We’ve taken a broad overview of the mental illness problem in our first blog (6/11) and outlined how the problem breaks down by the numbers in our second blog (7/9).  Here we’ll try to take a more specific look at the major mental illness conditions that affect the most people; anxiety, depression, schizophrenia, and their “kissing-cousin” bipolar.


Anxiety affects over 40 million American adults in any given year.  Depression affects another 20 million.  Mood disorders are the third most common cause of hospitalization in the U.S.

Anxiety disorders include panic disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), generalized anxiety disorder (GAD), and phobias (social phobia, agoraphobia, and specific phobia).

o   Panic disorder as well as social phobias typically develop in late adolescence or early adulthood

o   The first symptoms of OCD often begin during childhood or adolescence

o   About 30 percent of Vietnam veterans experienced PTSD at some point after the war and more won’t seek help

o   GAD can begin at any time, though the risk is highest between childhood and middle age

o   Individuals with OCD frequently can have problems with substance abuse or depressive or eating disorders

Depression and anxiety might seem like opposites, but they often go together.  More than half the people diagnosed with depression also have anxiety.

Either condition can be disabling on its own.  Together, depression and anxiety can be especially hard to live with, hard to diagnose, and hard to treat.

“When you’re in the grip of depression and anxiety, it can feel like the misery will never end, that you’ll never recover,” says Dean F. MacKinnon, MD, an associate professor at the Johns Hopkins Hospital in Baltimore.  “But people do recover.  You just need to find the right treatment.”

The Symptoms of Depression and Anxiety

Depression can make people feel profoundly discouraged, helpless and hopeless.  Anxiety can make them agitated and overwhelmed by physical symptoms—a pounding heart, tightness in the chest, and difficulty breathing.

Treatment for Depression and Anxiety

Depression and anxiety can be harder to treat than either condition on its own.  Getting control might take more intensive treatment and closer monitoring, says Ian A. Cook, MD, the director of the Depression Research Program at UCLA.  Here are some tips:

  1. Give medicine time to work.  Many antidepressants also help with anxiety.  It could take time for the drugs to work—and time for your doctor to find the ideal medicines for you.
  2. Put effort into therapy.  Although many types of talk therapy might help, cognitive behavioral therapy has the best evidence for treating anxiety and depression.  It usually works within a few months, or not at all!
  3. Make some lifestyle changes.  As your treatment takes effect, you can do a lot on your own to reinforce it.  Breathing exercises, muscle relaxation, and yoga can help.  So can the basics, like eating well, getting enough sleep, and exercising.
  4. Get a second opinion.  When they’re combined, depression and anxiety can be hard to diagnose.  If you have any doubts about your care, it’s smart to check in with another expert.

SCHIZOPHRENIA (affects about 24 million adults)

Schizophrenia is one of the most confusing and disabling mental illnesses.  The symptoms fall into three broad categories, including positive symptoms, such as hallucinations; negative symptoms, such as apathy and social withdrawal; and cognitive symptoms, such as memory problems.  People who have this condition often require medication to control the most troubling symptoms.

Schizophrenia does not mean “split or multiple personality.”  Although people with schizophrenia are often portrayed as violent on television and in movies, that is seldom the case.  Schizophrenia is one of the most disabling and puzzling mental disorders in existence.  Just as the term “cancer” refers to numerous related illnesses, many researchers now consider schizophrenia to be a group of mental disorders rather than a single illness.

What Causes Schizophrenia?

Generally, schizophrenia begins in late adolescence or early adulthood.  Research indicates a genetic link to the development of schizophrenia.  A child who has one parent with schizophrenia, for example, has about a 10 percent chance of developing the illness, compared to a one percent chance if neither parent has schizophrenia.

Current research suggests that schizophrenia is related to abnormalities in both the brain’s structure and biochemical activities.  Researchers also tend to agree that environmental influences may be involved in the onset of schizophrenia.

Unlike people with anxiety disorders, who know they have a problem but are unable to control it, people with personality disorders generally are not aware that they have a problem and do not believe they have anything to control.

People with schizotypal personality disorder display a combination of odd behavior, speech patterns, thoughts, and perceptions.  Additional traits of people with this disorder include:

  • Dressing, speaking, or acting in an odd or peculiar way
  • Being suspicious and paranoid
  • Uncomfortable or anxious in social situations, emotionally distant, aloof or cold
  • Having few friends and being extremely uncomfortable with intimacy
  • Tending to misinterpret reality or to have distorted perceptions (for example, mistaking noises for voices)
  • Having odd beliefs or magical thinking (for example, being overly superstitious or thinking of themselves as psychic)
  • Being preoccupied with fantasy and daydreaming


According to the NIH, over seven million people are affected.  Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.  Symptoms of bipolar disorder are severe and can result in damaged relationships, poor job or school performance, and even suicide.  Bipolar disorder has many elements of both depression and schizophrenia but can be treated, and people with this illness can lead ful and productive lives.

Drug Treatment

In 2012, Americans filled 49.2 million prescriptions for anxiety medication Xanax and 43.8 million prescriptions for sleep aid Ambien.  That represents billions of dollars to the pharmaceutical manufacturers.  Mental illness causes so much suffering and we spend so much money on it.

In Part IV next month, we’ll take a look at the two mental illnesses that in some ways affect the caregivers almost as much as the patients:  children and suicide.


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