Depression and anxiety are, in theory, antithetic to each other. Anxiety is a high-stress state of mind, best described as a form of persistent fear. It makes people high-strung and worried. Depression, on the other hand, is a state of low mood – and in most cases, low energy. People who struggle with severe depression sometimes find themselves paralyzed by an inability to find joy in anything. Where anxiety makes the mind hyperactive, depression shuts down any desire to be active.
Yet the two go together like bread and butter. Despite depression and anxiety clashing at first glance, many who struggle with one diagnosis also have the other. The question then becomes: why? Why do so many people struggle with both?
Why They Appear Together
Anxiety and depression share many risk factors. This means someone with depression is far more likely to develop anxiety as well. The relationship between these two can be traced to the way they influence thinking. Depression is a mood disorder characterized by low mood, but it’s diagnosed mostly based on how a person responds to certain questions regarding how they feel and what they think.
- People with depression are more likely to have low self-esteem, consider suicide, and struggle to find reasons to continue going to work or pursuing their hobbies. They also find themselves consistently sad, for weeks at a time.
- People with anxiety struggle with fear, but their thoughts are similar. They are plagued by insecurities and worries, constantly thinking of the worst possible outcome, and expecting it as a result.
It’s important to differentiate between feelings and disorders, although the distinction really just serves to draw a line between something temporary and something requiring treatment to overcome. We all feel depressed at times, and we all feel anxious at times. Context-appropriate sadness, even the severe kind, is normal. It’s also normal to feel insecure and anxious regarding an upcoming event or challenge, especially if we have previously experienced failure. But when these feelings exceed past context-appropriate moments, it shows that there’s more going on than just a human reaction to life’s challenges.
A variety of studies suggests that the majority of people diagnosed with major depression also struggle with generalized anxiety, which is a persistent fear of negative outcomes, regardless of the context. Some – up to a third, in one study – had symptoms of panic disorder, which is a very severe form of anxiety that causes a person to suffer panic attacks frequently.
There are several biological causes for depression and anxiety. Hormone imbalance caused by a thyroid disorder or a brain disease – such as a tumor – can cause mood disorders as well as personality changes. Chronic pain triggers depression and anxiety in patients who struggle to cope. Other disease that affect the body’s hormone production may also lead to a mood disorder. Dietary deficiencies, including those caused by disease, can lead to these conditions.
Some suggest that both depression and anxiety can be tied to abnormalities in the brain – an inborn chemical imbalance – but there’s not enough evidence to suggest that that’s true. There is a genetic link, but it probably doesn’t have anything to do with how the brain interprets neurotransmitters. Most likely, depression and anxiety are psychological conditions triggered by a consistent exposure to stress, coupled with an inadequate response to said stress. People with a family history of mood disorders are more likely to develop them, which suggests that something in our genes makes us more susceptible – more sensitive – to things that cause depression and anxiety. An unstudied yet potential link lies in the gut, where our microbiota plays a role in determining mood and thoughts.
Traumatic stress is more likely to lead to depression coupled with a form of anxiety, namely PTSD. Traumatic stress can be anything from childhood abuse, to abusive relationships, witnessing the death a close family member or friend, surviving assault, and so on. However, the brain doesn’t have to go through psychological trauma to develop these conditions. Persistent stress, such as bullying at school or being ostracized at home, can contribute to both anxiety and depression. Finally, some people develop these conditions without clear triggers, usually in their 20s.
For most people, however, all this information may be interesting but seems ultimately useless. That isn’t exactly right – knowing why depression and anxiety coexist so often gives us a hint on how to help people who struggle with both. I’ve personally dated and am related to people who fought both anxiety symptoms and major depression at the same time. Both have been coping for years, and both have struggled more under the anxiety than the depression. Research suggests that having both conditions amplifies the effect of each disorder. For some, the depressive symptoms are stronger. For others, it’s the anxiety that feels the most unbearable. But they can both be treated the same way – by understanding them better and tackling them the right way.
Overestimating the Problem, Underestimating Yourself
The common thread between depression and anxiety is the overwhelming problem, and the underwhelming self. More than just a matter of optimism vs. pessimism, depression belies the belief that you can achieve anything – instead, life seems like a constant cascade of failures, and anxiety is the ubiquitous fear of the next failure.
Tackling this construct is what therapy is about. But whether it succeeds in making the message stick depends on the rest of the treatment. Depression and anxiety are disorders that cannot be tackled half-heartedly – a multi-pronged approach is necessary. Therapy is one aspect, but we’re more than just our thoughts. A couple suggestions include:
Encouraging people to change their lives, adopt better lifestyles, seek support from friends and family and seek alternative treatments (from herbal supplementation to yoga).
Medication can be helpful. In severe cases, the right antidepressant will not only treat the symptoms of depression but will help a lot with anxiety as well. Medication should never be seen as a perfect cure – instead, it buys time for other treatments to work their magic in the long-term, while reducing symptoms enough to cope effectively. Anti-anxiety medication can also help, but anti-anxiety medication is generally riskier than antidepressants are, both in terms of side effects and potential dependency.
Living with both depression and anxiety is difficult, but it’s by no means untreatable. There are several treatment options, and the best one is likely going to depend on what you can afford, and what works best given individual preferences and differences. One thing that is clear is that these are not two conditions that should be treated separately. Their overlap is more than just a coincidence, and thankfully, a treatment approach that takes both into consideration often works just fine.
Gotta Treat Them Both
Let’s address medication first, to get the elephant out of the room. Anti-anxiety drugs are called benzodiazepines, and they’re a weaker class of drugs, and are similar to sedatives, tranquilizers, and barbiturates. These drugs induce a relaxant effect and increase dopamine in the system. Their side effects are relatively low compared to previous anti-anxiety medication such as barbiturates, but they’re still risky to use for a simple reason: addiction.
It’s possible to build up a tolerance to anti-anxiety medication, making the drug ineffective, and causing symptoms to return. However, they still have their use, prescribed in the short-term for panic disorders and other very severe anxiety symptoms. Herbal alternatives include kava, but keep in mind that this plant is subject to much controversy and was banned in Europe due to the potential of liver poisoning due in high doses. However, many see this as an overreaction – studies show conflicting results, and there’s not enough research for the FDA to consider kava dangerous.
Antidepressants are also shown to be effective in the treatment of both depression and anxiety but be mindful of which ones you take. SSRIs have the least number of side-effects, but that does not make them entirely safe. While black label side effects – such as an increase of suicidal tendencies – are very, very rare, antidepressants can commonly lead to temporary weight gain and sexual dysfunction.
Outside of severe cases of depression and anxiety, it’s possible to treat them both without the use of prescription drugs. Herbal remedies are not always effective, but it doesn’t hurt to try them and see which work, and which don’t.
Next, we have therapy, exercise, and special techniques. CBT and DBT are the two most common therapies applied in a 1-on-1 setting – they both focus on the concept of influencing your behaviors and emotions by changing your thoughts. Therapeutic activities like meditation, mindfulness training and journaling are often prescribed in conjunction with therapy to further practice what CBT teaches.
Exercise can help fight depression and anxiety through the regular release of dopamine, an increased sense of self-accomplishment, and better self-esteem. Exercise also leads to muscle relaxation, reducing skeletomuscular tension (which ties into anxiety), metabolizing excessive stimulants such as caffeine, as well as natural arousal neurotransmitters like adrenaline/epinephrine and thyroxin, effectively helping us calm down and relax after training. It’s important to choose a type of exercise you enjoy. If you hate running, try dancing, strength training, swimming, martial arts, etc. The list goes on and on.
Finally, special techniques can help reduce stress and relieve anxiety at the end of the day. Yoga has many excellent relaxation techniques, including a number of stretches to relieve tension throughout the spine and neck, especially from hours of sitting. These stretches in turn improve blood flow, but also reduce stiffness and pain. Learning how to breathe properly (and deeply) by activating the diaphragm (rather than breathing into the upper chest) also has a direct effect on the mind and our anxieties.
Anxiety and depression go hand-in-hand and treating them means treating them together. However, you won’t really know what works best until you try it.