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Symptoms of Anxiety & Depression

Anxiety may have psychological symptoms such as: fearful anticipation, irritability, a feeling of restlessness, sensitivity to noise, repetitive worrying thoughts, difficulty in concentration and poor memory. Physical symptoms may involve: breathing difficulties with difficulty in inhaling, a feeling of constriction in the chest and over breathing which can lead to a feeling of weakness, faintness, numbness, tinnitus, tingling in the hands, feet and face, headache and spasms; palpitations and awareness of missed heart beats; dry mouth, wind, swallowing difficulty, abdominal discomfort, frequent or loose motions; frequency or urgency of the bladder, menstrual discomfort, erection problems and lack of libido; tinnitus, dizziness, prickling sensations, blurring of vision; aching and stiffness – especially in the shoulders and back, trembling hands – impairs fine movements, headache; sleep disturbance.

Depression is associated with sleep disturbance, characteristically causing waking 2 – 3 hours early and sleep is unrefreshing. The patient may lay awake with depressive thoughts. There may be difficulty in getting off to sleep or even excessive sleepiness during the day but no feeling of refreshment from sleep at night.  Appetite may be poor or, occasionally increased. Similarly weight loss can be a feature but also weight gain. The patient slows down generally but can also be agitated. Mood is typically worse in the morning but can also be worse in the evening.  There may be loss of interest in work and pleasure activities, loss of energy and fatigue as well as loss of libido. There may also be constipation and lack of periods. Appearance may show a lack of care in dress and hygiene with reduced rate of blinking, reduced gestures with bent shoulders and head leaning forwards. Some people may smile on the outside but be unhappy on the inside. Speech may be minimal with hesitancy in response to questions. The mood may be miserable, unreactive and associated with anxiety and irritability. There may be morbid thoughts, dwelling on past events, guilt and self-blame. There may be a feeling of failure, lack of confidence and hopelessness about the future. Life may seem not worth living with suicidal thoughts. In severe cases there may be psychotic features such as delusions or hallucinations. Attention and memory may be impaired. There may also be physical symptoms such as generalised aching and complaints about pre-existing disorders. Other features may include phobias, obsessional or hysterical symptoms, hypochondriasis and depersonalisation.

Some people have bipolar disorder (formerly known as manic depression) where the above symptoms may alternate with hypomanic symptoms such as reduced sleep without fatigue, increased activity generally, increased appetite with weight loss and the patient is generally “speeded up”. There may be increased energy without fatigue, increased libido and uninhibited behaviour generally. Clothing may be bright and inappropriate. Risk taking behaviour and excessive activity may predominate with socially indiscrete behaviour.
Diagnosis of Anxiety & Depression

Anxiety must be differentiated from ‘organic’ (having an underlying physical cause) conditions that are associated with anxiety symptoms. These include presenile and senile dementia, alcohol and drug abuse, overactivity of the thyroid gland, tumour of the adrenal gland (incredibly rare) and low blood sugar associated with overtreated diabetes or food intolerance. Other, more severe psychiatric illnesses can also be associated with anxiety symptoms and include depression and schizophrenia. Usually a careful history and blood tests will exclude these conditions.
Depression can be associated with conditions associated with low energy states such as underactivity of the thyroid gland, Cushing’s disease, chronic fatigue states and diabetes, dementia, syphilis, brain tumour and drug abuse. Diagnosis is made from the history and other conditions can be excluded by suitable blood tests or brain scans.