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Discussion Starter · #1 ·
This is an excellent article, more up to date about anxiety disorders which it seems many of us suffer from. I fit the GAD category, and I really am very depressed a good bit of the time.

The trend in current research is to note that depression and anxiety (and I would then say DP/DR) come hand in hand in many circumstances.

I'm pinning this topic at the top of the board for now. I suppose it could be moved to the links section, but I feel it has some valuable information.

This tends to be my take on my own illness, and others may not agree with everything here, but I think this is a valuable resource in terms of definint various types of anxiety, and their link to depression. Very frustrating that nothing is directly mentioned about DP/DR. But this does discuss the presense of multiple symptoms that many of us seem to share.


Best,
D

University of Michigan Depression Center
Understanding Depression
Anxiety Disorders
The Anxiety Disorders

Anxiety disorders only infrequently occur in isolated, pure form. They
can vary in their presentation and are extensively co-morbid, with
other anxiety disorders and with depression and substance abuse. All
patients with depression and substance abuse should be screened for
anxiety disorders. A significant portion of female alcoholism may be
associated with panic and agoraphobia.


Patients will not present complaining of panic attacks, obsessions or
compulsions, or social phobia. When anxiety, obsessional traits, any
type of behavioral rituals, significant shyness, depressive symptoms,
or substance abuse are detected or suspected, then specific questions,
probing for the key features described below, should be asked.

Anxiety disorders cannot be "cured." Full, functional recovery is an
achievable goal, but complete resolution of symptoms and
invulnerability to relapse are not expected outcomes. Lingering
symptoms, vulnerability to "normal" anxiety, and stress-related
intensification of symptoms and anxiety contribute to a continuous risk
of relapse. These factors are directly addressed in CBT, which is
probably why it improves long-term outcomes.

Panic Disorder

Rapid onset, discrete, episodes of anxiety/distress/discomfort,
accompanied by physical symptoms that are often suggestive of cardiac,
endocrine or neurologic disorder. Panic patients become frightened of
fear itself and its symptoms. Associated with fear/avoidance of crowds,
driving, being closed in, being far from home alone, etc.
(agoraphobia). Temporal course of symptoms (sudden onset, rapid
progression to a peak, and recovery over 5 to 30 minutes) is as
important as enumeration of specific symptoms in diagnosing panic
attacks. Agoraphobic fears and avoidance help confirm the diagnosis.
Must always be evaluated for depression, substance abuse, and
suicidality.

First line treatment: CBT and/or medication (SSRIs). New data and APA
guidelines now support CBT as a first line treatment for Panic
Disorder.

Screening questions: Have you ever had a spell or attack when all of a sudden you felt frightened, anxious or very uneasy in situations when
most people would not be afraid or anxious? In the past 6 months, have
you had a spell or attack when for no reason your heart suddenly began
to race, you felt faint, or you couldn't catch your breath? Some people
have such an unreasonably strong fear of being in a crowd, leaving home
alone, traveling on buses, cars or trains, crossing a bridge that they
always get very upset in such situation or avoid it altogether. Did you
ever go through a period when being in any of these situations
frightened you?

Social Phobia

Generalized: Excessive anxiety/distress in nearly all situations in
which subject to attention, social scrutiny or evaluation

Specific: Anxiety and avoidance of a specific, social performance
situation (public speaking, using public restrooms...)
Extremely common, can be severely debilitating, and is often minimized
or ignored because social anxiety is "normal". Patients are also
generally embarrassed and avoidant, so they often won't disclose their
symptoms unless specifically asked. May have panic attacks but they are
confined to situations in which the patient may be the center of
attention.

First line treatment: CBT. Group CBT is our preferred treatment for
those who are candidates for it. Medication is used for patients who
are not likely to do well with CBT, such as those with extensively
generalized or severe symptoms or co-morbid depression. Try standard SSRIs or Effexor first; MAOIs may be more effective. Beta-blockers havelittle direct impact on anxiety but can be helpful in performance situations where physical manifestations of anxiety (e.g., sweating, tremor) undermine the performance or become distractions. Some patients need social skills training.

Screening question: Some people have an unreasonably strong fear of doing things in front of other people - like speaking in public, using
public rest rooms, eating in public, or even talking to people. Have
you had any of these kinds of fears?

Obsessive-Compulsive Disorder (OCD)

Obsessions are recurrent, intrusive thoughts, disturbing to the
patient, but experienced as uncontrollable, often involving fears of
harm coming to self or others. Typical examples include obsessive
thoughts about germ contamination leading to illness, obsessive
thoughts about making mistakes that will lead to harm. Violent, sexual,
or blasphemous content is common.

Compulsions are repetitive behaviors
(e.g., washing, counting, repeating, checking...) that are performed
according to certain rules or in a stereotyped fashion. Some patients
may resist their compulsions, but usually cannot control them. OCD is
the most hidden of the anxiety disorders. Patients must specifically be
asked about counting, checking, washing rituals and intrusive,
disturbing thoughts.

First line treatment: CBT and medication (SSRIs, often in high doses).
Some patients do well without medication. Recovery is often incomplete,
but substantial gains are usually possible.

Screening questions: Have you ever been bothered by thoughts that didn't make any sense, and kept coming back to you even when you tried not to have them? Was there ever anything you had to do over and over again and couldn't resist doing, like washing your hands again and
again, counting up to a certain number, or checking something several
times to make sure that you'd done it right?

Specific Phobia

Marked fear of specific, circumscribed objects or situations associated
with severe distress upon exposure. Nearly all patients experience
impairing avoidance. Impairment is often not evident to the patient, as
they have incorporated accommodation to the phobia into their lives.

Height phobias and claustrophobia are among our most commonly treated
phobias. Snake and spider phobias are among the most common in the
community but few people with these seek treatment. Blood, illness, and
injury phobias are common, impede medical care, and should be treated,
though they sometimes keep patients from even visiting the doctor's
office.

Treatment - CBT for phobias is simple, quick, and extremely effective.
These patients need help overcoming their reluctance to seek treatment.

Screening question: Are there things that you have been especially
afraid of, like flying, seeing blood, getting a shot, heights, closed
places, or certain kinds of insects or animals?

Generalized Anxiety Disorder

The hallmark of this disorder is chronic, excessive worry. Patients
often recognize that their worry is excessive and struggle with their
inability to control it. Additional symptoms include restlessness,
insomnia, poor concentration, fatigue and irritability. Though GAD can
occur in isolation, it is far more common to see it in association with
depressive symptoms, or other anxiety disorders. Many patients referred
to us with suspected GAD turn out to have major depression with
intense, ruminative anxiety.

First line treatment: antidepressant medication (SSRIs).

Screening questions: Are you a particularly nervous or anxious person?
Do you or people who know you well think of you as a "worry wort"?

Last updated on:
Wednesday, 05-May-2004 10:36:56 EDT

-----------------------------------------
This site developed and maintained by: John Bennett

University of Michigan Health System
1500 E. Medical Center Dr.
Ann Arbor, MI 48109
734-936-4000
http://www.med.umich.edu/
(c) copyright 2001 University of Michigan Health System
 

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Registered
Joined
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2,496 Posts
Discussion Starter · #2 ·
This is an excellent article, more up to date about anxiety disorders which it seems many of us suffer from. I fit the GAD category, and I really am very depressed a good bit of the time.

The trend in current research is to note that depression and anxiety (and I would then say DP/DR) come hand in hand in many circumstances.

I'm pinning this topic at the top of the board for now. I suppose it could be moved to the links section, but I feel it has some valuable information.

This tends to be my take on my own illness, and others may not agree with everything here, but I think this is a valuable resource in terms of definint various types of anxiety, and their link to depression. Very frustrating that nothing is directly mentioned about DP/DR. But this does discuss the presense of multiple symptoms that many of us seem to share.


Best,
D

University of Michigan Depression Center
Understanding Depression
Anxiety Disorders
The Anxiety Disorders

Anxiety disorders only infrequently occur in isolated, pure form. They
can vary in their presentation and are extensively co-morbid, with
other anxiety disorders and with depression and substance abuse. All
patients with depression and substance abuse should be screened for
anxiety disorders. A significant portion of female alcoholism may be
associated with panic and agoraphobia.


Patients will not present complaining of panic attacks, obsessions or
compulsions, or social phobia. When anxiety, obsessional traits, any
type of behavioral rituals, significant shyness, depressive symptoms,
or substance abuse are detected or suspected, then specific questions,
probing for the key features described below, should be asked.

Anxiety disorders cannot be "cured." Full, functional recovery is an
achievable goal, but complete resolution of symptoms and
invulnerability to relapse are not expected outcomes. Lingering
symptoms, vulnerability to "normal" anxiety, and stress-related
intensification of symptoms and anxiety contribute to a continuous risk
of relapse. These factors are directly addressed in CBT, which is
probably why it improves long-term outcomes.

Panic Disorder

Rapid onset, discrete, episodes of anxiety/distress/discomfort,
accompanied by physical symptoms that are often suggestive of cardiac,
endocrine or neurologic disorder. Panic patients become frightened of
fear itself and its symptoms. Associated with fear/avoidance of crowds,
driving, being closed in, being far from home alone, etc.
(agoraphobia). Temporal course of symptoms (sudden onset, rapid
progression to a peak, and recovery over 5 to 30 minutes) is as
important as enumeration of specific symptoms in diagnosing panic
attacks. Agoraphobic fears and avoidance help confirm the diagnosis.
Must always be evaluated for depression, substance abuse, and
suicidality.

First line treatment: CBT and/or medication (SSRIs). New data and APA
guidelines now support CBT as a first line treatment for Panic
Disorder.

Screening questions: Have you ever had a spell or attack when all of a sudden you felt frightened, anxious or very uneasy in situations when
most people would not be afraid or anxious? In the past 6 months, have
you had a spell or attack when for no reason your heart suddenly began
to race, you felt faint, or you couldn't catch your breath? Some people
have such an unreasonably strong fear of being in a crowd, leaving home
alone, traveling on buses, cars or trains, crossing a bridge that they
always get very upset in such situation or avoid it altogether. Did you
ever go through a period when being in any of these situations
frightened you?

Social Phobia

Generalized: Excessive anxiety/distress in nearly all situations in
which subject to attention, social scrutiny or evaluation

Specific: Anxiety and avoidance of a specific, social performance
situation (public speaking, using public restrooms...)
Extremely common, can be severely debilitating, and is often minimized
or ignored because social anxiety is "normal". Patients are also
generally embarrassed and avoidant, so they often won't disclose their
symptoms unless specifically asked. May have panic attacks but they are
confined to situations in which the patient may be the center of
attention.

First line treatment: CBT. Group CBT is our preferred treatment for
those who are candidates for it. Medication is used for patients who
are not likely to do well with CBT, such as those with extensively
generalized or severe symptoms or co-morbid depression. Try standard SSRIs or Effexor first; MAOIs may be more effective. Beta-blockers havelittle direct impact on anxiety but can be helpful in performance situations where physical manifestations of anxiety (e.g., sweating, tremor) undermine the performance or become distractions. Some patients need social skills training.

Screening question: Some people have an unreasonably strong fear of doing things in front of other people - like speaking in public, using
public rest rooms, eating in public, or even talking to people. Have
you had any of these kinds of fears?

Obsessive-Compulsive Disorder (OCD)

Obsessions are recurrent, intrusive thoughts, disturbing to the
patient, but experienced as uncontrollable, often involving fears of
harm coming to self or others. Typical examples include obsessive
thoughts about germ contamination leading to illness, obsessive
thoughts about making mistakes that will lead to harm. Violent, sexual,
or blasphemous content is common.

Compulsions are repetitive behaviors
(e.g., washing, counting, repeating, checking...) that are performed
according to certain rules or in a stereotyped fashion. Some patients
may resist their compulsions, but usually cannot control them. OCD is
the most hidden of the anxiety disorders. Patients must specifically be
asked about counting, checking, washing rituals and intrusive,
disturbing thoughts.

First line treatment: CBT and medication (SSRIs, often in high doses).
Some patients do well without medication. Recovery is often incomplete,
but substantial gains are usually possible.

Screening questions: Have you ever been bothered by thoughts that didn't make any sense, and kept coming back to you even when you tried not to have them? Was there ever anything you had to do over and over again and couldn't resist doing, like washing your hands again and
again, counting up to a certain number, or checking something several
times to make sure that you'd done it right?

Specific Phobia

Marked fear of specific, circumscribed objects or situations associated
with severe distress upon exposure. Nearly all patients experience
impairing avoidance. Impairment is often not evident to the patient, as
they have incorporated accommodation to the phobia into their lives.

Height phobias and claustrophobia are among our most commonly treated
phobias. Snake and spider phobias are among the most common in the
community but few people with these seek treatment. Blood, illness, and
injury phobias are common, impede medical care, and should be treated,
though they sometimes keep patients from even visiting the doctor's
office.

Treatment - CBT for phobias is simple, quick, and extremely effective.
These patients need help overcoming their reluctance to seek treatment.

Screening question: Are there things that you have been especially
afraid of, like flying, seeing blood, getting a shot, heights, closed
places, or certain kinds of insects or animals?

Generalized Anxiety Disorder

The hallmark of this disorder is chronic, excessive worry. Patients
often recognize that their worry is excessive and struggle with their
inability to control it. Additional symptoms include restlessness,
insomnia, poor concentration, fatigue and irritability. Though GAD can
occur in isolation, it is far more common to see it in association with
depressive symptoms, or other anxiety disorders. Many patients referred
to us with suspected GAD turn out to have major depression with
intense, ruminative anxiety.

First line treatment: antidepressant medication (SSRIs).

Screening questions: Are you a particularly nervous or anxious person?
Do you or people who know you well think of you as a "worry wort"?

Last updated on:
Wednesday, 05-May-2004 10:36:56 EDT

-----------------------------------------
This site developed and maintained by: John Bennett

University of Michigan Health System
1500 E. Medical Center Dr.
Ann Arbor, MI 48109
734-936-4000
http://www.med.umich.edu/
(c) copyright 2001 University of Michigan Health System
 

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Discussion Starter · #6 ·
Dear Dutchmark,
Having GAD with chronic DP/DR and depression, I can sort of answer this. I have had had numerous forms of therapy and have tried various medications for my problems over the years.

I've had psychotherapy (most helpful), psychoanalysis, CBT (helpful to an extent).

The reason GAD is more difficult to treat, as I understand it, is that it is indeed "generalized", that is it is not specifically related to a particular anxiety as mentioned above, e.g. a Phobia is a very specific fear that can be dealt with by exposing one's self to the object of fear and desensitizing.

OCD can be very responsive to CBT as again, there are specific obsessions/compusions/rituals. Working (very hard) to force the brain through repetition can "recondition" the brain.

GAD again is anxiety that permeates one's whole life, many situations. Also, depression can be a big factor. Depression does not respond as well to CBT. And DP/DR, for me chronic for years, present ALL the time, even in my dreams, is very treatment resistant.

I'm not articulating this well, but GAD is not FOCUSED on a particular fear/obsession etc. GAD encompasses a broad range of symptoms. And if one has no relief, and it is chronic, there is difficulty getting a "reward" for one's efforts. I.E. I haven't felt reality in years. My work to change my thinking is slowly helping... trying to be more positive, making myself be more active... but the SYMPTOMS do not respond as well.

I'm rambling on. If you reread the whole article, you will see what I'm trying to say:

GAD = more .... general.. no other way to say it, not a specific "problem" to work on. Many problems that permeate the personality and come with depression and many other symptoms.

I have responded best to meds and psychotherapy. I also came from a very dysfunctional, traumatic background which makes me overreact to ALL situations that shouldn't cause so much anxiety or make my DP/DR get worse.

I'm rambling.
Hope this makes a whit of sense.
Best,
D
 
G

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Yeah, I have OCD and social anxiety. These are my primary diagnoses I think. Especially OCD. I had social anxiety disorder as a child pretty bad. But I was undiagnosed. I was always the weird kid, lonely, outside, made fun of. Anyway, now it is OCD (and what I often think of as dp/ dr symptoms) that dominate me. My psychiatrist would not diagnose me with depersonalization disorder because he says if it occurs within the context of another disorder (with me OCD), he cannot do that. However, I don't know, dp and dr, if those are the correct labels for my problems feeling the way I do so much of the time, like I am unintegrated, not whole, broken, and not fully connected to reality, etc., dp and dr are a huge part of my life and what I identify with (in addition to OCD).

Depressions I have had and I still fear. Once in a while, I have a period of moderate depression now, and I have temporary moods and states of depression or transient depressive symptoms that come with certain situations. But actual depression is less of a direct problem now than it was 8- 10 years ago. Maybe this is due partly to medication and partly to coping skills.

Nikki
 

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Problem with this kind of self-diagnostic approach is that you are bound to see all the symptoms in yourself! I strongly believe that most or all people have a little bit of everything in them! Also there is a big difference between a clinically diagnosed condition and what I might diagnose about myself.
 

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ha :D that's so funny, avaya! i just read the top and was like "oh my gosh, maybe i have ocd..." and then i got down to your post and realized that it was just some good ole' hypochondria.
 

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What a night. I cannot do this again.

8:30 pm: Looked at the clock and said, "Wow, last night at this time, I was having a panic attack and had to take an Ativan. But because I'm up to 200 mg of Zoloft and feel good, I've made it. Maybe this will be my new dosage."

Ten minutes later, an attack walloped me over the head. It felt scarier than the others. The day hadn't been all terrific physically, though. I felt a kind of tightness in my scalp, but other than that, I was okay.

I decided not to immediately take the Ativan, and the monster lasted until just about half an hour ago. Of course, I cannot sleep yet.

I did talk to my sister long-distance for half an hour and told her something that had been eating at me regarding our relationship, but that must not be what's eating at me, because while it lifted briefly, it came back soon thereafter stronger than it had been earlier.

She's the one who's a doctor. She thinks that in my case it's primarily physical, so my task is to find a solution with my doctor. I suppose one day of a particular dose isn't the final word on the efficacy for me of 200 mg, but it certainly is discouraging.

I am never again going to not take an Ativan. Maybe I just have to be sedated at night or something. Everyone's so down on tranquilizers. I don't want to get addicted, but is one a day so very much?

Anyway, I really want to find a Catholic therapist, if I'm going to do therapy at all. I try to pray when I'm having an attack, but the irony is that when I'm in that state, I don't know if I even believe anymore.

Just now I felt it trying to come back, but I somehow got it to leave. I find that ignoring the physical manifestations doesn't work for me. All I do is suffer through a full-blown attack for, what, almost nine hours.

I'm starting to get sleepy, but I cannot get into bed until I am more ready than this. Thanks for listening.
 

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Sojourner,
I hope you are feeling better! :(
 

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Thanks, rain. I am feeling much better. I'm splitting up the 200 mg over the course of the day now. I slept from about 10:30 to 5:30 and feel pretty good. If the anxiety comes back tonight, I will take an Ativan, without guilt that I am not trying non-drug methods or worry that I will become an addict. My doctor said not to worry about that at all, because he feels I'm not an addictive personality and he can get me safely off it.

At least last night wasn't a total waste -- I know now for sure that I cannot control this with my will or my ingenuity in methods of distraction.
 

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Oh, and whether 200 will be the right dose is something we'll know in about five days. It was silly of me to think that one day would do it.
 

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Not silly at all. I am taking celexa and became extrememly frustrated when I didn't feel better in a week. We just want relief and I hope we all find it soon. 3 weeks later I am not much better, but I am still going to give it more time. Patience is very hard to have when you are suffering.

I am glad you got rid of your worry in regards to the ativan. You are not abusing the drug and the dr. is well aware that you do not want to become addicted. Let that worry go, I am sure you have others to bother you. Just glad you are feeling better.
 

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Yes, it can take longer than a couple of weeks.

I'm going to ask my doctor if I can just take an Ativan prophylactically and not have to wait until it starts, because it takes too long to work. I had no relief tonight for about 2.5 hours. That's not good.

So, I guess I have a plan until Zoloft gets to the right level. Gotta check with him tomorrow. I'm sure he'll say yes, but I also want to tell him that I had to take 2 ativan to ge relief. Actually, he had said take another half tablet, but that didn't help, so I took the whole thing half an hour later.

So I've had 1.0 mg. of ativan. The Zoloft must be covering the panic during the day. The thing is, rain, there's a lag time when we start a new dosage. I'm still operating under 150 mg, not 200 mg, even though I've taken 200 mg for two days. It will take about a week for the concentration level to get up to 200 mg in my blood. If the anxiety isn't handled then, he said 200 mg. is NOT the maximum dosage, so I guess we'd increase it again.

I am not going to worry about it, frankly. As long as I am not having anxiety attacks and feel as relaxed and good as I do right now, I am just not going to worry about it. I think worrying about when the next one will come is a product of not having a plan that works to keep them from occurring. If people aren't getting medicine, I can understand how they feel.
 

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You know if Zoloft doesn't work there are many other meds out there, and I am sure if the problem is only chemical you will find one to take care of it soon.

I always feel so bad at night. Alone and scared, noone to tell me that this will pass. Pity party for me, I know. :cry:

Praying the zoloft is your answer and that you continue to feel good.
 

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I know how you feel, rain. I get an attack at night, every night at 8:30. My doctor said today I can take Ativan prophylactically. Can you get something like that to help at night. It completely removes the anxiety for me and I wind up feeling just normal. After a while, I feel sleepy, but not tremendously so.

What medication are you taking now?
 

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I am taking 40mg of celexa everyday, and I have xanax for the times I feel it is unbearable. My GP mentioned either adding neurontin(sp) to the celexa or switching to effexor.

She doesn't really have much faith an any of it and keeps telling me to find a GOOD therapist. She doesn't think medicine will help which is very discouraging. She thinks it is PTSD.

I know I probably have some "issues," but I am scared of facing them. I am also scared of therapy, the little bit I have gone through has always made me worse. I am just so sick of this, I am ready for anything, electric shock treatment, whatever would help. :cry:
 
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