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All Posts in Category: Mental Health

Stress vs Depression

Some stress, caused by regular life challenges, is unavoidable. And while feeling nervous about a date, a work presentation or frustrated by an overprotecting parent or an obnoxious boss is not fun, nobody would compare it to the challenge that is depression, a serious illness.

Severe stress, however, is a different story. As anyone who has suffered chronic stress knows, with the resulting mood swings, sleeplessness, and low of self-esteem it can bring, the line between stress and depression can start to feel a little blurred.

So what is the difference, then?

Let’s start with Stress.

Stress is the feeling that you are under too much mental or emotional pressure. You feel overwhelmed. It is triggered by something in your life happening that feels too much for you personally to handle, stretching you coping capabilities, regardless of whether others can or can’t. This might be a work issue, dealing with relationship conflict, or debt problems.

Stress isn’t an illness or a disorder, but it can develop into one if it is left to become chronic.

While a little bit of stress is normal and can have positive results like getting you motivated for exams or taking useful risks in the workplace, too much stress over too long of a period can begin to negatively affect all parts of your life.

Common effects of stress are: Headaches, Muscle tension or pain, Chest pain, Fatigue, Change in sex drive, Stomach upset, Sleep problems, Drug/alcohol abuse, Anxiety, Restlessness, Lack of motivation or focus , Irritability or anger, Sadness or depression, Overeating or undereating, Angry outbursts, Tobacco use, Social withdrawal.

Now Depression. This is an entirely different beast.

Depression refers to an experience where you feel down most of the time which is called “low mood” and you have also lost interest in things you usually enjoy. You may also have changes in your sleep, appetite, feel guilty, demotivated and generally withdraw from others.

 

Depression exists in a social, psychological and biological context; that is depression is influenced by genetics, diseases, hormones, cognitive distortions, influences of family/workplace/friends, history and drug/alcohol use to name a few.

Depression is often based on old, repressed emotions that are making their way to the surface. As such, it rarely responds to logic. You can’t just ‘fix it’, or achieve or finish something that will make it go away. For example, if you moved to a new village and started feeling low, it is unlikely moving again will completely sort your depression.

Because of its irrationality, depression can often feel out of control. You might feel like you are acting like someone else altogether, unable to connect to people around you.

Depression tends to leave you feeling exhausted, even if you are sleeping (and often depression disrupts good sleep). It can feel like something is draining all your energy and like your head is filled with sand and you can’t think straight.

One if the biggest symptoms of depression is negative thinking, which can spiral into destructive thoughts if support is not sought.

What do stress and depression have in common?

  • both are individual (what triggers stress or depression in one person doesn’t in another)
  • they affect your energy levels
  • they affect your moods
  • sleeping patterns are disturbed
  • eating patterns can be disturbed (under or overeating)
  • you are ‘not yourself’
  • you can struggle to function normally
  • you can be irritable
  • you might feel less interested in socializing with friends and family
  • they both can feel overwhelming
  • you might not be able to concentrate
  • both affect the body’s stress response mechanism
  • both have been found to physically affect the brain in similar ways

How are stress and depression different?

  • stress tends to resolve if life events change vs depression can last up to years
  • stress tends to have an obvious trigger vs depression can hit out of nowhere
  • stress is related to life events vs depression can happen even if life seems fine
  • stress is related to current events vs depression can be linked to unresolved past events
  • stress can cause depression or anxiety disorders if left untreated vs depression can cause suicidal thoughts if left untreated
  • stress leads to adrenaline highs followed by crashes vs depression leads to fatigue
  • stress is socially acceptable and even encouraged vs depression still, sadly, bears social stigma
  • stress at very high levels has risk of heart attack vs depression at high levels has risk of suicide
  • low stress can be okay and keep you motivated vs low depression can still be debilitating

Another interesting comparison was done by Dr.Christie Fleetwood, ND. If you overlay the symptoms of Stress and Major Depression Disorder (MDD) as outlined by DSM-5 (a handbook used by health care professionals in the mental health area as the authoritative guide to the diagnosis of mental disorders), you would notice that there are only 3 major differences:

  1. Drug and alcohol abuse, tobacco use listed with Stress
  2. Feelings of hopelessness, helplessness, guilt, worthlessness, listed with Depression…which could lead to….
  3. Suicidal/homicidal ideation listed with Depression.

If you think you suffer from Depression, please give us a call. We can help.

 

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Catatonia

Catatonia is a fascinating medical condition marked by changes in muscle tone or activity associated with a large number of serious mental and physical illnesses. It was described for the first time by a German psychiatrist, Karl Ludwig Kahlbaum in 1874. The exact mechanisms underlying the pathophysiology of catatonia still remain a mystery. It seems that some people are more predisposed than others to develop this syndrome.

You might have seen this condition in some movies where the actor/patient seems to not respond to anyone or anything around him, being lost in his world and losing contact with reality. The best representation of this condition, I think, could be found in the movie Awakenings (1990) with Robert De Niro and Robin Williams.

The origin of the word Catatonia was traced back to late 19th century and it arrived from the combination of “cata” meaning badly and “tonos” meaning tension or muscular tone, therefore it can be loosely translated as “bad muscular tone”.

There are two distinct sets of symptoms that are characteristic of this condition.

In catatonic stupor (lethargy) motor activity may be reduced to zero. Individuals avoid bathing and grooming, make little or no eye contact with others, may be mute and rigid, and initiate no social behaviors. For example, the patient sits immobile in a chair for sixteen hours, staring fixedly, apparently unaware of other people or his own bodily needs. Specific to this condition is also a behavior known as cerea flexibilitas (waxy flexibility) in which the individual can be made to assume bizarre (and sometimes painful) postures that they will maintain for extended periods of time without no apparent fatigue or effort. The individual may become dehydrated and malnourished because food and liquids are refused. In extreme situations such individuals must be fed through a tube. This is the most common type of catatonia.

Cerea flexibilitas

Catatonic excitement is characterized by hyperactivity and violence; the individual may harm him/herself or others. On rare occasions, isolation or restraint may be needed to ensure the individual’s safety and the safety of others.

Catatonia can also be categorized as intrinsic or extrinsic. If the condition has an identifiable cause, it is    designated as extrinsic. If no cause can be determined following physical examination, laboratory testing, and history taking, the illness is considered to be intrinsic.

In terms of the most common associated signs with this rare condition, in a study involving more than 230 catatonic patients, the “staring,” was found in more than 80% of cases. Among other frequent signs, were the immobility in 70% of cases, the mutism (refusing to speak) in 60% of patients, and the withdrawal in 50% of them.

The causes of catatonia are largely unknown although research indicates that brain structure and function are somehow altered in this condition. While this and other information point to a physical cause, none has yet been proven. A variety of medical conditions also may lead to catatonia including head trauma, cerebrovascular disease, encephalitis, and certain metabolic disorders.

Catatonia was linked for a long time exclusively with schizophrenia. However, recent epidemiological studies showed that schizophrenia is found only in 20% of catatonic cases while mood disorders underlie 45% of cases. Catatonia is also frequent in children and adolescents, particularly in autism spectrum disorders where the prevalence varies between 12 and 17%.

Features of catatonia may also be seen in Neuroleptic Malignant Syndrome (NMS) which is an uncommon (but potentially lethal) reaction to some medications (antipsychotics) used to treat major mental illnesses. It will appear within 10 days of starting the drug in 90% of the cases. NMS is considered a medical emergency since 25% of untreated cases result in death.

It is estimated that approximately 90,000 cases of catatonia occur each year in US hospitals. Catatonia has a reported prevalence ranging from 7.6 percent to as high as 38 percent in psychiatric patients. It is most commonly associated with mood disorders (depression, bipolar disorders).

There are no laboratory or other tests that can be used to positively diagnose this condition, but medical and neurological tests are necessary to rule out underlying lesions or disorders that may be causing the symptoms observed.

Treatment of catatonia includes medications such as benzodiazepines (Xanax, Valium, Ativan etc) which are the first line of treatment. Electroconvulsive therapy (ECT) is most effective treatment for catatonic depression and may prove beneficial for clients who do not respond to medication. If these approaches are unsuccessful, treatment will be redirected to attempts to control the signs and symptoms of the illness.

There is currently no known way to prevent catatonia because the cause has not yet been identified. Research efforts continue to explore possible origins. Avoiding excessive use of neuroleptic (antipsychotic) drugs can help minimize the risk of developing catatonic-like symptoms.

Various drugs

And finally, there is interesting medical research that considered catatonia as an evolutionary remainder of defense strategies associated with intense fear. It seems that in front of predators, several survival behaviors have been developed. Among them, the most known one was the “fight or flight” strategy. In cases where none of these two options was possible, a third strategy called “tonic immobility” (TI) would be set up which consists of a tonic suspension of motor activity. This defense strategy is based on the fact that many predators are attracted by their prey’s movements. This hypothesis seems to be confirmed by the subjective experience of catatonic patients. Indeed, once remitted from their catatonia, patients report having felt invaded by a major and uncontrollable anxiety. Conversely, they do not seem to have been aware of their motor state and the time lapsed.

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