Sarah was in her therapist Donna's office, fiddling with the hem of her sweater. For the first time in years, after dealing with her "inner storms," she was finally able to do it. The pressure of anxious thinking and the empty silence of depression had gotten too heavy to carry by itself.
The Perfect Storm
Donna was listening closely to Sarah tell her story. She, like many, showed me how anxiety and depression are usually the result of a complicated complex. Sarah's grandfather had been depressed, which suggested genes that Donna already knew – those gene-based variations we inherit that shape the way we deal with emotion and stress.
"Think of it as a storm in a teacup," Donna mentioned. "These important chemical messengers are in your brain – neurotransmitters such as serotonin and dopamine. If they don't have a proper ratio, it's more like a system of communication, some of the signal gets lost or degraded."
Sarah nodded and thought of the family's divorce, the yearly moves, the middle-school bullies. These experiences had, Donna said, impacted her brain's stress-reduction network – the hypothalamic-pituitary-adrenal axis, or HPA axis.
"It's as if your brain's astrolabe lost its 'on' switch," Donna went on to say. "Infant trauma also early stress will activate this system to be more susceptible to future stresses. Combine that with new obstacles such as your job loss and pandemic isolation and you can see why you are feeling this way."
The Healing Journey
As therapy went on for weeks, Sarah found she was not the only one. Donna told me how one in five adults is anxious or depressed, and about 70% of those who are treated get a significant lift.
Sarah discovered in CBT how thoughts, emotions and behaviors were linked together. She mastered her negative thoughts – the "what-ifs" of anxiety and the "I'm not good enough" comments of depression. Sarah also found EMDR was effective in moving negative beliefs to more rational positive beliefs.
"It's a kind of operating system reset for your brain," Donna said in one session. "With every negative thought that you challenge, every new coping method you develop new neurons. This is neuroplasticity at work – your brain's magic carpet-cleaning trick."
The Power of Combined Treatment
Sarah thought extensively before considering a medication in addition to therapy. According to Donna, it is a possible addition to therapy. Sarah could take the medication to correct her brain chemistry and therapy would equip her with the resources to create long-term strength. The ability to eventually reduce or stop medication could be a possibility in the future.
Sarah's journey wasn't linear. It also had dips – weeks where anxiety came back, depression again. But she also found these were not missteps; they were the days of practice.
Building a New Foundation
Sarah started treatment, six months in, and the tide was turning. The panic attacks that used to be crippling were no longer common and not as severe. This thicket of depression was not out yet, but it had been let up.
As Donna explained, Sarah's improvement echoed what the evidence shows about the power of therapy:
Therapy regularly reprograms negative thinking circuits
Each session builds emotional regulation
These effects last for decades after treatment is complete
The combined treatment protocols have lower relapse rates
Sarah's newfound knowledge about stress management, sleep hygiene and the value of social relationships became her bedrock for mental health support.
Looking Forward
One year in, Sarah had sat in Donna's office during a check-up to see how she was doing. "It's not about treating anxiety and depression all at once," Donna told her. "You need to learn how to deal with them, and live a life where they don't run you."
Sarah is like thousands of other people who have gained treatment-based hope. We are all different, but the science says this: anxiety and depression can be controlled if understood and supported appropriately. With the brain's capacity for evolution and effective treatments, there is a solution to these relatively common but debilitating conditions.
The trick is to know that asking for help is not a weakness, but an act of self-care. As Sarah found, recognizing what causes anxiety and depression in the first place – in brain chemistry, in lived experience – clears the way for treatment.
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