Depression and Anxiety: Two Sides of the Same Coin
The terms “anxious” and “depressed” get thrown around a lot in casual conversation, and for good reason: both are normal emotions to experience, routinely occurring for us all in response to high-stakes or potentially dangerous situations (in the case of anxiety) or disappointing, upsetting circumstances (in the case of depression).
The relationship between these emotions — and their associated clinical conditions, anxiety disorders and mood disorders — is complex and somewhat idiosyncratic. (1)
For one person, anxiety can lead to avoidance and isolation, and isolation, in turn, can result in a lack of opportunity for pleasurable experiences and then, low mood. For another individual, feeling down may zap them of the energy to do things they typically enjoy, and attempts to re-engage with the world after being out of practice may result in some nervousness.
Understanding the distinctions between the two emotions and characterizing the severity of the problem can help you to determine how to go about the business of feeling better.
Anxiety and depression share a biological basis. Persistent states of anxiety or low mood — like those experienced by people with clinical anxiety and mood disorders — involve changes in neurotransmitter function. Low serotonin levels are thought to play a role in both, as do other brain chemicals like dopamine and epinephrine. (2)
While the biological underpinnings of these problems are similar, anxiety and depression are consciously experienced differently. In this way, these two states might be considered two sides of the same coin.
As described above, anxiety and depression can occur sequentially — one in reaction to the other, or they can co-occur. When anxiety and mood problems reach the threshold for clinical diagnosis simultaneously, the specific diagnoses are considered co-morbid conditions.
Differences in Psychological Features
Anxiety and depression have distinct psychological features.
Mental Markers of Anxiety
- Worry about the immediate or long-term future
- Uncontrollable, sometimes racing, thoughts about something going wrong
- Believing that it is better to avoid situations that could cause anxiety so that the feelings and thoughts don’t “get completely out of hand”
- If thoughts about death are present, they are about fearing death due to perceived danger of physical symptoms or anticipated dangerous outcomes
Depending on the nature of the anxiety problem, these mental markers can vary slightly. For example, someone with generalized anxiety disorder may worry about a variety of topics, events, or activities. An individual with social anxiety disorder is more apt to fear negative evaluation or rejection by others and to be apprehensive about meeting new people or other socially challenging situations. (3)
Obsessions — unrealistic thoughts or mental impulses (sometimes with a magical quality) that extend beyond everyday worries — are the hallmark mental manifestation of anxiety in people with obsessive-compulsive disorder.
Simply put, those with anxiety are mentally preoccupied with worry thoughts to a degree that is disproportionate with actual risk or in situations where there is actually nothing wrong.
Mental Markers of Depression
- Assumptions that the future is hopeless
- Lack of belief that positive experiences will occur in the future — for themselves, for others, or for the world — and therefore that “it is not worth trying” to think or feel differently
- Thought of worthlessness
- If thoughts about death are present, they may derive from a persistent belief that life is not worth living or that the individual is a burden on others. In cases of moderate to severe depression, more specific suicidal thoughts can be present.
In major depressive disorder, these types of thoughts are persistent most of the day, more days than not for weeks on end. (4) If an individual vacillates between a very low and very high mood state, then a diagnosis of bipolar disorder may apply. However, for any variant of a mood disorder, the low mood state is likely to be characterized by the type of thinking described above.
Differences in Physical Features
The physical state of anxiety can be conceptualized overall as that of heightened arousal. (5) Specific characteristics include:
Physical Characteristics of Anxiety
- Muscle tension
- Gastrointestinal distress (for example, nausea, diarrhea, or constipation)
- Increased heart rate, blood pressure, sweating
- Shortness of breath
- Difficulty falling or staying asleep due to racing thoughts or other physical symptoms
- Difficulty concentrating due to state of agitation or racing thoughts
Physical Characteristics of Depression
Depression is primarily characterized by changes in usual physical processes from baseline, such as: (4)
- Loss of appetite or significant increase in appetite
- Lack of energy
- Physical achiness without cause
- Moving or talking more slowly than usual
- Sleeping much more or much less than is typical due to ruminative thought processes or low energy
- Difficulty with concentration, focus, and memory due to ruminative thought processes or other physical symptoms
Ultimately, the physical symptoms of either anxiety or depression can be exhausting for the afflicted individual.
How Severe Are Your Symptoms?
It is not unusual to experience brief periods of low mood or anxiety, particularly in response to certain life stressors (for example, loss of a loved one, receiving a diagnosis of a physical illness, starting a new job or school, experiencing financial problems, etc).
To meet the diagnostic threshold of an anxiety disorder, however, symptoms must be persistent (often for several months) and impairing. (6)
Mood disorders are diagnosed when the associated symptoms occur more often than not for at least a couple of weeks.
To begin to assess the severity of your symptoms:
- Ask yourself some key questions about how much the symptoms are getting in the way of your day-to-day functioning. You might also ask trusted friends and family members questions as well — if they have noticed changes in you, and what kinds.
- Increase your mental health literacy by reading about typical presentations of mild, moderate, and severe versions of a problem like depression or anxiety.
- Track your psychological and physical symptoms for a week or two to get an accurate representation of fluctuations in mood and anxiety.
Even if you decide that your anxiety or mood problem is a “low-grade” issue for you, it can still be worth working on. Consider how much it is interfering with your life, and in what ways, to determine what kinds of interventions might be helpful.
If your symptoms are mild, tending to ebb and flow between present and absent, or if you have had formal treatment previously and are concerned about relapse, self-help interventions can be a reasonable place to start. These approaches typically involve little to no guidance by a professional. They can include the use of self-help books, electronic applications that adapt evidence-based psychotherapies, or Smartphone programs that offer an easy way to practice skills that target a highly relevant symptom (such as mindfulness meditation for anger or anxiety).
If your symptoms are persistent, are impacting your relationships and ability to fulfill various responsibilities, or are clearly noticeable to others, then more formal treatment is worth considering.
For depression and/or anxiety problems, there are several types of talk therapy from which to choose. There are also medications that can help.
In structured psychotherapy, like cognitive behavioral therapy (CBT), the treatment approach for anxiety and depression can vary slightly. (7) Naturally, CBT for these issues will teach you how to work with unhelpful thought traps. And, for either problem, CBT is likely to ask that you do more behaviorally.
For anxiety, however, this is to minimize avoidant behavior and to help you disconfirm a feared consequence. For depression, this is to help you experience positive emotion, a surge in energy (even if briefly), or another type of pleasant interaction with the world (the theory being that activating behavior, even when, or especially when your energy or mood is low can result in some type of positive reward).
In a psychodynamic talk therapy, sessions for anxiety and depression may look more alike than different. You will be asked to speak freely about the past and the present in order to become aware of unconscious thoughts and conflicts underlying your symptoms.
Do not despair if you think you suffer from separate, co-occurring anxiety and mood symptoms. As described above, there is an overlap in effective psychotherapies for these problems; similarly, a group of medications known as selective serotonin re-uptake inhibitors (SSRIs) are among those that have been shown to be helpful with both anxiety and depression.
When seeking more formalized help for anxiety or depression, you might start by speaking with your primary care physician.6
You can also research local referrals via national organizations including:
- The Anxiety and Depression Association of America
- The Association for Behavioral and Cognitive Therapies
- The Association for Contextual Behavioral Science
- The American Psychiatric Association
Bear in mind that while effective treatment for anxiety or depression need not be a long-term commitment, it is likely to require regular, ongoing appointments at least in the short-term (e.g., 6-12 months). Therefore, it is critical to find a professional you trust and with whom you feel comfortable speaking about your symptoms. It is equally important to make sure that you find a clinician that you can afford. Before making the commitment for ongoing care, you may want to meet with a couple of providers to get a feel for therapeutic styles/approaches and their treatment recommendations; you can then use this information to determine which path forward feels best to you.
Tina Ureten, MD, RDMS, RDCS