Do I Have Depression, Anxiety, or Both?

Anxiety and depression are two common mental health disorders that often occur comorbidly. Some estimate that 60% of those with anxiety also display symptoms of depression, and the numbers are about the same for those with depression symptoms struggling with anxiety.

Researchers have a couple of theories to explain the relationship. The first is that the two conditions have similar biological mechanisms in the brain, so they’re more prone to develop together. The second is that they have many similar symptoms, so patients often meet the criteria for both diagnoses.

At the offices of Dr. Michael Kullman, in White Plains and Pleasant Valley, New York, the team diagnoses and treats both anxiety and depression using an up-and-coming treatment option — ketamine. Here’s what you need to know about the two conditions and how we can help treat them.

What is anxiety?

Anxiety developed as a means of dealing with threats, usually in the environment. It ramped up its “danger” message whenever a person encountered threatening plants and animals, leading to the fight-or-flight response necessary for survival.

Today, we don’t have lions at the door, but anxiety is still a useful emotion, protecting us from modern threats such as speeding cars or muggers on the street. But anxiety is good only up to a point, because consistently high levels of threat hormones such as cortisol can damage bodily systems, to say nothing of making you constantly fearful of non-threatening things.

There are many types of anxiety and anxiety disorders, but most share many of the same symptoms, including:

Elevated heart rate
Rapid breathing
Difficulty concentrating
Restlessness
Sweating
Heart palpitations
Nightmares
Insomnia
Lack of engagement in routine activities
Avoidance of trigger situations
Complete withdrawal from social interaction

If you experience any of these, you need to seek medical help.

What is depression?

Depression is a mood disorder defined by a persistent feeling of sadness, hopelessness, and loss of interest in normal activities. Don’t confuse it with “the blues,” which are temporary mood fluctuations that most people experience as a normal part of life.

Depression is the leading cause of disability worldwide, affecting an estimated 3.8% of the global population. As with anxiety, symptoms of depression vary from one person to another and may include:

Blue mood
Decreased interest in social interactions
Loss of libido
Changes in appetite
Weight loss or gain
Sleeping too much or too little
Overwhelming fatigue
Feelings of worthlessness, hopelessness, or guilt
Difficulty thinking, focusing, or making decisions
Recurrent thoughts of death or suicide
Suicide attempt

Irritability, anxiety, mood swings, and dwelling on negative thoughts tend to occur more often in women. Closely related conditions that only appear in women are premenstrual dysphoric disorder and postpartum depression.

To be diagnosed with depression, you need to experience a depressed mood for at least two weeks.

Treating anxiety and depression

There are two main treatments for anxiety and depressive disorders: some form of psychotherapy (talk therapy) and medications. Most people benefit from a combination of the two.

Cognitive behavioral therapy is the gold standard in psychotherapy. It teaches you to think about your anxiety and depression in new ways, helping you work more effectively through specific symptoms. It also gradually exposes you to your triggers, so you can build the skills necessary to encounter a trigger without the usual panicked response.

Which medication we prescribe depends on the type of disorder you have and whether it’s accompanied by other mental or physical health issues. The problem with medications, though, is that they come with side effects such as:

Nausea, vomiting, or diarrhea
Headache
Drowsiness
Dry mouth
Insomnia
Agitation

To make matters worse, about 30-40% of people don’t respond to these first-line treatments or have too many side effects to continue. In addition, it can take four to six weeks each to determine if the medication is effective, and it’s pretty much a trial-and-error process. That’s where ketamine comes in.

How ketamine works

Most antidepressants target the monoamine neurotransmitters such as serotonin and norepinephrine. Ketamine, though, affects glutamate, the brain's most common excitatory neurotransmitter. It regulates the brain's processing of emotions, thoughts, and neuroplasticity (building neural connections). It handles a lot of how a person learns, remembers, and responds to experiences.

Glutamate produces and balances GABA, a calming neurotransmitter. It’s known that depleted glutamate and GABA can result in mood disorders, so ketamine increases glutamate levels and the number of its receptors to restore normal levels of both.

Once you’re back at normal levels, ketamine helps form new neural connections, resetting the brain and your mood. And best of all? It only takes 24 hours to do the work.

If you’re experiencing symptoms of anxiety and/or depression, Dr. Kullman and his team can help you get back to being yourself again. Call the office at 914-465-2882 to schedule a consultation, or visit our website for more options.