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Anxiety
adapted from: http://www.guardian.co.uk/lifeandstyle/besttreatments/anxiety What is it? Everyone gets anxious from time to time. But if you worry so much that it stops you getting on with life, you may have an illness called generalised anxiety disorder. We are calling it anxiety disorder for short. We've brought together the best research about anxiety disorder and weighed up the evidence about how to treat it. You can use our information to talk to your doctor and decide which treatments are best for you. What are the symptoms?
If you have anxiety disorder, the main symptom is that you worry all the time. This worry stops you doing what you want and can make your life miserable. Doctors call this illness generalised anxiety disorder. We'll call it anxiety disorder for short. There are differences between normal, everyday worrying and the sort of worrying that happens with anxiety disorder. In anxiety disorder:
Worrying too much in this way can stop you getting on with your life and daily activities. Perhaps you're too anxious to drive, or you worry about getting lost if you do. Maybe you don't apply for a job because you don't think you're good enough to get it. Or you won't go out because you're afraid something might happen to your home. Other symptoms If you have anxiety disorder, you will also have at least three of these other symptoms.
Physical symptoms Anxiety disorder can cause physical symptoms. These symptoms can be very frightening, and people with anxiety disorder often think they have a physical illness. You may see several doctors and have many tests to try to find out what's wrong. About half the people with anxiety disorder have been to see a doctor who specialises in heart problems. Here are some of the physical symptoms people get:
These symptoms all happen because of the way your autonomic nervous system is working. This network of nerves controls automatic activities in your body, such as your heart rate and breathing. For example, it makes your skin produce sweat in hot weather, your heart beat faster when you run, and your mouth release saliva when you chew food. If you are very anxious, your autonomic nervous system works "overtime". This can lead to symptoms such as sweating too much, palpitations or a dry mouth. Anxiety can also cause other physical symptoms that don't seem to be related to the autonomic nervous system. For example, you may have:
These aches and pains are real, but doctors can't find physical causes for them. Doctors call these psychosomatic symptoms. It means your body is translating your feelings into physical pain. We don't know why some people with anxiety disorder have these symptoms while others don't. References Ninan PT. Dissolving the burden of generalized anxiety disorder. Journal of Clinical Psychiatry. 2001; 62 (supplement 19): S5-S10. Andrews G, Creamer M, Crino R, et al. The treatment of anxiety disorders: clinician guides and patient manuals. 2nd edition. Cambridge University Press, Cambridge, UK; 2002. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th Edition. American Psychiatric Press Inc, Washington DC, U.S.A.; 2000. Schweizer E, Rickels K. The long-term management of generalized anxiety disorder: issues and dilemmas. Journal of Clinical Psychiatry. 1996; 57 (supplement 7): 9-12. Glossary Your nervous system includes your brain, your spinal cord and your nerves. Your autonomic nervous system is the part of your nervous system that controls the things that happen in your body without you thinking about them. It also senses what is going on in the outside world. And it allows you to react to things. For example, your autonomic nervous system makes your heart beat faster and stronger when you are frightened.
How Common Is Anxiety? It's hard to know how common anxiety disorder is. That's partly because many people who have it don't see a doctor, and when they do they may not get the right diagnosis. Doctors call this illness generalised anxiety disorder. We're calling it anxiety disorder for short. We don't know if anxiety disorder is becoming more common or less common. Older studies looking at anxiety disorder used different definitions for the disorder, so it's hard to compare their results with recent studies. This is what we know about how many people have anxiety disorder.
Ninan PT. Dissolving the burden of generalized anxiety disorder. Journal of Clinical Psychiatry. 2001; 62 (supplement 19): S5-S10. Wittchen HU, Hoyer J. Generalized anxiety disorder: nature and course. Journal of Clinical Psychiatry. 2001; 62 (supplement 11): S15-S19. Jordi Alonso and Jean-Pierre Lépine. Overview of key data From the European study of the epidemiology of mental disorders. Journal of Clinical Psychiatry. 2007; 68: 3-9. Oakley-Browne M, Wells E, Scott K. Te Rau Hinengaro: The New Zealand Mental Health Survey. September 2006. Available at http://www.moh.govt.nz/moh.nsf/pagesmh/5223 (accessed on 21 December 2009). Singleton N, Bumpstead R, O'Brien M, et al. Psychiatric morbidity among adults living in private households, 2000. International Review of Psychiatry. 2003; 15: 65-73. Lim L, Ng TP, Chua HC, et al. Generalised anxiety disorder in Singapore: prevalence, co-morbidity and risk factors in a multi-ethnic population. Social Psychiatry & Psychiatric Epidemiology. 2005; 40: 972-979. Greer H, McGinnity A, Meltzer H, et al. Mental Health of Children and Young People in Great Britain, 2004. Available at http://www.ic.nhs.uk (accessed on 21 December 2009).
What Will Happen To Me? There's no cure for anxiety disorder, and it rarely goes away on its own. Your symptoms may come and go, but if left untreated they could disrupt your life for years. Doctors call this illness generalised anxiety disorder. We're calling it anxiety disorder for short. Sometimes it's difficult to ask for help. You may not feel that you're ill. Or you may be afraid of being told you have a mental health problem. But getting treatment can make a difference. There are good treatments to help you control your worries and let you get on with your life. If you think you have anxiety disorder, the most important step you can take is to get professional help. If you don't get treatment, the feelings of anxiety may take over your life. The illness means you may find it hard to get a job, make friends, go to university or even do everyday things such as the shopping. And anxiety disorder can lead to other problems. Some people try to stop their anxiety by drinking heavily or by taking illegal drugs. Where can I get help? You should start by going to see your doctor. Doctors today are able to treat this kind of illness. But there are other specialists who are also trained to help people with anxiety disorder. So your doctor may refer you to a:
What kind of help? Whether you are treated by your doctor, a psychiatrist or a counsellor, they will try to:
You may have a talking treatment (psychotherapy) or be treated with drugs. Doctors often recommend both. Your doctor will help you find the treatment that works best for you. The choice may depend on:
When will I feel better? You'll probably never get rid of your worries completely. But treatment should help you control them so that they don't take over your life. Doctors call this remission. It means that although your disorder is not cured, your life is no longer full of worry. And your other symptoms (such as headaches or problems sleeping) are under control. Treatment takes time to work. After eight to 12 weeks, you should be worrying less. After about a year, you should be getting your life back. This could mean going out more, starting to look for a job or coping better with your family. Eventually, treatment helps many people control their feelings of anxiety. But only a few people find that their symptoms go completely. Research shows that a quarter of people with anxiety disorder are in remission two years after they see a doctor about it. After five years, about 4 in 10 people are in remission. And about half the people with anxiety disorder are in 'partial remission' after five years. This means that some of their symptoms have gone. But there is a risk that your symptoms will come back. One study shows that about 25 percent of people who are in remission will get symptoms again. About 40 percent of people in partial remission find that their symptoms come back. Children and young people may be more likely to get rid of their anxiety disorder altogether, with treatment. In one study, almost 8 in 10 children no longer had anxiety disorder after treatment with a talking therapy called cognitive behavioral therapy. It may take longer to feel better if you are suffering from depression or another mental health problem, such as a different sort of anxiety disorder. If you have both anxiety disorder and depression, the treatments don't work as well as they do in people who only have anxiety disorder. If you stop having treatment, the intense feelings of anxiety may come back. In one study, more than a quarter of patients got their old anxiety problems back five years after treatment. We don't know how long you should continue having treatment. And we don't know what sorts of things can make your symptoms come back. Anxiety disorder can last a long time. Treatment can help to control it, but it doesn't always work. No one can know whether treatment will work for you. We don't know why some people get better and others don't. But we do know that treatment gives you the best chance of leading a happier and more active life. How will I know I'm getting better? Everyone is different. Only you will know how you feel and whether the treatment is working. There are no scientific tests to see whether you're recovering from anxiety disorder. However, some doctors use questionnaires called symptom rating scales to measure how you are doing. Most doctors would say that the treatment is working if it reduces your scores on the symptom scales by about half. For some of these scales, the doctor rates your progress. For others, you do. Your scores show how you feel. In general, the higher your score, the worse your illness. Over time, a series of tests can show whether your treatment is working. Researchers often use these scales in studies to see whether treatments work. References Ninan PT. Dissolving the burden of generalized anxiety disorder. Journal of Clinical Psychiatry. 2001; 62 (supplement 19): S5-S10. Hoehn-Saric R, Noyes R. The Anxiety Disorders. 1st edition. Cambridge University Press, Cambridge, UK; 1998. Hidalgo RB, Davidson JR. Generalized anxiety disorder: an important clinical concern. Medical Clinics of North America. 2001; 85: 691-710. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the national comorbidity survey. Archives of General Psychiatry. 1992; 51: 8-19. Blair DT, Ramones VA. The undertreatment of anxiety: overcoming the confusion and stigma. Journal of Psychosocial Nursing and Mental Health Services. 1996; 34: 9-18. National Institute for Clinical Excellence. Anxiety Management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. December 2004. Clinical guideline CG22. Available at http://www.nice.org.uk/CG22 (accessed on 21 December 2009). Kessler RC, Wittchen HU. Patterns and correlates of generalised anxiety disorder in community samples. Journal of Clinical Psychiatry. 2002; 63 (supplement 8): 4-10. Yonkers KA, Dyck IR, Warshaw M, et al. Factors predicting the clinical course of generalised anxiety disorder. British Journal of Psychiatry. 2000; 176: 544-549. Lyneham HJ, Rapee RM. Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children. Behaviour Research And Therapy. 2006; 44: 1287-1300. Emmanuel J, Simmonds S, Tyrer P. Systematic review of the outcome of anxiety and depressive disorders. British Journal of Psychiatry Supplement. 1998; 34: 35-41. Andrews G, Creamer M, Crino R, et al. The treatment of anxiety disorders: clinician guides and patient manuals. 2nd edition. Cambridge University Press, Cambridge, UK; 2002. Barbee JG. Mixed symptoms and syndromes of anxiety and depression: diagnostic, prognostic, and etiologic issues. Annals of Clinical Psychiatry. 1998; 10: 15-29. Glossary Psychotherapy is a talking treatment. It is given by trained therapists (such as a psychiatrists, psychologists or social workers). Psychotherapy usually consists of regular sessions (often weekly) between the therapist and the patient. There are many types of psychotherapy, including cognitive behavioural therapy and interpersonal therapy. A psychiatrist is a doctor who specialises in psychiatry. Psychiatry is the branch of medicine that covers mental, emotional or behavioural problems. A social worker is trained to support people experiencing discomfort in their lives. Social workers look at not only the person but their support networks not only within the person's family but in society (work, community etc). Some social workers have specific mental health training and experience and provide mental health care in hospitals, clinics, schools or to private patients. A psychologist is trained to study the human mind and human behaviour. A clinical psychologist provides mental health care in hospitals, clinics, schools or to private patients. A counsellor is a professional who is trained to help people, usually with the emotional part of their illness. Counsellors talk to people about their illness. They also suggest ways that people can make changes for the better. A psychotherapist is a health professional who treats mental disorders by talking with their patients, rather than by prescribing medicines. There are many types of psychotherapy, including cognitive behavioural therapy and interpersonal therapy. If you have a phobia of something, you are much more afraid of it than would be expected. You could have a phobia about things (such as dogs) or activities (such as going out in public). Phobias can make you feel panicky. They can also make your heart race or give you an upset stomach. How do doctors diagnose anxiety disorder? If you think you may have anxiety disorder, you should see your GP. He or she will need to ask you questions to see how anxious you are and how much you worry. It's normal to worry, so your GP will need to find out whether you are worrying more than you should. Here are the sorts of questions your GP will ask to find out whether you have anxiety disorder:
You doctor will also ask whether you've had any of these symptoms and if so, how often:
Your doctor may also ask about your general health, whether you are taking any medication, and what's going on in your life. He or she may want to talk to your family and partner too. He or she may want to ask about your medical history or do a physical examination to rule out any medical problems. It can be hard to talk about yourself in this way. Try to give your answers in your own words and in your own time. Some doctors also use special questionnaires to measure your symptoms. To read more about these tests, see Symptom rating scales. Anxiety disorder can be hard to spot Doctors often don't diagnose anxiety disorder straight away. Many patients end up seeing several doctors, over many months or years, before they find out they have anxiety disorder and start having treatment. There are several reasons for this.
Some of the physical diseases that share symptoms with anxiety disorder can be very serious. So your doctor will want to be certain that you don't have any of these disorders. Depending on your symptoms, your GP may give you blood tests or other medical tests to rule out the possibility of heart disease, thyroid disease or other illnesses. Discussing the options If your GP does decide you have anxiety disorder, he or she should discuss with you all the options for treatment. Your GP should also agree with you a plan for your treatment that includes how long it will take to work and how often you will see a health professional. Your GP may also be able to tell you about any self-help groups, both national and local, that can offer you support. Most people with anxiety disorder can be treated by their GP. But if your treatment is not working, you may be referred to a team of professionals who specialise in mental health. This might include a psychiatrist, a psychiatric nurse, a social worker and a psychologist. To learn more see How anxiety disorder is treated. References Ninan PT. Dissolving the burden of generalized anxiety disorder. Journal of Clinical Psychiatry. 2001; 62 (supplement 19): S5-S10. Andrews G, Creamer M, Crino R, et al. The treatment of anxiety disorders: clinician guides and patient manuals. 2nd edition. Cambridge University Press, Cambridge, UK; 2002. Wittchen HU, Hoyer J. Generalized anxiety disorder: nature and course. Journal of Clinical Psychiatry. 2001; 62 (supplement 11): S15-S19. Hoehn-Saric R, Noyes R. The Anxiety Disorders. 1st edition. Cambridge University Press, Cambridge, UK; 1998. National Institute for Clinical Excellence. Anxiety Management of anxiety (panic disorder, with or without agoraphobia, and generalised anxiety disorder) in adults in primary, secondary and community care. December 2004. Clinical guideline CG22. Available at http://www.nice.org.uk/CG22 (accessed on 21 December 2009). Barbee JG. Mixed symptoms and syndromes of anxiety and depression: diagnostic, prognostic, and etiologic issues. Annals of Clinical Psychiatry. 1998; 10: 15-29. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-IV). 4th Edition. American Psychiatric Press Inc, Washington DC, U.S.A.; 2000. Baughan DM. Barriers to diagnosing anxiety disorders in family practice. American Family Physician. 1995; 52: 447-450. Glossary A psychiatrist is a doctor who specialises in psychiatry. Psychiatry is the branch of medicine that covers mental, emotional or behavioural problems. A social worker is trained to support people experiencing discomfort in their lives. Social workers look at not only the person but their support networks not only within the person's family but in society (work, community etc). Some social workers have specific mental health training and experience and provide mental health care in hospitals, clinics, schools or to private patients. Depression is a mental illness in which your mood is low and you feel sad most of the time. It can range from a mild illness through to a severe one in which you lose interest in life and may be suicidal. Questions To Ask Your Doctor If you've been diagnosed as having anxiety disorder, you may want to ask your doctor some of these questions.
What Treatments Work? Everyone gets anxious from time to time. But if you worry so much that it interferes with your life, your anxiety may have become an illness. Doctors call this illness generalised anxiety disorder. We're calling it anxiety disorder for short. There are several good treatments for anxiety disorder, but there are no quick fixes and no cures. Key points about treating anxiety disorder
To learn more about how you may be treated see How anxiety disorder is treated. Treatments for anxiety disorder Which treatments work best? We've carefully weighed up the research on treatments for anxiety disorder and found that they fall into three categories. And we've ranked each treatment to show whether it works. You can find out more about each treatment by clicking on the links below. We've looked at how well these treatments work for adults and for children and teenagers. For help in deciding which treatment is best for you, see . Treatments that work
Treatments that are likely to work
Treatments that work, but whose harms may outweigh the benefits
Treatments that need further study
Other treatments The following treatments have not been studied in the same detail as other treatments on our site. (See .) But we wanted to cover these treatments because you may be interested in them.
Glossary Summary Everyone gets anxious from time to time. But if you worry so much that it stops you getting on with your life, you can have treatments to help you feel less anxious. We've brought together the best and most up-to-date research about anxiety to see what treatments work. You can use our information to talk to your doctor and decide which treatments are best for you. When worry becomes an illness Anxiety is a normal human emotion. We all worry at times about things like money, our families, or our jobs. But some people get more anxious than others. Anxiety becomes an illness when you worry so much that it interferes with your life. You can't stop worrying even though you try. You probably worry over lots of different things. Your worry is out of proportion, and it makes you feel ill and tired. When worrying becomes an illness, your doctor may say you have generalised anxiety disorder. We call it anxiety for short. What are the symptoms? When anxiety is an illness:
Worrying in this way can stop you getting on with your life and daily activities. Perhaps you're too anxious to drive, or you worry about getting lost if you do. Or you won't go out because you're afraid something might happen to your home. Other symptoms You will also have at least three of these other symptoms.
Physical symptoms Some people with anxiety also get physical symptoms. For example, you may get cold, clammy hands, have a dry mouth, or feel sick. Or, when you feel anxious, you may get diarrhoea, palpitations (which is when your heart beats faster than normal), headaches, or feel short of breath. These symptoms can be very frightening. But there is usually nothing medically wrong. What treatments work? Your doctor might advise you to try a talking treatment (psychological treatment) or medicines to help your anxiety. It's not clear from research whether medicines or talking treatments work best. So your doctor may recommend both. Different treatments suit different people. Talking treatments There are two talking treatments that work well for anxiety.They are called cognitive behaviour therapy and applied relaxation. If you have them, your symptoms should get better and you should feel calmer. But these treatments don't work instantly. And you will need to practise the things you're taught, while you're at home. During these treatments you work with a therapist who has been trained in helping people with mental health problems. You normally see someone once a week over a period of several weeks. Sometimes, you may need to see someone more often. Sessions normally last between one and two hours. Here are the two types of talking treatment used. Sometimes they are used together. Cognitive behaviour therapy is a talking treatment where you and your therapist work together to try to change the way you think and how you behave. Usually, the therapist tries to find out which thoughts make you worried and ill. For example, every time you want to drive you might think, "I could crash the car". Or every time the phone rings you might think, "Someone must have died". You then learn ways to be more positive. For example, you might learn to change the thought "My boss thinks I'm hopeless" to "I must be good at my job. I've never been laid off, my colleagues like me and I always meet my deadlines". Applied relaxation involves doing exercises to relax your muscles. In some exercises, you relax groups of muscles, such as those in your shoulders and neck. In other exercises, you relax your whole body. When your body relaxes, your mind also seems to relax or calm down. You may also be shown how breathing can help you relax and how you can use your imagination to help you relax (visualisation). You can practise these techniques at home. Medicines Some medicines work fast to make you feel better if your anxiety is very bad. Others are used to treat anxiety in the long term. Antidepressants can help reduce feelings of anxiety, help you sleep better and feel more comfortable around people. But they take at least three weeks to start working. The ones usually used to treat anxiety are paroxetine (brand name Seroxat), escitalopram (brand name Cipralex), and imipramine. Antidepressants can make you feel drowsy and dizzy. They can also cause falls, nausea, and sexual problems. If antidepressants help your anxiety, you'll usually take them for at least six months. Drugs called benzodiazepines, such as diazepam and lorazepam, work quickly. They can help you relax and feel less worried. But you shouldn't take them for more than two weeks as you can become addicted to them. You may feel drowsy when you take one of these drugs. And you may have trouble remembering things or concentrating. You shouldn't take a benzodiazepine if you're pregnant. You might be given a drug called hydroxyzine if your anxiety suddenly gets much worse. It works within a few hours and can help you feel calmer and more relaxed. Brand names for hydroxyzine include Atarax and Ucerax. Treatment with hydroxyzine might make you feel drowsy. You will usually only be prescribed hydroxyzine for a few weeks. Pregabalin can help you feel less anxious. But it seems to take about four weeks to work. The brand name for pregabalin is Lyrica. It can cause mild side effects, such as feeling dizzy and sleepy, getting headaches, and having a dry mouth. Buspirone can help reduce anxiety and fear and help you sleep better. It may also help with physical symptoms such as sweating. But it takes about six weeks to start working. The brand name is Buspar. It might make you feel sick and dizzy. And it may not work so well if you've recently been treated with a benzodiazepine. Things you can do for yourself Talking treatment doesn't end when you stop going to a therapist. It is meant to teach you how to help yourself. Then, if old ways of thinking and behaving come back, you can be your own therapist. You can also use what you have learnt about relaxation. This is a good approach for people who want to help themselves get better. Your doctor may suggest you join a local support group for people with anxiety. Sharing your feelings may help you feel more able to cope and get on with your life. Anxiety in children Some treatments have also been tested for children. We know that cognitive behaviour therapy and some antidepressants work for children with anxiety. But antidepressants may have serious side effects in children, so they're not often used. What will happen to me? You'll probably never get rid of your worries completely. But getting professional help should help you control them so that they don't take over your life. Your life will no longer full of worry. And your other symptoms (such as headaches or problems sleeping) should also get better. © BMJ Publishing Group Limited ("BMJ Group") 2010
adapted from: http://www.guardian.co.uk/lifeandstyle/besttreatments/depression-in-adults-description Depression is so misunderstood that some people don't even realise it is a disease. That's understandable. Doctors don't know exactly what goes wrong, and the symptoms are not always obvious. People with depression often hide their illness instead of looking for help. Yet for people who are diagnosed with depression and given help, the results can be very good. Many people have big improvements in their mood.
Key points for people with depression
How you feel Everyone feels down sometimes, but depression is more than feeling unhappy. If you have depression you may be irritable, tired, unable to sleep, unable to eat and unable to make decisions. You may also feel dissatisfied, guilty, hopeless, helpless and you may want to cry all the time. And as much as you try, you can't make yourself feel better. Although everyone can have these feelings from time to time, if you have depression, they accumulate and don't go away. They can last for weeks or months. They can affect your sleep, relationships, job or school work, hobbies, sex drive and appetite. To learn more, see What are the symptoms of depression? Some people with depression have symptoms that are not typical. If you're a man or a child, you may be anxious or irritable. If you're an older adult, you may suddenly lose your memory or concentration. You can have depression at the same time as other illnesses, such as diabetes, cancer, a heart attack or a stroke. Depression could also happen after a traumatic event, such as the death of someone close to you. Some people can become depressed after they've been drinking alcohol or using illegal drugs. Many people with depression don't ask for help. About half of all depression isn't properly treated. Depression is not just a state of mind or something you can will away. With depression, the most important thing is to recognise that you may have it and to see someone qualified to give you the right diagnosis and treatment. It's also good to remember that the hopelessness you may feel is a symptom of your depression, and it doesn't mean that there really is no hope. It may help to confide in someone you trust, and to keep busy and meet up with people rather than stay at home on your own. Men, in particular, are at risk of not being treated. They may not recognise their anger or feelings of hopelessness as depression, and they are less likely than women to tell someone how they feel. Also, doctors are less likely to suspect depression in men than in women. Men's depression is often covered up by drinking or drug-taking, or lots of overtime at work. Understanding what goes wrong No one knows for certain what causes depression. Doctors and researchers think that personal experience can often play a role in the development of depression. For example, it can be triggered by the death of a loved one, the break-up of a relationship, financial trouble or a stressful change in your life. A difficult childhood also can mean that you may be more at risk of getting depression. Depression is also linked to changes in how the brain works. This makes sense, given that our emotions, thoughts, sleep, appetite and behaviour are regulated by our brain. The brain sends signals from nerve to nerve using special chemicals called neurotransmitters. But the levels of certain neurotransmitters in your brain called noradrenaline and serotonin are abnormal if you have depression, and they don't work properly. Family history also appears to play a part in depression. In some cases, depression seems to run in families, suggesting that it can be caused by genes. In other cases, however, it can occur in people with no family history of depression. What's more, hormones may contribute to depression, especially in women, who are more likely than men to be depressed. Depression in women is sometimes linked to changes in their menstrual cycle, pregnancy, miscarriage, having just had a baby (postnatal depression) and the menopause. Different names for depression The word depression is used to describe a range of emotions. We often say we're depressed when we're down in the dumps or feel a bit sad. Depression is also used to describe feelings of utter hopelessness and withdrawal that stop you doing things you used to enjoy or getting on with life. Doctors often use other words to describe different types of depression. In what's called major depression, you feel depressed or uninterested in doing anything nearly every day for at least two weeks. You also have several other symptoms, including changes in sleep, appetite and concentration. Major depression is also called clinical depression or unipolar depression. Dysthymia is a less severe illness that lasts at least two years. Some people with dysthymia have episodes of major depression as well as low-grade depression. This is sometimes called double depression. Another kind of depression is manic depression, in which a person swings between high and low moods. This is also called bipolar disorder. If you get big mood swings in different seasons of the year, it is known as seasonal affective disorder (SAD). People with SAD usually get more depressed in winter. If you have SAD you may also have unusually high moods (mania) in spring. Some women have postnatal depression soon after childbirth. This may be because having a baby leads to changes in a woman's hormones, as well as her lifestyle and responsibilities. Why me? The exact causes of depression are often complicated. However, there are some things that increase your chances of becoming depressed. Doctors call these risk factors. A stressful situation, such as losing someone close to you or being in a difficult relationship, can trigger depression. Some people are prone to depression and find that other people in their family have had it too. This suggests that the genes we inherit from our parents may have something to do with whether we get depressed or not. To learn more, see Risk factors for depression. References American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4th Edition. American Psychiatric Press Inc, Washington DC, USA; 2000. Reus V, Braunwald E, Fauci AS, et al. Mental disorders. In: Harrison TR (editor). Harrison's Principles of Internal Medicine. 15th edition. McGraw-Hill Publishing Co.; 2001. National Institute of Mental Health. Depression. October 2007. Available at http://www.nimh.nih.gov/health/topics/depression/index.shtml (accessed on 24 March 2009). Guyton AC, Hall JE. Psychotic behavior and dementia: roles of specific neurotransmitter systems. In: Textbook of medical physiology. 9th edition. WB Saunders, Philadelphia, U.S.A.; 1996. Glossary Diabetes is a condition that causes too much sugar (glucose) to circulate in the blood. It happens when the body stops making a hormone called insulin (type 1 diabetes) or when insulin stops working (type 2 diabetes). You have a stroke when the blood supply to a part of your brain is cut off. This damages your brain and can cause symptoms like weakness or numbness on one side of your body. You may also find it hard to speak if you've had a stroke. Noradrenaline is a neurotransmitter, which is a chemical that helps to send information between nerve cells. It is similar to adrenaline. Your body produces adrenaline when you're in stressful situations, which increases your blood pressure and heart rate. Serotonin is a neurotransmitter, which is a chemical that helps to send information from a nerve cell to other cells. It is thought to play a role in learning, sleep and control of mood. Your genes are the parts of your cells that contain instructions for how your body works. Genes are found on chromosomes, structures that sit in the nucleus at the middle of each of your cells. You have 23 pairs of chromosomes in your normal cells, each of which has thousands of genes. You get one set of chromosomes, and all of the genes that are on them, from each of your parents. Hormones are chemicals that are made in certain parts of the body. They travel through the bloodstream and have an effect on other parts of the body. For example, the female sex hormone oestrogen is made in a woman's ovaries. Oestrogen has many different effects on a woman's body. It makes the breasts grow at puberty and helps control periods. It is also needed to get pregnant. The menstrual cycle is the regular monthly process that causes an egg to be released from the ovaries so that a woman can get pregnant. The menstrual cycle causes her period, the bleeding that happens if she does not get pregnant. © BMJ Publishing Group Limited ("BMJ Group") 2010
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