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DEAR DR. ROACH: What is the difference between a cold and the flu? -- A.T.R.

ANSWER: Both colds and influenza (the "flu") are respiratory illnesses that are caused by viruses. Influenza is caused specifically by the influenza viruses, which come in two main types (A and B). Influenza A is further broken down into different subtypes based on hemagglutinin (H) and neuraminidase (N).

H1N1 and H3N2 are currently the most-common circulating influenza A viruses. Even within these subclasses, there is strong variability among flu viruses, which is one reason why we need a new flu vaccine each year.

Many viruses cause colds. Rhinoviruses ("rhino-" is the Greek word for nose) are the most common, but corona-, parainfluenza-, entero- and respiratory syncytial viruses are all well-known causes of respiratory illnesses, which can be difficult or impossible to tell apart from any other type of cold.

Unfortunately, there are so many of these viruses, some of which change quickly and others that escape our immune system, so it is (so far) impossible to get immunity by an infection or a vaccine to all the cold viruses. Viruses are generally less severe than influenza.

It isn't always easy to tell flu from a cold, especially in young people. Both can cause a fever, cough, runny nose and sore throat. However, the flu often causes muscle aches, which can be severe. The flu tends to cause higher fevers, more cough and worse headaches, and it often comes along suddenly. ("I got hit by the flu truck.") Runny nose and nasal congestion tends to be worse with a cold.

Since there is specific antiviral treatment for influenza, clinicians will sometimes make decisions on whether to treat a person based on their symptoms, or they may get a lab test to look for the flu specifically. (Some tests will also test for COVID-19, a special type of coronavirus, at the same time.)

People who are at a high risk for severe flu may be recommended antiviral treatment, whereas there is not a specific antiviral treatment for colds.

It's particularly important for people over 65 and those with any heart, lung or immune system issues to get the influenza vaccine. The optimum time to get it is now through the end of November.

DEAR DR. ROACH: What do we now call what was once referred to as a "nervous breakdown" in the 20th century? -- A.M.

ANSWER: I asked this question to my psychiatry professor way back in the late 20th century when I was a first-year medical student. My professor replied that the term didn't have a meaning anymore. There is no formal medical or psychiatric diagnosis of a "nervous breakdown." The term is used by laypeople to describe when a person has severe impairment of their day-to-day function as a result of a psychiatric diagnosis, especially mood disorders like generalized anxiety disorder or major depressive disorder.

An adjustment disorder may resemble a major depressive disorder, but it occurs within a few months of a traumatic life event. A severe case might also be termed a "nervous breakdown." It is not usually used to describe a person with acute psychosis (a term meaning a grossly distorted sense of reality), such as a person with schizophrenia or bipolar affective disorder in their acute and uncontrolled state.

All these conditions have effective treatments. Treatment starts by talking to someone, who might be your own regular doctor or a mental health professional. For people who are in acute distress with thoughts of hurting themselves, the 988 Suicide and Crisis Lifeline is an option in the United States and Canada.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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