04 November 2015 17:11:28

Stress, depression and panic attacks: why speaking up really matters

Getting no joy from life is bad enough, but imagine if you veered between misery and sheer panic. One in five women and one in 10 men suffer depression at some point, many more suffer panic attacks and some get both.

Getting no joy from life is bad enough, but imagine if you veered between misery and sheer panic. One in five women and one in 10 men suffer depression at some point, many more suffer panic attacks and some get both.

I often hear people joking that their football team lost last night so they're really depressed this morning. No they're not - at least, not from a medical perspective. Although we use the term 'depression' lightly, it's a serious medical condition. Women are about twice as likely as men to suffer from depression. Fortunately, milder cases often settle without medication, but it's still worth speaking to your doctor. They can often give advice about changes you can make to improve matters, or refer for talking therapy.

Many of the symptoms of depression are similar to those of stress, and almost all of us get stressed from time to time. Not all stress is bad - we need a certain amount to motivate us. In fact, if we didn't have any stress, we'd probably never get anything done. The difference is that with depression, symptoms are more persistent and have an effect on your whole life. I feel very sad when so many patients feel guilty about the way they feel and believe they should be able to 'snap out of it'. You can't recover from asthma or a broken leg just by pulling yourself together, and depression is every bit as much a 'proper' condition.

Doctors use two screening questions which can be helpful to tease out whether it's stress or something more serious. Ask yourself if, in the last two weeks, you've been feeling down, depressed or hopeless; or if you've got less pleasure or taken less interest in things. If you've been bothered by these feelings on at least half of days, you could have depression.

Other symptoms include sleep problems (waking early, problems getting to sleep or being unable to get up in the mornings); a change in your appetite; problems concentrating; feeling guilty (for instance that you're a failure or you've let others down); feeling tired; or feelings that you'd be better off dead; or thoughts of harming yourself in some way.

Panic attacks can come hand in hand with depression, can start at times of major stress or just arrive out of the blue. More than one in 20 people get them at some point and they may run in families. Patients often come to me convinced they're having a heart attack or are going to die when they first suffer panic attacks - in fact, they don't do any physical damage, but they can be terrifying. You may feel faint, breathless, shaky, sweaty or light-headed; have palpitations or chest pain; and get numbness or tingling, especially in hands and feet.

It's very likely that your doctor will suggest considering a talking therapy like cognitive behavioural therapy (CBT). The idea behind it is simple - when you're depressed, you tend to interpret things that happen to you negatively. For instance, if someone doesn't return your phone call you assume they don't like you, rather than recognising they're just snowed under. This leads to a train of automatic negative thought - maybe you're not worth liking; maybe nobody likes you etc. If you suffer panic attacks, a trigger you might not even recognise can send you into a spiral of anxiety. CBT aims to help you challenge these negative thoughts and replace them with more realistic reasoning. Computer-based CBT works well for some people and other forms of counselling, including group sessions, can also be helpful.

Occasionally your doctor may recommend short-term tablets to help with panic attacks, although talking therapy is more effective in the long term. For more serious depression, antidepressant tablets (for at least six months for best effect) can make a huge difference. You need to be aware that it'll be some weeks before they take full effect. You may get short-term side effects, but try not to stop them without speaking to your doctor - these often wear off within weeks.

Exercise is a remarkably effective treatment for depression - it raises levels of natural 'feel-good' chemicals in the brain. Don't feel embarrassed about seeing your doctor - they see lots of patients with depression and take it seriously.

With thanks to 'My Weekly' magazine where this article was originally published.

Dr Sarah is unable to provide medical advice or respond directly to questions concerning your health. If you have health concerns we recommend contacting your GP.