Confused Internet Queen

Dear Confused:

Here are my common-sense definitions:

Depression generally means that a person feels sadness, irritability or tension and has less interest in the usual fun stuff of life. Often it comes with low energy: you feel slowed down. A change in appetite or sleeping habits (too much or not enough) is common, ditto for problems making decisions or concentrating. Depression may be caused by an imbalance of brain chemicals or be a reaction to a difficult event (a death, a breakup, losing your job, etc.). At its most severe, depression can mean feeling worthless or hopeless, and even suicidal.

Anxiety is a little trickier. Who doesn’t experience “normal” anxiety? It’s part of life. However, when psychotherapists like me use the term in our work, it’s more specific.

Anxiety comes in many forms. For most of us, it brings on such crummy experiences as excessive worry, obsessive negative thoughts, physical symptoms like headaches, problems sleeping and concentrating, and feeling irritable or restless.

Here are some of anxiety’s “greatest hits” (not available in stores). These are the diagnoses that most doctors and psychotherapists use, usually because insurance companies demand them:

Social anxiety is prolonged and intense fear and/or embarrassment in social situations.

Panic disorder is known by the onset of sudden feelings of intense fear – often called “panic attacks” – where you’re likely to experience physical symptoms that can mimic a heart attack and include dizziness, nausea, feeling suffocated or trapped.

Generalized Anxiety Disorder is what it sounds like: daily feelings of worry and anxiety that last for six months or more.

Obsessive Compulsive Disorder (OCD) shows up in two ways: (1) thoughts that you can’t stop from repeatedly thinking (“obsessions”) and/or (2) actions you can’t stop (“compulsions”) that temporarily lower your anxiety. This is the “I can’t sleep without checking every door to make sure it’s locked” type of behavior.

Most of us experience anxiety and depression. Life throws us good times and bum times, and everyone feels it. So why might your doctor recommend pills to cope with it? Because she/he may feel you are “clinically” depressed or anxious. What does this mean? Here’s my definition: If anxiety or depression interferes with your ability to get through the day, then it may be intense enough to be considered “clinical depression” or “generalized anxiety disorder” or some other textbook definition. If your depression or anxiety comes and goes relatively quickly, then it probably wouldn’t be considered a psychological diagnosis.

Bipolar disorder used to be called “manic depression” because you (1) experience symptoms of mania, intense and extreme moods, sleeplessness and increased energy that often results in wild and reckless behavior, and (2) experience depression (defined above). This isn’t about moodiness, folks. Real mania is quite uncommon. It’s not about dancing drunken on the bar at Rich’s (unless you do it regularly) or buying something you really can’t afford (occasionally). True mania usually lasts a week or longer, and typical symptoms include: little need for sleep, racing thoughts, extreme self-confidence (delusional), super-high (but unfocused) energy, and, worst of all, engaging in extremely risky behavior that endangers you or others.

Please talk with your doctor about your concerns and ask her/him all your questions. Be a mildly cynical patient (it’s good for your health) and trust yourself. Switch doctors if your doctor doesn’t see you as an equal or talks down to you. I think you are wise to question whether pills are right for you or not. For some people, medication is a real lifesaver (take that, Tom Cruise!), while for others, it may help a little, but is not worth the side effects. And be cynical about information you find on Internet sites – you can find anything out there, from one extreme to the other. Trust yourself, quiz your doctor, do your homework and make your decision.