A Complicated Relationship: Anxiety, Depression or Something More?

Vinay Saranga MD

Saranga Psychiatry -Child, Adolescent, Adult Psychiatrist

People often refer to ‘anxiety and depression’ as if they are the same illness. They share some similar symptoms like fatigue, increased irritability and worthlessness. Yet, even with their similarities, they are two different disorders and should be treated individually. Sometimes it’s not easy to identify the difference. So, how do you know if you’re suffering from depression or just having a bad day? Are you nervous for a big upcoming event or is it something more? Here’s a few tips…

Identify You Emotions 

Keep track of how you are feeling each day. Life is full of daily stressors for all of us. It’s normal to feel burdened by a work deadline. However, once the task is complete, you should experience relief- not ongoing anxiety. Anxiety often manifests in an abundance of energy whereas depression often shows as lethargy. Keep a journal for a week and write down your emotions to help you better understand your feelings and symptoms.

The Past, Present and Future 

Though there is no sure way for you to self-diagnose your condition, understanding the difference between the two disorders starts by identifying your symptoms. Anxiety often focuses on what could go wrong in the future. Those suffering from anxiety fixate on worrying. They may avoid certain situations that could cause further anxiety or fear. A person suffering from anxiety often experiences a ‘fight or flight’ response accompanied by increased heart rate, trouble breathing and shaking or sweating.

Alternatively, depression can be linked to a painful past. Thoughts, ideas and daily triggers can send someone into a depressive state. Consequently, even good memories can bring on depression when you realize that time is over. At this point, we start to see symptoms like guilt, emptiness and loss. Someone suffering from depression might experience lack of energy, headaches and hopelessness.

A Complicated Relationship 

Furthermore, since depression and anxiety have many commonalities, it’s not always easy to understand what’s going on. Depression and anxiety have a complicated relationship. Your condition could be something more like mania or bipolar disorder. The only way to be properly diagnosed and treated is by seeking professional help. Depression and anxiety are not weaknesses! Don’t try to “muscle” through feelings of despair, hopelessness, or overwhelm. Reach out and let us help!



Vinay Saranga MD

Saranga Psychiatry -Child, Adolescent, Adult Psychiatrist

  • Published on October 19, 2017
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Linden Lodge Joins With NAMI in Grieving the Loss of a Staunch Mental Health Ally

NAMI Mourns the Loss of Senator Pete Domenici

Sep 13 2017

ARLINGTON, Va., September 13, 2017 – NAMI, the National Alliance on Mental Illness, is saddened to hear the news that former-Senator Pete Domenici of New Mexico has passed away. Senator Domenici served in the U.S. Senate for 35 years. Along with his wife Nancy, the senator worked tirelessly to educate his colleagues about mental illness and the need to improve mental health services and supports.

NAMI Chief Executive Officer Mary Giliberti expressed her heartfelt sorrow to Mrs. Domenici and the entire Domenici family: “Today, we mourn the loss of one of our staunchest allies. Senator Domenici has been a longtime advocate fighting for equal treatment for mental illness. He leaves behind a legacy in Congress on behalf of people with mental illness and their families that will never be forgotten. NAMI offers our deepest condolences to Nancy and their family.”

Senator Domenici’s legacy includes legislative accomplishments like significantly increasing the budget of the National Institute of Mental Health, passing a major bill to help homeless individuals with mental illness and co-occurring substance use disorders, and establishing priorities for biomedical and clinical research.

Senator Domenici had a remarkable capacity to work across the aisle with Democratic colleagues on legislation of mutual interest. Perhaps the best example of this was the federal mental health and addictions parity bill in 2007. Against great odds, Senator Domenici reached out to his Democratic colleagues—Senator Paul Wellstone of Minnesota and Senator Edward Kennedy of Massachusetts—to pass this landmark federal law. It is fitting that the law’s title is “Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.”

“Parity of insurance is almost a civil-rights issue,” Senator Domenici once said. “We take care of people with heart trouble, we operate on them, we have great learning centers where we study all there is to know about the heart. And insurance companies have paid for all those surgeries. And yet, if you have schizophrenia, which is an illness of the brain instead of the heart, because we started off early on saying it wasn’t an illness, we kept it and they wouldn’t let us change it.”

Senator Domenici was the father of eight children. One of his children began to show symptoms of schizophrenia in her late teens. After attending a NAMI support group, the Domenici family attended NAMI conventions and gave back to the NAMI community with words of wisdom and comfort. Mrs. Domenici even served on NAMI’s National Board of Directors between 1989 and 1992.

Although much progress has been made, Giliberti reflected that many barriers remain in achieving true parity in mental health care: “We all owe it to Senator Domenici to honor his legacy by continuing his hard work to achieve systems of care that are truly fair and just for people with mental illness and their families.”


Copyright © 2017 NAMI. All
Rights Reserved.
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Linden Lodge Bear Hugs Program is a Big Hit

Emily receives a THANK you card from Pinecrest StudentsOne of our Linden Lodge residents, Emily, who started our Bear Hugs program received this thank you card from the students in the Exceptional Family Member Program at Pinecrest High School where she volunteers. As we always say, “a little kindness and thoughtfulness” and caring about others,  goes a long way in this world!Emily's Pinecrest Students made a THANK you card
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Let’s Talk About Suicide – NYTimes.com

People adding posters to a memorial for Chester Bennington. His band, Linkin Park, has set up a suicide-prevention web page in his memory.
Edgard Garrido / Reuters


Chester Bennington, the lead singer of the band Linkin Park, was found dead on Thursday in his home near Los Angeles. The coroner’s office has confirmed that the 41-year-old died of suicide. That’s something I — and so many millions of other Americans suffering from mental illness — have considered.

The platinum-selling lead singer was open about his depression and anxiety. In Linkin Park’s single “Heavy,” Bennington sings: “I don’t like my mind right now / Stacking up problems that are so unnecessary / Wish I could slow things down.” And the lyrics in their hit single “Crawling,” deal with substance abuse: “There’s something inside me that pulls beneath the surface / Consuming, confusing.”

Bennington suffered, but he was not alone. In the United States, nearly one in five adults have some form of mental illness in a given year. That means that 43.8 million adults, nearly twice the population of Australia, experience a mental health disorder every year.

Yet more often than not, we don’t talk about mental health. And shows like Netflix’s “13 Reasons Why” or artists like indie pop singer Lana Del Rey have sensationalized or glamorized mental illness and suicide rather than taking it seriously.

Worldwide, 350 million people (that’s 5 percent of the population) suffer from depression every day. And they are suffering – and sometimes dying – in silence because we can’t seem to talk openly about mental health. Middle and high school health classes are the perfect place to begin the dialogue but mental health education in the classroom is essentially nonexistent.

When I began self-harming I was in sixth grade. In my middle school health class we learned about nocturnal ejaculations and how pubic hair would soon be growing all over our bodies but we never talked about our mental health. In high school, as I was becoming more withdrawn, we learned how to put condoms on a banana, we discussed alcohol and drugs while watching a few episodes of “Freaks and Geeks” but we never defined illnesses like depression, anxiety, personality disorders, suicide or PTSD, or learned that 50 percent of lifetime cases of mental illness begin by age 14.

In college, I became even more depressed. I would cry myself to sleep. My weight fluctuated by 10 to 20 pounds each semester. I would drink to forget and in my drunken blurs I leaned far too heavily and unfairly on friends who were just as lost and scared as I was. During what felt like the worst period of my depression, I took a health and wellness class my junior year. In that class, we discussed nutrition, healthy relationships and conflict resolution skills. We even had a unit on “stress management and resiliency.” But we never talked about mental illness or how to recognize or treat it.

And the truth is that everyone can benefit from learning about mental health. It shouldn’t scare us; it should light a fire under us to ensure that people across the United States and the world can recognize these illnesses like they would high cholesterol or asthma or any other health condition.

We should not be afraid to put a name to these illnesses. Chester Bennington wasn’t. We should not be afraid to come forward or tell our stories about our struggles with these issues. We should be open to learning the symptoms and the signs of mental health disorders. We should encourage everyone (not just those with mental health issues) to seek therapy because therapy is good for your mind just as exercise is good for your body.

If it was not for my family and friends, who knows what would have happened to me. But I do know that if I had learned about depression and anxiety, or even that therapy is an option, when I was 11, I wouldn’t be staring at my faded scars as I write this. We must push the conversation about mental illness forward whether it be in the classrooms of public schools or with our families and friends. These issues are real and lethal, and the first means of prevention is acknowledging their existence.

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Mental Illness Affects About 10 million Adults

More than a third aren’t getting help, federal study says

WebMD News from HealthDay

By Steven Reinberg

HealthDay Reporter

MONDAY, June 12, 2017 (HealthDay News) — Nearly 10 million American adults have a serious mental illness, and a similar number have considered suicide during the past year, according to a new government report on the nation’s behavioral ills.

The report also said that 15.7 million Americans abuse alcohol and 7.7 million abuse illicit drugs.

The nation’s growing opioid epidemic was also a focus in the report. The researchers found that 12.5 million people are estimated to have misused prescription painkillers such as oxycodone (OxyContin, Percocet) or hydrocodone (Vicoprofen).

Despite the growing number of Americans with mental health problems, about a third of those who need help aren’t getting it, said researcher Dr. Beth Han. She’s from the Center for Behavioral Health Statistics and Quality at the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).

“These are real increases,” Han said. The reasons people aren’t getting the help they need are varied. They include not having health insurance and not knowing where to go for help, she said.

Han believes that stigma continues to play a part in why people with mental health problems don’t seek help. “They are afraid that other people may find out,” she said.

Among teens, marijuana use has gone down slightly, from nearly 8 percent in 2011 to 7 percent in 2015, though with more states legalizing its use, more people continue to accept the drug as safe and discount its potential harms, the researchers said.

“For teens, marijuana is a substitute for other behaviors like binge drinking,” said Dr. Scott Krakower. He’s the assistant unit chief of psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y.

Often, substance abuse is driven by other mental problems such as depression or bipolar disorder, Krakower said. These mental problems may also be a product of the substance abuse, he said.

On the bright side, fewer teens are smoking cigarettes. And fewer teens started using marijuana, drugs or alcohol in 2015 than in previous years, the researchers said.

Mental illness is a growing problem among adolescents. Three million teens from 12 to 17 had major depression in 2015. The problem is particularly acute among girls, the researchers found.

Among teens, depression increased from 2 million in 2011 to 3 million in 2015, Han said.

Among adults, 9.8 million Americans reported having serious thoughts about suicide in the past year. This continued an upward trend that started in 2012. In 2011, 9 million adults reported thoughts of suicide, Han said.

These numbers are rising along with the opioid epidemic, she said.

In addition, 9.8 million adults have a serious mental illness. That number has remained about the same since 2011, Han said.

Despite this, only about two-thirds of those who need it are getting treatment for mental health problems.

Poor people have less opportunity for treatment, Krakower said.

People who are uninsured or who have insurance with large deductibles may be more likely to deal with a physical problem rather than a mental problem, he said.

In addition, wait times for treatment can be very long — up to a year, Krakower said. That’s because of the lack of trained staff and resources.

“The country needs to figure out a better model so people get the mental health care they need,” he said.

The prescription drug abuse epidemic also continues, Han said.

Many of these people get their drugs from a friend or relative or from a doctor, the researchers said.

People without health insurance were nearly twice as likely to have misused a prescription painkiller as those with insurance in the past year, according to the report.

In 2015, more than 1 million Americans were being treated for substance abuse. From 2011 to 2015, the number of people receiving medication-assisted therapy, mostly methadone, as part of a narcotic treatment program has increased about 16 percent.

Looking for an explanation for the behavioral health problems in the country, Krakower speculated that the mood of America is feeding mental health and drug issues.

“The morale of the country has been down,” he said. “The economy drives a lot of people’s mood. I don’t think people feel comfortable in this country. When that kind of morale happens, it has an effect on people’s psychology,” Krakower said.

The findings are published in the Behavioral Health Barometer — United States, 2016, which was released June 12 by SAMHSA.

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Thalamus-Targeted Drugs Could Treat Schizophrenia

 Thalamus plays a larger role in memory than previously thought.

Published Online: May 15,2017
Laurie Toich, Assistant Editor
American Journal of Pharmacy Benefits


Three groups of collaborating researchers discovered that the thalamus, an egg-shaped structure in the brain, is involved with thinking circuitry. Previously, the structure was thought to only relay information, but has been observed to help distinguish categories and keep thoughts in the mind, according to new study published by Nature and Nature Neuroscience.

The authors manipulated neurons in the thalamus to control an animal’s ability to remember how to receive a reward. These findings could lead to a targeted treatment to reduce cognitive problems associated with various psychiatric disorders, such as schizophrenia.

“If the brain works like an orchestra, our results suggest the thalamus may be its conductor,” said researcher Michael Halassa, MD, PhD. “It helps ensembles play in-sync by boosting their functional connectivity.”

Previous studies have suggested that the thalamus had a relay-like role in the brain due to its connections to portions of the brain that process sensory input. However, the authors of the new study state that the thalamus has connections to many other parts of the brain.

Specifically, the authors investigated the circuit that connects the mediodorsal thalamus with the prefrontal cortex (PFC), which controls thinking and decision making. Brain imaging has suggested that patients with schizophrenia often have decreased connectivity in this circuit.

The authors discovered that neurons in the thalamus and PFC communicated back and forth in mice, according to the study. Then, they monitored neural activity in mice performing an activity requiring working memory – the mice were tasked to follow cues to determine which door had a reward behind it.

Interestingly, when the neuronal activity in the thalamus was suppressed, mice were unable to choose the correct door, but when neuronal activity was stimulated, the mice had improved performance, according to the study.

These findings confirm previous notions about the role for the thalamus and also demonstrated a specific role in maintaining information in working memory.

The authors noted that sets of PFC neurons held memory regarding information about the correct door choice. The thalamus did not relay this information, but increased functional connectivity of PFC neurons, which was deemed vital for sustaining memory of the category, according to the study.

“Our study may have uncovered the key circuit elements underlying how the brain represents categories,” Dr Halassa said.

The second group of investigators found similar results when testing mice’s ability to find a reward in a maze. The authors also discovered the differentiated roles for subgroups of PFC neurons and how they communicate with the hippocampus.

They found that thalamus input to the PFC maintained working memory by stabilizing activity during a delay before the mice received the reward. Signals from the PFC to the thalamus sustained memory retrieval and action, according to the study.

These findings confirm that input from the hippocampus was required to encode the reward location in PFC neurons, according to the study.

“Strikingly, we found 2 separate populations of neurons in the PFC. One encoded for spatial location and required hippocampal input; the other was active during memory maintenance and required thalamic input,” said researcher Joshua Gordon, MD. “Our findings should have translational relevance, particularly to schizophrenia. Further study of how this circuit might go awry and cause working memory deficits holds promise for improved diagnosis and more targeted therapeutic approaches.”

The third group of investigators observed that the thalamus plays a role in short-term memory as well. The authors found that the thalamus cooperates with the cortex through bi-directional interactions, according to the study.

Before the mice received the reward, they needed to remember where to move after a delay. The authors found that the thalamus was communicating with the motor cortex when the mice were planning to move.

There was electrical activity in both structures during this time, which indicates that they work together to sustain information predicting the movement of the mice. An additional analysis revealed that the activity of the cortex and thalamus was dependent on one another, according to the study.

“Our results show that cortex circuits alone can’t sustain the neural activity required to prepare for movement,” said researcher Charles Gerfen, PhD. “It also requires reciprocal participation across multiple brain areas, including the thalamus as a critical hub in the circuit.”

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Linden Lodge Helps to Shatter the Silence at Local Rally

This gallery contains 5 photos.

Shattering the Silence Posted by Linden Lodge Foundation, Inc. on Saturday, May 20, 2017 Today Linden Lodge Foundation participated in a gathering, at Linden Lodge, to draw attention to mental illness issues, how they are addressed (or not!) in our … Continue reading

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Insane Consequences: D J Jaffe’s Attempt To Turn A Spotlight On The Seriously Mentally Ill

(5-1-17) Given the ongoing dispute about who will be the first Assistant Secretary for mental health and substance abuse, it seems a fitting time to discuss D.J. Jaffe’s new book, Insane Consequences: How the Mental Health Industry Fails The Mentally Ill.

For the past thirty years, Jaffe has been deeply involved in advocating for better care for the seriously mentally ill and his book provides a roadmap for what he is convinced needs to be done to rescue and reform our current system.

Jaffe became an advocate because of a family member. In his case, it was his wife’s younger sister, Lynn. What happened to Jaffe, his wife, Rose, and to Lynn has become an all too common story.

She started becoming paranoid, convinced that conversations taking place across the street involved plots to kill her…We took her to the emergency room. She was admitted, diagnosed, medicated, and provided rehabilitative therapy. But to “protect her privacy,” her doctor wouldn’t tell us her diagnosis, what medication she’d given Lynn, or what would happen when her hospitalization ended. Lynn returned home to us and stopped taking the antipsychotic medications we didn’t even know she’d been prescribed…”

Thus, Jaffe was thrust into our baffling mental health care system which he quickly found to be both frustrating and lacking. Determined to help change it, he began by knocking on the door of the National Alliance on Mental Illness, raising money for its New York City chapter and eventually joining its board. From there, he moved to the Treatment Advocacy Center where he became a strong advocate for Assisted Outpatient Treatment and a dedicated admirer of Dr. E. Fuller Torrey, one of TAC’s founders. More recently, he has launched his own organization, Mental Illness Policy. Org, which he describes as “a nonpartisan think tank that creates detailed policy analyses for legislators, the media and advocates.” Continue reading

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Cost of not caring: Stigma set in stone

Excellent USA Today article on attitudes about mental health and failure to provide equal treatment with physical ailments in this country. Stigma = discrimination. Absolutely.

Liz Szabo of USA Today continues with her excellent series of articles profiling America’s failing mental health system. This is a worthy read!

  • Stigma against the mentally ill is so powerful that it’s been codified for 50 years into federal law, and few outside the mental health system even realize it.

    This systemic discrimination, embedded in Medicaid and Medicare laws, has accelerated the emptying of state psychiatric hospitals, leaving many of the sickest and most vulnerable patients with nowhere to turn.

    Advocates and experts who spoke with USA TODAY describe a system in shambles, starved of funding while neglecting millions of people across the country each year.

    The failure to provide treatment and supportive services to people with mental illness – both in the community and in hospitals – has overburdened emergency rooms, crowded state and local jails and left untreated patients to fend for themselves on city streets, says Patrick Kennedy, a former congressman from Rhode Island who has fought to provide better care for the mentally ill.

    The USA routinely fails to provide the most basic services for people with mental illness — something the country would never tolerate for patients with cancer or other physical disorders, Kennedy says.

– See more at: http://www.cmhnetwork.org/news/cost-of-not-caring-stigma-set-in-stone#sthash.PEacUE5q.dpuf

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Moore County Leadership Institute Envisions a Wellness Garden at Linden Lodge


Moore County Leadership Institute

MCLI is a yearlong program offered by the Moore County Chamber of Commerce. Individuals accepted into the program spend one day a month learning about a different aspect of Moore County — touching on education, government, agriculture, tourism, business, and health care. Each individual also works within a team on a project to help a nonprofit organization or fill an unmet need in the community. Developed in 1989, MCLI has had more than 500 graduates to date.

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