Anxiety and Depression

How to Choose a Doctor and Hospital for Your Treatment


Hospitals and doctors are not all alike…

…they vary in quality due to differences in their training, experience and services. These differences in quality become greater and matter more when you need sophisticated medical care for a complex condition.

A surgeon who performs a complex procedure often, for example, has better success with it than a surgeon who does the same procedure only occasionally. The complication rate and success rate for the same procedure may be many times higher at one hospital than another.

Clearly, the doctor and hospital you choose have a direct impact on how well you do — especially when you need treatment for a problem as serious as anxiety or mood disorders such as depression.

About 1 in 20 Americans — over 11 million people — experience depression every year. Depressive illnesses take a staggering toll, not only causing great pain to the millions of people involved, but disrupting the lives of family and friends and resulting in an estimated loss of $44 billion to the economy.

As serious as these statistics are, family and friends can take comfort in the fact that help is available and often successful. Because treatment is a continuous process, you will want to carefully consider where to go for care. In addition, treatment programs are often more successful when based on the needs of an individual, recognizing that what works for one person may not help another. You will also want to look for a program that involves patients and their families in the plan of care.

Admitting that you or someone you care about has a mental illness is not easy. And, selecting a doctor and hospital involves making some important decisions. This brochure explains anxiety and mood disorders — their diagnosis and the treatment options available. You may be reading this because you or a loved one is affected by one or more of these diseases and you don’t know where to turn for treatment. You will want to make a decision based on careful comparisons of doctors and hospitals. This brochure provides information to help you do that.


How Do You Judge Quality?

Most of us do more research when we buy a car or television than when we choose a doctor and hospital. That may be because we don’t know what questions to ask or on what to base our evaluation.

Quality of care can be measured in many different ways, and no universal agreement exists on which should be used. At The Cleveland Clinic Foundation, however, we believe that you can use the following six points, or quality indicators, to compare health care providers:

• Credentials

• Experience

• Range of services

• Participation in research and education

• Patient satisfaction

• Outcome

Choosing a doctor or hospital often is influenced by values. You may want to go to a doctor who is close to home. You may want a hospital with a specific religious affiliation. But when you need specialized medical care for the treatment of mental illness, you also should consider a doctor’s qualifications and a hospital’s outcome record. The quality indicators explained in this guide will help you make that kind of evaluation.

This guide discusses anxiety and mood disorders. Anxiety disorders include panic, generalized anxiety, obsessive compulsive disorder (OCD), social phobia and post-traumatic stress disorder (PTSD). Mood disorders consist of major depression (or unipolar disorder), and manic depression (or bipolar disorder).

While reading this guide, it is essential to remember that anxiety and depression are not anyone’s fault. They are not a weakness. Mental disorders are medical illnesses and are treatable.


A Step-By-Step Guide

This guide helps you choose a doctor and hospital by:

• explaining anxiety and depression;

• describing the latest treatment options;

• explaining six points that indicate quality; and

• providing questions and answers from the Cleveland Clinic that you can use to compare doctors and hospitals.


Anxiety Disorders

Anxious feelings are common and often occur in people who are emotionally healthy. These feelings become a problem, however, when they persistently affect a person’s daily life or sense of well-being and self-esteem.

Anxiety disorders are not just a case of the "nerves." They are disorders that often are related to the biological makeup and life experiences of the individual.

Common symptoms that indicate an anxiety disorder include:

• anxiety attacks

• obsessions

• compulsions

• phobias

• fear of social situations

• performance anxiety

• continuous worry

There are several types of anxiety disorders, each with its own distinct features. This brochure gives brief explanations of generalized anxiety disorder, panic disorder, phobias, obsessive-compulsive disorder and post-traumatic stress disorder.

Generalized Anxiety Disorder (GAD)

Generalized anxiety disorder is chronic, exaggerated worry and tension. People with this disorder consistently anticipate disaster and often worry excessively about health, money, family or work. Sometimes, the precise cause of worry is hard to pinpoint.

People with GAD are unable to relax, often have trouble falling or staying asleep, and their worries are accompanied by physical symptoms, especially trembling, twitching, muscle tension, headaches, irritability, sweating or hot flashes. They may feel lightheaded, out of breath, nauseated or have to go to the bathroom frequently. Many individuals with GAD startle more easily than other people, tend to feel tired, have trouble concentrating and sometimes suffer depression.

Panic Disorder

People with panic disorder have feelings of terror that strike suddenly and repeatedly with no warning. They can’t predict when an attack will occur and may develop intense anxiety between episodes, worrying about the next one. Untreated, the disorder can become disabling.

When a panic attack strikes, your heart may pound and you may feel sweaty, weak, faint or dizzy. Your hands may tingle or feel numb, and you might feel flushed or chilled. You may have chest pain or a sense of unreality, or fear of impending doom or loss of control. You may genuinely believe you’re having a heart attack or stroke, losing your mind, or on the verge of death. Attacks can occur at any time, even waking people from sleep. While most attacks average a couple of minutes, occasionally they can go on for up to 10 minutes. In rare cases, they may last an hour or more.


Second Opinions

If you or someone in your family has been told they need treatment for a mental disorder, you may want to seek a second opinion to discuss what other treatment options may be available or if the treatment prescribed is the most appropriate.

You will want to make sure that the diagnosis is confirmed by experts at an institution experienced in identifying different types of mental illness.

Phobic Disorders

Phobias occur in several forms. A specific phobia is an irrational and excessive fear of a particular object or situation (e.g. heights). Social phobia is a fear of being painfully embarrassed in a social setting. Social phobia often runs in families and may be accompanied by depression or alcoholism. Agoraphobia, which often accompanies panic disorder, is a fear of being in any situation that might provoke a panic attack, or from which escape may be difficult if one occurred. Severe agoraphobia can result in being housebound.

Obsessive Compulsive Disorder (OCD)

People who suffer from OCD become trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. Persistent fears that harm may come to self or a loved one, an unreasonable belief that you have a terrible illness, or an excessive need to do things correctly or perfectly, are common. Again and again, the individual experiences a disturbing thought, such as "My hands are contaminated — I must wash them."

In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions, such as washing, checking, counting, repeating, hoarding and endlessly rearranging objects in an effort to keep them in precise alignment. Most people with OCD struggle to prevent themselves from engaging in compulsive behaviors, and OCD sufferers often attempt to hide their disorder rather than seek help. An unfortunate consequence of this secrecy is that people with OCD usually do not receive professional help until years after onset of the disease.

OCD occurs in a spectrum from mild to severe, but if severe and left untreated, can destroy a person’s capacity to function at work, at school or at home.

Although OCD symptoms typically begin during the teenage years or early adulthood, recent research shows that some children develop the illness at earlier ages, even during the preschool years. Studies indicate that at least one-third of cases of OCD in adults began in childhood.

OCD is sometimes accompanied by depression, eating disorders, substance abuse disorder, attention deficit disorder or another anxiety disorder, especially panic attacks.

Post-Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder is a debilitating condition that follows a terrifying event. People with PTSD have persistent frightening thoughts and memories of their ordeal and feel emotionally numb. Some people with PTSD repeatedly relive the trauma in the form of nightmares and disturbing recollections during the day. They also may experience sleep problems and depression. They may be irritable, more aggressive than before, or even violent. Seeing things that remind them of the incident may be very distressing, which can lead them to avoid certain places or situations that bring back those memories. Anniversaries of the event often are difficult.

Treatment for Anxiety Disorders

Certain medications, cognitive-behavioral therapy, relaxation techniques, exposure therapy and biofeedback have proven successful in treating anxiety disorders. Support from family and friends can help speed recovery.


Depression and Other Mood Disorders


Depression — also referred to as unipolar or major depressive disorder — is not just "feeling blue." It is more than being sad or feeling grief. Depression is a major medical disorder, just like high blood pressure or heart disease are medical disorders. Depression influences people day after day, affecting thoughts, feelings, physical health and behavior.

Unfortunately, nearly two-thirds of the 11 million people who experience depression each year do not receive appropriate treatment because their symptoms are not recognized, are blamed on a personal weakness, or the symptoms are so disabling that people cannot reach out for help or are misdiagnosed and wrongly treated. Despite these statistics, it is essential for people to know that depression can be treated successfully.

Depression may be caused by many things, including family history and genetics, other general medical illnesses, certain medicines, drugs or alcohol or other psychiatric conditions. Specific life conditions, such as extreme stress or grief, may bring on a depressive episode or prevent a full recovery. For women, vulnerable times include premenstruation, post-partum and perimenopause. In some people, depression occurs even when life is going well.

Symptoms of Depression

People who have major depressive disorder have a number of symptoms nearly every day, all day, for at least two weeks. These always include at least one of the following:

• loss of interest in things you used to enjoy

• feeling sad or blue

You must also have at least four of these symptoms:

• feeling slowed down or restless and unable to sit still

• feeling worthless or guilty

• increase or decrease in appetite or weight

• thoughts of death or suicide

• problems concentrating, thinking, remembering or making decisions

• trouble sleeping or sleeping too much

• loss of energy or feeling tired all of the time

With depression, there often are other physical or psychological symptoms, including:

• headaches

• other aches and pains

• digestive problems

• sexual problems

• severe PMS

• feeling pessimistic or hopeless

• being anxious or worried


Other Major Diagnostic Categories

In addition to anxiety and mood disorders, there are a variety of clinically diagnosed mental illnesses for which treatment is available and highly effective. They include:

• schizophrenia

• personality disorders

• substance abuse

• eating disorders

• attention deficit disorders

• psychological factors affecting physical condition

• psychosis

Treatment for Depression

Successful treatment reduces the pain and suffering, removes all of the symptoms of depression and returns you to normal life. As with other medical illnesses, the longer you have the depression before seeking treatment, the more difficult it can be to treat.

The major treatments for depression are antidepressant medicine, psychotherapy or a combination of the two. In some cases, other treatments such as electroconvulsive therapy (ECT) and light therapy also are useful.


National Resources

The National Institute of Mental Health (NIMH) has launched the Depression/Awareness, Recognition and Treatment (D/ART) campaign to help people:

• recognize the symptoms of depressive disorders, including bipolar disorder

• obtain an accurate diagnosis

• obtain effective treatments

For more information about D/ART or for other resources regarding mental illness, contact the NIMH at 800/421-4211.

Manic Depression

Manic-depressive illness — also known as bipolar disorder — involves episodes of serious mania and depression. A person’s mood usually swings from overly high or irritable to sad and hopeless, and then back again, with periods of normal moods in between. At least 2 million Americans suffer from manic-depressive illness.

Manic depression typically begins in adolescence or early adulthood and continues throughout life. It often is not recognized as an illness and people who have it may suffer needlessly for years or even decades.

Signs and symptoms of mania include:

• extreme irritability and distractibility

• feeling "high" or unusually euphoric

• increased energy, activity, restlessness, racing thoughts and rapid talking

• decreased need for sleep

• unrealistic belief in one’s abilities and powers

• uncharacteristically poor judgment

• increased sexual drive

• abuse of drugs, particularly cocaine, alcohol and sleeping medications

• obnoxious, provocative or intrusive behavior

• denial that anything is wrong

Help is available

Too often people do not get help for their anxiety or depression because they don’t recognize the symptoms, have trouble asking for help, blame themselves or don’t know that treatments are available. If you or someone you care about has symptoms of anxiety or depression, it is essential to know that effective treatments are available that greatly alleviate the suffering caused by these disorders.


Where Do You Begin?

Measuring quality in ways that are useful to people is a relatively new idea in health care. Because of that, it may not be possible to get complete information for each of these quality indicators. But the willingness of providers to give you as much information as possible is a good sign. It shows they are dedicated to maintaining and improving their quality, responsive to patients and confident of their capabilities.

If you or your loved one needs treatment for anxiety or depression, ask your family doctor for names of specialists and hospitals that provide individualized treatment options. Get the names of several doctors who have the most experience in treating these disorders and hospitals that offer the newest, most effective treatments.

Ask the questions we suggest. Make comparisons. Then make your decision. Be an informed consumer for yourself and your family.


How to Use Quality Indicators

How can you use these indicators to judge if one doctor or hospital is better for you than another? By combining information from more than one quality indicator, according to a report, "The Quality of Medical Care: Information for Consumers," produced by the U.S. Congress, Office of Technology Assessment.

According to the report, patients about to have an operation, for example, can be confident if the hospital performs a high number of operations and if the surgeon has extensive training and experience in the procedure.

On the other hand, the report states "... if a hospital has a ...low volume of procedures, the patient might wish to question the surgeon about that hospital and about alternatives, even if other hospitals require longer travel."


1. Credentials

Do the doctor and hospital measure up?

Credentials have been set by nationally recognized medical professional organizations to verify that doctors and hospitals meet certain standards in health care delivery.


Psychiatrists may be board certified in psychiatry by the American Board of Psychiatry and Neurology. Psychologists must be licensed by the state to practice. National associations also provide further certification in areas such as geriatric psychiatry, child psychiatry, substance abuse and addiction, and pain. Nurses, occupational therapists, social workers and counselors also may be certified or licensed by state and national organizations.


The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is the nationwide authority that surveys hospitals. The JCAHO decides whether a hospital gets, keeps or loses accreditation based on its meeting certain criteria for staffing, equipment and facility safety requirements. Although accreditation is voluntary, most hospitals go through the process. If the hospital that you are considering is not accredited, it is important to know why.

Hospitals that provide treatment for anxiety and mood disorders may also have accreditation by state organizations. In Ohio, the Ohio Department of Mental Health has developed standards for mental health centers and licenses the centers that adhere to those standards.

Hospitals that do measure up are often in the public spotlight for their medical advances and the quality of their care. Information about a hospital’s reputation is widely available through the mass media, the government, consumer groups, and books and magazines such as U.S. News & World Report.


For information about a hospital’s status, call the Joint Commission on Accreditation of Healthcare Organizations at 630/916-5800. You also can visit their web site at

Are the physicians who treat mental disorders board certified?

All Cleveland Clinic psychiatrists are board certified*. In addition, a number of psychiatrists are board certified in other specialties including forensic psychiatry, geriatric psychiatry, child and adolescent psychiatry, internal medicine, addictions and pain therapy.

Are the nurses, occupational therapists and social workers certified?

Yes. All Cleveland Clinic nurses, occupational therapists and social workers have specialized training. Psychiatric social workers are licensed as independent social workers (LISW), credentialed by the Board of Social Work. All occupational therapists are licensed by the State of Ohio, Board of Occupational Therapy, Physical Therapists and Exercise Physiology and are certified by the American Occupational Therapy Certification Board, Inc.

Do psychiatrists and psychologists hold professional leadership positions?

Yes. Many staff members have held leadership positions in national, state and local associations including the Academy of Psychosomatic Medicine, American Psychological Association, American College of Psychiatrists, Cleveland Consultation Liaison Society, Cleveland Psychiatric Society (past four presidents), National Academy of Neuropsychology, Ohio Psychiatric Association (past three presidents). Clinic physicians routinely are examiners for the psychiatry board certification exam.

Is the hospital accredited by the JCAHO and the Ohio Department of Mental Health?

Yes. The Cleveland Clinic is JCAHO certified and has maintained accreditation by the Ohio Department of Mental Health since 1967.

Has the hospital been consistently recognized for medical excellence and leadership?

Yes. (See box at left.)

*Board certification or its international equivalent became a requirement in the Cleveland Clinic in 1989 for doctors being appointed to the medical staff.


One of America’s Best

The Cleveland Clinic is often named among the top medical centers in the country. Some of the recognition the Clinic has received includes:

• Every year since 1990, a survey by U.S. News & World Report of leading American physicians identified the Cleveland Clinic as one of "America’s Best Hospitals." In 1997, the Department of Psychiatry and Psychology was ranked among the top 20 mental health programs in the United States.

• Modern Healthcare magazine published studies that listed the Cleveland Clinic among the "top 100" best-performing hospitals (1994-1997).

• Cleveland Clinic psychiatrists are listed in the "The Best Doctors in America" data base, a listing based on peer-reviewed evaluations by Woodward/White, Inc.

• The Clinic received the 1998 Mercury Award as a top choice for health care. The awards, given by region, are sponsored by HCIA, a leading provider of health care information, and America’s Health Network, a 24-hour cable station and web site.


2. Experience

Does practice make perfect?

In the case of treatment for mental illnesses, the more experience the doctors and hospital have, the better the results usually will be.

Experienced physicians who have handled many cases are prepared for the most difficult situations and potential complications that may arise.

Physicians who dedicate a large portion of their practice to treating depression and anxiety have the experience and professional judgment needed to make an accurate diagnosis, appropriate treatment recommendations and careful decisions throughout the course of treatment. A hospital’s experience includes the length of time a program has been in existence and the total number of patients treated over the life of the program.

Seeking treatment from a doctor or hospital with experience in treating mental illness is particularly helpful for those who have previously sought treatment but had an unsuccessful outcome. Those with experience are more likely to have seen a greater number and variety of cases, and have more treatment options available.

How many people are hospitalized for mental illness each year?

The Cleveland Clinic treats more than 800 inpatients for mental illness each year.

How many people are treated as outpatients for mental illness each year?

The Cleveland Clinic treats about 10,000 outpatients a year.

How many follow-up sessions are held each year?

More than 35,000 patient visits at the Cleveland Clinic for mental illness (the majority of which are anxiety and mood disorders) and chemical dependency ocurr each year.

How many years has the program existed?

Since 1959, the Cleveland Clinic has been responding to the psychiatric and mental health needs of the community.


Support Programs

Support programs are an integral part of a maintaining mental health, providing emotional support and the opportunity to share experiences while on the road to recovery. The inpatient staff invites speakers to a Sunday morning brunch for families and patients as a way to introduce them to the available support network. Community resources include:

• Recovery Inc.

• Emotions Anonymous

• Alliance for the Mentally Ill

• Adult Children of Alcoholics

• Al-Anon

• Families Anonymous


3. Range of Services

What services are available?

Hospitals with a broad range of services can treat more complex medical conditions and better handle complications that may occur. If complications arise, or if you have other medical problems, you want the best medical care available and you want it immediately.

Range of specialty departments

Medical conditions do not always exist in isolation. Therefore, immediate access to a full range of specialty departments within a facility is critical. It is an advantage to seek treatment at a facility that allows access to physicians who specialize in treating a variety of medical conditions. You or your loved one will benefit from receiving treatment at a facility that can coordinate medications and treatment plans successfully.

Range of diagnostic and treatment options

No one treatment program works for everyone. Because only a medical professional can best determine what combination of treatment options will work best, you will want to look for a facility that offers a wide range of treatment options — including inpatient and outpatient treatment, counseling, individual and group therapy sessions and support groups.

Mental illness affects not only the dependent person, but that person’s family and loved ones. And, because family and friends can play an important role in treatment, it’s important to ensure they receive some support through special groups designed specifically for the family and friends of someone who has a mental disorder.

Is help available from a full range of specialty departments?

The Cleveland Clinic’s more than 750 physicians provide care in 100 specialties and subspecialties, including psychiatry and psychology, hypertension and nephrology, cardiology, gastroenterology and endocrinology. All of these specialties are present in one facility, so prompt consultation, diagnosis and treatment are available.

Does the hospital offer a variety of options for treating mental health problems?

The Cleveland Clinic Department of Psychiatry and Psychology offers a number of outpatient opportunities for care as well as an inpatient program. The Mood and Anxiety Clinic, for example, provides quick access to the full spectrum of inpatient and outpatient services within the department.

Specific outpatient services include:

• observation services

• intensive outpatient programs (nine to 12 hours per week of structured therapy)

• partial hospitalization program

• educational sessions for patients and families with specific diagnoses

• transitional outpatient therapies for individuals, couples, families and groups

• medication management

Are patients’ families included in the decision-making process?

Yes. The Cleveland Clinic believes family members play an integral role in mental health recovery and provide input regarding treatments and discharge planning. Family members, with the patient’s permission, are invited to participate in a number of treatment activities. Their needs and goals also are addressed in the treatment plan.

Do patients, even those receiving outpatient treatment, have 24-hour access to a therapist?

Yes, Cleveland Clinic patients 24-hour access to a member of the department.


Special Programs

The Cleveland Clinic Department of Psychiatry and Psychology offers a variety of programs to treat psychiatric and mental health conditions.

• The Alcohol and Drug Recovery Center

• Child and adolescent psychiatry

• The Health Psychology Program

• Chronic Pain Rehabilitation Program

• The Psychiatric Consultation-liaison service

• Neuropsychology services

In addition, the Cleveland Clinic offers a full range of supplemental programs, including:

• stress management

• support groups

• occupational counseling

• spiritual counseling

• individual therapy

• group therapy

• biofeedback

• educational sessions for patients and families

• family and marital therapy

• sexual dysfunction program

• smoking cessation

• anxiety and mood disorder clinic

• disability evaluation


4. Participation in Research and Education

What type of hospital is it?

Selecting a hospital that combines patient care with research and education offers many advantages.

Ideally, the individuals engaged in patient care, research and teaching are organized around a given disease or class of patients, facilitating the sharing of knowledge, research and clinical findings. This approach results in the most rapid transfer of basic scientific knowledge from the laboratory to care delivered at the patient’s bedside.

Those individuals on the staff of such a hospital are exposed to an important interchange of ideas. They also are exposed to the newest treatments and technology. At teaching hospitals, physicians are available 24 hours a day. Choosing a teaching hospital for your care may offer other advantages as well. Major teaching hospitals in the Cleveland area had lower mortality rates and shorter hospital stays than other types of hospitals, according to a studypublished in the August 13, 1997 issue of the Journal of the American Medical Association.

Is the hospital associated with a teaching program?

Yes. Incorporated in 1935, The Cleveland Clinic Educational Foundation sponsors one of the nation’s largest physician post-graduate training programs and is affiliated with The Ohio State University College of Medicine.

Does the hospital have a fully accredited fellowship program in treatment for mental illness?

Yes. The Cleveland Clinic offers a fully accredited psychiatric residency training program for residents in both adult and child specialties. Additional fellowships in treating behavioral and mental disorders are offered in substance abuse and psychology.

Does the hospital offer education programs in mental health for nurses and counselors?

Yes. The Cleveland Clinic has affiliations with area universities to instruct nursing and counseling students.

Does the hospital conduct clinical trials related to mental disorders?

Yes. The Cleveland Clinic Department of Psychiatry and Psychology is participating in several national clinical trials and research studies. Areas of focus include depression, social phobias, electroconvulsive therapy, sexual dysfunction and substance abuse.


5. Patient Satisfaction

Is everybody happy?

If you ask one person about his or her experience with a doctor or hospital, you get one person’s point of view. Patient satisfaction surveys allow you to judge quality based on the experience of many previous patients. This provides you with a more objective measure to use.

Most hospitals routinely use surveys to learn if patients are satisfied with their medical experiences. The hospital can use these results to improve its services.

Patient satisfaction often reflects the personal side of care. Surveys ask questions such as, How willing are the doctors and nurses to listen? Do they answer questions and explain treatments? How much time does the doctor spend with the patient? Is the hospital clean? Is the food good?

Patient satisfaction information may predict what your experience in a particular hospital is likely to be.

How satisfied are outpatients with their overall experience?

More than 87% of patients who received outpatient treatment from the Department of Psychiatry at the Cleveland Clinic rated the quality of their care and their overall experience as good or excellent.

How satisfied are inpatients with their overall experience?

Inpatients are surveyed regarding evaluation of pro-gram components and their satisfaction with their care providers.

88% of inpatients and 87% of their families rated the information obtained related to their illness and their recovery as good or excellent.

87% of the inpatients evaluated their treatment groups and individual therapy sessions as good or excellent.

How many patients treated at this hospital would return for care?

94% of the outpatients surveyed would return for services at the Cleveland Clinic.

Is there a program to help patients and their families with the difficulties that may arise during a hospital stay?

Cleveland Clinic patients may call an ombudsman — another name for a patient-relations representative — if they have concerns about their care.

Patients in the Cleveland Clinic hospital may speak to nurse staff 24 hours a day if they have any problems, questions, suggestions or concerns related to service.


Focus on Satisfaction

The Department of Psychiatry and Psychology at the Cleveland Clinic is constantly striving to provide the best possible care. That is why we encourage patients to provide us with feedback about specific elements of their treatment. Patients’ comments are reviewed periodically and their suggestions are taken into account when programs are being modified.


6. Outcome Indicators

What are the risks?

Many different outcome indicators can be used alone or in combination to measure the success of treatment. Which indicators you use depends on the type of treatment.

Treatment for mood or anxiety disorders can be considered successful when the symptoms have resolved or stabilized and the patient can function with a minimum of interference from the symptoms.

Complete recovery from any manifestation of these disorders is ideal, but since these conditions may be chronic with or without acute exacerbation, treatment focuses on managing debilitating symptoms and enhancing the patients quality of life.

Many factors contribute to one’s quality of life: how one feels about oneself, one’s general state of well-being and health and how one measures one’s own productivity and success.

On the following page, we provide Cleveland Clinic data pertaining to symptom management related to mood, self-esteem and the patient’s perception of productivity and general health. Most data were derived from a survey presented at the time of admission and discharge to a sample of inpatients suffering from depression.

When seeking treatment for anxiety or depression, you want to find a comprehensive program that provides a variety of options. Ask about the facility’s overall success with symptom management and improved quality of life.

How successful is the hospital in treating depressed patients in the hospital setting?

In 1997, a sample of depressed patients being treated as inpatients was surveyed on admission and at discharge.

60% of the patients admitted with complaints of sleep disturbances reported improvement before discharge.

80% of the patients who reported severe sadness on admission reported mild to no feelings of sadness upon discharge.

90% of the patients who reported feelings of self-loathing on admission experienced improved feelings of self-image at discharge.

100% of the patients reported improvement in their overall satisfaction and enjoyment of everday activities.

What is the average length of stay for people hospitalized with a mood or anxiety disorder?

Most people are treated for anxiety disorders in an out-patient setting. Patients with a mood disorder must meet certain medical criteria related to the severity of their symptoms before being admitted to the inpatient unit. An inpatient stay is typically necessary to stabilize severe symptoms and to initiate a strong discharge plan for outpatient treatment.

In 1997, the average length of stay for inpatient treatment at the Cleveland Clinic was 5.2 days with a readmission rate of 4.1%. According to the Health Care Financing Administration, the national average was 6.5 days.

A shorter length of stay allows patients to return more quickly to their regular daily activities, family and community. Following inpatient treatment, patients may be transitioned to one of several treatment opportunities available in the outpatient setting.


Treating the Individual

Each patient seeking treatment for anxiety or mood disorders in the Cleveland Clinic Department of Psychiatry and Psychology receives a comprehensive assessment, including a thorough medical and psychological evaluation, complete with laboratory tests. An individual treatment plan is formulated based on that assessment.


Pioneering Work in Treating Mental Disorders

• Dixon Weatherhead, M.D., the first chairman of the Department of Psychiatry and Psychology was among the first psychiatrists in the country to successfully treat manic depressive illness with lithium.

• Since the 1960s, Cleveland Clinic psychologists have worked nationally to improve and expand the use of psychological testing to measure personality characteristics and neurological functioning in order to enhance diagnostic and treatment interventions.

• For the past 20 years, a Cleveland Clinic psychologist has been a national leader in the development of biofeedback in treatment of stress-related disorders, helping to develop the guidelines for biofeedback applications and the standardized curricula for training programs.


For an Appointment or More Information

If you are experiencing any of the signs or symptoms mentioned in this guide, please discuss your concerns with your primary care physician. For an appointment with a primary care physician at the Cleveland Clinic, call 216/444-2535 or 800/223-2273, ext. 42535.

If you would like to make an appointment in the Cleveland Clinic Department of Psychiatry and Psychology, please call 216/444-5812 (Cleveland) or 800/223-2273, ext. 45812 (toll free outside of Cleveland).

To receive any of the other guides in our series, "How to Choose a Doctor and Hospital for Your Treatment," please call 216/444-8919 (in Cleveland) or 800/545-7718 (toll free outside of Cleveland), or visit us on the World Wide Web at