Friday, January 30, 2009

One Argument for Measuring Decreases in Anxiety: Depression

by Tara Deliberto

This post is an augmentation of a previous post entitled "Two Thoughts on Depression: Dexamethasone Suppression Tests and Cortisol."

As stated in previous entries, Acceptance and Commitment Therapy (ACT) does not advocate conscious attempts at anxiety reduction in favor of having the client experience and work through anxiety. Although I really do think this is a useful skill for many reasons (honest! see previous posts), I would argue it is very important not to lose sight of how important long term anxiety reduction can be for the health of the patient.

We know several facts:
1. Prolonged anxiety leads to prolonged cortisol exposure
2. Prolonged cortisol exposure leads to dysfunctions of the Hypothalamic-Pituitary-Adrenal axis (HPA-axis; which is involved w/ regulating emotions)
3. HPA dysfunction can lead to depression

Along with many other reasons previously stated, because constantly experiencing anxiety rather than decreasing anxiety may lead to depression (and I'd bet other physiological problems), I would argue that treatment should include as ONE metric, measurable decreases in the experience of anxiety over time.

If that is too subjective for you, I would advocate going straight to the source and measuring early morning levels of cortisol over time. Afterall, studies such as the one published in 2005 by Portella et al. suggest that elevated morning levels of cortisol can be a *risk factor* for depression, not just an indicator of current depression. I realize this is usually only done in research and not clinical practice; however, psychology should move in the direction of making clinical decisions from hard physiological data. I don't think it is beyond reason to suggest that in the future, people should be able to go to the doctor, expectorate (aka drool) into a tube, and have their cortisol levels tested a few times a year to see if they're at risk for developing depression, one of the most costly diseases in the country that puts people at risk for death by suicide.
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