Depression and Anxiety

Mental health problems such as depression and anxiety can accompany an illness. The following information includes information on signs, symptoms and treatment.

Symptoms of Depression

Depression is characterized by feelings of sadness, despair and discouragement. It often follows a personal loss or injury. It is not a sign of weakness nor does it represent a moral failing.

Sadness that lasts a long time and a loss of enjoyment in almost all activities are the central features of depression. Sadness is a symptom, but not the same thing as depression. Everyone is sad sometimes. The type of sadness that occurs in depression lasts all day or most of the day, every day for a long time (at least two weeks). Other symptoms include feelings of worthlessness or guilt, suicidal thoughts, loss of concentration, decreased energy, slowed thinking and movement, appetite loss and sleep problems.

It is important to remember that many of these symptoms can occur with illnesses such as brain injury or stroke or even less serious problems like a cold or flu, but may not indicate depression. Even if you have trouble sleeping, lack of appetite and problems concentrating, there is no reason to be concerned about a separate mental health condition unless you also feel sad most of the time or rarely find enjoyment in life.

What is the difference between normal grief and depression?

Some symptoms of depression as described above are normal after any kind of loss including the onset of a disability or severe illness. If you have had these symptoms for a long time it may be helpful to talk with a mental health professional. It is also helpful to talk to someone if you have other symptoms such as feeling guilty or worthless, or if sadness interferes with the ability to do important life tasks (take medication; go to therapies, work or school).

---

Symptoms of Anxiety

Following a major life-changing event like a disabling illness, it is normal to feel a great deal of stress. Stress can build up over time and can lead to anxiety. Anxiety can be a response to a specific situation such as learning to walk all over again; it can also be more generalized such as not wanting to leave the house after being discharged from the hospital.

The most common symptoms of anxiety are fear and worry. Anxiety can also cause restlessness, and difficulty concentrating and sleeping. Sometimes people will express anxiety by being irritable, tired or even stubborn. Anxiety can cause physical symptoms like muscle tension, shortness of breath or even feelings of panic. Nearly everyone feels anxiety when faced with a bad physical problem. Anxiety becomes a concern when these feelings are very strong and interfere with important tasks in life.

Can anxiety or depression be different depending on age?

Children and older adults often show anxiety and depression differently. Children may misbehave either at school or at home. Older adults might report vague physical problems when there is no clear medical cause.

---

Treatment

Both depression and anxiety can go away over time but without treatment the symptoms last longer and may return. Chronic depression or anxiety can cause low self-esteem and poor quality of life.

Anxiety and depression are usually treated with medication and/or psychotherapy (counseling) by a trained professional. Treatment is usually quite successful, so there is little reason to delay seeking help.

If feeling anxious or depressed, it is important to admit to it and get help. Even when family and friends are around for support, professional attention is best. A good first step is to discuss concerns with your regular doctor. He or she can provide advice about the best treatment and suggest a qualified therapist. There are several types of mental health professionals who can provide psychotherapy (counselors, social workers and psychologists), but any medications must be prescribed by a physician (your regular doctor or a psychiatrist). It is important to select a therapist with whom you fee comfortable and can talk honestly about your feelings. Psychotherapy can be done individually, with other family members, or in a group.

Sometimes it is best to both take medication and see a therapist. Medications can be helpful in many cases. Sometimes people are afraid of acting and thinking strangely, or becoming dependent on drugs used to treat anxiety and depression. When these medications are taken as prescribed by a doctor, bad side effects can be reduced or eliminated and there is little risk of becoming addicted to them. Remember that these medications are not the same as street drugs used to get high.

---

Tips for Coping with Anxiety and Depression While in the Hospital

There is no single, simple way to adjust to a disability, but there are a few tips to keep in mind.

• Follow a routine. Aside from the regular therapy schedule, try to go to bed the same time each night, and to set aside time for relaxing and visiting (either in person or on the phone).
• Be open with staff, family and friends regarding your needs.
• Ask questions about any aspect of your care that is unclear.
• Share things that worry you with others. Keeping feelings bottled up often makes being in the hospital more difficult. Sometimes people have problems admitting anything bad has happened as a way to be protected from depression and anxiety. It is healthier to admit you may not be able to do everything you used to do.
• Acknowledge that you will be sad about this for a while until you find new things to do that you enjoy. Try not to exaggerate these losses with thoughts such as “I can’t do anything anymore;” “I’ll never be able to find anything worthwhile to do again.”

---

Tips for Coping with Anxiety and Depression after Leaving the Hospital

Sometimes people have prejudices about physical disability that make them feel like “second class citizens” when they become disabled themselves. Sometimes people with a disability get into the habit of letting other people do things for them and as a result they start to feel helpless. Sometimes people with a disability start to avoid situations that make them nervous (for example going out in public where others can see that they look or act differently). This makes those situations much more scary or upsetting when they can no longer be avoided.

• Set up a routine and stay with it to work on your recovery after leaving the hospital.
• Stay involved in life. Find enjoyable activities – either ones from before or new ones.
• Acknowledge improvements. This decreases the risk of boredom and depression and will boost self-confidence.
• This is a stressful time, so be open to the support of others. Healthy relationships with family, friends or others with a disability can go a long way in preventing depression and anxiety.
• There is also evidence that a strong spiritual life can help keep you healthier and hopeful.

---

Special Tips for Parents

Parents may need to provide more comfort and support than usual for their children. It is not unusual for a child to regress to an earlier stage of development following a traumatic event. Children may find it hard to separate from parents, become clingy or emotionally needy during a hospital stay. Children usually show signs of greater independence by the time of discharge. Please talk to your physician if these problems do not improve.

---

Additional Resources

American Medical Association (1998). Essential Guide to Depression. New York: Pocket Books.

Bourne, E.J. (2000). The Anxiety and Phobia Workbook. New Harbinger Press.

Mental Health: Does therapy work? Consumer Reports. November, 1995.

Sheffield, A. (1998). How You Can Survive When They’re Depressed. New York: Harmony.

Internet resources

For adults:

• American Psychological Association
• National Institutes of Mental Health
• Psychology Information Online

For children:

• Kids Health