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Psychiatry and Mental Health
Generalized Anxiety Disorder
Lincoln and Churchill Lived Lives of Quiet Desperation
By Dr. W. Gifford Jones
July 4, 2004
Abraham Lincoln once wrote, " I am the most miserable man alive. To remain as I am is impossible. I must die or get better." Winston Churchill echoed the same reaction when he told his doctor, " I don't like to stand by the side of a ship and look down into the water. A second's action would end everything. Is much known about worry, Charles?"
Today, Lord Charles Moran, Churchill's physician, could answer, "Yes, Winston, we now know a good deal more about depression and what's called "Generalized Anxiety Disorder" (GAD). This is good news for the millions of North Americans from all walks of life who, like Lincoln and Churchill, live lives of quiet desperation.
It's unfortunate that psychiatrists don't label this illness the "Lincoln and Churchill Depression and Anxiety Disorder". The knowledge that this affliction strikes such prominent world figures would eliminate much of the stigma of those suffering with these common conditions.
Depression and GAD often go hand in hand. The symptoms of hopelessness, lack of interest in activities including sex, fatigue, appetite and weight change, difficulty concentrating, excessive worry, agitation, and the feeling of unshakable sadness are often accompanied with thoughts of suicide and death.
Recent research also shows that 80 per cent of people fighting depression and GAD are also suffering from physical symptoms such as backache, headache, stomach pains, nausea, dizziness and hand tremors.
Lincoln and Churchill could relate better than anyone else that depression and GAD do not strike because of personal weakness, but rather they're real diseases that require treatment. A major concern is that without treatment the problem is likely to worsen.
What is it that triggers depression and GAD in famous personalities and lesser mortals? Some families, such as Ernest Hemingway's, have a strong genetic background of depression and suicide. For others the illness may be precipitated by the death of a loved one, work stress, heart attack or cancer.
But in recent years researchers have used brain imaging techniques to explore the brain's chemistry. This reveals that two critical neurotransmitters, serotonin and norepinephrine, used by cells to communicate, are sometimes out of balance.
In 1987, researchers hit the bull's eye with the discovery of Prozac. This drug, like a single bullet, is able to affect the action of one of the neurotransmitters, serotonin. And it can make a huge impact on treating depression, in particular anxiety.
Since then researchers have struck the bull's eye with a double hit. They've developed Effexor XR, a novel dual action antidepressant medication that affects both the serotonin and norepinephrine neurotransmitters.
According to a recent study published in the Journal of Psychiatric Research the double action of Effexor XR is particularly effective in treating depression and generalized anxiety disorders and that it's a well-tolerated and safe medication.
Additional research conducted by Dr Jeffrey E. Kelsey, a psychiatrist at Emory University School of Medicine, Atlanta, reports accumulating evidence that dual action antidepressants such as Effexor XR provide "more rapid, robust and sustained antidepressant effects than those affecting just one neurotransmitter".
Today more than two-thirds of people who suffer from depression and GAD do not seek help. This can have disastrous consequences. Every year 4,000 Canadians and 30,000 Americans commit suicide.
One solution is to react quickly if you see symptoms of depression and GAD present in a family member. Some people can be helped by a caring family physician. Others will require psychotherapy or more intensive treatment with antidepressant medication.
The future looks grim. Dr. J. Raymond De Paulo, Professor of Psychiatry, Johns Hopkins University, predicts that by the year 2020 depression will be the most debilitating disease worldwide, second only to heart disease. It's also worrying that younger generations are experiencing depression at an earlier age.
The impact of depression and GAD on our society is so immense it cannot be ignored by governments. It's estimated in Canada the annual cost of treating depression and GAD along with lost productivity and absenteeism is 14 billion dollars. And unfortunately telling Lincoln, Churchill and others to "snap out of it", or to take two aspirins and call in the morning won't cure this problem.
W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of The Harvard Medical School. He's been a ship's surgeon, hotel physician and family doctor and later trained in surgery at McGill in Montreal, University of Rochester N.Y. and Harvard. His medical column is published by 60 Canadian newspapers and several in the U.S. He is the author of seven books. Dr. Walker has a medical practice in Toronto. His Web site is: www.mydoctor.ca/gifford-jones. He can be reached at letters@canadafreepress.com
