Feeling depressed or anxious is usually what brings someone to my office.

                                                                                                    Depression

While it is not uncommon to have some days where you just feel down, those who have experienced depression can easily identify the signs of frequent sadness, loss of interest, isolation, and sense of hopelessness.  But sometimes people do not recognize that they are depressed. Some of the less obvious signs of depression are: frequent irritability, cranky or critical mood, impatience, changes in appetite or sleep, bodily aches and pains, lack of energy,  feeling agitated or angry, lack of motivation, difficulty concentrating or thinking clearly, poor attention or memory.

Depression is one of the biggest health issues in the U.S.  If you think you may be depressed seek advice and consultation as soon as possible.  Try to keep to a regular routine in terms of sleep, diet, exercise, and activity level. Stay involved and avoid isolation.

However, people with depression may have difficulty reaching out to to others, or communicating that they are in pain because they feel that they should be able to handle their emotions themselves, or do not want to be a burden on others.  I feel that it shows strength - not weakness -  when people can be open about their feelings and seek support from others.

                                                                                                           Anxiety

Many factors in our lives can make us feel anxious at times.  Often, anxiety is a normal response to stressful events. It can even be a helpful coping mechanism.  Anxiety tells us when we are in a dangerous or threatening situation, and it marshals the body’s adrenaline reaction to prepare you for “fight or flight”.

However, frequent anxiety may be a sign of an anxiety disorder.  Like depression, anxiety can be very impairing, and often feels intolerable to those who experience it.  Untreated anxiety can affect job performance and ability to carry out everyday activities.  It may also lead to depression and an increased risk of alcohol and drug abuse.

For some, a state of anxiety is experienced in bodily sensations of “butterflies” in the stomach, nausea, tightness in the chest or throat, trembling, or feeling faint.  For others anxiety is predominantly a mental experience - negative thoughts, worries, and ruminations. Often, there is a connection between frequent worrying and physical symptoms, and one feeds the other. As you ruminate on problems or worries, you might find your chest getting tight or feeling trembling or short of breath. Cognitive-behavioral and relaxation techniques can be very helpful in the management of anxiety.  I often pair this modality with a psychodynamic exploration of a person's fears, because anxiety has meaning. It is not just dysfunctional or irrational reactions of body and mind.

Anxiety and depression can be influenced by our inner voice.  How we talk to ourselves, and what we say can either ameliorate or exacerbate symptoms.  Often, I find that people speak to themselves in critical and harsh ways.  I help clients identify their negative voice and teach them to make the kind of caring and supportive statements to themselves as they would to a friend or loved one.