depression and anxiety symptoms treatment

depression and anxiety symptoms treatment Every problem area in this volume is intertwined with every other, and nowhere are the mutual involvements more evident than with depression and anxiety. Students who are depressed or anxious are sure to struggle elsewhere— in their studies, in relationships, and with eating and substance use. In turn, problems in other areas betoken and can trigger depression or anxiety. So, in practice, helping suff ering students is rarely a straightforward process of targeting a discrete set of symptoms. Treating depression and anxiety requires understanding complex human beings who may need clinical attention on a number of fronts at once. Matters get just as complicated when we try to pin down a depressed or anxious student’s diagnosis. For one thing, there are so many diagnostic categories to consider. According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) (American Psychiatric Association, 2000), there are four kinds of depressive disorders—with major depressive disorders distinguished for severity and dysthmic disorders for chronicity—and nine bipolar disorders, all involving manic or hypomanic episodes, usually in addition to depressive episodes. Th ere are a full dozen anxiety disorders, including panic disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder, and several kinds of phobias. Th ere are the adjustment disorders: reactions to stress that normally involve anxiety, depressed mood, or both. Finally, we come to a grab bag of other diagnoses in which depressive or anxious symptoms may fi gure prominently, among them medical conditions, personality disorders, schizophrenia and schizoaff ective disorder, pain disorder, hypochondriasis, and body dysmorphic disorder. Th e list is daunting. As if so many diagnostic options weren’t challenging enough, many college therapy patients don’t fi t snugly into any of these categories, or, as with the adult population, may warrant dual or multiple diagnoses. Because they are clinically fl uid and because unrest and excesses are normative at their age, many have symptoms suggesting fi rst one diagnostic category and then another, or seem quite diagnosable for a while and later not at all. It’s as if we’re trying to take their pictures but they refuse to stand still. Add to this the fact that there’s considerable overlap between diagnostic categories anyway and depression and anxiety symptoms treatment so ample room for disagreement: One clinician’s dysthymia may be another’s
generalized anxiety disorder or recurrent major depressive disorder or depression
not otherwise specifi ed. Given all this uncertainty, assigning diagnoses
strikes us as a useful exercise to aid understanding and guide treatment and
as a check on sloppy thinking or vague planning, but we shouldn’t mistake it
for an exact science. Sometimes the best we can do, given our patients’ clinical
slipperiness and the DSM-IV’s limitations, is affi x a question mark or a ruleout
notation to a handful of categories, hoping to approximate the clinical
picture by creating a diagnostic composite.
As a fi nal caution about clinical complexity, we should also stress that
depression and anxiety are usually not separate phenomena. Rather, they tend
to occur together and to fuel one another, to the point where sometimes it’s
hard to tell them apart. Th eir close association is one reason for covering both
of them in a single chapter. Another is that certain treatment principles and
strategies tend to prove eff ective for each. In the following section, we will
allude to particular depressive and anxiety disorders in a brief discussion of
evidence-based treatment (EBT). But in the remaining sections—on assessment,
the therapy relationship, and various treatment approaches—though
we sometimes focus on either depression or anxiety and occasionally single
out particular disorders, mostly our points apply more widely to all students
who wrestle with mood and anxiety problems.