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Anxiety and depression can be a factor when dealing with a chronic disease. Medications can also have anxiety and depression as a side-effect.
The neurotransmitters involved in anxiety and depression are affected by GABA, which provides the “slow down” and “off” switch to excitability of the neurons. When GABA is not sufficient, the ability to inhibit or filter out excessive action potentials (stimuli) is impaired.
With stiff-person syndrome there are natural concerns: inability to function properly, fear of falling, having spasms in public, threats to safety, security, and independence. These are all to be expected and you can learn to cope with them.
Anxiety and depression are feelings that arise independently and out of proportion to the rational concerns. You can have free-floating anxiety with no specific trigger.
Signs and symptoms of anxiety:
w Butterflies in the stomach.
w Increased breathing rate or, hyperventilation.
w Increased pulse rate.
w Heaviness in the chest.
w Hand tremors.
w Knees shaking or weak legs.
w Urgency as if you must do something, anything, but you don’t know what, feeling like you are “crawling out of your skin.”
w Ruminating on a specific concern, an inability to let it go.
w Spinning or racing thoughts.
w Fear with no specific threat in place.
These feelings can be mild or extreme (a full-blown panic attack).
Benzodiazepines such as Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam), and Klonopin (clonazepam) are the first line of treatment for the spasms. They can also help with anxiety. An increase in anxiety can be a sign that your dosage needs to be titrated up or that you have missed a dose.
There are multiple symptoms associated with benzodiazepine withdrawal. It is crucial that you take your medication as directed. Do no take additional doses (which can lead to increased need), skip doses, or stop taking benzodiazepines or other GABA-ergic drugs without talking to your doctor first and being weaned off.
There is a difference between situational depression (triggered by an event such as a diagnosis) and prolonged clinical depression that can be caused by hormonal or neurotransmitter imbalances.
Hormones and neurotransmitters operate in a very sensitive feedback loop. Autoimmune diseases such as thyroid disease, diabetes, chronic fatigue, lupus, fibromyalgia, and stiff-person syndrome can affect the feedback mechanisms leading to symptoms of anxiety and depression.
Situations that cause anxiety and sadness or grief can alter the feedback mechanism as well, reference the stressor list.
If you cannot rationally cope with, come to terms with, or shake the symptoms, especially if they last for months without respite, you need further treatment.
Signs and symptoms of depression.
w Loss of appetite.
w Inability to sleep.
w Sleeping too long.
w Lack of energy.
w Low sex drive.
w Low self-esteem.
w Difficulty concentrating.
w Unresolved frustration and quick to anger.
w Free-floating sadness or grief.
w Feeling isolated and lonely.
w Feeling weepy or tearful for no particular reason (emotionally labile).
w Feeling angry or bitter out of proportion to the situation.
w Feeling an unshakable dread about the future.
w Feeling like you have to conceal your illness or symptoms.
w Feeling like you have to avoid situations in public because of your condition.
w Being overly concerned or fearful about other people’s reactions to you.
w Having problems with close personal relationships: unusual conflict or communication issues.
w Feeling a lack support from close family or friends.
w Feeling unable to communicate with people.
w Feeling ignored by people.
w Feeling of worthlessness.
w Fear of being a burden to others.
w Feeling that the world would be better off without you.
Situational depression is short term, resolving after the stressor has passed. Clinical depression is an inability to resolve depression.
When stressed, there are higher circulating levels of cortisol and noradrenaline as the body and mind respond to excessive arousal. Prolonged stress can lead to lower levels of dopamine and serotonin.
Norepinephrine constricts blood vessels and raises blood pressure.
Dopamine affects pleasure and motivation. Problems with dopamine transmission can lead to psychosis, hallucinations, and delusions.
Serotonin regulates sleep, appetite, mood, and inhibits pain.
Glutamate is the primary excitatory neurotransmitter. High levels of glutamate can damage the delicate balance. Insufficient levels of GABA, the primary inhibitory neurotransmitter, can also lead to damage. GAD antibodies impede the production of GABA.
Insufficient thyroid hormones and poor insulin control can also lead to defective function of neurotransmitters.
Depression can feed on itself, making the temporary shift in hormones and neurotransmitters the new “normal.” The body becomes incapable of returning to normal without help.
There are several self-assessment tools to help you recognize problems with depression:
In addition to anxiety and depression, symptoms directly related to the physical manifestations of stiff-person syndrome add to the problem.
w Poor quality of sleep (frequent tossing, turning, wakefulness).
w Not getting enough restful sleep (8 -9 hours per night).
w Excessive sleepiness (sleeping more than 8-9 hours per day).
w Memory problems: limited instant recall and limited long-term memory recall.
w Impaired cognition such as poor concentration, trouble finding the right words, trouble speaking or articulating words, being “tongue-twisted.”
Diabetes and low-thyroid hormones can cause problems with memory and cognition. Successfully managing your hormones can improve neurotransmitter function.
The brain has the power to rewire itself and to shift the levels of neurotransmitters with the right treatment.
Depression is often treated with several categories of drugs. A neurotransmitter is sent, received, broken down, and recycled. Reuptake inhibitors block breakdown or recycling of neurotransmitters, resulting in higher circulating levels. It acts like a plug in a sink, leading to a rising level.
1. Tricyclic antidepressants (TCAs) block the absorption (reuptake) of serotonin and norepinephrine, increasing the availability of these chemicals in the brain.
2. Monoamine oxidase inhibitors (MAOIs) inhibit monoamine oxidase, preventing the breakdown of neurotransmitters which increases their availability. MAO-A reduces the breakdown of serotonin, melatonin, epinephrine, and norepinephrine. MAO-B reduces the breakdown of phenylethylamine and trace amines. Both reduce the breakdown of dopamine.
3. Selective serotonin reuptake inhibitors (SSRIs) block the reuptake (absorption) of serotonin, increasing availablility.
4. Serotonin and norepinephrine reuptake inhibitors (SNRIs) increase availability of serotonin and norepinephrine.
Depression and anxiety can also be treated by a variety of therapies.
w Cognitive therapy can help you improve negative or self-defeating messages and behaviors. It has been called the “talking cure.” Having someone with no stake in the game, no judgment, no preconceptions, who can listen and really hear you, can be immensely healing.
Other things that can lift your spirits and motivate you include:
w Physical activity.
w Hobbies and leisure activities.
w Music and comedy.
w Inspirational books, film, and television.
w Spiritual guidance.
w Participation in charitable activities can be uplifting.
w Massage therapy.
Depression is not a weakness or a character flaw. It is a medical condition that affects your mental state. Just as you would not ignore signs of a heart condition, you should not ignore signs of depression.
ANXIETY & DEPRESSION