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Introduction

We wish to start this section with a clear definition of what we mean by the terms depression, anxiety and the very high levels of sudden-onset anxiety known as panic.

Together, these affect more than one in five people at some time in their lives.

What is depression?

Feeling fed up and low in mood is a normal part of life. When difficulties or upsetting events occur it is not unusual to feel down, stop enjoying things and to feel understandably low for a time as a reaction to these events.

Likewise when good things happen, a person may experience happiness, pleasure and a sense of achievement. The reasons for low mood are usually clear - a stressful situation, a relationship difficulty, feeling let down by someone, financial difficulties, unforeseen events or some other practical problem.

Most of the time the drop in mood only lasts for a short period of time and then we "bounce back".

Occasionally, however, a person's mood may seem to fall for little or no obvious reason and it may be difficult to begin with to know quite why. In some cases this "depressed" feeling can worsen and completely dominate the person's life. When someone feels very low for more than two weeks and feels like this day after day, week after week, this is called a depressive illness.

It is important to say that there should no stigma attached to the diagnosis of "depression". In reality the term is simply a convenient way of describing a broad range of symptoms that vary from person to person but are having an unhelpful impact on their lives.

b). What is anxiety?

Anxiety, worry, tension and stress are all terms that are used to describe what is a widespread experience for many people. Anxiety is a common emotion, which at times can be helpful even though it can feel very unpleasant.

For example, in situations of danger we begin to feel anxious and this prompts us to try to deal with it by getting away as rapidly as possible. If you walk along a badly maintained path next to a large drop, anxiety can be life saving, appropriate and helpful.

However, sometimes anxiety can occur inappropriately and then it becomes unhelpful. The person may feel anxious in situations that are not really dangerous at all, or notice excessive anxiety well beyond what is actually helpful or appropriate in the circumstances.

Worrying thoughts are common in anxiety. In worry, the person goes over things again and again in their mind in a way that is unhelpful because it does not actually help to resolve the difficulty that is being worried about. Instead, problems are turned over and thought about again and again.

Sometimes the worry may be out of all proportion; something that may originally have happened in a few moments, perhaps something that someone has said to you, can dominate your thinking for much of the following days or weeks, adding up in total to many days or even weeks of worry over the following months.

In anxiety, the person often overestimates the threat or danger they are facing, and at the same time usually underestimates their own capacity to cope with the problem.

Normally, when there is no stress, the person feels able to cope with the problems they face. In other situations, they may begin to feel stressed. Either they see the problem as too large or overwhelming, or they think they cannot cope.

In both situations, the anxiety balance is upset, and the person begins to feel increasingly stressed and upset. At times of emotional distress, it is sometimes easy to forget that we are not alone when we face life's difficulties - we do not only have our own capacity to cope, but also upon the support of others around us including friends, relatives, voluntary sector groups and health care practitioners such as your GP as well as those working within the mental health services..

c). What are panic attacks?

Sometimes anxiety can come on very rapidly (usually within 10 minutes) to such a high level that the person feels so mentally and physically tense and unwell that they stop what they are doing and try to leave or escape from the situation. Failing that they may become paralysed into inactivity like rabbits caught in the headlamps of a car and just wait, expecting disaster to strike at any moment.

They do this because they fear that something terrible or catastrophic will happen. This feeling of acute fear, dread or terror is called a panic attack.

Panic attacks typically have a rapid onset and are short-lived, usually lasting no longer than 20-30 minutes. During panic, the person can experience catastrophic fears that a sudden and threatening physical illness or terrible event will occur right now.

"I'm going to faint", "I'm going to suffocate" "I'm going to collapse", "I'm going to have a stroke", or "I'm going to have a heart attack", are the sorts of thoughts that will go through their minds.

Sometimes the fear is that a catastrophic mental event will occur such as going mad and losing control. These fears may take the form of a mental image (for example, a picture of losing control or of being admitted to hospital with a heart attack).

Sometimes fears may be focused upon the reaction of others (e.g. a fear that others will look and laugh or mock you if you were to collapse).

The key point is that the fear is immediately threatening, scary and catastrophic. Sometimes the person becomes so fearful that even just thinking about the situations and places where panics have previously occurred may result in them feeling anxious.

They may find themselves worrying that a further panic attack will occur and this anticipation itself can add to the person's anxiety. The person commonly reacts by avoiding anything to do with that situation or place.

The result is often an increasingly restricted lifestyle, reduced confidence and additional long-term distress. When this happens, the person is described as having a phobia as well as panic attacks.

A phobia is anxiety that regularly occurs in a specific situation. You may have heard of people who have panic attacks on buses or in shops or crowded situations - the most common form of phobia and is sometimes called agoraphobia.

Panic attacks also commonly occur in other specific situations (in open spaces, and in phobias of certain animals such as spiders and snakes, and even such apparently harmless creatures as butterflies).

In some cases the person may not have a specific fear or anxiety but experience panic attacks when other upsets or fears build up and up in their minds. It is important to realise that problems of anxiety, depression and panic may occur together, or quite separately.

However they are affecting you, this chapter will help you to find out more about the causes of these, and help you to begin to plan ways of changing this. How common are depression, anxiety and panic?

Depression and anxiety are far more common experiences than most people think. Anxiety and depression can affect anyone.

Some well known people have experienced them. You may have seen television programmes or read books about their experience of tackling these problems. Around 1 in 5 people experience depression and at least 1 in 10 people experience a panic attack at some time in their lives.

It is extremely likely that you will know one or two friends, family members or people you come across on a daily basis who regularly experience these problems.

There will probably be many more people around who are suffering from depression, anxiety and panic than you are aware of because of the unwillingness of many people to admit having such experiences.