Stress, anxiety and depression

The acute response to stress is embodied in the 'fight or flight reaction', inducing a state of anxiety. When stress is long-continued, depression may develop insidiously under the croak of continuing anxiety symptoms. Depression inhibits the ability to cope with stress and so a 'vicious circle' becomes established, depression aggravating stress and vice versa. Of 100 patients attending the Maudsley Stress Clinic, 49 were suffering from major depression (DSM-III-R). Treatment with antidepressant drugs was highly effective in breaking the vicious circle and improvement in depression was accompanied by a reduction in severity of the various stress factors measured. Choice of drug is important, and when sleep disturbance is prominent, then it is better to use a sedative antidepressant. Alternatively, a short-acting hypnotic may be useful particularly during the first few weeks of treatment. It is better to use both antidepressant and hypnotic drugs that restore a normal pattern of sleep, particularly in relation to deep sleep. (C) 1997 by John Wiley & Sons, Ltd.