References
Prescribing where there is a comorbid presentation of anxiety and depression: a case study
Abstract
This case study considers a complex presentation of anxiety with associated depression, and describes a stepped approach to care and treatment, as advocated by the National Institute for Health and Clinical Excellence. The classification of mental disorders is referred to in the case study. Mixed anxiety and depression is a common presentation in primary care, characterised by a mix of anxiety and depressive symptoms without clear prominence of any one type and the presence of one or more physical symptoms that are present for more than six months. Anxiolytic medication is often used as a first aid measure in anxiety, and is very useful and appropriate for this. However, it is quite difficult to assess the longer-term effectiveness of these drugs, as anxiety tends to vary for reasons other than drug treatment, such as external pressures. There is good evidence to support the efficacy of psychological interventions in anxiety spectrum disorders. Consequently, self help and cognitive behaviour therapy may be the first line of treatment for less severe cases and can be used in conjunction with medication.
People with anxiety can have a variety of symptoms (National Institute of health and Care Excellence (NICE), 2011). These can be divided into two main groups: psychological and physical. Psychological symptoms include fear, irritability, poor concentration, restlessness, sensitivity to noise, disturbed sleep, such as waking during the night or unpleasant dreams, and poor memory, usually because of poor communication. Physical symptoms are mainly the result of increased muscle tension, such as problems with passing wind, loose motions, blurred vision, dizziness or loss of libido; breathing problems, such as tight chest or difficulty breathing; heart changes, such as palpitations, heart pain or missed beats; tension resulting in headache or tremor; and panic attacks leading to sudden episodes of extreme anxiety or apprehension. This is because of overactivity of many parts of the brain, usually caused by some external pressure or reason. The symptoms may be caused by this overactivity. The result is that many systems in the body become overactive, including muscle control, thinking and worrying (Tovote et al, 2015).
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