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The Relationship Between Depression and Anxiety

Did you know that anxiety disorders are the most common mental health illness in the United States and that depression is the leading cause of disability worldwide? In fact, The Anxiety and Depression Association of America states that anxiety affects about 40 million Americans, while the Depression and Bipolar Support Alliance notes that about 17.3 million Americans are affected by major depressive disorder.

However, depression and anxiety are not always separate from one another. As the ADAA notes, “nearly one-half of those diagnosed with depression are also diagnosed with an anxiety disorder”. This also applies the other way around, meaning those with anxiety are also at a higher risk for being diagnosed with depression. When someone is affected by two or more conditions at the same time this is called comorbidity.

One study found that the number of similarities between depression and anxiety was more than their number of differences. Because of this, the study suggested that most diagnoses are overlapping, and that a diagnosis of specifically one or the other was rare. Another study noted that almost all their participants diagnosed with depression showed anxiety-specific symptoms. The study also noted that the diagnosis of depression was based on the presence of anxiety symptoms.  

Because of this, some psychologists and mental health professionals believe that anxiety and depression may be part of a single mental health disorder that hasn’t been identified yet. However, at the current time there is no evidence to support this claim, so anxiety and depression are still being defined as separate, but similar mental health conditions.

When you consider the fact that depression is generally characterized by low energy, while anxiety is generally characterized by high energy, the relationship between the two seems almost impossible. However, recent research has begun to show that the relationship between anxiety and depression is a very real thing. Before diving head first into how this relationship is believed to work, let’s take a look at how anxiety and depression are defined individually.

What is Anxiety?

Closeup of a woman biting her nails with an anxious expression looking off into the distance

Anxiety is defined by the DSM-5 Diagnostic Criteria as “excessive anxiety and worry (apprehensive expectation”, occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance)”. The definition continues to note that an individual with anxiety finds it difficult to control the worry and the worrying is generally accompanied by symptoms such as: restlessness, feeling keyed up or on edge, being easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbances.

While the above defines anxiety as it pertains to Generalized Anxiety Disorder, there are a range of anxiety disorders that can include:

  • Generalized Anxiety Disorder (GAD)
  • Panic Disorder
  • Specific Phobias (fear of heights, needles, spiders, flying, etc.)
  • Social Anxiety Disorder

In some cases, obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) may also be classified as an anxiety disorder. While each specific anxiety disorder has its own set of unique symptoms, they all fit under the larger sphere of anxiety.

What is Depression?

Woman lying on couch, snuggling a pillow and looking unhappy

Depression is defined by the DSM-5 Diagnostic Criteria as experiencing at least five or more of the following symptoms: depressed mood most of the day for nearly every day, markedly diminished interest or pleasure in all, or almost all, activities, significant weight loss or gain, decrease or increase in appetite, slowing down of physical movement, fatigue, feelings of worthlessness or guilt, difficulty concentrating, and recurrent thoughts of death or suicidal ideation.

Just like anxiety has a range of different anxiety disorders, so does depression. Depressive disorders, or types of depression, can include:

  • Major Depression or Major Depressive Disorder
  • Persistent Depressive Disorder
  • Bipolar Disorder
  • Seasonal Affective Disorder (SAD)
  • Psychotic Depression
  • Peripartum (Postpartum) Depression
  • Premenstrual Dysphoric Disorder (PMDD)
  • Situational Depression
  • Atypical Depression

Each specific type of depression has its own set of symptoms, however they all fall under the larger category of depression.

Similarities Between Depression and Anxiety

A key similarity between depression and anxiety is that they can both be perpetuated by thought patterns. Now, the types of thought patterns differ among individuals with depression vs. those with anxiety, but they also form a vicious cycle.

Consider this: individuals with depression generally feel hopeless in their situation, while those with anxiety feel helpless about their situation. Well, a person who feels hopeless can easily begin to feel helpless, while a person who feels helpless can slide into feeling hopeless. Because of this, some people with depression will develop anxiety and vice versa.

It is also important to note that one of the main symptoms of anxiety and depression are also closely related. One of the main symptoms of anxiety is avoidance. Specifically, the object or situation that causes anxiety is likely to be avoided at all costs. Similarly, one of the main symptoms of depression is withdrawal. With depression, if something seems to painful or too difficult, the reaction is to stop trying. While avoidance and withdrawal are not entirely synonymous, they both come back to the same idea of “I can’t”.

With anxiety, the “I can’t” is because of the fear of the situation or object itself, while with depression it is the fear of failure or pain. Nevertheless, both avoidance and withdrawal symptoms continue to reaffirm the principles of being either helpless or hopeless, or even both. While some people might believe that their coping mechanism of avoiding or withdrawing from certain objects, situations, or experiences is helping, it is actually quite deteriorating overall. And this is the case for both depression and anxiety.

Another commonality with depression and anxiety is their ability to become partially or completely debilitating to the individual. Although each specific condition can exemplify this in different ways, the underlying effects on the individual are quite similar. For example, someone with extreme social anxiety may refuse to leave the house, while someone with depression may not be able to get enough motivation to leave their bed.

Even though both individuals have different reasons for their symptoms, the end result is that both individuals are not leaving their house, nor socializing with others. Not only will this continue to make them feel isolated, but it can also cause them to feel a lack of control within their own lives. This again establishes the underlying feelings of helplessness and hopelessness.

Finally, both anxiety and depression have been known to affect the same neurotransmitters. A neurotransmitter is a chemical messenger that communicates messages from one neuron to another. Skipping a long technical conversation on neuroscience, basically it affects moods and behaviors.

The three main neurotransmitters associated with anxiety and depression are dopamine, epinephrine, and serotonin. Dopamine plays a role in physical movement, influences motivation, affects how reality is perceived, and is part of the brain’s reward system. When dopamine transmission is affected, this often causes distorted thought patterns.

Computerized image of a neurotransmitter

Epinephrine, or adrenaline, is responsible for increasing blood sugar levels, heart rate, and how hard the heart contracts, as well as for relaxing airway muscles for breathing. Ultimately, epinephrine is responsible for the “adrenaline rush” or fight-or-flight response. It is also closely associated with norepinephrine. Norepinephrine, or noradrenaline, acts similar to epinephrine, but can also constrict blood vessels, increasing blood pressure.

Serotonin is responsible for regulating sleep, appetite, mood, and for reducing pain. Additionally serotonin is also known as the “feel-good chemical” because it keeps the body feeling relaxed and content. With depression, serotonin transmission is usually reduced.

Individuals who are experiencing anxiety and depression simultaneously may exhibit the following symptoms:

  • Problems sleeping (either too much or too little sleep, as well as not being able to wind down)
  • Restlessness
  • Irritability (towards oneself or others)
  • Fatigue
  • Difficulty concentrating (anxiety can cause distractions, while depression slows the mind)
  • Obsessive painful or pessimistic thoughts (keep you from moving forward)
  • Worry
  • Guilt (for not being able to control yourself or your actions)
  • Tearfulness (from feeling helpless and hopeless)
  • Increase or decrease in appetite
  • Loss of libido
  • Loss of pleasure in once enjoyable activities
  • Loss of motivation and ambition
  • Loss of self-esteem
  • Physical symptoms such as a racing heart, dry mouth, irritable bowels, stomach acid, tremors, sweating, shortness of breath, or headaches.

Treatments for Anxiety and Depression:

Because anxiety and depression have so many similarities, the treatment for the two also has similarities. Currently, most treatment plans are centered around combating either the chemical imbalances or thought patterns associated with the two. In some cases, a combination approach works best.

yellow antidepressant pills with emoticon faces in a foil pack against a sky blue background

When it comes to correcting chemical imbalances, medications are often used. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for both depression and anxiety. SSRIs work by reducing the amount of serotonin that is absorbed into the bloodstream. By preventing the absorption of serotonin into the bloodstream, SSRIs keep more serotonin in the brain. The increase of serotonin levels in the brain can help to reduce or eliminate the symptoms of depression caused by low serotonin levels. Contrary to popular belief, SSRIs do not create additional serotonin, they just help the body effectively utilize it.

Common SSRIs for depression are:

  • Citalopram (Celexa)
  • Escitalopram (Lexapro)
  • Fluoxetine (Luvox)
  • Paroxetine (Paxil, Paxil XR, Pexeva)
  • Sertraline (Zoloft)

Common SSRIs for anxiety are:

  • Escitalopram (Lexapro)
  • Paroxetine (Paxil, Paxil XR, Pexeva)
  • Sertraline (Zoloft)

When it comes to thought patterns, talk therapy with an anxiety or depression psychologist is often recommended. Talk therapy can used a variety of techniques to identify, address, and alter thought patterns that can be perpetuating the symptoms of anxiety and depression. It works well for those with anxiety and/or depression because it directly addresses the thought patterns associated with the two similar disorders.

One such technique is cognitive behavior therapy (CBT). CBT is based on the idea that one’s thought process and perception of reality directly affects their moods and behavior. Thus, CBT functions to identify and modify negative thought patterns or incorrect perceptions of reality. With CBT, problem-solving skills and special strategies are learned to help individuals manage their thought patterns on their own in their daily lives. Although this approach takes time and requires the active participation of the individual, many people have experienced an improvement of their symptoms using this method.

Are you one of the many people affected by both anxiety and depression? Do you find yourself feeling helpless or hopeless in your everyday life? Then, take control of your life and schedule a consultation with an anxiety psychiatrist or depression psychiatrist at NJ Family Psychiatry & Therapy today!

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