Depression and anxiety can impact individuals of any age. People with depression frequently also suffer from anxiety.
The causes of depression and anxiety appear to be complicated. While there may be a biochemical cause, meaning that certain chemicals-neurotransmitters-in the brain may be low, it is not clear if the low level of the neurotransmitter is the primary cause of the depression, or simply a marker for the cause of depression. In addition to biochemical causes, there are also genetic, psychological, emotional, environmental, social, and spiritual factors that influence depression and anxiety.
Depression is the most common psychiatric disorder. It is a disabling condition that adversely affects a person's family, work or school life, sleeping and eating habits, and general health. In the United States, the incidence of depression has increased every year in the past century, and now one out of six people will experience a depressive episode.
Depression is typically characterized by low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Symptoms include:
Some more facts about depression:
Anxiety is a normal reaction to stress , and it can serve as a prompt to deal with difficult situations. However, when anxiety becomes excessive, it may fall under the classification of an anxiety disorder. Almost one out of four people experience an anxiety disorder during their lifetime.
Anxiety disorder is characterized by emotional, physical, and behavioral symptoms that create an unpleasant feeling that is typically described as uneasiness, fear, or worry. The worry is frequently accompanied by physical symptoms, especially fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, and hot flashes.
While generalized anxiety disorder is the most common, there are other anxiety disorders, including obsessive-compulsive disorder, panic disorder, phobias, and post-traumatic stress disorder
Just as no two people are affected the exact same way by depression and anxiety, there is no "one size fits all" treatment. What works for one person might not work for another. The best way to treat depression or anxiety is to become as informed as possible about the treatment options, and then tailor them to meet your needs.
There are many types of therapy available. Three of the more common methods used in depression include cognitive behavioral therapy, interpersonal therapy, and psychodynamic therapy. Often, a blended approach is used.
Some types of therapy teach you practical techniques on how to reframe negative thinking and employ behavioral skills in combating depression and anxiety. Therapy can also help you understand why you feel a certain way, what your triggers are, and what you can do to stay healthy.
Interpersonal and cognitive/behavioral therapies are two of the short-term psychotherapies that research has shown to be helpful for some forms of depression. Interpersonal therapists focus on the patient's disturbed personal relationships that both cause and exacerbate the depression. Cognitive/behavioral therapists help patients change the negative styles of thinking and behaving that are often associated with depression.
People suffering from anxiety disorders often participate in cognitive-behavioral therapy, which focuses on recognizing and changing thought patterns and behaviors that lead to troublesome feelings. This type of therapy helps limit distorted thinking by looking at worries more realistically.
Psychodynamic therapies are sometimes used to treat depression. They focus on resolving the patient's internal psychological conflicts that are typically thought to be rooted in childhood. Long-term psychodynamic therapies are particularly important if there seems to be a lifelong history and pattern of inadequate ways of coping (maladaptive coping mechanisms) in negative or self-injurious behavior.
Medicines used to treat anxiety disorder may be especially helpful for people whose anxiety is interfering with daily functioning. The medications most often used to treat anxiety are:
Dependency on anti-anxiety medications is a potential complication of treatment. Other side effects of medications include sleepiness and sexual problems.
In ECT, an electric current is passed through the brain to produce controlled convulsions (seizures). ECT is useful for certain patients, particularly for those who cannot take or have not responded to a number of antidepressants, have severe depression, and/or are at a high risk for suicide. In many people, ECT relieves depression within one to two weeks after beginning treatments. After ECT, some patients will continue to have maintenance ECT, while others will return to antidepressant medications. In recent years, the technique of ECT has been much improved.
Lifestyle changes are simple but powerful tools in treating depression. Sometimes they might be all you need. Even if you need other treatment as well, lifestyle changes go a long way toward helping lift depression. Lifestyle changes that can treat depression include:
Numerous well-designed studies have found exercise  to be as effective as prescription antidepressants or psychotherapy, which are roughly equivalent to each other in their success rates for treating depression. The bulk of studies evaluating the impact of exercise on anxiety have found an improvement in symptoms with increased physical activity.
Exercise stimulates the body to produce serotonin and endorphins, which are chemicals in the brain (neurotransmitters) that alleviate depression. But that only partially explains the positive impacts of exercise on depression.
Participating in an exercise program can increase self-esteem, self-confidence, and sense of empowerment, as well as improve social connection and enhance relationships . All of these things have a positive impact on a depressed individual.
A number of studies have shown that a diet  high in simple sugars or in caffeine (750 mg daily) is related to increased rates of major depression. In one small study, eliminating refined sugars and caffeine results in improved symptoms of depression within one week. Long-term use of caffeine has been linked with anxiety as well.
Longer term studies in this area are needed, but minimizing refined sugars and caffeine is currently an easy and logical recommendation.
Depressed populations also have more problems with alcohol use. People suffering from depression should stop drinking alcohol. If alcohol abuse underlies the depression, it is critical that it be addressed directly.
Poor sleep has a strong effect on mood. Make getting the amount of sleep you need a priority.
Strong social networks  reduce isolation, a key risk factor for depression. Keep in regular contact with friends and family, or consider joining a class or group. Volunteering is a wonderful way to get social support and help others while also helping yourself.
Make changes in your life to help manage and reduce stress . Too much stress exacerbates depression and puts you at risk for future depression.
A 2001 large survey study of people in the U.S. who considered themselves anxious or depressed, found that more people used complementary and alternative therapies than conventional therapies. In fact, 53.6 percent of respondents suffering from severe depression reported using complementary and alternative medicine for treatment in the 12 months prior to the survey published in the American Journal of Psychiatry.
While people with depression perceive integrative therapies to be as effective as conventional medicine, the existing research literature does not necessarily confirm the effectiveness of integrative interventions. There is a significant lack of large, methodologically rigorous studies on integrative therapies for depression. However, that is not decreasing their popular usage.
Part of the reason people might be attracted to integrative care for depression or anxiety is the holistic perspective found in most integrative approaches. This perspective takes into account the complex nature of depressive disorders and the numerous reasons why people experience them.
While there have not been many well-designed studies looking at relaxation training, meditation , hypnosis or imagery  in the treatment of depression, these practices have been an important part of traditional healing approaches for millennia (e.g. Ayurvedic, Chinese, Tibetan). In addition, hypnosis is used by conventional psychotherapists.
Early studies in yoga , breathwork , stress reduction, and relaxation therapy are promising, but require further investigation. But given that it costs little to learn these practices and there is little risk, they are worth pursuing. Therapists often recognize the importance of simply doing something and creating a sense of control over some aspect of life, and these practices can provide that.
Music therapy involves actively listening to or performing music to promote health and healing. In an early, small study with an older population and depression, music therapy produced a significant positive impact. More and larger studies are needed before recommendations are clear, but given the low cost and risks, this may be a helpful approach for those individuals who have interest in this area.
The uniqueness of each person's biochemical processes is only just beginning to be appreciated. The evolving field of Functional Medicine attempts to take into account both the genetic information and the unique differences that occur in each person's metabolism, including their extra need for certain nutrients.
Current recommendations, as follows, come from a generalized understanding of human brain chemistry, without these individual considerations. Typical doses for each botanical are indicated below. However, you should talk with your healthcare provider before adding botanicals to your health regimen and ask about the right dosage for you.
Naturopathy  includes diet, exercise, natural botanicals and supplements, mind/body practice, hydrotherapy, and other tools. For those preferring natural approaches, treatment with a naturopath can certainly be partnered with psychotherapy of some kind.
Traditional Chinese Medicine practitioners work with an individual to optimize their nutrition, activity, and internal energetic balance, using herbs, acupuncture , movement practices (Qi Gong and Tai Chi), massage (Tui Na ), and other techniques. Acupuncture for mild to moderate depression has been found to be promising in early studies, although larger prospective studies have not been completed.
Homeopathy is another systemic approach used by some individuals in combination with psychotherapy.
When suffering from depression or anxiety, it is critical to have a working relationship with a provider, or team of providers, who can help you navigate through this time. The provider can be a conventional physician, therapist, or other professional who is philosophically aligned with your perspective on your disease.
It is important to try to understand what is causing depression or anxiety. A depression triggered by a major trauma or loss may be a very appropriate response to a situation and should not be suppressed, although the individual may require supportive coaching or therapy to work through the situation. However, these responses should not be prolonged and should be examined after six months. Worry and anxiety can also be triggered by an underlying or unresolved situation or issue and may signal a need to explore where you need to make changes.
Depressions that do not appear to have a "cause" in everyday life may originate from a biochemical imbalance, but may also be part of a larger pattern of imbalance. A combination of self-care practices (e.g. exercise, healthy diet, alcohol abstinence, self-reflection, mind/body skills), psychotherapy of some type, and conventional medical supervision (with optional medication) seems to be the safest and most optimal scenario.
If any oral natural supplements (other than homeopathy) are used in combination with conventional prescription medications, it is critical for both the prescriber and the pharmacist to be aware of the supplements being taken.
If there are any thoughts of or plans for suicide, a conventional therapist, psychiatrist, or physician must be involved immediately, even if that necessitates the use of emergency medicine services. If someone doesn't willingly request help, the family or other supportive members of that person's social sphere may need to intervene and engage services.
The risk for suicide often increases after early improvement induced by either medications or supplements, as the individual finds more energy and a sense of self-control. Support during this time of treatment is critical.
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Hammerly, M. (2001). Depression: The New Integrative Approach : How to Combine the Best of Traditional and Alternative Therapies (New Integrative Approach) . Philip Lief Group
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Institute of Functional Medicine http://www.functionalmedicine.org/ 
National Center for Complimentary and Alternative Medicine - Naturopathy http://nccam.nih.gov/health/naturopathy/ 
Holistic On-line - Depression http://www.holisticonline.com/remedies/Depression/dep_home.htm 
Depression handouts for patients from the University of Wisconsin http://www.fammed.wisc.edu/integrative/modules/depression