Jitters vs. Depression: How to recognize the difference

Photo by Priscilla Du Preez

By Dr. Chris Koutures

Pre-dance jitters and butterflies in the stomach are a common occurrence before a big show.

However, what do you do when it’s more than just pre-show jitters? Do yourself a big favor. Sit down, think about the last two weeks, and honestly respond with how often you may have been bothered by the following problems:

  • Feeling nervous, anxious or on edge?
  • Not being able to stop or control worrying?
  • Feeling down, depressed or hopeless?
  • Little interest or pleasure in doing things?

These questions are from the PHQ-4, which is a commonly used screening tool for depression and anxiety. If you answered one or more of the 4 question with at least several days a week, you might be dealing with depression or anxiety (more than just the anxiousness that happens before a performance). And please be aware, you are not alone.

This is not intended to increase any feelings of sadness, fear or feeling out of control. Rather, this blog is intended to empower you, to reduce feelings of isolation, erase stigmas, and make you more aware of the value of emotional health in the dance world.

If at any time you feel you might have depression, anxiety or any other emotional or mental health concern, please immediate contact a healthcare professional for urgent evaluation. If you have thoughts of harming yourself or someone else, or thoughts of suicide, immediately go to your nearest emergency room. The National Suicide Prevention Hotline at 1-800-273-8255 is confidential and available 24 hours a day.

What exactly is depression?

According to Mayoclinic.org, Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. It can affect how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living. More than just a bout of the blues, depression isn’t a weakness and you can’t simply “snap out” of it.

Symptoms of depression may include:

  • Feelings of sadness, tearfulness, emptiness or hopelessness
  • Angry outbursts, irritability or frustration, even over small matters
  • Loss of interest or pleasure in most or all normal activities
  • Sleep disturbances, including sleeping too much or too little
  • Tiredness and lack of energy, so even small tasks take extra effort
  • Reduced appetite and weight loss or increased cravings for food and weight gain
  • Anxiety, agitation or restlessness
  • Slowed thinking, speaking or body movements
  • Feelings of worthlessness or guilt, fixating on past failures or self-blame
  • Trouble thinking, concentrating, making decisions and remembering things
  • Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
  • Unexplained physical problems, such as back pain or headaches

What is anxiety?

Again, according to Mayoclinic.org, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).

These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time.

Symptoms of anxiety include:

  • Feeling restless, wound-up, or on-edge
  • Being easily fatigued
  • Having difficulty concentrating; mind going blank
  • Being irritable
  • Having muscle tension’
  • Difficulty controlling feelings of worry
  • Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep
  • Depression and Anxiety in the Dance World

Like many forms of exercise, dance can reduce some signs and symptoms of depression and anxiety. A studio is home to a host of emotional responses to the demands of dance. You’ve likely lived the highs of dance – the artistic expression, satisfaction of learning new routines, and the exhilaration of a standing ovation that can all amplify the sense of positive emotional health.

However, you also have likely experienced unique challenges and low points that can intensity feelings of depression and anxiety:

  • The regular failure in dance – literally and figuratively falling down – and trying to get back up again
  • Regularly hearing about inadequacies from instructors about technique and appearance
  • Those inevitable comparisons to others about talent, skills and body appearance (and those studio mirrors and selection of costumes often don’t help).
  • Mental and physical fatigue that comes from an enormous time investment in classes and performances
  • Trying to balance dance with school, work, family and other social/community commitments
  • That drive to excel can also be the same drive that leads to depression
  • Living gig to gig often without consistent paychecks or medical benefits
  • Your sense of identify seemingly dependent on hitting that last jump, earning that key role, or having it all thrown asunder after a major injury
  • Being forced out of dance due to injury or not earning a role can have intensified feelings of inadequacy, isolation and sadness

Spending a tremendous amount of time with fellow dancers and instructors may reveal emotions and behaviors that may not be seen by others outside of dance. This unique perspective can in itself be stressful and at times frightening. You will watch others act (or yourself may feel) stressed out, anxious, and down in the dumps.

The dancer who admits to butterflies before a big audition or cries after not getting a desired role is showing more apparent (and common) emotional behaviors. However, there are other all too common behaviors that may suggest a more serious emotional disturbance.

If you feel, or see one or more of the following situations, this is the time to ask for help:

  • Showing less connection with others and appearing distant or preoccupied
  • Missing more classes and rehearsals
  • Voicing multiple complaints of pain or frequent injuries
  • Injuries that appear to take longer to resolve
  • Sleeping too much or too little
  • Loss of energy and endurance
  • Having a plateau or reductions in technical skills
  • Recent major injury
  • Recent life stressors (family change, illness, loss of key role or position in a company)
  • Increased use of prescription or recreational drugs or alcohol
  • Readily apparent change in body weight (namely weight loss)
  • Maybe you might now actually may be more aware that you are depressed or anxious but are afraid to share concerns with others. You may fear that no one else understand, or that others will cast judgement and you might lose roles, identity, and prestige.

And even if you honestly feel that you are doing okay, maybe a close friend or troop member is going through depression or anxiety. Perhaps they feel alone, that no one else understands their feelings too.

Final Thoughts

If you suspect a potential issue, don’t be afraid to dig deeper, even if it might seem personal, overly critical, or even nosy. You might be the next step to getting yourself or someone close to you important help. Maybe reading this will allow you to get help yourself or someone close to you out.

If you identify concerns, offer assistance, support, and help seek qualified expert healthcare evaluation and treatment. If at any time you feel out of control or feel scared for your safety or the safety of someone else, dial 911 or immediately go to the nearest emergency room. Medical treatment is essential and may include behavioral therapy and possibly medications that can lead to a higher level of emotional health.

How can studios and companies support emotional health?

  • Establish relationships with local dance medicine and mental health resources to foster efficient and expert responses to dancers with immediate needs
  • Open and regular discussions about emotional health should be encouraged
  • Acknowledge failure as a regular part of dance, and place emphasis on best efforts and learning from mistakes
  • Routinely asking dancers about school, family, and lives outside of dance
  • An empathetic response to an injured or ill dancer that gives a greater sense of personal control can foster recovery
  • Allow injuries or ill dancers to help decide how involved they want to be during their recovery period. Some will want to attend rehearsals and classes to remain part of the group, others may favor time away.
  • Offer professional medical and emotional support and continually ask about needs
  • Dancers and instructors should be prepared to support colleagues or students in need.
  • Dancers who perceive supportive communities feel more enabled to report mental health issues, seek qualified care and ultimate be able to enjoy not only better dance performances, but overall higher life satisfaction.
  • No dancer should be ignorant to the signs and symptoms of depression and anxiety.
  • No dancer should ever feel the need to go solo with emotional health concerns.
  • No dancer should never be afraid to seek help.
Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA.

Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit activekidmd.com or follow him on twitter (@dockoutures).


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