• Do you worry about things, both little and big, on a regular basis and are unable to stop?

• Are you overwhelmed by fear, uncertain as to its origin?

• Is it necessary for you to drink in order to be social because without it you will have excessive self-consciousness and/or panic?

• Do you experience intrusive and disturbing thoughts, feelings or body memories that you are unable to quiet?

• Do you engage in rigid patterns and/or ritualistic behavior that without it will leave you with great uncertainty?

• Do you often feel unsafe?

Anxiety shows up in many ways.

Anxiety is a symptom of everyday life. It is inescapable. Eustress is considered good anxiety because it is just enough to get us mobilized, from cramming for a test, to preparing for a dinner party to voraciously researching an unwanted new medical diagnosis. It is when the symptoms of anxiety become overwhelming, do not remit and/or are too much to bear, that it becomes problematic.

Anxiety can paralyze you. It can come on when least expected and it can be chronic and unable to shake for some who never feel safe. It can be trapping and inescapable and it can be so harrowing that leaving the safety of one’s home becomes an impossible task. With panic, or panic attacks, is the fear of impending death; there is no control over the menacing circumstances. Sweating, shortness of breath, numbness, dizziness and the feeling of being smothered are but some of the anxiety symptoms. Separation anxiety is at the core for many who are unable to live an independent life, separate from a loved one or from their parents.

Anxiety is a basic experience. In the medical model it is a symptom of conflict. It is a sign that there is something not right. It notifies us that there is danger or an internal experience we choose not to confront. Often rooted in early developmental or shock trauma, associations have left us with responses so conditioned that the trigger is far removed. So instead of sadness, fear or a variety of other experiences that the danger may have initially triggered, we experience anxiety. The symptoms are very real as was the experience, but in order to rid ourselves of anxiety we need to attack it not only from the ‘top-down’ but from the ‘bottom-up’. That is—we not only need to learn strategies and skills to manage it, but we need to learn the root cause and heal the injuries or trauma from which it began.

With sufficient anxiety comes circumvention: in order to reduce anxiety many people avoid the circumstances that trigger it, thereby limiting their livelihood and capacity to engage in normal day to day activities. This might show up, for example, as checking, isolation and/or limited activities, hoarding and for others attempts at control which invariably give way.

Anxiety Disorders are the most prevalent of the mental health disorders. An estimated 30% of individuals have an anxiety disorders, with 18.1% diagnosed and 4.1% of adults having a severe disorder. The average age of onset is 11. There are twice as many women as men and more age 35 or under. There is significant overlap as anxiety co-occurs with many other psychiatric conditions. In fact, anxiety and stress are present in most.

There are various signs and symptoms of anxiety. Anxiety disorders typically present as one of the following:

• Generalized Anxiety Disorder (GAD)
• Panic Disorder -Panic Attacks
• Social Anxiety Disorder (Social Phobia)
• Obsessive Compulsive Disorder (OCD) – Body Dysmorphic Disorder, Hoarding,
• Trichotillomania, Excoriation, Substance/Medication-Induced Obsessive
• Compulsive Disorder, Obsessive Compulsive and Related Disorder Due to
  • Another Medical Condition, Obsessive Compulsive Disorder
  • Post-traumatic Stress Disorder (PTSD) – Acute Stress Disorder, PTSD
  • Agoraphobia
  • Specific Phobia
  • Separation Anxiety Disorder
  • Substance/Medication-Induced Anxiety Disorder
  • Anxiety Disorder Due to Another Medical Condition
  • Unspecified Anxiety Disorder
  • Selective Mutism

Like other psychiatric conditions, anxiety disorders have at its origin one or more variable such as, but not limited to, genetic factors, physical and physiological variables, personality factors, addictions, environmental and familial causes as well as side-effects to medication.

With a thorough assessment these variables have to be carefully ruled-out in order to determine what is and what isn’t treatable by both conventional Western practices, such as cognitive-behavioral therapy (CBT), psychodynamic psychotherapy, family therapy, group therapy or EMDR or hypnosis or Eastern based practices such as Mindfulness and meditation. Mindfulness Based Stress Reduction is an effective top-down approach that is helpful for anyone who experiences signs of anxiety.

Dr. Winter works with all of these processes and will determine the best for you at the appropriate time. When needed she will refer out for medication management and ancillary treatment.

• Has your energy tanked recently and has it become a task to eat and/or sleep?

• Is it hard to shake sadness, depression or anger?

• Does it feel like the darkness is inescapable and that there is no end to the pain?

• Has joy been replaced by overwhelming feelings of helpless, hopelessness and numbness?If so, you may be depressed. And it may be more than a short-term situational depression.

Mood Disorders, or disorders of mood, intrude on everyday life. It has been estimated that one in ten adults, over 18, struggle with a form of mood disorder; 6.7% report depression, leaving the other three people, or 2.6% to have other various forms, such as bipolar disorder or cyclothymia, the latter being a somewhat subtler version of its manic-depressive counterpart. The statistics are higher in adolescents, women and the elderly. As the leading cause of disability and productivity, it costs the government and employers money ($210 billion), but mostly, it imposes a tremendous cost to the individual and family. As a country that has been described as the land of opportunity, we are ranked 15 th on a happiness scale; not surprising given the statistics.

Andrew Solomon says that “the opposite of depression is not happiness but vitality”. The capacity to live life. Or according to dictionary.com, ‘the capacity for survival or for the continuation of a meaningful or purposeful existence’. With clinical depression, there is no way to predict how long it will last. When we are depressed we may not ponder meaning but simply survival.

Sometimes we get struck with debilitating depression and it feels like we have hit a wall. And while It may feel like it emanates from nowhere, there are always precipitants, albeit not always obvious.

Sadness and grief can be overwhelming but clinical depression is disabling. It is critical to differentiate the three: sadness and grief have a purpose wherein there is a mobilization of the affective state or feeling; there is movement. In depression there is an absence of movement, only a state of inertia.

Depression symptoms vary; they can show up as feelings of hopelessness, isolation, anger, changes in sleep and eating and thoughts of suicide. Depression can also appear as busyness, denial, addiction, illness and chronic anger, amongst other maladies. it is all encompassing—depression invades our thoughts, emotions, behavior and even our bodies.

Since major depression has at its roots many sources, such as, but not limited to, developmental trauma, loss, complicated bereavement, physical and physiological states, medication side-effects, as well as genetic and environmental factors, a thorough examination of the events and experiences that proceed its onset is vital. Childhood anxiety is often a precipitant to adult depression, anxiety and depression are closely linked.

There are those whose dips into depression are not as severe but typically more chronic. Low self-esteem and ongoing feelings of inadequacy are presented in a low-grade chronic type depression, formerly known as dysthymia. Alternatively, those with chronic mood changes, more so than is typically seen in depression and that do not fit the criteria for mania, is the cyclothymic. With mania comes cycles and bipolar disorder, typically accompanied by other co-occurring disorders.

There are a few main categories of Mood Disorders. These include:

• Major Depressive Disorder – Single and Recurrent
• Persistent Depressive Disorder (Dysthymia)
• Seasonal Affective Disorder
• Psychotic Depression
• Disruptive Mood Dysregulation Disorder
• Bipolar Depression
• Bipolar Disorder
• Post-Partum Depression
• Substance/Medication-Induced Depressive Disorder
• Depressive Disorder Due to Another Medical Condition
• Other Specified Depressive Disorder
• Unspecified Depressive Disorder

Treatment for major depression and bipolar disorder might take various forms, each of which is dependent upon the etiology or cause. The various modalities of treatment might include psychodynamic psychotherapy, cognitive-behavior therapy (CBT), family therapy, group therapy, mindfulness techniques and trauma treatment such as EMDR. In some cases, medication is an option; in some situations, it is mandatory. Dr. Winter, at times, may refer out for medication as well as other therapies such as neuro-feedback, somatic therapy or energy work. Regardless, it is important to address the emotional, physiological (body), cognitive (CBT) and behavioral aspects. In cases where the is a strong genetic or physical component, treatment for depression can provide a strong support and coping strategies.

Bipolar depression and bipolar disorder typically require ongoing psychotherapy and medication is typically part of the protocol. The other modalities are applicable and show success in long-term stabilization and improvement.

Dr. Winter has been treating mood disorders for over 35 years. With most other diagnostic issues that present for treatment, particularly the addictions and personality disorders, there is often a co-occurring mood disorder. Dr. Winter can help identify and treat any mood disorder and when ancillary help, like medication, is required she will make the appropriate referral.