A person with PTSD will have persistent frightening thoughts and memories of the traumatic event and will feel emotionally numb, especially with people they were once close too in their life.  Some people experience the trauma over again repeatedly in the form of nightmares, flashbacks or disturbing recollections during the day.  They may also experience a feeling of being detached or numb, sleep problems or an exaggerated startle response.  They may have trouble feeling affection and lose interest in things they once enjoyed.  They may feel irritable and sometimes get aggressive or violent.  They may avoid certain places or situations that bring back the distressing memories of the trauma and the anniversaries of the traumatic event can be difficult for them.

PTSD is often accompanied by depression, anxiety or substance abuse.  A person with PTSD may have trouble working or in social situations.  The symptoms may be worse if the trauma was deliberately initiated by anther person such as a kidnapping, rape or torture. Not every traumatized person gets PTSD or the full-blown PTSD.  The symptoms have to last more than a month and usually develop within 3 months of the trauma.  The course of PTSD can vary.  A person can recovery within 6 months or the symptoms can last much longer and become a chronic condition.  Occasionally the symptoms of PTSD do not show up until years after the trauma has occured.

Most people with PTSD are helped with medication and psychotherapy which will be discussed here in a subsequent posting.

The first thing that is done at the doctor’s or therapist’s office is the diagnostic evaluation which will help the doctor determine if you have an anxiety disorder, which one you have and any coexisting conditions that may be present.  If the coexisting disorder is having a big impact that it may be necessary to treat that first before the anxiety.

If medication is needed for the anxiety disorder, this is usually prescribed by a psychiatrist or sometimes by a family doctor. Ask your doctor about the side effects of the drug and how the drug is supposed to work to help you.  Many of the medications for anxiety must be taken daily and cannot be stopped abruptly but must be tapered off slowly.

The recommended treatment for most anxiety disorders whether medication is needed or not is psychotherapy. This involves talking with a mental health professional, such as a psychologist, counselor, psychotherapist or social worker to learn how to deal with problems like anxiety disorder.

Some of the most effective psychotherapies for anxiety disorders is cognitive-behavioral therapy (CBT), behavior therapy and a treatment approach called exposure and response therapy.  These types of therapies usually last around 12 weeks.  Many “homework” assignments are also given to the patient to work on between sessions. 

Stress management techniques, meditation or guided imagery may help to calm the patient down and enhance the effects of therapy.  Also exercise, yoga and other forms of aerobic activity may be of value.  Of course, anyone with an anxiety disorder should consider decreasing or eliminating their use of caffeine or any illicit drugs.

So if you are suffering with an anxiety disorder, please seek help with a professional mental health worker in your area and consider the different forms of treatment we have discussed above.

Medications

Medications for bipolar disorder are mostly known as “mood stabilizers” and are typically prescribed by a Psychiatrist who is a Medical Doctor with expertise in the diagnosis and treatment of mental disorders.  There are several different types of mood stabilizers available.  Usually a person begins treatment taking a mood stabilizer which will be used for extended periods of time (usually for many years) and then other medications can be added if needed for break through mania or depression symptoms.  Work closely with your Psychiatrist and if a sudden change in mood occurs, report it immediately to prevent a full-blown episode by making adjustments to your medication management treatment plan.

Psychosocial Treatment

Psychosocial treatment can help in connection with medications for bipolar disorder.   It can provide education, support and guidance to people with bipolar disorder including their family members.  Psychotherapy, often referred to as “talk” therapy, can help with increased mood stability, fewer hospitalizations, and improve functioning in several areas including family, work and social interactions.  A licensed counselor or psychologist can provide these therapies and often works closely with a psychiatrist to help monitor patients progress.

The four most common types of psychosocial interventions that are used for bipolar disorder include cognitive behavioral therapy (CBT), family therapy, psychoeducation and interpersonal and social rhythm therapy.  Another treatment that can be used, if the combination of medication and psychosocial treatment prove ineffective or slow to work and where symptoms of psychosis or suicidality occur, is electroconvulsive therapy (ECT).  It is a highly effective treatment for severe depression, manic, and/or mixed episodes and the risks have been significantly reduced with the modern ECT techniques.

Support Groups  

Many people with bipolar disorder benefit from joining support groups.  There may be support groups offered in various different places in the community.  They are usually sponsored by the National Alliance for the Mentally Ill (NAMI), the National Depressive and Manic Depressive Association (NDMDA) and the National Mental Health Association (NMHA).  Families and friends may also attend these groups and get great benefit and support from these organizations.

Hospitalization

Sometimes a person with bipolar disorder may not realize they need help, especially if they are in the midst of a severe episode.  They may have to be strongly encouraged by family or friends to get an evaluation or treatment and may even have to be hospitalized against their wishes.  If this happens, usually the person is stabilized in the hospital for a few days or so and then referred for ongoing treatment in the community with a psychiatrist and mental health professionals.

Major depression is  a medical condition.  It is more than just having “the blues”.  It is not a sign of personal weakness or something to be ashamed about.  You cannot “shake if off” or “let it go”.  Depression affects a person’s mood and outlook on life. The depressed person’s mood is nearly always sad, hopeless, and usually feels a loss of interest or pleasure in activities once enjoyed. 

Unfortunately, suicide can be a real danger for a person with depression.  If the negative thoughts about themselves and their future increases, then feelings of hopelessness and worthlessness may increase the thoughts of suicide.  If you or someone you know has thoughts of suicide, please take them seriously.  Get them immediate professional help at an emergency room, crisis center, local mental health center or doctor’s office.

The symptoms of depression are as follows:

• A persistent sad mood
• Loss of interest or pleasure in most activities (anhedonia)
• Changes in appetite or weight
• Changes in sleep patterns
• Restlessness or decreased activity
• Loss of energy or feeling fatigued frequently
• Difficulty in concentrating or making decisions
• Feelings of worthlessness or inappropriate guilt
• Repeated thoughts of death or suicide

When 5 or more of these symptoms are present and have lasted for at least 2 weeks, a person is experiencing a major depressive episode.  If you or someone you love is suffering with depression, it is very important to talk to a healthcare professional.

We will talk more about the treatment of depression in a subsequent posting.

These are the symptoms associated with Mania and Depression:

Mania

• Abnormal or excessive elation
• Unusual irritability (Hypomanic)
• Decreased need for sleep
• Grandiose notions
• Increased talking
• Racing thoughts
• Increased sexual desire (Hypersexual)
• Markedly increased energy
• Poor judgement
• Inappropriate social behavior

Depression

• Persistent sad, anxious, or empty mood
• Feelings of hopelessness, pessimism
• Feelings of guilt, worthlessness, helplessness
• Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex (Anhedonia)
• Decreased energy, fatigue, being “slowed down”
• Difficulty concentrating, remembering, making decisions
• Insomnia, early-morning awakening, or oversleeping
• Appetite and/or weight loss or overeating and weight gain
• Thoughts of death or suicide; suicide attempts
• Restlessness, irritability
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Some types of depression run in families, suggesting that a biological vulnerability can be inherited.  This seems to be the case with bipolar disorder.  Studies of families in which members of each generation develop bipolar disorder found that those with the illness have a somewhat different genetic makeup than those who do not get ill.  However, the reverse is not true: not everyone with the genetic makeup that causes vulnerability to bipolar disorder will have the illness.  Apparently additional factors, possibly stresses at home, work, or school, are involved in its onset.

We will discuss treatment for bipolar disorder in a subsequent post.

Most people that have GAD realize that their concerns and worries are more intense than the situation warrants.  Their anxiety also can be accompanied by physical symptoms such as muscle aches or tension, fatigue, headaches, irritability, difficulty swallowing, trembling, twitching, sweating and hot flashes.  Also they may often feel nauseated and have frequent trips to the bathroom.  People with GAD find it difficult to relax and often have difficulty concentrating. Trouble falling and staying asleep may also be a problem.

There are many other anxiety related disorders such as panic disorder, obsessive compulsive disorder, phobias, post traumatic stress disorder and others that will be discussed in subsequent posts as well as the treatment and statistics of these disorders.

Bipolar disorder is a very complex illness involving the brain chemicals that are out of balance.  It is not known what the specific cause of bipolar disorder is at this time, but it is known that genes play a role. 

Mood swings may have triggers associated with them, so it is important to know what triggers your symptoms such as health and lifestyle changes as well as other events. 

We will talk about the symptoms, triggers, treatments and risks connected to bipolar disorder in the next few posts.

The next thing to consider is how to access services for mental health counseling.  If you are employed by a major corporation they usually offer some type of employee assistance program (EAP) to get started with treatment.  If not, and you have health insurance, call or go online and see which counselors are available under your plan.  Another option, if you either do not have insurance or do not want to use your insurance plan, is to check the yellow pages and find several counselors in your area to call for an appointment.  The reason to find several is because you may want to speak with the office manager or the counselor to find out if the counselor meets your needs for mental health counseling discussed above.  If so, make an appointment for an initial evaluation session.

Today there is another option for mental health counseling that is both convenient and practical known as online counseling.  Some forms of online counseling is phone, live chat or email.  Usually phone and live chat counseling has to be scheduled so that you and the counselor are available at the same time.  Email counseling has the added benefit of anytime, anywhere because it does not have a time coordination and is usually answered within 24 to 48 hours.  That is why Tina Cannon, LMHC, PhD has chosen to offer email counseling as an alternative form of online counseling, if you are not able to visit her office in Winter Park, Florida.