Living and coping with depression.

Postpartum Depression

Postpartum depression is depression that may occur in women in the postpartum period. In the terminology, the terms postpartum or postnatal depression are also used.

Baby blues or postpartum depression?

If you are in a depressive mood only a few days after birth, it is also called howling days or baby blues. This is normal and may be temporary due to the hormonal changes.

On the other hand, postnatal depression or postpartum depression persists for several weeks and may become chronic in severe cases. In very severe cases, even a postnatal psychosis or a puerperal psychosis can occur.

Post-traumatic stress disorder is referred to as having experienced childbirth as traumatic. After a premature birth or the birth of a sick or handicapped child, depressive reactions may occur as well.

About fifty to seventy percent of all women experience the baby blues after delivery in childbirth. Ten to fifteen percent of all women develop postpartum depression in the postnatal period. Puerperal psychoses, however, are very rare with 0.1 to 0.2 percent.

About three-quarters of all post-natal depression and psychosis affect women who have a child for the first time. Post-traumatic stress disorder occurs after about one to two percent of all deliveries. Depressive reactions occur in about twenty to fourty percent of all premature births or births of sick or disabled children.

What are the causes of postpartum depression?

The causes of baby blues and mild postpartum depression are above all the changed living situation, the hormonal change as well as the overstimulation, the lack of sleep and the lack of rest.

More severe postpartum depression occurs when additional social support is lacking, problems exist in the partnership or one’s own expectations regarding the role of mother are too high and then can’t be met. Physical causes and diseases can also contribute to the development of postnatal depression:

  • thyroid disorders
  • iron deficiency
  • birth complications
  • toxoplasmosis
  • medicines like anticonvulsants, antirheumics or heart medications (beta-blockers)
  • birth trauma

Depression that has already occurred during pregnancy is also considered the cause of postpartum depression.

In addition, previous mental disorders or mental illnesses in the family can promote the development of puerperal depression and, in severe cases, lead to puerperal psychosis.

Post-traumatic stress disorder can occur if the delivery was perceived as traumatic. For example, a strong sense of helplessness and being mistreated by a lack of care during childbirth can be a significant psychological burden.

In addition, there is often a lack of sufficient processing of the birth experience. Even earlier traumatic experiences can play a role.

Depressive reactions are usually the result of loss events. Often the grief is not sufficiently processed or even not approved. In preterm or sick and disabled children, concern for health and related, necessary measures can lead to depressive reactions.

Signs of postnatal depression

The baby blues and postpartum depression are expressed by:

  • general increased sensitivity
  • mood swings
  • increased irritability
  • depression
  • the feeling of guilt and failure
  • concentration and sleep disorders
  • anorexia
  • limpness

The baby blues reach their peak about three to five days after delivery and close until about the tenth day. Serious postnatal depression, on the other hand, occurs rather creeping within the first few weeks after birth. If these symptoms still appear after weeks or after birth, everything points to postnatal depression.

In a postnatal psychosis behavioral changes, unfounded fears and thought disorders are added. In part, perceptual disorders such as delusions, hallucinations or the hearing of voices occur. Postnatal psychosis usually begins during the first two weeks after delivery.

Post-traumatic stress disorders are characterized by nightmares and flashbacks, in which experiences of childbirth recur. Sleep disorders, sadness, a sense of inner deafness, irritability, social withdrawal and other depressive symptoms are the result.

Post-traumatic stress disorder occurs in most cases immediately after a traumatically perceived childbirth. But you can also express yourself after several weeks or months.

Depressive reactions focus on shock and a feeling of inner deafness. Often follow more depressive symptoms and a prolonged depression. Depressive reactions usually begin within the first few days to weeks after birth.

How are postnatal depression diagnosed?

For the diagnosis of postpartum depression, there is a specialized questionnaire. The Edinburgh Postpartum Depression Scale helps assess the presence of depression.

The questionnaire includes ten questions about mental health during the post-partum period. Also in the assessment of depression, which already occur during pregnancy, the test can help.

What treatment options are available for childbed depressions?

In the case of baby blues, psychotherapy is usually unnecessary. For the most part, a supportive consultation by the midwife, the woman doctor or the family doctor is sufficient. In more severe cases, professional help from a psychotherapist should be sought.

If inpatient treatment becomes necessary, special mother-and-child treatments offered by some clinics may be helpful. In the case of a drug treatment, it must be taken into account that the active substances may possibly harm the infant since they also enter the breast milk.

Support from relatives and support groups can also play an important role in overcoming postpartum depression, postnatal psychosis or other mental postnatal disorders.

What is the course of childbed depression?

The course of childbed depressions depends on when they are detected. The diagnosis is sometimes difficult, as the symptoms often can’t be clearly differentiated from normal mood or behavioral changes after delivery.

Therefore, postpartum depression is often detected too late or not at all, which can lead to a disturbed relationship between mother and child. In some cases, the psychological distress due to the lack of therapy can become so great that the affected women suicidal thoughts or attempts.

Can one prevent postpartum depression?

To prevent postpartum depression, it is important to have good social support. Increased support from the partner and the family can help reduce the risk of postpartum depression.

However, too much care may increase the feeling of failure in those affected. In such cases, professional help is recommended.

In order to avoid depressive reactions, one’s own expectations of the mother role should not be set too high and the image of the “happy and carefree mother”, as it is sometimes conveyed in public, should not be overstated.

If depression has already occurred during pregnancy or is a prelude to past mental health problems in one’s own or family history, it is best to start dealing with the issues as early as possible and, if necessary, quickly seek professional help.

Baby blues or postnatal depression in the father

Almost one in ten fathers, according to Australian researchers, is stressed, worried, and often does not see the end of the tunnel after the birth of a child. The symptoms are quite similar to those of the postpartum depression of young mothers.

“We were surprised that fathers’ problems are more common than with mothers,” said research director at the Parenting Research Center in Melbourne, Australia, Jan Nicholson. 9.7 percent of the fathers mentioned several stress symptoms in the first twelve months of their offspring. For women it was 9.4 percent.

“Mental problems can be persistent and inexorable with fathers,” says the study, published in the journal Social Psychiatry and Psychiatric Epidemiology. The researchers interviewed 5,000 young mothers and 3,471 new fathers. According to Nicholson, fathers described:

  • anxiety
  • a lot of worries
  • feeling unable to do it and seeing no improvement

“Among young fathers, the rate of those who describe such problems is 40 percent higher than among men in general,” Nicholson said.

“It is often assumed that postnatal depression in mothers has biological causes, and that they have to do with the fact that in the beginning mothers are especially concerned about the children – but as far as the fathers are concerned, we have not been right so far watched”. She said. As for women, there must be help for men at this stage, she demanded.

Treatment For Generalized Anxiety Disorder

A generalized anxiety disorder can determine the life and accompanies many people for a long time. But there are different ways to learn how to control fear and return to a normal life. Also, certain medications can help.

People with a generalized anxiety disorder (GAD) are not afraid of very specific things or situations but are afraid of everything possible.

Therefore, one speaks also of “generalized” fear. It is psychologically very stressful and also causes various physical symptoms such as dizziness, muscle tension or tachycardia.

To be constantly afraid is very exhausting. However, there are several treatments that can reduce anxiety to a tolerable level.

In contrast to other anxiety disorders, generalized anxiety disorder often occurs only in middle adult life. Basically, you can get an anxiety disorder at any age.

What can I do on my own?

Many people with a generalized anxiety disorder do not even get the idea to go to a doctor. They first try to get their fears under control themselves, for example by using books and information from the internet.

Some learn relaxation techniques such as progressive muscle relaxation, autogenic training or yoga. The efficacy of such self-management options for anxiety disorders has not been well explored in studies.

Relaxation techniques are often used in the context of psychotherapy. How useful they are, if they are used without other aids, we don’t know yet.

Some people resort to herbal sedatives such as valerian, lavender or passion petals. These funds have hardly been researched so far by studies.

Many people assume that herbal medicines are better tolerated and safer than other medicines. But they can certainly have side effects and partly influence the effect of other drugs.

Self-treatment can make it take a long time to seek professional help. When an anxiety disorder severely limits everyday life, certain psychotherapies and medications can help.

What happens during a psychotherapy?

There are several psychotherapeutic procedures for treating a generalized anxiety disorder. The best studied and most effective is cognitive behavioral therapy (CBT).

Cognitive behavioral therapy

A CBT not only has a positive effect on anxiety. It can also relieve other symptoms, such as depression, that can be associated with anxiety disorder.

However, since therapy requires a direct examination of one’s own fears, the treatment itself can sometimes be distressing. Generally, adverse effects of psychotherapy have not been well considered in studies so far.

Cognitive behavioral therapy is offered by behavioral therapists and usually adopted by the statutory health insurance. It usually consists of weekly sessions over several weeks or months.

Cognitive behavioral therapy involves two parts: a “cognitive” part that deals with thoughts and feelings and one that deals with behavior.

The goal of the cognitive approach is to change anxiety-causing thought patterns by learning to

  • recognize and question unrealistic fears and worries
  • to estimate the actual probabilities and consequences of anxiety triggers and
  • to deal with uncertainty

An example of fearsome thought patterns are “catastrophizing” thoughts, such as: drawing extreme, exaggerated conclusions about the extent of the supposedly impending disaster as soon as something disturbing happens.

When such thoughts are recognized by therapists, they are working to break them down to better deal with them. Ultimately, CBT helps to think more clearly and to better control one’s own thoughts.

The second part of the therapy is about gradually reducing the anxiety in certain situations and changing the behavior. In doing so, one faces the fear, in order to overcome it gradually.

For example, a working mother who is constantly calling nursery school to make sure her child is well could gradually reduce the number of her calls. In order to facilitate such behavioral changes, the therapy also conveys what can help to keep calm – for example breathing exercises or relaxation techniques.

Other psychotherapeutic approaches

The effectiveness of psychotherapy, which is more concerned with the possible causes of anxiety, such as traumatic events in childhood, is not well understood in people with generalized anxiety disorder.

The few studies comparing cognitive behavioral therapy suggest that these “psychodynamic” therapies are less helpful than CBT.

What treatments are available?

For the treatment of a generalized anxiety disorder, various drugs are considered. Agents from the group of selective serotonin reuptake inhibitors (SSRIs) are often used.

Selective serotonin reuptake inhibitors (SSRIs)

These drugs belong to the group of antidepressants. They can alleviate anxiety symptoms and help against depressive symptoms that many sufferers have to deal with additionally.

It usually takes 2 to 6 weeks for SSRIs to have an anxiolytic effect. However, they help only a part of the people who take them. Therefore, it may be necessary to try several drugs.

From the group of SSRI escitalopram and paroxetine for people with generalized anxiety disorder are well studied and approved.

If treatment with SSRIs has improved, it is recommended that you take the medication for another 6 to 12 months and then slowly reduce the dose. Studies indicate that the risk of a relapse is then smaller.

However, some people find it difficult to take the medication permanently. One reason can be side effects, another: When you feel better, you can quickly stop taking it.

Possible side effects of SSRI include nausea, insomnia and sexual problems. For example, some people have less desire for sex or no orgasm. In men, ejaculation may be weaker or absent. For most people, however, there are no side effects.

In insomnia or nausea, it is sometimes difficult to say whether the drugs are actually the cause. Because these complaints are generally quite common.

Often the body gets used to the active ingredients. Most side effects occur only in the first weeks of use. It may therefore be worthwhile to wait and not stop the treatment immediately if a side effect is noticeable.

Other medicines

There are a number of other medications that can be used in generalized anxiety disorder.

Many, however, usually come into question only if a treatment with SSRI has not been successful or is not possible for certain reasons:

  • Selective norepinephrine reuptake inhibitors (SNRI): These include the active substances duloxetine and venlafaxine. They work in a similar way to SSRIs.
  • Pregabalin: This remedy is used primarily for nerve-related pain. However, it is also approved for the treatment of generalized anxiety disorder. The efficacy of the drug has been demonstrated in several studies. However, it often causes dizziness and fatigue.
  • Opipramol: Opipramol is an antidepressant whose efficacy has been poorly studied and therefore only in exceptional cases is in question.
  • Buspirone: This remedy can relieve anxiety symptoms but is not as well studied as other medications. Therefore, it is usually only used when, for example, SSRIs do not work or are not tolerated. Possible side effects of Buspirone are dizziness, nausea and insomnia.
  • Hydroxyzine: This antihistamine drug is also likely to relieve symptoms of generalized anxiety disorder. However, it is also less well studied than other means and is therefore rarely used.
  • Benzodiazepines: Benzodiazepines are sleep aids and tranquilizers that also help to solve anxiety. Their effect sets in quickly, but they can make after a few weeks dependent. Therefore, these agents are not recommended for the treatment of generalized anxiety disorder.

Although drugs such as imipramine from the group of tricyclic antidepressants or the neuroleptic quetiapine have been shown in studies to have an effect on generalized anxiety disorder.

Off-Label Medication

However, as there are more effective and better tolerated drugs with the SSRIs, these agents are not approved for the treatment of the disorder. Doctors prescribe these medications only if all other treatments have not helped (so-called off-label use).

There are relatively few studies comparing drugs directly. There are no clear benefits to a given drug from existing studies. Since not every medication works the same way in every human being, it can be useful to try different medications.

Which treatment is suitable?

Whether you opt for psychotherapy or drug treatment has a lot to do with personal attitudes and needs. Appropriate psychotherapy can be very effective and help to overcome the anxiety.

But it requires a lot of initiative and strength, and often you have to wait longer for a therapy place. Depending on the personal situation and the severity of the illness, it may therefore be useful to take medication first.

Sometimes it is only possible to start psychotherapy if the symptoms have been alleviated by medication.

Some people do not want to take antidepressants because they fear becoming addicted. Unlike certain painkillers, sleep aids and tranquilizers, however, antidepressants do not make them dependent.

Others find it a sign of weakness to use pills to help them overcome their problems. But there is no reason to be ashamed when taking medication for mental illness. To overcome deep fears, medications can be helpful, sometimes even necessary.

However, you decide, there are both medications and psychotherapies that can help you cope with a generalized anxiety disorder and live a normal life again. So it is your choice.

Difference Between Major and Manic Depression

Manic depression or bipolar disorder is an oft-misunderstood and at times scary disorder. Unlike major depressive disorder and milder forms of depression, a bipolar disorder is characterized by regular mood cycles.

Although not completely understood, something in the brain seems to make people who struggle with bipolar experience life through several different lenses.

Because it is not fully understood, there are a lot of misconceptions around manic depression, or bipolar disorder.

First: they are both the same thing, but with a different name.

Second: there are several different types of bipolar disorder, with varying degrees of intensity or severity, and different treatment approaches.

Lastly: bipolar disorder is different from simply having severe mood swings.

People with bipolar struggle with manic episodes as well as depressive episodes. These episodes can last days, weeks, or even months. On average, a person will go through 1-2 cycles per year.

More rapid cycles, usually alongside milder symptoms, points towards cyclothymia – a milder form of depression, characterized by episodes of a consistent and irrationally low mood.

What is Mania?

The biggest challenge in recognizing a bipolar disorder isn’t in the depressive symptoms, but in the mania. To most people, mania is understood to be a form of exaggerated emotion.

When people think mania, they think of an unhealthy obsession. For the most part, this is accurate – but to be more specific, mania is a state of mind characterized by hyperactivity.

Everything is bigger, louder, and more urgent in a state of mania. Someone currently manic would:

  • Not get much sleep.
  • Engage in multiple activities at once (extreme multitasking).
  • Talk loudly, incessantly, and excitedly.
  • Struggle to stay focused.
  • Risky behavior.
  • Rapidly changing subjects and ideas.
  • Hypersexuality.
  • Potential irritability.
  • Increased vigor and zeal, pompous personality changes.

Sure, everyone gets excited, some people simply have active and outgoing personalities, and some of these symptoms can be the result of a buttload of caffeine.

But if a person consistently exhibits these symptoms alongside hyperactivity and a general change in behavior and personality, they may be going through a manic episode.

It’s important to understand that mania is not a good thing. It’s not a positive thing. Despite being on the opposing side of the mania-depression spectrum of bipolar disorders, it doesn’t represent happiness.

Rather, it represents activity and excitability, mental arousal, and the consequences of feeling “in-flight”. Someone consciously going through a manic episode may feel constantly endangered, anxious, and generally in a precarious mental state of flux.

Other Forms of Mania

Another possible way in which mania can express itself in cases of bipolar disorder is through hypomania. Generally classified as a less severe form of mania with many of the same symptoms, hypomania and mania are differentiated purely based on subjectivity.

A doctor or professional is going to make a diagnosis of manic symptoms or hypomanic symptoms off a patient’s self-reporting, and there are no definitive tests for figuring out which you’re experiencing. The main difference is that:

  • Mania severely interferes with a person’s ability to function normally, impeding social contact.
  • Hypomania may mildly interfere with a person’s day-to-day functions, but not enough to pose a debilitating threat.

Mania is treated with anti-manic medication, lithium, anti-seizure drugs if seizure is a concern. Yes, lithium is prescribed for bipolar disorder. Why it works is generally a mystery, but it may have something to do with helping the brain better regulate neurotransmitters.

A professional diagnosis of mania is much safer than a hunch off the internet, but if any of this sounds familiar, it’s not a bad idea to call a doctor or a therapist and get yourself checked out. There is much more to discuss about bipolar conditions outside of the peculiarity of mania.

While many people with bipolar disorder struggle with the anxieties and irritability of going through a manic phase, the subsequent depressive phase isn’t easier to deal with, in most cases.

Mild to Major Depression

Just as hypomania and mania describe one side of the bipolar spectrum, mild to severe depressive symptoms dominate the other side.

Depression is characterized by a consistently low mood, lack of euphoria or joy, frequent doubt and negative thinking, and potential self-harm.

Other ways depression in a bipolar disorder manifests itself include:

  • Having little energy.
  • Irregular sleeping patterns.
  • Irregular appetite.
  • Struggling to get out of bed.

Mild and major depression are differentiated by risk of self-harm, as well as the severity of the negative thoughts.

Someone with a mild depression might be making their way through life with a constant dark cloud hanging above their head, struggling to be happy or cheerful, and maintaining a low mood despite no apparent cause.

Someone with a severe depression, on the other hand, would be having much darker thoughts of suicide, helplessness, and worthlessness.

Depressive symptoms in cases of manic depression or bipolar disorder are not different from depressive symptoms in MDD or other forms of depression. What sets bipolar apart is the change from depressed to manic, and manic to depressed.

Why Do Bipolar Disorders Occur?

Depression occurs most often in people who have a family history of depression and is triggered by some form of high-stress leading to the kind of thinking that quickly catapults a person into a downward spiral.

We’re not 100% sure how or why this happens, and it’s one of the major shortcomings in our understanding of neurobiology and psychiatry – we can identify when a person’s behavior is so severely influenced by an abnormality that they’re struggling with a disorder, but the exact cause or mechanism of the disorder is poorly understood.

The same thing goes for bipolar disorders. Yes, doctors and therapists can diagnose someone with bipolar, and if they’re thorough enough, it will be an accurate diagnosis.

It can take time and requires sifting through a lot of information to figure out where on the spectrum a person lands, but the important part is identifying whether an individual struggles with depression, or depression coupled with mania.

What Causes Bipolar Disorder?

As for what causes this difference, it’s not currently known. Genetics still play the biggest part. If one parents has or had a diagnosis of bipolar disorder, then there is about a 1 in 10 to 1 in 6 chance that their child will struggle with the disorder as well.

If both parents are bipolar, the chance jumps to about 1 in 3. But genetics aren’t the only reason. Even in genetically-identical twins, the risk of developing a bipolar disorder in twin B if twin A was diagnosed is between 40-70%. So, while genes play a role, the environment is important as well.

Consistently negative or severely traumatic childhood experiences are most likely to contribute to a mood disorder like depression or bipolar.

Going through a particularly rough experience in high school or struggling with poverty throughout college can kickstart a bipolar disorder. It usually starts early on in life, and rarely begins after a person has moved on past their teens.

If you have bipolar, there’s no telling exactly why or how it started. The idea that depression is a matter of neurochemical imbalance is compelling but doesn’t have a lot of convincing evidence.

Hormones play a big role, which is why physical causes for depression do exist – things like a benign brain tumor or hypothyroidism.

Medication and Mania

More troubling is the fact that, sometimes, antidepressants can trigger mania. This means if you’ve been struggling with depression but haven’t had a manic episode and have history of bipolar disorder, antidepressants might kick off your bipolar disorder.

Stimulants are even more dangerous – drugs that excite the system and increase dopamine production and retention, like cocaine, ecstasy, and amphetamine. Usually, these medication-caused manic episodes end after quitting the drug/going off the medication.

Anti-manic drugs do exist to help counteract the manic symptoms in cases where antidepressants induced the mania – but again, these are short-term solutions for a problem that’s best approached through therapy and alternative treatments.

Mania Without Depression

Whereas about 2.5% of adolescents have some form of bipolar, only 1.7% experience mania without depression.

Mania with depression is associated with greater severity, greater disability, and impairment, as well as greater risk of comorbidity (which means having other mental health issues, such as disordered/stress eating or anxiety).

The thing about manic depression and bipolar disorder is that both are effectively a misnomer – while manic depression implies both mania and depression, and bipolar disorder implies both sides of the spectrum, the actual diagnosis for bipolar I just requires one verified episode of mania (bipolar II requires mania *and* a major depressive episode).

Meaning, if someone experiences mania without the subsequent low mood or depression, they’re still technically dealing with a bipolar disorder.

The treatment for severe mania largely involves medication (antipsychotics), but hypomania or manageable forms of mania can be treated with therapy and calming exercises, meditation, breathing, regular exercise, and a supportive home environment.

Bipolar disease comes and goes, either in the form of mania, or mania and depression. While it cannot be cured in the sense that the symptoms stop occurring, it can be managed, and effectively curbed.

You can stop a bipolar disease from taking over your life – but the first step is to seek out help, from friends, family, and professionals.

What Are Panic Attacks?

Your heart begins to beat faster. You have trouble catching your breath. Sweat breaks out. You feel a distinct pain in your chest. You feel ready to faint as the world slowly spins. Panic attacks can occur out of nowhere, for no reason, sending the world around you spinning.

Some panic attacks are smaller – these are called limited-symptom panic attacks, where you’re feeling distinctly uncomfortable, and are experiencing four or fewer symptoms of a full-blown panic attack.

At other times, panic attacks can feel life-threatening – the fear can be so intense that you’re sure you will die.

Panic attacks are random, occurring at times of intense stress, and out of nowhere in a state of absolute calm. Sometimes, a panic attack points towards a possible panic disorder.

The attack may also be a symptom of a different anxiety disorder. Panic attacks are a physical reaction to stress, both external and internal, and they evoke the fight-or-flight system.

That feeling of intense and sudden terror is what makes us react faster and run for our lives (and at times freeze up) in the fear of explicit and sudden danger.

However, some people experience brain disorders that cause this signal for flight to occur without any external stimuli in place. This makes you react as though you are in life-threatening danger, without any danger present.

Panic attacks can feel like heart attacks, and although they’re not usually fatal, over time they can stress the body. Thankfully, they’re very treatable. But ignore them, and they could get worse.

What a Panic Attack Feels Like

Panic attacks are a physical reaction to stress, even when no stress is present. The body reacts as it would in a situation of extreme fear. You may feel like you’re dying, but you’re not. You’re panicking.

It all starts with adrenaline, which the adrenal glands pump into the bloodstream. In reaction to fear, the body begins to get to work. First, you start to sweat while your heartrate jumps, causing you to breathe harder to get more oxygen into your blood as it pumps through your body.

Requiring a boost in energy, your blood sugar spikes. Your senses get sharper, and seconds feel like minutes. You start to shake. Out of nowhere, your heart and lungs are working so hard that you can feel spikes in your chest.

You start to look around. If you know what’s happening, then the fact that you’re conscious of the panic will make it worse. If you mistake it for something else – like a fatal heart attack – then fear will make it even worse.

Although panic attacks usually only last a few minutes, their effects can linger for hours. You’ll feel exhausted and shaky yet wired. By some estimates, your adrenaline jumps to over twice the normal amount when you’re going through a panic attack.

This goes for random panic attacks as well, which can send your body into a fight-or-flight reaction from a completely calm state of mind.

Why Panic Attacks Happen

Usually, panic attacks occur in response to stress. That’s the simplest explanation for why they occur – when a person struggles with an anxiety disorder, from generalized anxiety to panic disorder, they perceive threats and possibilities as much more distinct and dangerous than they actually are.

What might be a nigh-impossible worst outcome will manifest itself as an unavoidable doom. What might be a minor challenge to most can seem impossible to overcome for those with anxiety. It takes a normal perception of reality and warps it, causing everything to cast an intimidating shadow several times its own size.

As such, most panic attacks are in response to a sudden influx of stress that, while uncomfortable to most, may be perceived as incredibly dangerous to some.

Panic Attacks Can Come From Nowhere

There are cases of panic attacks occurring for absolutely no reason. You may start breathing quickly, gasping, and crying, your heart suddenly beating much faster than just a few seconds ago – despite sitting in your room, calm and completely unbothered.

Panic attacks sometimes begin long before they are actually palpable. Sometimes, the heart starts to beat just a smidge faster for a good half hour or more before the panic comes.

Most of the time, when it comes to random panic attacks, the trigger may be an underlying thought process (even something as minor as remembering something you had forgotten to do), an underlying physical factor (too much caffeine that day, having just come back from a heavy cardio session, going for a run), or a psychological factor (certain anxiety disorders can cause random panic attacks, for reasons that are not quite clear yet, but likely have to do with neurobiology).

How Common are Panic Attacks?

Panic attacks happen most often in people diagnosed with a panic disorder, but they can happen in many other illnesses. While having a panic attack doesn’t immediately qualify you for a disorder, they’re most likely to happen if you’re struggling with a phobia, post-traumatic stress, or an anxiety disorder of some kind.

People with depression and bipolar disorder may also experience panic attacks in times of high stress, and panic attacks have even been listed as common for people struggling with irritable bowel syndrome, perhaps due to the link between the gut and the brain. Sleep disorders are another issue that may lead to more frequent panic attacks due to improper sleep, or total lack of sleep.

If you have been regularly experiencing panic attacks and have other symptoms that may point toward a mental health issue, consider getting help to find out what you’re dealing with.

If you were previously diagnosed with something like depression but have been getting more frequent panic attacks, these may be another symptom of the depression rather than being related to another problem. Try to trace the origin of the attacks to a source, if you can.

When Panic Becomes a Disorder

Panic disorder is a type of anxiety disorder characterized by frequent panic attacks, usually out of nowhere. If you’re struggling with a panic disorder, then you’re dealing with both the random panic attacks and the consistent fear of another panic attack – which, in turn, can make you more sensitive to panic triggers.

Panic disorder can come and go. According to the ADAA, about 2-3% of Americans experience a bout of panic disorder in a given year, with women being more susceptible.

Children may also be prone to panic disorder, although it can be harder to diagnose a child because they may not be able to completely articulate how they feel during a panic attack.

The good news is that panic disorders are treatable. As a form of anxiety, panic disorders are tackled through therapy, medication, and alternative treatments like meditation and yoga.

While anxiety can be persistent, panic disorders are very responsive to treatment and usually go away once properly addressed. Anxiety as a symptom may linger, but the random panic attacks will go away.

Why Treatment is Critical

The challenge isn’t getting effective treatment. For many, the challenge is getting treatment at all. Many people are reluctant to get a consultation for any mental symptoms, with panic attacks being one of them.

Some might be embarrassed, and others might think it’s just temporary, despite occurring regularly. Please consider seeing a therapist just to confirm your symptoms. Otherwise, you may end up making something treatable even worse.

If your panic attacks are truly rare and random, then there are solutions that don’t involve seeing a professional. Consider cutting out substances that further aggravate anxiety, including anything with caffeine, excess amounts of sugar, and other stimulants.

Be sure to get quality sleep and consider exercise or sports to get rid of excess energy before bedtime, to stave off sleeping problems. Several supplements aid in managing symptoms of anxiety, including Valerian root, chamomile, and kava.

Aside from herbal supplements, making certain adjustments to your lifestyle – such as avoiding excess stress and taking more time for yourself – can also help stave off feelings of anxiety.

Treating Panic Attacks

There is no surefire way to treat anxiety, but several things are sure to help, including the aforementioned herbal supplements and lifestyle changes. By avoiding stimulants, getting enough sleep, staying physically active and avoiding excess stress, you can eliminate most of the factors that make anxiety worse.

But if you’re still finding yourself feeling anxious, the issue may be deeper. Anxiety disorders require psychotherapy to completely treat – this involves sitting down and confronting the thought processes that make your anxieties worse or give them life to begin with.

Panic attacks can be symptoms of a greater anxiety disorder, symptoms of a panic disorder, or just self-contained events that hint that you should probably hit the breaks and evaluate how you’re living your life. Sometimes, being sad is just being sad, and being scared is just being scared – and even when these thoughts take it to the extreme, the answer may lie in some self-reflection rather than talk therapy.

But don’t try to downplay what could certainly be a serious condition. Getting treatment early means getting better faster, and that’s important with mental health problems, which have a habit of getting worse if left unchecked.

Depression In Men: Same But Different

Depression is a woman’s disease – at least, that’s what the numbers say. But plenty of signs are pointing towards the possibility that the numbers are skewed – and that depression in men is much more common than we might previously expect.

The statistics speak a clear language: depression is female. Women are twice as likely to be treated for depression as men.

But there’s some contradicting evidence. Three times as many men commit suicide. Experts estimate that up to 70 percent of suicides are due to depression. This shows one thing above all: the enormous need for action in men with depression.

A sad taboo: Male suicides

Public attention was given to the topic of male depression mainly due to tragic suicides of celebrities. The suicides of Robert Enke in 2009, Robin Williams in 2014 and Chester Bennington in 2017 filled fans with dismay and horror.

Obviously, no one was prepared for that – even though Robert Enke had never made a secret of his depression. That a depressive illness should not be underestimated, is now known.

After all, the reverberation of tragic deaths not only has negative effects. An established taboo is wavering – depression is now being talked about, including with, with and among men.

Depression in women and men – the old debate about nature and culture

Is it really true that women suffer so much more from depression than men? Are the statistics telling the truth? If so, how can the differences be explained? Are they biological?

Depression and biology

Fact: When it comes to depression, biology is sometimes on the men’s side. Purely biological, women carry a slightly higher risk. Hormone fluctuations are a key risk factor for depression and depressive moods. For cyclical reasons alone, the risk for women is therefore increased. In addition, there is the so-called postpartum depression, which affects 10 to 20 percent of women after the birth of a child. Causes can be high levels of stress and abrupt hormonal changes during and as a result of the birth of a child. However, these specifically female cases are by no means capable of explaining the supposedly twice as high risk to women.

Depression and socialization

So perhaps culture also plays a role. Does socialization mean that women are more likely to suffer from depression than men? From childhood, boys and girls learn and internalize different patterns of behavior, even when they are changing and differences are less pronounced than they used to be. Showing vulnerability is still a trait that is more conceded to girls than boys. On the other hand, boys often have to prove their “strength” as children.

As a consequence, the socially accepted behavior of men is different from that of women. Stereotypes of man and woman are defined. The image of the “strong man” is still present in society and not only firmly anchored in the minds of men. Belonging to this male stereotype is to be stress-resistant and resilient, to maintain control and independence, to cope with dangers and to avoid the associated fears and suffering. Accordingly, classic depressive features such as depression, lightheartedness, pondering and self-doubt are often considered “unmanly”. On the other hand, a certain amount of elbow mentality and competitive thinking is socially accepted and is often interpreted positively as an enforcement force.

The Stereotype of Masculinity

A number of researchers doubt the clear sex differences in the statistics on depression. The so-called “artifact theory” states that the differences in depression are artificial in both men and women. The statistics are distorted and do not correspond to reality. Finally, gender role attribution makes it difficult for the man to admit depression.

Affected men sometimes do not perceive depressive symptoms as such, they try to ignore or overplay. In addition, seeking help is different: women seek help faster and in earlier stages of depression, while many men only go to the doctor when the symptoms are already unbearable. This is also supported by the fact that the harder the depressive episode, the closer the numbers of men and women are. At the family doctor, which is the first port of call for many patients, men often first describe physical conditions such as tiredness, sleep disorders, difficulty concentrating, pain or sexual problems.

Bravely sticks the “one-man-knows-no-pain” mentality. Depression often means for men to admit weakness. This different request for help may indicate that the disease is underdiagnosed in depression in men.

Male Depression is Misunderstood

But the stereotypes do not only come from inside: not only affected men themselves have difficulty recognizing depression symptoms. Even doctors and psychotherapists often recognize depression in men too late.

Since a depressive episode often involves physical complaints such as back or headaches, doctors often resort to diagnoses that relate to the body. Depression is often hidden behind addiction: More men than women resort to alcohol or drugs to hide their emotional vulnerability. Symptoms of depression are drowned out by it.

In Australia there is even a campaign that encourages men to cry when they are sad – with the aim of preventing greater suffering.

Male Depression as a Separate Condition

In recent years there has been increasing discussion in science about whether prototype male depression differs from “female symptomatology”. There have been calls to take a different approach to male depression. The term “male depression” came into being when Wolfgang Rutz, the psychiatrist and former European Regional Director of the World Health Organization, launched a prevention program on the Swedish island of Gotland in the early 1990s to reduce the suicide rate of those affected by depression. While the program was able to reduce women’s rates by 90 percent, the number of male suicides remained unchanged.

Then Rutz and his team formulated the concept of “men’s depression” and developed the “Gotland Scale of Male Depression”, a screening tool to better identify depression in men. In a second part of the study social withdrawal, low impulse control, antisocial behavior and aggressiveness were considered as risk factors for suicide in addition to the classic criteria of depression. In this second part, the depressive men were recorded and as a result the number of male suicides was reduced.

Male Depression Is Not Always Specific

The experts are not unanimous whether a distinction in gender-related forms makes sense. Anyone who represents the concept of men’s depression assumes that depression can be expressed differently in men than in women. Of course, this does not apply to all men, and at the same time there are women whose depressive symptoms are more on the “masculine” side of the spectrum.

It is also central in this context that the phenomenon of masculine depression is not a counter-concept to the usual depression. Rather, it is meant to sensitize, in addition to the conventional symptoms, to other features that can hide depression.

Male Depression and Hidden Symptoms

Common depressive symptoms such as inner emptiness, depressed mood and suicidal thoughts remain central to depression – with the added implication that many men find easier access to other conditions that are less likely to jeopardize their social role. The differences are based on a prototypical role model and not on biological differences and are therefore changeable and by no means universal.

According to proponents of “male depression”, the depressive mood in men is more often associated with increased irritability than in women. While most women tend to listen to themselves in sadness, many men are more likely to “externalize,” according to the men’s depression. Concerned it is harder than before to control impulses, the stress limit is reached faster.

Men Respond to Stress Differently

Increasingly aggressive defense reactions can be an indication that one is about to slip into a depressive episode. Evolutionary psychology is also referred to as the “fight or flight” pattern, with which, in particular, men react to stress: one fights or escapes from the situation. Evolutionary and socialization-related, women are more likely to react with a pattern that is called “tend and befriend”: guard and appease. It makes sense: with offspring in the arm, it does not fight or flee as fast as without. Of course, one can not generalize this, especially as role models break up and men and women need both ways of reacting in order to be successful.

It comes to typical defense mechanisms such as social withdrawal, which is denied at the same time. Depressed men often feel the need to be left alone. Grief and dejection do not carry them out, they rather try to hide their suffering in order not to admit helplessness. Characteristic of the “male depression” is an increased vulnerability. Criticism is taken more quickly than usual because it makes you feel threatened faster. At the same time, people with men’s depression are more likely to be very strict with themselves. Even because of trivialities they reproach themselves, are afraid to fail. The masculine depression also features strong inner restlessness. The concentration decreases, you get sleep problems.

Many men increasingly resort to alcohol, cigarettes, but also to excessive work, excessive sport or television consumption. The self-injurious behavior can lead to suicide in extreme cases – in depressed men more often than in depressed women.

Suicides in Men

Although the rate of suicide attempts is higher among women, men choose the violent forms, so that there are twice as many suicides of depressive men as women.

Sociological research has dealt with deviating risk factors in addition to the clinical picture. According to Anne-Maria Möller-Leimkühler, a professor of medical sociology, men are “particularly vulnerable to stressors that threaten their social status”. While women encounter risk factors at different levels, the professional role of men is the overriding source of stress. However, unlike a generation or two ago, there are more and more women who mainly define themselves through their job rather than family or friendly relationships.

This change in the role model of women shows one thing above all: Of course, the different risk factors are not carved in stone, but go back to the socialization and resulting different role models. The more the social roles of men and women converge, the more the risk factors will resemble each other. If the socioeconomic status of a family is traced back to the woman as much as to the man and it is socially accepted to be a homemaker as well as a housewife, a separate consideration of depression in both men and women will most likely become superfluous. As a consequence, this means that the phenomenon of “male depression” is a transient construct and that such a distinction may not be necessary at some point.

Depression in Men – Undoing the Taboo

Of course, the specific “men’s depression” does not mean that the usual symptoms of depression do not apply to men. There is no doubt that the usual symptoms of depression are for both men and women. But in men, the leading symptoms often appear masked. Precisely because the assumption is obvious that men are underdiagnosed and underrepresented in the statistics, there are calls in professional circles to extend the symptom catalog of depression to men typical complaints. The goal is to better recognize depression in men.

The gender paradox in the rates of depression and suicide makes it clear: not the depression, but the statistics are female. At the same time, depression requires more attention in men. Tiredness, irritability, workaholism, excessive alcohol, back and headache – just because depression in men is often first on the basis of physical symptoms, doctors should ring in such descriptions the alarm bells. The topic of depression in men must be extracted from the taboo in order to detect illnesses earlier and, in the final analysis, to prevent suicides. An overly rigid masculinity ideal can only be a hindrance.

Treating Depression Without Medication?

Not everyone can afford antidepressants – and many people are skeptical about their efficacy. But can you treate depression without medication?

Antidepressants are associated with an increased risk for suicide, for example, and there is a lot of content online dedicated to making people believe antidepressants are far more dangerous than they are helpful. But the reality is that it isn’t that simple.

Knowing several people who use these medications to combat severe depression – including frequent thoughts of suicide and worthlessness – I can tell you that antidepressants most definitely save lives.

But they’re not always necessary. Depressive disorders can be treated without medication, on a case-by-case basis. Treating depression without medication works. Other people, however, do need them. The key lies in differentiating between the need for antidepressants, and the need for a treatment that does not involve medication.

Differentiating Between Sadness and Depression

Depression exists on a spectrum, but there is a healthy range of negative thoughts that exists outside that spectrum. Usually, where depression is involved, there is some kind of condition to be treated.

But the human condition cannot be treated, it can only be addressed and lived through. Sometimes, these normal emotions can grow in power and potency, and turn into something worrying. But often, there is a clear line between what it means to feel sad and what it means to be depressed.

That line is reality. Sadness is a normal emotion and can be further tied to many different thoughts or emotions. We may be sad and guilty, or sad and mournful, or sad and filled with regret.

Trying to live a life without sadness is futile and irresponsible, because it’s these powerful and painful memories that help us grow as individuals. There is a reason for sadness, and it is to help us avoid pain – or more accurately, learn from it and adapt.

Depression is removed from reality and has no place in the mindscape of a healthy individual. Where sadness helps us become better people and allows us to rise from adversity stronger than before, depression tears us down and makes us cower, making life harder, and chipping away at us without any meaningful purpose.

Depression Must Be Treated

Depression is not a test to conquer – it’s a disease to treat. Where sadness might let us re-evaluate our actions, depression puts thoughts in our head that defy the truth, making us think less of ourselves and forcing us to put ourselves down and lose trust in who we are.

It’s wholly destructive, where sadness can be constructive. It’s wholly negative, where sadness can be positive.

But even in depression, there are different levels of severity. At the top are depressive thoughts that encourage, normalize, and glorify suicide, eventually leading to death.

At the bottom are thoughts that eat away at our confidence and self-esteem, subtly yet enough to make an impact on who we are and what we do. In between lies everything – a journey of doubt feeding into self-loathing, apathy, and suicide.

Not All Depressive Disorders Are Alike

Depression can be generalized as severe sadness or low mood, but it comes in different forms and for different reasons. Some are biological, others are purely psychological, and often there’s the factor of genetics.

This matters immensely, especially in the treatment of depression. If you have not been diagnosed by a therapist or doctor, it’s worth investing in getting a full checkup. Blood tests can reveal vitamin deficiencies that have been linked to depression.

Underlying conditions, including thyroid problems and benign brain tumors, can lead to mood disorders like depression. And sometimes, depression has nothing to do with an abnormality in the body, but simply occurs in perfectly healthy people due to a genetic predisposition, or a long series of grueling and unfortunate events.

Getting a proper diagnosis that takes a look into your individual factors and comes up with a reasonable origin for your depressive thinking is important in figuring out treatment, both from the perspective of professionals, and from your own.

Relieving Depression Without Medication

There are many things you can do to relieve depressive symptoms without picking up a single prescription, including:

  • Healthier lifestyle choices and a complete diet.
  • Regular exercises of the kind you enjoy the most.
  • Spending time with friends and family.
  • Removing yourself from people who drain you emotionally.
  • Balancing work and play.
  • Switching to a more rewarding career or job.
  • Taking herbal supplements to combat depression.
  • And more.

There are cases where the depression is too severe to wait for therapy to take effect. It can take weeks and months for therapy to work, and it takes much longer if the patient has a hard time believing in themselves or the hope for progress.

Unlike medication, therapy requires that a patient has faith in their therapist and the method of therapy they’ve chosen. It’s in cases like this where antidepressants can help make the difference between a long life well spent, or an untimely death.

Why Antidepressants Save Lives

Antidepressants are simple, rather than complicated. They increase the effectiveness of naturally-produced serotonin, keeping it available for longer.

Some do more than that, also increasing the availability of norepinephrine and dopamine. But why exactly these drugs improve symptoms of depression is not completely understood.

The hypothesis is that by increasing serotonin, a person is less likely to have depressive thoughts, and will have an improved mood. But with that comes a myriad of side effects, because serotonin and these other neurotransmitters do more than just control mood, and different antidepressants use different mechanisms to affect the brain.

I’ve known people who have taken antidepressants with no side effects. And I’ve known people who have struggled with weight gain and sexual dysfunction due to antidepressants.

How and why side effects occur is not completely understood – but in the long-term, and on a societal level, one thing is undeniable: since antidepressants have been introduced, suicides have gone down.

However, as with most prescription drugs, antidepressants have also been overprescribed, which is another issue altogether.

These drugs have risks. It takes time for the drug to take effect (about two weeks) and it takes time to switch to another drug (up to a month), and it may often take several attempts to find an antidepressant that works.

However, they do have their place in treating certain cases of depression. And ultimately, it’s up to you if you want to risk using them. Natural or herbal alternatives exist, but there’s also no good way of knowing if they can be effective.

Never Rely on Medication

Antidepressants are not usually addictive, although some – especially SDRIs and NDRIs – have addictive properties. The most common antidepressants prescribed today are SSRIs and SNRIs, and these drugs do not elicit the same dopamine release as drugs like alcohol, benzodiazepines, opioids, and other problematic substances.

But that doesn’t mean you can’t get emotionally dependent on your medication. It’s important to recognize that antidepressants are not meant to be the key to living a life without sadness – they’re just meant to be a crutch to help you get walking.

It’s a very long road from the wheelchair to the end of a marathon and getting out of the chair in the first place is the crucial beginning.

From there, medication helps you “walk” again, kickstarting the rest of your treatment.

It’s how you approach your addiction through the help of therapies like cognitive behavioral therapy, dialectical behavior therapy, exercise, and art therapy, that determines how long it takes until you make it to the finish line – until you make it to a point where you no longer have to rely on medication to be happy and keep the depressive thoughts in check.

Then there are cases where therapy and medication doesn’t help, but alternative treatments make depression without medication possible.

From acupuncture to cutting-edge techniques like transcranial magnetic stimulation, “treatment-resistant depression” can still be affected by certain therapies not usually used or prescribed.

Moving Past Medication

Therapists and doctors do not want to keep you on your meds forever. While depression is not exactly something you can cure like the common cold, the most progress in managing a depression is done through lifestyle changes, regular therapy, and stress management, rather than medication. In a sense, treating depression without medication is already a common ethos.

For professionals, medication is a means to an end to help a patient get to a better mental place before treatment can fully take effect in them.

It’s important to remember this when thinking about antidepressants and their effects. Ideally, a medical professional should prescribe medication to you with the intent of taking you off the meds once you’re ready.

It’s difficult to determine what “ready” means. It’s partially up to you and your therapist to find the right time to start weaning off the medication.

If you’re beginning to feel comfortable in your own skin, comfortable with your life, and mostly free from depressive thinking, you may be at a point where you can continue to manage the symptoms of your condition with therapy and healthy lifestyle decisions. Finally, a way to manage depression without medication.

Remember: depression is managed, not cured. It can be driven into “remission”, wherein your symptoms don’t effectively show up anymore, but they could resurface in moments of extreme stress or when you’re confronted with a great challenge.