refuses to seek help. What can I say to convince him that he could benefit from therapy?

DEAR READER: Most men don't like to ask for help or to talk about their feelings. That's not going to be easy for your husband. However, doing nothing could make it harder for him. If he is suffering from depression and doesn't get help, it could threaten everything important in his life, starting with family, friends and work.

Can certain foods help me combat anxiety?

DEAR DOCTOR K: I suffer from anxiety but would rather not take medication. I already exercise and practice relaxation therapy. Could dietary changes help further quell my worries?

DEAR READER: To help answer your question, I turned to my colleague Dr. Uma Naidoo. She is a psychiatrist at Harvard-affiliated Massachusetts General Hospital and a professional chef. She noted that the relationship between food, mood and anxiety is garnering more and more attention.

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.