If you have a persistent cough or a sore that won’t heal, you’re likely to seek prompt medical attention. But when it comes to persistent emotional symptoms, such as tension, worry, gloom, and discouragement, Americans are notoriously reluctant to seek help. That’s unfortunate, because treatment can often make a profound difference in your level of happiness and, indeed, your overall health. Emotional problems can not only interfere with recovery from disease, but new research also shows they can increase your risk of heart disease, diabetes, dementia, and other disorders.

Negative emotions are, of course, a normal part of life for most people, especially those coping with illnesses or recovering from accidents or other trauma. Most of the time bad moods are fleeting, even if the underlying situations that cause them are not. Sometimes, however, bad moods become continuous and disabling, and it’s not always obvious when to seek help. The percentage of U.S. adults reporting “frequent mental distress” is on the rise, from 8.4 percent in 1993 to 10.1 percent in 2001, according to an October 2004 report by the federal Centers for Disease Control and Prevention. Unfortunately, only a third of the 44 million Americans a year who are beset by anxiety, depression, or other psychological disorders get the help they need.

That is particularly unfortunate for those whose emotional symptoms are related to a physical disease. Certain medications, including beta-blockers and corticosteroids, and illnesses, such as thyroid disease, diabetes, and cancer, can also cause depressive symptoms. And it’s now well established that emotional problems can complicate the treatment of and delay recovery from many diseases, including some that are life- threatening. Individuals who become depressed in the wake of a heart attack, for example, typically take longer to recover. Arthritis sufferers who become depressed tend to experience greater disability than do similar patients who stay upbeat. Depression also seems to delay the knitting of broken bones and to speed the progression from HIV to AIDS.

Evidence is mounting that emotional problems can cause as well as exacerbate physical illness. A 2003 report from the National Institute of Mental Health found depression to be just as significant a risk factor for cardiovascular disease as high blood pressure and elevated cholesterol. And research suggests that depression and possibly anxiety as well may raise the risk of developing osteoporosis and even Alzheimer’s disease. A study of almost 2,000 people has also found that depression doubles the likelihood of developing diabetes.

“Depression is an illness that has profound physiological effects all over the body,” says Steven P. Roose, M.D., professor of clinical psychiatry at Columbia University’s College of Physicians and Surgeons in New York City. For example, depression impairs circulation by making platelets “stickier.” And in people with anxiety or depression, the body secretes extra cortisol, a stress hormone that can damage the blood vessels. Ominously, these physiological changes can occur even in the absence of full-blown mental illness. Says Roose, “Risk increases proportionally to the severity of your symptoms.”

One strategy for keeping emotional distress in check is to be reflective about your moods and relationships. “That means observing negative patterns in your life and understanding the things that control you and hold you back,” says Gail Saltz, M.D., associate professor of psychiatry at Weill-Cornell School of Medical Sciences in New York City. “If you can become aware of the patterns, you can direct them so that you can be your own pilot and not be driven by them.”

The self-check questions for emotional symptoms is designed to alert you to symptoms that need evaluation. And the table treatment strategies for emotional disorders summarizes symptoms and treatments for the most common forms of emotional disorders. Here are some ways to find the right treatment.

Many Americans view an emotional problem as a personal weakness rather than a medical problem, Saltz says. “We’ll spend tons of money on a great haircut but won’t do what’s needed to evolve into someone who is more aware of emotional issues and therefore better able to get what we really want out of life,” she adds.

Some people are so fearful of being labeled mentally ill that they deny the problem exists. Others deny that the problem is severe enough to warrant treatment. Financial barriers to treatment can also be significant. A single session with a psychiatrist can easily cost $100, and the cost of many antidepressants can run several dollars a pill. So those without insurance may find it difficult to afford help.

Another force that discourages treatment is the fear that unauthorized release of a person’s medical records might jeopardize his or her employment or insurability. Despite prohibitions against this practice, violations continue. “Unauthorized disclosure of sensitive mental-health information can be devastating,” says Ron Honberg, legal director of the National Alliance for the Mentally Ill. “It’s a major concern.”

Physicians who are too quick to offer drug treatment as the only option may be another barrier. Those who wish to avoid drug treatment should know that many studies have shown that various types of counseling and talk therapy can effectively relieve a range of emotional disorders. Talk therapy may take longer to have an impact than prescription drugs, but it also causes fewer side effects and can be a reasonable alternative when symptoms are not severe.

Modern antidepressants, including selective serotonin reuptake inhibitors (SSRIs) like fluoxetine (Prozac) and sertraline (Zoloft), are often prescribed for depression and anxiety disorders. “They do work for a large majority of people,” says Eric J. Nestler, M.D., Ph.D., chairman of the department of psychiatry at the University of Texas Southwestern Medical Center in Dallas, though they’re not “wonder drugs.” Side effects include weight gain and loss of libido, and recent evidence suggests that they may raise the risk of suicidal behavior in the first few weeks of treatment. A change in prescription can sometimes diminish side effects, and Nestler encourages people who could benefit from antidepressants not to be afraid of them.

A Consumer Reports survey of 3,079 readers with depression or anxiety found that drug therapy relieved symptoms faster than talk therapy. The majority of people who described their therapy as “mostly medication” had good outcomes. But it took trial and error to find the right medication. And the rates of adverse drug effects were much higher than those noted on the medications’ package inserts.

Talk therapy rivaled drug therapy in effectiveness. Respondents who said their therapy was “mostly talk” and lasted at least 13 sessions had better outcomes than those whose therapy was “mostly medication.” Therapy delivered by psychologists and clinical social workers was perceived as being just as effective as that given by psychiatrists. Other professionals who offer therapy include psychoanalysts, psychiatric nurses, and marriage and family counselors.

If you need therapy, don’t just pick a name from an ad or the Yellow Pages. Difficult as it may be when you’re in distress, try to approach therapy as an active consumer. Ask your doctor and friends for referrals, and speak to potential therapists over the phone or in the office. (Many will meet with you briefly without charge.) Even a brief interview should tell you if you’d be comfortable sharing your most intimate thoughts and feelings.

No one type of therapy is best for all people. Many therapists favor a particular theoretical approach, although they often use a combination. Clinical trials have proved that two types of therapy are most consistently effective: cognitive behavioral therapy and interpersonal therapy. Both are designed to produce a meaningful improvement within 15 to 20 sessions. Both teach people to manage their moods—to think and behave their way to better mental health.

Cognitive behavioral therapy focuses on training patients to identify and consciously correct the distorted thought patterns associated with anxiety or depression. Anxious people tend to overestimate the likelihood of a catastrophe, while depressed people tend to react to setbacks or disappointments with extreme self-criticism and a feeling of hopelessness out of proportion to the situation. The therapy typically involves specific “homework” assignments. For instance, a depressed person might be assigned to arrange an enjoyable social activity or become more assertive on the job. Or an anxious person might be assigned to take steps to confront a feared situation.

Interpersonal therapy, used primarily for depression, focuses more on the patient’s relationship problems with others, such as spouses, children, or co-workers. It can be especially effective when depression results from a major life transition, such as the birth of a child, divorce, loss of a job, or bereavement. Therapy typically involves learning to change one’s manner of dealing with family and friends, adapting to changed life circumstances, or building up one’s social skills.

• Avoid unhealthy situations that can trigger negative emotions. These include chronic stress, unacknowledged anger, poor sleep habits, and lack of exercise.

• Monitor moods. As a general rule, it’s time to consult your doctor if emotional problems persist beyond two weeks or interfere significantly with everyday life. In cases of bereavement and other severe loss, however, several months of depressed feelings are not unusual.

• Listen to a friend. Emotional problems can blunt your powers of observation and judgment, so you may not recognize symptoms that are obvious to others. If someone you trust voices concern or observes that you seem unusually sad or tired, don’t be quick to dismiss his or her viewpoint.

• Comparison shop for a therapist. Referrals from health professionals and friends are a good starting point. Consider whether you have preferences regarding your therapist’s gender, academic background, therapeutic approach, or other characteristics. Interview prospective therapists until you find someone you feel is a good fit.