Many Having Difficulty Dealing With Depression From Sept. 11 Events by Gina Shaw Signs and Symptoms What are some of the possible symptoms of depression, post-traumatic stress disorder or other emotional problems in the wake of such a tragedy? There could be many: ï Recurring, often intrusive thoughts about the events of Sept. 11 and the aftermath ï Persistent fear and avoidance of situations ï Inability to return to a regular routine; not wanting to go back to work or school ï Increased irritability, stress and strain in interpersonal relationships ï An increase in physical problemsóif you have a chronic pain problem or other medical condition, it may flare up ï Difficulty sleeping ï Severe appetite changes ï Sadness and tearfulness for no particular reason ï An inability to enjoy oneself or to take pleasure in daily events Been having trouble sleeping lately? Do you feel nervous, anxious, unenthusiastic about your usual daily activities? Youíre not alone. In the wake of the Sept. 11 attacks and ensuing fears about terrorism bo th in the United States and U.S. and allied targets abroad, many people report that they are experiencing depression, anxiety and stress. On Oct. 11, the one-month anniversary of the attacks, screenings for depression were held around the country as part of National Depression Screening Day. An annual event in its 11th year, Depression Screening Day has proven particularly timely this year. Local clinicians in all 50 states volunteered their time to offer free educational and screening programs at about 1,750 public sites, such as libraries and shopping malls, as well as the offices of about 1,400 primary care doctors. An extra component was added to this yearís screening program to help people determine if they are suffering post-traumatic stress following the attacks. People who tested positive for depression or post-traumatic stress disorder at a screening were referred to a variety of mental health resources in their community. (Even though the official "screening day" is over, you can still get information and referrals for depression and PTSD screening at www.mentalhealthscreening.org.) "Even people who thought they were handling the aftermath of the tragedy well may find that as the month elapses, their state of mind is still fragile," said Dr. Douglas G. Jacobs, founder and executive director of National Depression Screening Day and a member of the faculty at Harvard Medical School. Reports from screening sites are still coming in, so itís hard to tell yet if more people were screened this year. In an average year, the screeners see between 60,000 and 80,000 people nationwide. "Weíve noticed, anecdotally, of those people that were screened for PTSD that a high percentage scored positive," Jacobs said. "People who recognize that they have symptoms come in, and most of the time theyíre right. They should trust themselves and seek out health care. These disorders donít go away by themselves." Clinical psychologist Dr. Robert C. Simmons has seen an increase in patients at his private practice in Alexandria, Va., not far from the site of the Pentagon attacks. "Particularly in the past week or two, there seems to have been an upsurge in people who are coming in for issues that are at least somewhat related to the incidents of Sept. 11," he said. "I think everybodyís been affected to some extent and has gone through different symptoms of exposure to trauma. But some people, at this point, are not getting back to their usual routine, their usual level of functioning." But simply because youíre experiencing some of these symptoms doesnít mean thereís "something wrong with you." In fact, it would probably be difficult to find someone who hasnít gone through at least a brief state of depression or post-traumatic stress since Sept. 11. Interviewers working with national screening day used tools to help sort out the distinctions between grief and depression, stress and post-traumatic stress disorder. "We need to be mindful of the fact that just because people may have symptoms doesnít mean they have depression or PTSD," said Jacobs. "Often, they may be normal responses to whatís going on. To determine if itís a problem, we look at the frequency, quantity and persistence of the symptoms and the degree to which they impair oneís functioning. Obviously, suicidal thoughts are almost universally indicative of an underlying disorder, not seen in grief." In particular, people with pre-existing problems with depression and other feelings of helplessness may find their symptoms more overwhelming than usual. "People who tend to feel helpless about their lives and their situation have, understandably, felt more helpless lately," Simmons said. "One of the biggest things that a terrorist attack produces is a sense of helplessness in people, so if youíre already feeling somewhat helpless, then that intensifies." A new study also indicates that people who felt particularly anxious before the attacks might be more likely to focus on threatening images than those who didnít have high levels of anxiety previously. Humans have an adaptive element that keeps us focused on threatening images, explain the authors of a new study on anxiety and attention toward threatening stimuli, to be published in the December issue of the Journal of Experimental Psychology. The study, done at the University of Essex in England, found that people with heightened anxiety levels found it more difficult to focus on anything but threatening images than people with normal levels of anxiety. "Anxious people are not just shifting their attention toward the location of the threat," said lead author Dr. Elaine Fox. "They may be unable to disengage their attention to a noticed threat as quickly." This may explain why some people seem glued to coverage of the tragedy and are unable to focus on anything else, despite the emotional upheaval it causes. What if you handled the aftermath of Sept. 11 relatively well? Maybe you cried; like most people you probably sat glued to the television for hours, but for the most part you were able to go on with your normal life. That doesnít mean that you wonít find yourself struck by the tragedy a few months down the line, some experts say. "It will be months from now, when weíve all gone back to our everyday lives, that the effects of the tragedy will really take hold," said Jay Segal, professor of health studies at Temple University and an expert on stress and stress-related illnesses. "People will have headaches, sleeplessness and anxiety. The vulnerability issue is at the heart of these tragedies," added Segal. In many cases, life will return to normal after a few months and symptoms of post-traumatic stress and depression will go away. "Some of what people are feeling is a normal response to a horrible situation," said Jacobs. Simmons recommends the following steps to take care of yourself: ï Give yourself permission to have these painful feelings and try to name what they are: fear, helplessness, shock, grief. ï Talk with a trusted figure in your life: a spouse, family member or friend. "Talking about whatís going on and the feelings involved can be extremely helpful," said Simmons. ï Make efforts to maintain a usual routine. ï Limit your exposure to TV and other media coverage of the tragedy. "I know thatís become almost a clichÈ, but I think that can be important for a lot of people to do," Simmons said. If youíre still having trouble with basic daily functioning after a couple of months, then experts agree that that is the time to seek help. To find a therapist who can help, contact either the American Psychological Associationís national office (www.apa.org or (800) 964-2000) or your state psychological association for a referral. Community health centers also offer mental health services if cost is a factor. "PTSD and depression are both illnesses, not weaknesses, and there are specific treatments. They donít have to be long-term, but the longer you wait to seek treatment, the harder it is," Jacobs said. "Too many people are undiagnosed and untreated, and treatment is out there." Gina Shaw is the medical writer for The Washington Diplomat.