Depression & Anxiety in Military: Symptoms, Treatment & When to Get Help

Bottom Line Up Front: 20-30% of service members experience depression or anxiety (vs. 8-10% general population). Symptoms: Persistent sadness, loss of interest, irritability, panic attacks, constant worry, sleep issues, difficulty concentrating. Treatment works: 60-80% improve with therapy (CBT) + medication (SSRIs like Zoloft, Lexapro). Free resources: Military OneSource (24/7), base Mental Health clinic, TRICARE (covers unlimited sessions). Seeking help does NOT ruin career - thousands serve with treated depression/anxiety. Untreated = job performance decline, relationship problems, substance abuse, suicide risk. Get help early.

Depression vs. Anxiety (Understanding the Difference)

Depression Symptoms

Emotional:

• Persistent sadness, emptiness ("nothing makes me happy")
• Loss of interest (hobbies, activities, sex - all feel pointless)
• Hopelessness ("things will never get better")
• Guilt, worthlessness ("I'm a failure," "everyone would be better without me")

Physical:

• Fatigue (exhausted despite sleeping)
• Sleep changes (sleeping 12+ hours OR insomnia)
• Appetite changes (eating way more or way less)
• Aches, pains (no medical cause)
• Slowed movements, speech

Behavioral:

• Social withdrawal (isolating from friends, family)
• Declining performance (work, PT, duties)
• Substance use (drinking to cope)
• Suicidal thoughts

Duration: Symptoms most of the day, nearly every day, for 2+ weeks = clinical depression

Anxiety Symptoms

Emotional:

• Excessive worry (can't stop worrying about everything)
• Fear, dread (feeling like something terrible will happen)
• Irritability, on-edge feeling
• Difficulty concentrating ("brain fog")

Physical:

• Rapid heartbeat, pounding heart
• Sweating (even when not hot)
• Trembling, shaking
• Shortness of breath
• Nausea, stomach issues
• Dizziness, lightheadedness

Panic Attacks:

• Sudden intense fear
• Feel like you're dying, having heart attack
• Lasts 10-30 minutes
• Physically exhausting

Behavioral:

• Avoidance (avoiding situations that trigger anxiety)
• Reassurance-seeking ("Am I OK? Tell me I'm OK")
• Hypervigilance (always scanning for threats)

Both Depression AND Anxiety (Common)

50% of people with depression also have anxiety

• Feel hopeless (depression) + constant worry (anxiety)
• Treatment addresses both

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Why Military Rates Are Higher

Unique Stressors

Combat exposure:

• Seeing death, violence
• Hypervigilance (always alert for danger)
• Survivor's guilt ("why did I live and they died?")

Frequent moves:

• Uproot every 2-3 years
• Lose social support (friends, community)
• Spouse/kids stressed (affects family)

Work pressure:

• Long hours, shift work
• High-stakes decisions (lives depend on you)
• Toxic leadership (abusive commanders)

Separation:

• Deployments (away from family 6-12 months)
• TDY, training (away weeks/months)
• Relationship strain

Stigma:

• "Suck it up" culture
• Fear of appearing weak
• Career concerns (think help = end of career)

Result: High stress, limited support, stigma = higher depression/anxiety rates

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When to Get Help (Red Flags)

Mild vs. Clinical (When It's a Problem)

Normal stress response (NOT clinical depression/anxiety):

• Sad for 1-2 days after stressful event
• Anxious before big event (promotion board, deployment)
• Bounce back within days/weeks

Clinical depression/anxiety (NEEDS treatment):

• Symptoms most days for 2+ weeks
• Interferes with life (work, relationships, daily tasks)
• Not improving on own
• Thoughts of self-harm

Warning Signs to Seek Help Immediately

Depression:

• ⚠️ Suicidal thoughts ("I want to die," "everyone would be better without me")
• ⚠️ Self-harm (cutting, burning)
• ⚠️ Complete withdrawal (not leaving house, ignoring everyone)
• ⚠️ Can't perform basic tasks (showering, eating, going to work)

Anxiety:

• ⚠️ Panic attacks multiple times per week
• ⚠️ Avoiding work, relationships, life (due to anxiety)
• ⚠️ Physical symptoms severe (chest pain, can't breathe)
• ⚠️ Substance abuse (self-medicating anxiety with alcohol/drugs)

If any above: Call Military OneSource (800-342-9647) or base Mental Health clinic TODAY

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Treatment Options (All Free via TRICARE)

Therapy (First-Line Treatment)

Cognitive Behavioral Therapy (CBT) - Most Effective

What it is:

• Identify negative thought patterns
• Challenge and change them
• Develop coping skills
• 12-20 sessions (weekly)

Effectiveness: 60-70% improvement

Example:

• Negative thought: "I'm a failure, I'll never succeed"
• CBT challenge: "Is this factually true? What evidence contradicts it?"
• Alternative: "I've succeeded before, this setback doesn't define me"

Where to get:

• Base Mental Health clinic
• TRICARE civilian network therapist
• Military OneSource (12 free sessions/year)

Other effective therapies:

• Interpersonal therapy (relationship-focused)
• Acceptance and Commitment Therapy (ACT)
• Mindfulness-based therapy

Medication (Often Combined with Therapy)

SSRIs (Selective Serotonin Reuptake Inhibitors) - First Choice

Common SSRIs:

• Sertraline (Zoloft) - most prescribed for military
• Escitalopram (Lexapro)
• Fluoxetine (Prozac)
• Paroxetine (Paxil)

How they work:

• Increase serotonin (brain chemical regulating mood)
• Take 4-6 weeks to work (not immediate)
• Continue for 6-12 months minimum (even after feeling better)

Effectiveness: 50-60% see significant improvement

Side effects (usually temporary):

• Nausea, headache (first 1-2 weeks)
• Sleep changes
• Sexual side effects (20-30% of people)

Military concerns:

• Flight status: Some medications disqualifying (check with flight surgeon)
• Weapons qualification: Usually OK (if medication working and you're stable)
• Deployment: Can deploy while on medication (bring adequate supply)

SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors)

• Venlafaxine (Effexor)
• Duloxetine (Cymbalta)
• Used if SSRIs don't work

Benzodiazepines (For Severe Anxiety) - SHORT-TERM ONLY

• Alprazolam (Xanax)
• Lorazepam (Ativan)
• Clonazepam (Klonopin)
• Risk: Highly addictive, military often avoids long-term use
• Use: Short-term (2-4 weeks) while waiting for SSRIs to kick in

Lifestyle Changes (Complement Treatment)

Exercise:

• 30+ minutes, 5x/week
• Reduces depression by 20-30% (as effective as medication for mild depression)
• Reduces anxiety significantly

Sleep hygiene:

• 7-9 hours/night
• Same bedtime/wake time
• No screens 1 hour before bed

Limit alcohol:

• Alcohol = depressant (makes depression worse)
• Interferes with medications

Social connection:

• Isolation = worsens depression
• Force yourself to see friends, family (even when you don't want to)

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Where to Get Help (Free Options)

Military OneSource (Start Here if Unsure)

Phone: 800-342-9647 (24/7)

Services:

• Crisis support (immediate, phone counseling)
• Short-term counseling (12 sessions/year, FREE)
• Completely confidential (commander NOT notified)

Best for:

• Not sure if you need "real" help
• Want to try therapy before seeing base clinic
• Concerned about confidentiality

Base Mental Health Clinic

Services:

• Assessment, diagnosis
• Ongoing therapy (unlimited sessions)
• Medication management (psychiatrist)
• Group therapy

How to access:

1. Call clinic directly (self-referral, no approval needed)
2. OR get referral from primary care

Confidential?

• YES (unless suicidal/homicidal or unable to perform duties)
• Commander NOT automatically notified just for seeking help

Cost: $0 (active duty), $0-$30 per session (family members depending on TRICARE plan)

TRICARE Civilian Network

If you prefer civilian provider:

1. Find TRICARE network therapist (TRICARE website or call)
2. Call, schedule appointment
3. Attend sessions (unlimited, covered by TRICARE)

Cost: $0-$30 copay per session (depends on TRICARE plan)

Best for:

• Want off-base provider
• Prefer specific type of therapy
• Scheduling easier (civilian often has more availability)

Crisis Resources (Immediate Help)

If suicidal:

• Military/Veterans Crisis Line: 988, press 1 (OR text 838255)
• National Suicide Prevention Lifeline: 988
• Emergency Room: Go immediately (they can't turn you away)

24/7, free, confidential

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Career Impact (Will Help Ruin My Career?)

The Truth

Seeking help does NOT automatically:

• ❌ End your career
• ❌ Result in discharge
• ❌ Lose security clearance
• ❌ Get you kicked out

What CAN affect career:

• ✅ Refusing needed treatment (shows poor judgment)
• ✅ Untreated mental health destroying job performance
• ✅ Substance abuse (self-medicating instead of getting help)
• ✅ Suicidal behavior without seeking treatment

Reality:

• Thousands serve with treated depression/anxiety
• Many hold Top Secret clearances while on medication
• Many deploy while in treatment/on medication

When Treatment MIGHT Affect Career

Medical discharge (rare):

• Condition so severe you can't perform duties
• Multiple hospitalizations
• Doesn't respond to treatment

Flight status (pilots, aircrew):

• Some medications disqualifying (temporarily or permanently)
• Discuss with flight surgeon before starting medication

Deployment (rare deferral):

• If starting new medication (may defer deployment until stable)
• If in crisis (stabilize first, then deploy)

Security clearance (very rare):

• Only if: Untreated psychosis, refusing treatment, current suicidal ideation
• Treated depression/anxiety = usually fine (see Security Clearance guide)

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Action Steps

If You Think You Have Depression/Anxiety:

1. ✅ Call Military OneSource: 800-342-9647 (24/7, free, confidential)
2. ✅ Screen yourself (PHQ-9 for depression, GAD-7 for anxiety - free online)
3. ✅ Schedule appointment with base Mental Health OR civilian therapist

If You're in Crisis:

1. ✅ Call 988, press 1 (Military Crisis Line - immediate help)
2. ✅ Go to Emergency Room (if suicidal)
3. ✅ Tell someone (friend, family, chaplain - don't suffer alone)

During Treatment:

1. ✅ Attend all sessions (consistency is key)
2. ✅ Take medication as prescribed (don't skip doses)
3. ✅ Be honest with provider (they can't help if you lie)
4. ✅ Give it time (4-8 weeks to see improvement)

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Related Guides

• PTSD Symptoms, Treatment & VA Disability
• Sleep Issues in Military
• Substance Abuse When to Get Help

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Remember: Depression and anxiety are medical conditions, not character flaws. They're treatable - 60-80% improve with therapy + medication. Seeking help does NOT ruin military career (refusing help might). Free confidential treatment available (Military OneSource, base clinic, TRICARE). Thousands serve with treated depression/anxiety. Early treatment = faster recovery. Don't suffer in silence. You earned the benefits - use them.