Chief Complaint: ANXIETY and DEPRESSION

Chief compliant: ANXIETY

I KNOW WE ARE ALL experiencing symptoms of confusion, anxiety, panic and hopelessness right now.

Even before the COVID-19 crisis, our alway-on-the-go and gotta-do-it-all culture has put many of Americans on antidepressants.

With high levels of uncertainty, financial pressure, altered daily routines, and social isolation, many American have felt that this COVID-19 crisis is harming their mental health.  Nearly everyone has been impacted by these changes in some way- from unemployment, homeschooling, and virtual human connections- these small changes have a big impact on our brains and our bodies.

In the wake of this pandemic, pharmaceutical companies have started increasing production of antidepressant drugs in preparation for life after shelter in place.

Yesterday, I treated more patients with anxiety complaints than for COVID symptoms. And this was expected.

I know that in a few weeks or months when all the shelter in place restrictions are lifted, many of my patients will come in requesting prescriptions like Xanax (short-acting anxiety medication), Lexapro (anti-depressant) Ambien (sleep aid), and Norco (narcotic- pain relief) for their anxiety.

Before you think you need to be to medicated, let's discuss clinical vs situational depression and when anti-depressants are warranted.


Clinical Depression: 

Clinical depression (or unipolar depression) is a mood disorder that causes persistent feelings of sadness and loss of interest. To be diagnosed with clinical depression, you have to meet 5 of the 9 following criteria:


  • Depressed mood most of the day
  • Decreased interest or motivation in activities in most of the day
  • Weight changes (excessive weight gain or weight loss)
  • Insomnia
  • Fatigue
  • Agitation
  • Feeling of worthlessness or excessive guilt
  • Impaired ability to think or concentrate
  • Recurrent thoughts of death

Clinical depression differs from situational depression because clinical depression physically affects your ability to function and go about your normal routine. People with clinical depression often lack the motivation to go to the gym or cook dinner for their kids. They struggle to get out of bed to take a shower or even go to work.

Situational Anxiety/ Depression:

Situational anxiety, on the other hand, is anxiety that is normal response to difficult or overwhelming circumstances.  For example, when you are going through a divorce or a financial hardship due to COVID-19, it is NORMAL to feel sad, overwhelmed, and depressed. You may struggle with insomnia, sadness, headaches, and fatigue as a result of your anxiety.

It would be ABNORMAL to think that you should be happy when you  lost your job or lost a loved one from COVID. It would be abnormal if you weren't crying or emotional affected by any major life changes. If you are able to pinpoint the root cause of your anxiety (ie: a  difficult boss at your job or your financial situation), then you are most likely suffering from situational depression. 

With situational depression, it does not alter your ability to FUNCTION in your normal daily routine. That feeling of worry and sadness with situational depression usually resolves within a few months when the situation improves. People who suffer from situational depression do NOT benefit hugely from antidepressants.

Here are some symptoms shared by situational depression  and clinical depression:

  • Feeling sad or hopeless
  • Tearfulness, frequent crying
  • Changes in appetite
  • Trouble sleeping
  • Increased worry and anxiety
  • Headaches and stomachaches
  • Low energy or fatigue
  • Withdrawal from loved ones or social activities previously enjoyed
  • Increased absence from work or school
  • Trouble concentrating and making decisions


How do you treat situational depression?

  • Exercise regularly
  • Mediate and breath deeply during anxious times
  • Seek a therapist for cognitive behavioral therapy
  • Prioritize 8 hours of sleep
  • Eat a well balanced diet
  • Challenge negative thoughts into logically thinking
  • Do more fun activities
  • Spend time with loved ones
  • Focus your energy on the  positive aspects of your life
  • Get outside to take in some vitamin D



What about Antidepressants? 

Antidepressants are typically prescribed to treat CLINICAL DEPRESSION. These medications are prescribed to help you FUNCTION better. It helps rebalance the chemistry in your brain to adjust your mood and emotions.

Patients who are clinically depressed may not need antidepressants.  

Cognitive behavioral therapy  (CBT) should be the FIRST LINE treatment for clinical depression. CBT is a therapy technique that helps people find new ways to behave by changing their thought patterns. It works by focusing on their thoughts, beliefs, and attitudes to combat their negative behavior and feelings.  Antidepressants should only be used in addition to therapy.

Antidepressants can help:

  • Increase your energy levels
  • Sleep better
  • Improve appetite
  • Enjoy activities
  • Feel more motivated
  • Reduce anxiety and fatigue

Antidepressants typically take about 1-3 weeks to start working, but most can take up to 4- 6 weeks to reach maximum efficacy. Most of the time patients will need multiple medication and/or dosage adjustment to reach therapeutic relief. WHY? Because antidepressants affects each one of us differently. We all have different genetic make up, thus, sometimes providers have to do a little trial and error to find the right medication that best suits you. 

Also, antidepressants have a HUGE side effect profile  which often makes them less appealing. Some side effects may include: 

  • Nausea/ vomiting
  • Sexual dysfunction (low libido or erectile dysfunction)
  • Weight gain
  • Headaches
  • Constipation
  • Fatigue/ drowsiness

Keep in mind that anti-depressants are NOT meant to make you FEEL emotionally better.  Your healthcare provider cannot prescribe happiness in a form of a pill. Happiness only exists in our mind. 

If you think you are depressed, please contact your primary care provider to determine if you are experiencing symptoms of clinical depression vs situational depression, and if therapy or medication is right for you.  

And remember, there is NO SHAME in the mental game. Mental health is EQUALLY, if not, more important than physical health. The human mind is such a powerful weapon as it navigate us through life. If we don't have a functional, clear mind, how can we live our best life?



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