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Depression and Anxiety are the two most common issues that people seek treatment for in counseling. The good news about that is (1) you are not alone if you are currently suffering from either of these and (2) there are many comprehensive treatments out there to help you get through it.



Signs of Depression

Many people, including thousands here in Philadelphia, suffer from episodes of depression.  However, it is very common to not know that you are dealing with depression.  This is especially true in men.  So, how do you know if you are depressed and not just sad? Here are some common signs:

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One of the most common signs is that you have stopped enjoying the things you used to do.  Have you stopped running the Rocky steps at the Philadelphia Art Museum? Have you stopped tailgating and following the Philadelphia Eagles when you used to be invested despite their record? No longer shopping at Reading Terminal on weekend mornings?  Any of significant changes like these or others could be a sign of depression?

It is best to screen yourself with a mental health counselor or use an objective rating like the depression screening tool provided here.

Treatments for Depression



Psychotherapy and/or Medication

Because hopelessness is a symptom of depression, you may feel like there is nothing you can do.  This is simply not true. Depression is highly treatable. If you believe you may have depression, your first step is to visit a primary care physician for screening. This is an important step so that you do not begin treating the wrong issue. Depression symptoms can often look similar to the symptoms of thyroid disorders and viral infections.

If you are diagnosed with depression, your doctor may present you with a few choices for treatment: (1) psychotherapy, (2) medication, or (3) both in combination. Psychotherapy addresses either cognitive patterns, emotional affect or behaviors that reinforce depression.  Medication addresses brain chemistry that may be contributing to symptoms of depression.

Studies show that combining medication with psychotherapy could offer the best outcomes for recovery. A 2014 meta-analysis by Cuijpers et al. (doi:10.1002/wps.20089)  of clear evidence that combined treatment with psychotherapy and antidepressant medication is more effective than treatment with antidepressant medication alone. The results of this study also suggested that the effects of psychotherapy and medication are mostly independent of each other.  This means they both contribute to treating depression.

Psychotherapy treatments include psychodynamic therapy, cognitive behavioral therapy, and family therapy. Medications include Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs).


Psychodynamic Therapy

Psychodynamic therapy addressed unresolved and usually unconscious conflicts stemming from childhood. Because the conflicts are unconscious, the person is unable to directly address them. The goal of this therapy is to help the person understand and cope with these conflicts by bringing them to the surface and talking about how they affect the person in the present.


Cognitive Behavioral Therapy

Cognitive behavioral therapy focuses on how negative thinking affects the way a person behaves and feels. The therapist works with the client to change their thinking patterns and behaviors in response to thoughts. Once thought patterns are identified, the client and therapist work collaboratively to change these associations and help the client feel better and behave differently in response to stress. Although life circumstances may not change, the clients’ reactions to them will.


Family Therapy

Family therapy focuses on the interactional patterns between a client and his family, friends, social network, colleagues, and others.  By analyzing the different systems the client belongs to, the therapist can help the client improve their communication, self-esteem and emotional responses to different stimuli. By changing the way the client interacts with different system members, the client often gains new insight and experiences an emotional shift.



SSRIs are the most commonly prescribed class of antidepressants.  They work to treat an imbalance of serotonin, which may contribute to depression. By decreasing the reuptake of serotonin to the brain, more serotonin remains available. Common SSRIs prescribed by physicians and psychiatrists include Zoloft, Prozac, Lexapro, and Paxil. Before agreeing to take medication, you should weight the potential benefits against potential side effects.



SNRIs work by improving the levels of serotonin and norepinephrine in your brain. Experts believe these changes can reduce the symptoms of depression. Similar to SSRIs, SNRIs block the reuptake of serotonin and norepinephrine.  These medications are also used to treat anxiety.

Common SNRIs are Cymbalta, Effexor, and Pristiq. Before agreeing to take medication, you should weight the potential benefits against potential side effects.


Before you pay for counseling or medication, start an exercise routine! Exercise increases the production of endorphins, natural chemicals that increase tolerance for pain. Exercise may also boost norepinephrine, a neurotransmitter that may affect mood. Despite the success of exercise as a treatment for depression, many physicians and counselors do not present it as a viable treatment option.


Setting a fixed diet of healthy foods like vegetables and lean proteins can help ease the symptoms of anxiety. Conversely, poor eating habits like eating junk food or drinking sugary drinks can increase the negative symptoms of depression.  So, watch what you eat and monitor how it affects your mood. Healthy foods can be bought at Reading Terminal or the Italian Market in South Philadelphia.

Change Routines

Changing routines and doing something new can help kick depression to the curb. Often, people suffering from depression will become stuck in a monotonous schedule and have lost track of those activities that brought them pleasure. You can help ease these symptoms by trying a new activity or getting out of negative patterns. Volunteer, try a new sport, take a different walk to work and see if things improve over time.



Anxiety, by itself, it’s not a disease or illness. It is a natural response to stimuli. Through the course of human history, humans have responded automatically to threatening stimuli. Usually, the response is to fight or flee from anything that is perceived as a threat. Over time, this a person may begin to have the “fight or flight” response to non-threatening stimuli that are perceived as threatening.

Anxiety becomes a problem when it begins to interfere with normal life functioning. Because anxiety is usually behavior based and a learned behavior, the causes can be identified and the behavior can be changed. Medications can treat the acute symptoms of anxiety, but they often do not address the causes.


Signs of Anxiety



Excessive Worry

Are you constantly worrying about every little thing in your life? Occasional worrying or fearfulness about an upcoming event is normal.  But, if your worrying has reached the point where it interferes with your enjoyment of life, then you may have an anxiety disorder.

Chronic Indigestion

Many people miss this sign that of an issue with anxiety, but your stomach often communicates your emotions. If you have chronic issues with indigestion or stomach pain or you have a disorder like IBS that flares up unexpectedly, this could be a sign of anxiety.

Panic Attacks

People often mistake panic attacks for heart attacks. Feelings of fear are accompanied by chest pain, shortness of breath, inability to speak, sweating, racing heart, and/or numbness in the extremities. Panic attacks are often the result of anxiety and the attacks are so scary that they can create a positive feedback loop that creates additional anxiety about future panic attacks.


Is your best still never good enough? There are many people who are “perfectionists”, but if you are overly focused on achieving an objective “perfectly” to the point that it interferes with your ability to achieve the objective at all then you may have anxiety.

Compulsive Behavior

Obsessive-compulsive disorder is classified as an anxiety disorder because the behaviors displayed by those that suffer from the disorder are meant to help ease anxiety.  While you may not have OCD, if you display obsessive thinking or participate in compulsive behaviors as a result of stress, you may be suffering from anxiety.

Inability to Trust Yourself

Severe second-guessing or self-doubt is a sign of anxiety. If you cannot make a decision or handle uncertainty, anxiety may be paralyzing you from living your life to its full potential.

Sleep Interruptions

Problems with sleep are a sign of many issues and unfortunately, this includes anxiety.  If constant worrying keeps you awake, you could be suffering from anxiety.



Treatments for Anxiety


Many of the treatments for depression are also helpful with anxiety. These include exercise, diet, and cognitive behavioral therapy.


Learning deep breathing exercises can help calm you down to think rationally and determine whether your current anxiety is rational. Yoga or a therapist can help you learn the proper breathing techniques necessary to keep anxiety in check. For yoga, try Philly Power Yoga or CorePower Yoga in downtown Philadelphia.

Practice Mindfulness

Buddhists and other eastern practitioners originally practiced mindfulness, but it is now mainstream. Mindfulness involves paying attention to the current moment and being fully aware of your body and surroundings.  Like any practice, it can be uncomfortable at first and takes work to master.  The Shambala Meditation Center in Philadelphia offers distinct classes on mindfulness at 2030 Sansom Street.

Exposure Therapy

If you have an anxious reaction to a specific stimulus, for example flying in a plane, an exposure therapist can work with you to slowly expose yourself to your fear and work through it.  Those suffering from certain traumatic experiences should not participate in exposure therapy.


Medications do not treat the causes of anxiety, but rather the symptoms. Antidepressants like SSRIs and SNRIs can help with anxiety.  There are also anti-anxiety medications that treat acute anxiety.  One such class are benzodiazepines.  Xanax is a popular medication that falls in this class.  However, users should be careful because these medications can be habit-forming.


Interested in getting treatment for depression and/or anxiety? Let’s talk!


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