Depression, anxiety, and posttraumatic stress disorder (PTSD) often coexist and are generally called "mood disorders." Thirty percent of people with FM are currently depressed and 60 percent have a lifetime history that includes a depressive episode. There are several subtypes of depression, each having a slightly different clinical presentation and treatment. Generally, depression is diagnosed based on a history of feeling down, sad, blue, hopeless, guilty, anxious, or fatigued. Besides mood changes, there are often changes in eating and sleeping patterns, all of which can interfere with daily life and normal functioning. As with most chronic illnesses, there is no single known cause of depression. Instead it is thought to be caused by a combination of genetic predisposition, environmental factors, and environmental triggers that alter biochemistry. There is a preponderance of evidence from brain-imaging technologies demonstrating consistent brain alterations compared to people without depression. Specifically, the parts of the brain responsible for sleep, appetite, behavior, and mood are affected. Neurotransmitters such as serotonin and norepinephrine also are out of balance, and neurotransmitters are a key to optimal communication between nerve cells.
Therapy for depression includes prescription medication combined with talk therapy. Cognitive behavioral strategies largely have replaced psychoanalysis in the treatment of mood disorders. The main key to success in treatment appears to be early and adequate intervention. Drug classes for depression include tri-cyclic antidepressants, SSRIs, SNRIs, and occasionally monoamine oxidase inhibitors (MAOIs). However, MAOIs have multiple drug and food interactions. Occasionally, stimulants or anti-anxiety medications are used in conjunction with antidepressants. Exercise, electrical therapies, and light therapy are all helpful in some types of depression.
Depression is a major risk factor for suicide, and suicide is the leading cause of premature death in FM. Types of depression include: major depressive disorder, dysthymic disorder (a low-grade, chronic depression), postpartum depression, psychotic depression, and seasonal affective disorder. Bipolar disorder previously was called manic depression but is not technically a form of depression. A diagnosis of depression is made by patient-reported history. Physical exam and laboratory tests may be done to rule out thyroid or other endocrine disorders, viruses, and other medical issues.
Anxiety is a symptom that may include physical or psychological feelings of distress and worry, changes in heart rate, skin temperature, and myriad other features. Generalized anxiety disorder (GAD) is an anxiety disorder that presents as excessive, uncontrollable, and often irrational worry about everyday problems for at least six consecutive months. This worry limits people's ability to work, go to school, and function in the community. People with GAD are more symptomatic than people with anxiety as a symptom. They may anticipate disasters, exhibit catastrophic thinking, have fatigue, fidgeting, headaches, muscle aches, trembling, sweating, and insomnia.
PTSD is an extreme anxiety disorder that is disabling and exhibits permanent neurological changes. Although an estimated 50 to 90 percent of people encounter some trauma over their lifetime, only about 8 percent will develop full-blown PTSD. It can either appear after a person encounters a single traumatic event or ongoing terrifying experiences, such as military combat, natural disaster, or violent attack. The encounter that triggers PTSD can either take place when the individual is the prime victim or when witnessing a traumatizing experience. High predictors for developing PTSD include childhood trauma, chronic severe adversity, and high family stress. PTSD is commonly treated using a combination of psychotherapy and medications. Drugs used to stop panic attacks also may prove useful in reducing the impact of traumatic memories.
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