Madeeha Syed

Learn about the common triggers of anxiety and why you might experience anxious feelings even when everything appears to be going well in your life. Gain insight and tips on how to manage these emotions effectively.

Why You Feel Anxious When Everything Is Going Well?

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ZAKA CLINIC GULBERG LAHORE

Saad Ullah Siddiqui

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Do Supplements And Herbs Cure Depression?

Introduction

As predicted earlier by the World Health Organization (WHO), major depressive disorders now account for a major illness in the world<a href="#accordion">[1]</a>, especially since the emergence of <a href="https://www.merisehat.pk/disease/covid-19">COVID-19</a>. As the pandemic rapidly swept across the globe, it induced a considerable degree of fear, worry and concern in populations at large. Additionally, social isolation and loneliness worsened mental health worldwide.&nbsp; 
&nbsp;

Major depressive disorder is a major contributor to the incidences of suicide and ischemic heart disease. Moreover, it is the second leading cause of years lived with disability (YLDs) worldwide<a href="#accordion">[2]</a>. <a href="https://www.merisehat.pk/disease/depression">Depression</a> not only affects day-to-day activities but also decreases the quality of life and well-being of people. The mood disorder can present with mild to potentially debilitating and life-threatening symptoms.&nbsp;

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Over the years, the increase in the prevalence of psychiatric disorders, depression, anxiety, and insomnia has led to a search for more effective treatments. For this reason, people look to manage depression with more natural remedies. Hence, treatment (often self-treatment) with supplements and herbs continues to gain popularity. But natural does not always mean safe or effective.&nbsp; 
&nbsp;

Herbal formulas are commonly prescribed for the treatment of mental illnesses. More people are now turning to herbal medications because of the various side effects, high prices, and increased relapse rates associated with prescription medications. Over the past decade, several studies have been conducted on the mechanism of action of supplements and herbal medications for treating depression, anxiety, and insomnia.&nbsp;

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Understanding the role of natural remedies  in treating depression

Below are some supplements and herbs that are most widely used for the treatment of depression:&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Omega-3 fatty acids&nbsp;</h5>
	</li>
</ul>

Omega-3 fatty acids are essential fats that help with treating depression. A randomized control trial conducted on pregnant women in 2020 concluded that omega-3 fatty acids significantly improve symptoms of depression and postpartum depression<a href="#accordion">[3]</a>. Supplements containing the two omega-3 fatty acids eicosatetraenoic acid (ECA) and docosahexaenoic acid (DHA) are most effective. Omega-3 supplements containing 60% or more eicosapentaenoic acid (EPA) show an overall positive effect on treating depressing symptoms<a href="#accordion">[4]</a>. While there is a lack of research to support the argument, the supplement is a well-tolerated and considered healthy addition to your diet that may help treat the mood disorder.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>NAC (N-acetylcysteine)&nbsp;</h5>
	</li>
</ul>

NAC is a precursor of glutathione, an important antioxidant in your body. It is essential for protecting cells against oxidative damage and regulating inflammation<a href="#accordion">[5]</a>. Studies have shown that people with depression are more likely to have higher levels of inflammatory markers. Thus, taking NAC may reduce inflammation and relieve the symptoms of depression. Doses of 2 to 2.4 grams in a day are thought to help treat mental health conditions. 
&nbsp;

<ul>
	<li>
	<h5>Vitamin D&nbsp;</h5>
	</li>
</ul>

Vitamin D is an essential nutrient for the body. However, many people, especially in Pakistan don&rsquo;t have sufficient vitamin D. Studies have further shown that people with depression are deficient in vitamin D. Similarly, people with vitamin D deficiency have more severe depressive symptoms<a href="#accordion">[6]</a>. Vitamin D helps curb depression by reducing inflammation and regulating mood. A randomized control study highlighted that vitamin D supplements are beneficial for people with clinical depression<a href="#accordion">[7]</a>. Another study found that 300,000 IU of adjunctive vitamin D significantly improved the severity of illness and overall quality of life in people with clinical depression<a href="#accordion">[8]</a>. 
&nbsp;

<ul>
	<li>
	<h5>B vitamins&nbsp;</h5>
	</li>
</ul>

B vitamins play an essential role in the regulation of mood. These vitamins include folate, B12 and B6, and are needed to produce serotonin or the &ldquo;happy hormone&rdquo;. Studies have shown that a deficiency in vitamin B12 and folate increases the risk of depression. Whereas, supplementing vitamin B12 may help reduce depressive symptoms. According to a study published in 2020, low vitamin B12 levels are associated with a high risk of developing depression<a href="#accordion">[9]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Zinc&nbsp;</h5>
	</li>
</ul>

Zinc is an essential mineral for brain health and a deficiency in the mineral may increase the risk of depression and the severity of symptoms. Studies have further shown that zinc when used alongside antidepressant medications may reduce depressive symptoms.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Magnesium&nbsp;</h5>
	</li>
</ul>

Magnesium is an important mineral that may help with the symptoms of depression. A randomised study concluded that 248 mg of magnesium per day for 6 weeks can significantly reduce the symptoms of depression<a href="#accordion">[10]</a>.&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Creatine&nbsp;</h5>
	</li>
</ul>

Creatine is an organic compound that is essential for maintaining brain energy, which has shown to be involved in the development of depression. Some studies have shown that supplementing creatine can help with the symptoms of clinical depression.&nbsp; 
&nbsp;

<ul>
	<li>Rhodiola Rosea&nbsp;</li>
</ul>

Rhodiola Rosea is a popular herb that has several health benefits when taken in the form of a supplement. In addition to helping the body cope with stressful situations, the herb is known to reduce symptoms of depression. The herb when used in combination with saffron can significantly reduce depression and anxiety symptoms of mild to moderate depression<a href="#accordion">[11].</a>&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Saffron&nbsp;</h5>
	</li>
</ul>

Saffron is a spice that is commonly used in Asian foods. The spice is packed with antioxidants that have been shown to improve the symptoms of depression. While the exact mechanism behind it is unknown, studies have shown that saffron increases levels of the &ldquo;happy hormone&rdquo; in the brain 
.

<ul>
	<li>
	<h5>Ginseng&nbsp;</h5>
	</li>
</ul>

The ginseng plant has been used by the Chinese for thousands of years to help reduce the effects of stress, and improve mental clarity and energy. Derived from the plant, ginseng supplements have properties that help with low energy and motivation levels in people with depression. However, currently, there are not many studies to support the benefits of ginseng for depression&nbsp;&nbsp; 
&nbsp;

<ul>
	<li>
	<h5>Chamomile&nbsp;</h5>
	</li>
</ul>

Studies have shown that chamomile is useful in the management of depression and anxiety. The herb provides significant relief from depressive symptoms. However, there is a need for further studies to support the benefits of chamomile to treat depressive symptoms.&nbsp;

&nbsp;

Key Points

<ul>
	<li>While herbal and natural supplements may work for some people, they are not a substitute for conventional treatments. Especially, for people who also struggle with thoughts of self-harm or suicide.&nbsp;</li>
	<li>Depression is a treatable illness, and you may try different herbs and supplements, but they may have potential side effects.&nbsp;</li>
	<li>These herbs and supplements can also interact with other drugs, reducing their potency.&nbsp;</li>
	<li>If you struggle with depression or have thoughts of suicide or self-harm, seek professional help immediately.&nbsp;</li>
</ul>

&nbsp;

[1].Depressive disorder (depression). World Health Organization. Accessed May 18, 2023

[2].Ferrari, A.J., Charlson, F.J., Norman, R.E., Patten, S.B., Freedman, G., Murray, C.J., Vos, T. and Whiteford, H.A., 2013. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS medicine, 10(11), p.e1001547.

[3].Zhang, M.M., Zou, Y., Li, S.M., Wang, L., Sun, Y.H., Shi, L., Lu, L., Bao, Y.P. and Li, S.X., 2020. The efficacy and safety of omega-3 fatty acids on depressive symptoms in perinatal women: a meta-analysis of randomized placebo-controlled trials. Translational psychiatry, 10(1), pp.1-9.

[4].Liao, Y., Xie, B., Zhang, H., He, Q., Guo, L., Subramanieapillai, M., Fan, B., Lu, C. and McIntyre, R.S., 2019. Efficacy of omega-3 PUFAs in depression: a meta-analysis. Translational psychiatry, 9(1), pp.1-9.

[5].Šalamon, Š., Kramar, B., Marolt, T.P., Poljšak, B. and Milisav, I., 2019. Medical and dietary uses of N-acetylcysteine. Antioxidants, 8(5), p.111.

[6].Menon, V., Kar, S.K., Suthar, N. and Nebhinani, N., 2020. Vitamin D and depression: a critical appraisal of the evidence and future directions. Indian journal of psychological medicine, 42(1), pp.11-21.

[7].Vellekkatt, F. and Menon, V., 2019. Efficacy of vitamin D supplementation in major depression: A meta-analysis of randomized controlled trials. Journal of postgraduate medicine, 65(2), p.74.

[8].Vellekkatt, F., Menon, V., Rajappa, M. and Sahoo, J., 2020. Effect of adjunctive single dose parenteral vitamin D supplementation in major depressive disorder with concurrent vitamin D deficiency: a double-blind randomized placebo-controlled trial. Journal of Psychiatric Research, 129, pp.250-256.

[9].Sangle, P., Sandhu, O., Aftab, Z., Anthony, A.T. and Khan, S., 2020. Vitamin B12 supplementation: preventing onset and improving prognosis of depression. Cureus, 12(10).

[10].Tarleton, E.K., Littenberg, B., MacLean, C.D., Kennedy, A.G. and Daley, C., 2017. Role of magnesium supplementation in the treatment of depression: A randomized clinical trial. PloS one, 12(6), p.e0180067.

[11].Bangratz, M., Abdellah, S.A., Berlin, A., Blondeau, C., Guilbot, A., Dubourdeaux, M. and Lemoine, P., 2018. A preliminary assessment of a combination of rhodiola and saffron in the management of mild–moderate depression. Neuropsychiatric disease and treatment, 14, p.1821.

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A Guide To Basic Attachment Styles

Overview

The idea of attachment styles was derived from British Psychologist John Bowlby&rsquo;s &lsquo;Attachment Theory&rsquo;. This theory has been much researched, built on and expanded and has had a substantial impact on our view of human relationships. This is the idea that children are born with an inherent need to bond emotionally and physically with at least one of their caregivers and develop attachment styles based on the response they get from these figures. This happens during the first six months of infancy and sticks with a person throughout their life. Our attachment styles essentially decide how we are going to relate to ourselves, our peers, our lovers and even our colleagues. 
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Attachment Theory

There are 4 types of attachment styles:

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You find it relatively easy to get close to people, lean on them in times of need and are dependable when they need you. You aren&rsquo;t constantly worried that your friend or lover might abandon you, similarly you don&rsquo;t freak out when people start getting too close. 
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If this is something you identify with then it means you have a secure attachment style. Such people comfortably express their emotions and are receptive of others emotions as well. There&rsquo;s no need to run in the other direction when conflict arises nor a drive to over compensate by becoming too available or aggressive in your approach. In <a href="https://merisehat.pk/article/how-to-rekindle-love-in-long-term-relationships">interpersonal relationships</a>, there is honesty, there is tolerance of differences and there is a healthy amount of emotional intimacy along with personal resources to work through conflict. If you are someone who exhibits secure attachment then that means most of your relationships are healthy, fulfilling and reciprocal.

Securely attached adults tend to have parents who were able to respond to their child&rsquo;s needs in a timely manner, while being a present, dependable and soothing figure in the child&rsquo;s life.

&nbsp;

Needing excessive emotional support, approval and intimacy with your partner, experiencing heightened anxiety when needs aren&rsquo;t met and trying to mitigate this by becoming clingy or demanding are just some of the features of an anxious-preoccupied attachment style. 
 
If you are someone who identifies with this, chances are that you don&rsquo;t do well on your own and require your partner to always be there. You use the relationship as a way to shield yourself from feelings of discomfort and are very likely to end up in a victim-savior dynamic. 
Such people fear abandonment and might try to compensate by over giving or becoming doormats. There&rsquo;s a lack of trust and in many cases these individuals will self-sabotage in relationships. This further reinforces their personal view of self and others and leads to deteriorating self-esteem. More often, these people also end up attracting an avoidant partner and find themselves stuck in a vicious cycle. 
 
This style is usually observed in adults who had suffered from emotional or physical neglect/abuse as children or were separated from their caregivers very early on. Hence the need for excessive reassurance, approval and closeness. 
&nbsp;

These individuals tend to exhibit a high level of emotional independence and often see themselves as &lsquo;lone-wolves&rsquo;. They don&rsquo;t feel the need to form close emotional bonds and tend to be self-sufficient. They neither depend on others, nor invite others to depend on them. They&rsquo;ll shy away from situations requiring higher emotional intelligence and receptivity, avoiding dangers of intimacy through engaging in solitary activities and withdrawing completely into themselves. 
A positive view of self is cultivated by excessive personal achievements instead of fulfilling relationships where others could provide a sense of approval and acceptance. More often than not, this is not due to an abhorrence for intimacy but a defense mechanism in order to avoid rejection from others. 
Adults exhibiting this were kids who were discouraged from expressing their emotions and needs. Not having caregivers who they could rely on in times of distress or even for basic emotional needs, self-soothing was the only solution they had. 
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They also tend to avoid emotional intimacy while deeply desiring it at the same time. One moment strong emotional attachments are avoided in order to stay safe in their bubble and the next moment great strides are made in order to form intimate emotional connections. This constant back and forth leads to disorganised thought patterns, they not only view themselves as not deserving of the love they are receiving but there&rsquo;s also a deep mistrust of the person providing any kind of support. 
 
All of this essentially makes it a mixture of an anxious-preoccupied attachment style and dismissive-avoidant attachment style. This is rooted in a childhood where the parents or caregiver frightened the child by being inconsistent and unpredictable. There are moments of immense love and attention which is then not followed through in other times where the parent might fail to respond to even the most basic needs of their child.

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Bottom Line

Most of us are already aware of our behaviors and how we like to maneuver through relationships. Knowing these attachment styles puts a name to these behaviors and ways of relating to our surrounding. Acknowledging your style helps gauge whether something is really serving your best interests or not. It&rsquo;s also important to note that you are not stuck with your attachment style. If you have an attachment style that hampers your ability to form healthy, reciprocal relationships then you can learn and evolve. Extend yourself some compassion and gracefully accept your shortcomings, reach out to people and sources where you can obtain that much needed emotional schooling from and know that things are simply never as bad as they might seem.&nbsp;

Dr. Safia Mehmood

For some people, happiness is hard. Have you ever felt like curling into a ball in a corner or hiding under the covers in your bed when everything in your life is going well? It&rsquo;s confusing isn&rsquo;t it? But it&rsquo;s okay. It&rsquo;s nothing to further panic about.

It&rsquo;s not unusual to feel more anxious after you&rsquo;ve finally reached a good place in your life &mdash; whether it&rsquo;s hard-earned success, good news you were hoping to receive, reaping the fruits of your labour or when something you really wanted is finally happening. 
&nbsp;

Carla Marie Manly, a clinical psychologist and author of the book Joy From Fear says, &ldquo;<a href="https://merisehat.pk/disease/anxiety">Anxiety</a> can be a bit tricky, as it&rsquo;s a primitive response that&rsquo;s hard-wired into the brain. The brain&rsquo;s fear circuit works very quickly, and it doesn&rsquo;t always pause to differentiate between good anxiety and bad.&rdquo;

She reveals that for some people it&rsquo;s physically hard to accept happiness. Because the physical symptoms your body experiences when something good happens are very similar to those associated with fear or panic. 
&nbsp;

Happiness Hard For Some

This is because your body and you are most likely addicted to pain. It sounds ridiculous, because who enjoys pain, right? It&rsquo;s because your body is attuned to being in a state of panic. The pain is what&rsquo;s familiar. It&rsquo;s the &lsquo;normal&rsquo; your body is used to being in.

According to studies, when your body has become accustomed to being in a constant state of anxiety, positive changes, both physiological and emotional, that happen in your body following something good can be triggering. In the sense your body starts sending signals that something isn&rsquo;t right. Because feeling good isn&rsquo;t &lsquo;normal&rsquo; for your body. You&rsquo;re used to being hypervigilant. 
&nbsp;

Other Shoe to Drop

Some people &mdash; a lot of people actually &mdash; are in a state where they&rsquo;re constantly waiting for the other shoe to drop. Such people react almost fearfully to life going well, as if they&rsquo;re waiting for something bad to happen.

This may be because when they were younger, periods of calm or happiness were followed by something sudden or bad happening.

There are a variety of complex reasons why anyone chooses to react fearfully to good things in life. This could include growing up in a family where the news of your success was met with anger or resentment or experiencing loss after getting something. It might also be trouble with being comfortable feeling vulnerable &mdash; you have happiness and something to lose now. 
&nbsp;

Conclusion

The good thing is, anxiety can be managed. You don&rsquo;t have to live an anxious, fearful life especially when there is nothing to be anxious or fearful about and everything to celebrate or feel grateful about. With some tips and practise on managing anxiety, you can learn to enjoy the calm and sit back, instead of waiting for everything to fall apart. 
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