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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by UgottaHaveHope on March 4, 2007, at 12:46:15
I was talking to a pdoc recently and he said something that just slapped me in the face: "Anxiety very, very rarely comes before depression."
It has made me rethink my entire situation.
I have always thought I had an anxiety first, and then if the anxiety got really bad, withdrawal and depression.
When all of this started in 1997, it began with just an absolute rush of adrenaline out of nowhere, or better described as "free-floating anxiety." I could not calm down and have difficulties doing so in the years since. It must be noted in the past 10 years, whenever I have been able to find something to calm me down, I have been able to cope with life so much better.
However, I do recall during times before 1997 I was midly depressed, like your typical person. It was never clinical depression, though. I never sought or felt like I needed treatment. In other words, it was manageable without any therapy or medication (although looking back, maybe one or both wouldve been beneficial).
Now I am wondering, based on the words of the wise and veteran doc, that perhaps years and years of mild depression led up to the breakout of anxiety.
Does any of this make sense? Thanks, Michael
Posted by Declan on March 4, 2007, at 13:22:12
In reply to Chicken before egg? Anxiety before depression?, posted by UgottaHaveHope on March 4, 2007, at 12:46:15
I never had depression until I'd had years of anxiety first (although nothing like the kind of anxiety you speak of, Michael).
Not so many young healthy people get depression, at least not as many as among older people.
I like the idea that depression is the result of years of stress (including anxiety).
Posted by Phillipa on March 4, 2007, at 13:55:04
In reply to Chicken before egg? Anxiety before depression?, posted by UgottaHaveHope on March 4, 2007, at 12:46:15
Definitely as it may be the same for me except for the painic in 20's which went away for years with valium always cutting down and a lot of school, kids, and interests. Love Phillipa
Posted by Meri-Tuuli on March 4, 2007, at 14:12:17
In reply to Re: Chicken before egg? Anxiety before depression?, posted by Declan on March 4, 2007, at 13:22:12
I think I conform to all these ideas:
years of psychosocial stress => depression => and now => anxiety & depression
Eh, great.
Posted by stargazer on March 4, 2007, at 14:39:52
In reply to Re: Chicken before egg? Anxiety before depression?, posted by Meri-Tuuli on March 4, 2007, at 14:12:17
Not all depressions present in a sad or melancholic way, you know. Many occur with lots of energy and present typically with insomnia or anxiety. Anxiety rarely stands alone as a symptom. It's usually considered a symptom of depression or something else. At least that is what I have heard about anxiety.
SG
Posted by Declan on March 4, 2007, at 16:14:48
In reply to Remember agitated depression?, posted by stargazer on March 4, 2007, at 14:39:52
One doctor said to me that the form of depression most commonly presenting these days was agitated depression.
I wondered if depression as immobility and stuckness had been replaced by depression as agitation in response to some long term trend in our society.
Posted by med_empowered on March 4, 2007, at 17:39:47
In reply to Re: Remember agitated depression?, posted by Declan on March 4, 2007, at 16:14:48
I think also docs tend to dx things differently over the years. Agitated depression now sometimes==a bipolar mixed state, usually in BP II or another "soft bipolar". If its really bad, the agitation can be interpreted as a symptom of some underlying psychosis, so neuroleptics might be implemented.
I also think the massive use of psychotropics might be affecting mental illness. Patients who originally present as withdrawn and lethargic may be thrown into agitation through antidepressants OR some sort of kindling induced by meds used for previous episodes. Also, since docs used to call everything strange "schizophrenia," a lot of yesterday's "schizophrenics" are todays "complicated" depressives.
Posted by Ines on March 4, 2007, at 17:57:37
In reply to Chicken before egg? Anxiety before depression?, posted by UgottaHaveHope on March 4, 2007, at 12:46:15
> I was talking to a pdoc recently and he said something that just slapped me in the face: "Anxiety very, very rarely comes before depression."
>
> It has made me rethink my entire situation.
>
> I have always thought I had an anxiety first, and then if the anxiety got really bad, withdrawal and depression.
>
> When all of this started in 1997, it began with just an absolute rush of adrenaline out of nowhere, or better described as "free-floating anxiety." I could not calm down and have difficulties doing so in the years since. It must be noted in the past 10 years, whenever I have been able to find something to calm me down, I have been able to cope with life so much better.
>
> However, I do recall during times before 1997 I was midly depressed, like your typical person. It was never clinical depression, though. I never sought or felt like I needed treatment. In other words, it was manageable without any therapy or medication (although looking back, maybe one or both wouldve been beneficial).
>
> Now I am wondering, based on the words of the wise and veteran doc, that perhaps years and years of mild depression led up to the breakout of anxiety.
>
> Does any of this make sense? Thanks, Michael
I think it does. I've had various levels of depression on and off since my teens, but until my 1st episode of clinical depression I had never suffered from anxiety. In fact, I was a remarkably calm person. During that 1st episode I developed severe anxiety, and that's stayed with the permanently since then (even through periods of feeling good by my standards). I grind my teeth pretty much all the time (don't even notice it) to the extent that I've cracked a whole load of them and have bad gum retraction, and I keep getting stress related things (ulcers etc). I find I get incredibly anxious at the first sign of mood plumeting- I know I make it worse but can't control it- I become a giant grinding machine! In my case I believe it is in great part the effort of trying to keep a normal day to day life while having serious mood issues- it takes so much out of me that I end up completely drained and feel I'm always on the verge of not coping. Which makes me incredibly anxious! Definitely chicken and egg...
Posted by stargazer on March 4, 2007, at 20:13:27
In reply to Re: Chicken before egg? Anxiety before depression?, posted by Ines on March 4, 2007, at 17:57:37
My depressions when they recur usually begin with the inabiity to filter important stuff from background stuff. I internalize all of it and it's as if my mind gets more and more revved up trying to complete everything that I think I have to do. Wierd. Over time unless I do something about it, I get more and more manic, talking constantly about evrything that's making me "crazy" (usually work) before I eventually crash andget very sad and energy level goes from being extremely energized to becoming comatose, fearful, tearful in a matter of a few days.
Does this sound like bipolar or something else?
SG
Posted by FredPotter on March 4, 2007, at 21:18:06
In reply to Re: Chicken before egg? Anxiety before depression? » UgottaHaveHope, posted by Phillipa on March 4, 2007, at 13:55:04
I think anxiety and depression are different facets of the same thing. I don't think one causes the other
Posted by Phillipa on March 4, 2007, at 21:23:50
In reply to Re: Chicken before egg? Anxiety before depression?, posted by stargazer on March 4, 2007, at 20:13:27
Stargazer sounds like what I do I get overwhelmed blow things out of proportion then start making mistakes like not paying attention driving find myself almost on the wrong side of the road. I attribute mine in inability to slow my mind down and think rationally. I have an analogy for this. The first time I was taking patients in ICU there were about l0 IV lines. I looked at them and said holy *hit where do they all go and what's in each one. I wasn't anxiety or depressed then and said wait a minute I will trace each line only see one at a time and see where each one goes. It worked and I wasn't anxious and could tell you what each IV had and which line the med was in. Love Phillipa
Posted by UGottaHaveHope on March 4, 2007, at 22:34:30
In reply to Re: Chicken before egg? Anxiety before depression? » stargazer, posted by Phillipa on March 4, 2007, at 21:23:50
The Larry Hoovers, med-emp, link, yxibow, Crazy Horse, SLS, etc.
Posted by TheMeanReds on March 5, 2007, at 11:43:34
In reply to Chicken before egg? Anxiety before depression?, posted by UgottaHaveHope on March 4, 2007, at 12:46:15
I always had a theory all along that my axiety was causing my depression. Maybe its the opposite.
Posted by stargazer on March 6, 2007, at 9:16:33
In reply to Where are all the DEEP THINKERS? Please sound off, posted by UGottaHaveHope on March 4, 2007, at 22:34:30
It appears the DEEP THINKERS are recharging their brain power packs. That's good, not everyone has the capacity to really analyze what needs to be done with these very complicated issues. I would rather wait for the right analysis instead of trying the various suggestions so often made without any data to support its content.
Too much superficial advice can be dangerous when what is usually needed is much more time consuming. I find this to be true so often and spend alot of time on reading and helping my pdoc figure out what to do next.
BTW, my pdoc called and wants to see me today. I asked if he had spoken to the pdoc I saw two weeks ago for a second opinion. He said not yet. I hope he does this before I see him at 4 pm else why bother seeing me? I'm doing OK but want to know what else might be a viable treatment for me.
Stargazer
Posted by FredPotter on March 6, 2007, at 16:46:06
In reply to Re: Where are all the DEEP THINKERS? UGOTTA, posted by stargazer on March 6, 2007, at 9:16:33
Thanks for pointing out that apart from a chosen few we all talk rubbish
Posted by stargazer on March 7, 2007, at 12:02:53
In reply to Re: Where are all the DEEP THINKERS? UGOTTA, posted by stargazer on March 6, 2007, at 9:16:33
Sorry you took my message so personally, that is not what I had intended.
It's just that sometimes there is so much posted about a particular thing, it's hard to tell what is relevent and what is not. So when I to try and scan everything, it can be very frustrating.
I think this is what Ugotta was requesting of certain individuals that are known to be able to digest the more scientific and clinical parts that most of us can only guess at.
Peace...SG
Posted by kilgor trout on March 8, 2007, at 15:58:52
In reply to Chicken before egg? Anxiety before depression?, posted by UgottaHaveHope on March 4, 2007, at 12:46:15
Gotta chime in before I read the rest of this thread. It stunned me when I read it yesterday, but I didn't have time to write.
I would definately say that my Anxiety (which at times becomes overwhelming to the point of appearing frozen) can trigger depression. Often the anxiety causes events that cause existential trauma, hopelessness and then depression. Often my hypomania happens as a reation to the depression, me trying to pull myself up and out. (BTW I am bipolar, diagnosed since high school.)
Posted by UgottaHaveHope on March 9, 2007, at 0:29:30
In reply to Chicken before egg? Anxiety before depression?, posted by UgottaHaveHope on March 4, 2007, at 12:46:15
Love to hear your opinion.
Posted by yxibow on March 10, 2007, at 13:32:53
In reply to Re: Larry Hoovers, Quintal, Yxibow, Blueberry???, posted by UgottaHaveHope on March 9, 2007, at 0:29:30
> Love to hear your opinion.
I'm not really sure what the statement means. Anxiety disorders fill the DSM with all sorts of differential diagnoses just as much as depression.
If you, like most people on here and we can debate and argue, but since I know for myself that in most cases when people go through years of various mental illnesses its biological and genetic. Certainly is for me anyhow.
So variation through lifetime is a factor, and I kinda have a pretty sh*tty variation at the moment that doesn't seem to be in my control really. OCD while nasty, was in my control eventually -- of course you have it for life but its in the background and pales in comparison to this Somatiform mess which has robbed me of 5 years of living in the real world. Anyhow..
I have had anxiety and depression concommitant for most periods of my life.
Sometimes the depression is primary (intrinsically genetic/biological), sometimes its secondary (this disorder is damn crappy so I have depression), sometimes its both, which is what it seems for the moment, MDD.I've also had and still have phobias and various foibles concommitant with dysthymia in college, which was much milder, but also concommitant with slight OCD/short attention span which made me have to read passages in books sometimes twice or more to remember what I was reading.
There always was the trouble that you could treat one but not the other at the same time especially with SSRIs, that some anxiety would inevitably come from the treatment for depression, or depression wasn't covered enough and anxiety at least was partially covered.
My OCD was part of the onset of puberty and the discovery that my sexuality was not the same as my peers, not any particular depression I can think of. I mean I tended to be a loner at the small high school I went to, but I had always been one. Would be nice to go back and have more self esteem and win 'em over again so to speak but I'm way past wanting to remember certain parts of adolescence.So the answer to chicken and egg is, the chicken and the egg. But that's for me. Because everybody is different. Maybe your doctor had a deeper meaning than I can interpret but it hasn't particularly been the case for me, I think at any rate.
-- tidings
Posted by Larry Hoover on March 11, 2007, at 10:57:48
In reply to Re: Larry Hoovers, Quintal, Yxibow, Blueberry???, posted by UgottaHaveHope on March 9, 2007, at 0:29:30
I shy away from any blanket conclusions, almost as second nature.
My anxiety came first. I used to see myself as pathologically shy. I simply learned to act as if I wasn't. But that didn't end the internal activation. It was better, I suppose, but not over.
Anxiety is a stressor, and I'm a big believer in the stressor/diathesis model of mental illness. You're born with the vulnerability (diathesis), but it only becomes active under stress. The stressor(s) could be anything. A common virus. Environmental toxin exposure. Anything.
Anxiety could also be a product of stress. Its own diathesis, apart from depression. So, depression could be primary or secondary to anxiety, just as anxiety could be primary or secondary to depression.
I don't know what is gained by arguing depression comes before anxiety. Or by the contrary.
The mere fact that one treatment might alleviate both is not evidence in support of either hypothesis, IMHO.
Lar
Posted by UGottaHaveHope on March 11, 2007, at 11:57:55
In reply to Re: Larry Hoovers, Quintal, Yxibow, Blueberry??? » UgottaHaveHope, posted by Larry Hoover on March 11, 2007, at 10:57:48
nm
Posted by Quintal on March 13, 2007, at 23:37:12
In reply to Re: Larry Hoovers, Quintal, Yxibow, Blueberry???, posted by UgottaHaveHope on March 9, 2007, at 0:29:30
I had this discussion once with my psychiatric nurse with regards to my benzo use for anxiety. He believed that depression was causing my anxiety (and the benzos were worsening my depression) and if we could get my mood very high the anxiety would disappear. It's partly true - that's how amphetamine and stimulating antidepressants like Parnate can be helpful for 'social anxiety' even though they are quite anxiogenic and agitating. They made me feel confident and assertive enough to tackle the world head on. I once needed to cancel a subscription to a magazine notorious for using high-pressure sales techniques, and while on amphetamine I had no problem - the guy backed down immediately. I guess there must have been a tone in my voice that warned him I was on the ball and taking no sh*t?
I don't know which came first for me. I think I've always had agitated/anxious depressions - my depressions seem to have been triggered by circumstances that caused me much anxiety. My mother was ill a lot when I was small, and was dying at one point - I must have known but I can't remember anything about it now. I suppose a lot of my depression and anxiety stemmed form that, OCD too. I remember thinking that if I ran up and down the stairs nine times, (avoiding every third step - multiples of three, my 'magic number') she would be alright. It's a way of trying to take some control of your anxious feelings I suppose.
I also think this has something to do with my homosexuality, I read this by L.Ron Hubbard (Scientology founder) the other day and I have to agree with it in my case. It's the most accurate, concise and persuasive description of my character and the reasons I became this way that I've ever read.
__________________________________________________"The "aberration" was caused by a child trying to "continue the life" of a dominant parent of the opposite sex."
Minshull described the "the gentle-mannered homosexual" as a classic example of the "subversive" 1.1 personality, commenting that they "may be fearful, sympathetic, propitiative, griefy or apathetic. Occasionally they manage an ineffectual tantrum." They were claimed to be social misfits:
"Homosexuals don't practice love; 1.1s can't. Their relationships consist of: 1) brief, sordid and impersonal meetings or 2) longer arrangements punctuated by dramatic tirades, discords, jealousies and frequent infidelity. It could hardly be otherwise since the tone is made up of suspicion and hate, producing a darling sweetness interspersed with petty peevishness. Their "love" turns to deep contempt eventually."
"Sexual perversion, a category in which he included homosexuality, was termed "covert hostility" and given a score of 1.1, "the level of the pervert, the hypocrite, the turncoat, ... the subversive." Such people were "skulking coward[s] who yet contains enough perfidious energy to strike back, but not enough courage ever to give warning."
"In Hubbard's 1951 book Handbook for Preclears, he set out instructions for Dianeticists to "cure" homosexuality. After claiming that the cause of homosexuality was a fixation on a dominant parent of the opposite sex, he advised: "Break this life continuum concept by running sympathy and grief for the dominant parent and then run off the desires to be an effect and their failures and the homosexual is rehabilitated."
http://en.wikipedia.org/wiki/Scientology_and_Homosexuality
__________________________________________________It's horrible, harsh and abrasive, but I can't deny the truth of the matter in my own case. I think the cure for much of my mental suffering lies in the path he describes.
Q
Posted by sdb on March 14, 2007, at 14:29:14
In reply to Re: Larry Hoovers, Quintal, Yxibow, Blueberry??? » UgottaHaveHope, posted by Larry Hoover on March 11, 2007, at 10:57:48
> My anxiety came first. I used to see myself as pathologically shy. I simply learned to act as if I wasn't. But that didn't end the internal activation. It was better, I suppose, but not over.
>
> Anxiety is a stressor, and I'm a big believer in the stressor/diathesis model of mental illness. You're born with the vulnerability (diathesis), but it only becomes active under stress. The stressor(s) could be anything. A common virus. Environmental toxin exposure. Anything.
>
> Anxiety could also be a product of stress. Its own diathesis, apart from depression. So, depression could be primary or secondary to anxiety, just as anxiety could be primary or secondary to depression.
>
> I don't know what is gained by arguing depression comes before anxiety. Or by the contrary.
>
> The mere fact that one treatment might alleviate both is not evidence in support of either hypothesis, IMHO.
>
> LarI can follow your words.
There are the genes plus factors could be the educational background received by your parents or early experiences from kindergarten and school. Somatic things contribute too.
There is evidence that some individuals overcome torture (in school, at home, Abu Ghraib or wherever) more easily than other individuals mentally damaged forever.
warm regards
sdb
Posted by Dr. Bob on March 24, 2007, at 22:56:25
In reply to Re: Larry Hoovers, Quintal, Yxibow, Blueberry??? » UgottaHaveHope, posted by Quintal on March 13, 2007, at 23:37:12
> I also think this has something to do with my homosexuality
Sorry to interrupt, but I'd like to redirect follow-ups regarding homosexuality to Psycho-Babble Social. Here's a link:
http://www.dr-bob.org/babble/social/20070322/msgs/743844.html
Thanks,
Bob
This is the end of the thread.
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