The words “anxiety” and “depression” may sound different, but these two conditions can often feel very similar – both can lead us to experience withdrawal, isolation, fatigue, irritability, and difficulty concentrating, among other feelings, thoughts, and behavioral changes. In fact, according to the AADA (Anxiety and Depression Association of America), around half the people that are diagnosed with depression also suffer from an anxiety disorder. Although we can sometimes feel alone when struggling with difficult feelings, both anxiety and depression are very common. Neither condition is something to be ashamed of and both are understandable and treatable.
The American Psychological Association (APA) defines anxiety as an emotion distinguished by feelings of tension, worried thoughts, and physical changes such as increased blood pressure, sweating, trembling, dizziness or a rapid heartbeat.
As with many emotions, anxiety is our brain’s way of taking care of us and helping us to deal with the world around us. Anxiety exists to help us when we are facing danger; it is the brain perceiving a threat and telling the body to prepare to escape or to fight the threat – the ‘flight or fight’ response.
Anxiety was very useful to our ancestors – it’s what kept them alive when they were facing life-threatening danger. Today’s perceived dangers are different, but the anxiety response can still be very helpful to us now, motivating us to meet a deadline at work or to prepare for an important test at school, for example.
While occasional anxiety can be productive, the intensity of how the anxiety feels to us, and the duration, determines whether it is more harmful than useful to us. In simple terms, if it wears you down, it is bad for your health, especially if it becomes unmanageable or overwhelming.
An anxiety disorder has severity and duration which are often out of proportion to the original stressor. While anxiety is (1) a realistic response to a realistic situation or problem, (2) related to a particular problem or situation, (3) proportional to the problem or situation, and (4) lasts only as long as the problem or situation, a person with an anxiety disorder is having recurring intensive concerns or thoughts for seemingly no reason. In addition:
- The response to the problem or circumstance is much stronger than expected.
- The individual may experience fear of something that might never happen (unrealistic anxiety).
- The anxiety lasts even after the issue or situation is resolved.
- The person may feel they cannot control their anxiety.
Anxiety disorder sufferers usually tend to avoid going about their everyday lives as a means to avoid things or situations that they believe could trigger anxiety symptoms. This avoidance can also manifest as procrastination and can have detrimental effects on work performance.
Many sufferers can also feel trapped by their feelings and thoughts, even though they know intellectually that their anxiety is not reality-based. This is when an anxiety disorder interferes with their daily function and causes them to experience a lot of uncomfortable physical health issues and physical sensations.
Symptoms of Anxiety
Some of the most common signs that can cause distress in your everyday life are:
- Muscle tension
- Trouble concentrating
- Excessive worry
- Feeling exhausted easily
- Sleep disturbances
- Feeling overwhelmed
- Memory issues
- Feeling easily frustrated
- Change in eating habits
- Feeling anxious or angry
- Feeling that you can’t get over your difficulties
If these symptoms persist for more than 6 months, you may receive a diagnosis of generalized anxiety disorder (See below).
Types of Anxiety Disorders
According to the Diagnostic and Statistical Manual of Mental Health Disorders, anxiety disorders are classified into the following main types:
- Generalized anxiety disorder (GAD) – The most common anxiety disorder, where people feel anxiety but can’t really put their finger on what exactly is causing the anxiety. In this chronic condition, the individual has long-lasting worries and anxieties about situations, objects, and life events that are nonspecific.
- Panic disorder – Also referred to as panic attacks, these are sudden or short-lived attacks of intense terror that take place after prolonged stress or frightening experiences and can result in breathing difficulties, dizziness, nausea, confusion, and shaking. They tend to reach their zenith within 10 minutes after their onset but could last for several hours. However, panic disorders may also occur without the presence of a trigger/stressor. The person having a panic disorder feels it as a life-threatening event, which may lead them to take drastic measures to prevent future panic attacks.
- Phobias – Unlike with other panic disorders, phobias relate to a particular cause. A phobia is an irrational fear of anything from everyday objects to animals and situations (e.g., going to the dentist). The person with a phobia usually reports being unable to control their specific feelings that trigger the phobia, although they realize their fear is extreme or illogical. For that reason, they move away from the particular trigger (e.g., being in an open space or using public transport in the case of agoraphobia).
- Social anxiety disorder – Characterized by a fear of public embarrassment or negative judgment in social situations, social anxiety disorder is sometimes also referred to as social phobia. People with this type of anxiety usually experience fear of being rejected or humiliated, fear of intimacy, and stage fright, which can drive them away from human contact and public situations, making their daily lives particularly difficult, and often lonely and isolated.
- Selective mutism – Most commonly seen among children, selective mutism is exactly what the term describes – choosing to remain silent because you are unable to speak in certain contexts or certain places (e.g. school).
- Separation anxiety disorder – Individuals with separation anxiety disorder feel extremely insecure and unsafe when they separate from a place or a specific person and the separation may lead to experiencing physical symptoms of panic.
Note: Previously, PTSD (post-traumatic stress disorder), OCD (obsessive-compulsive disorder), and acute stress disorder were also considered anxiety disorders. The new DSM edition (what psychologists use to define these issues), however, does not group these mental health issues under anxiety anymore.
How Anxiety Affects the Brain
Anxiety can lead to the buildup of cortisol in the brain, a hormone that helps restore balance to the body after a stressful event, regulate blood sugar levels, and more. High levels of this hormone can have long-term effects on the brain and wear down its ability to function properly. In detail, chronic stress and anxiety impair the function of the brain in several different ways. For instance, it may result in the avoidance of interactions with other people and the loss of sociability by disrupting the regulation of the synapses or even shrink the brain’s prefrontal cortex, which is responsible for things like learning and memory, as well as the amygdala, and eventually put the brain in constant fight or flight mode.
The good news is that these brain changes are not necessarily permanent because the human brain has a miraculous recovery system (aka plasticity), according to recent research. Anxiety-induced damage can indeed be reversed, especially when it is treated early on (so that the brain can create new neural pathways or regain the lost ones easily) via interventions that involve activities such as socializing and exercising regularly.
It is estimated that more than 16 million US adults have experienced at least one major depressive episode in their lives. The APA defines depression as a serious illness that adversely affects the way a person feels, thinks, and acts. Depression should not be mistaken for sadness or grief, although these can indeed be associated with depression. Often characterized by a loss of interest in activities that were once liked, as well as a severe withdrawal from daily life, if left untreated depression can lead to a variety of emotional and physical problems.
Although both anxiety and depression can be marked by lack of lack of action, anxiety tends to be more about deliberate avoidance whereas for those who are really suffering from depression, a basic action like brushing your teeth can feel insurmountable.
Contrary to what many people believe, depression is complicated and often much more nuanced than a brain chemical imbalance that can be ‘fixed’ solely through the use of medication. Speaking with a trained professional is the most effective way to uncover and address the causes of depression and determine the best treatment.
Symptoms of Depression
Compared to anxiety, the symptomatology that comes with depression is much more intense and includes the following:
- Feelings of sadness, hopelessness and/or despair
- Increased fatigue or loss of energy
- Having a depressed mood or powerful mood changes
- Appetite loss or sudden increase in appetite
- Sleep disorders (i.e., sleeping too much or too little)
- Difficulty in making decisions
- Difficulty concentrating and thinking
- Having suicidal thoughts or thoughts of death
- Feeling guilty or worthless
- Slowing of movement
- Withdrawing from other people
- Lack of motivation
- Feeling irritable or agitated
To be diagnosed with major depressive disorder, a person will need to have experienced at least five of the symptoms mentioned above for at least two weeks.
It is also possible that individuals who experience some of the symptoms related to depression are diagnosed with:
- Premenstrual dysphoric disorder
- Dysthymia or PDD (persistent depressive disorder)
- A depressive disorder caused by another condition
How Depression Affects the Brain
Depression is found to impact the nervous system central control center and the physical structures on the brain, including:
- Brain size – Studies have found that the amygdala, thalamus, hippocampus, prefrontal cortices, and frontal cortices are parts of the brain that can be effected by depression, leading to a decrease in their size. This, in turn, impairs the functions related to the particular sections. For example, a reduction in the size of the amygdala and the prefrontal cortex, the areas responsible for recognizing emotional cues in other people and controlling our emotional responses, can result in a reduction in empathy; a condition called PPD or postpartum depression. The amount of this shrinkage depends on the length and severity of the depressive episode. It has been found, though, that the hippocampus of some depressed women is 9%-13% smaller than the one of people that are not depressed.
- Brain inflammation – Although not yet 100% conclusive, studies show that there is a connection between depression and brain inflammation. In turns out that the brains of the individuals who have been dealing with depression for 10 years are 30% more inflamed than people that have been depressed for shorter periods of time. When the brain is inflamed, the cells die, which can lead to dysfunctions in learning, brain development, mood, and memory, among others.
- Reduced oxygen – Oxygen restriction and depression are found to be related. This could be due to the breathing changes caused by depression, which sends limited amounts of oxygen to the brain (compared to normal breathing) – a condition referred to as hypoxia. This can lead to brain cell injury, inflammation, or even the death of brain cells, and consequently to symptoms associated with mood, memory, learning, and development.
An experienced and compassionate therapist can help not only with the immediate treatment of the symptoms of depression, but also with understanding the root causes so as to help people
The Relationship Between Anxiety & Depression
You have probably noticed that there is overlap in the symptomatology of both anxiety and depression (e.g., fatigue, irritability, and sleep disorders are symptoms of both depression and anxiety), and many people do suffer with both anxiety and depression. However, not every person who experiences anxiety is depressed and vice versa – there are some distinguishing features that help tell a person that is depressed from one that experiences anxiety.
For instance, people with anxiety usually struggle with harnessing their racing thoughts (hence, are more keyed up) while the reactions of individuals with depression seem dulled or flattened. Also, a depressed person is less likely to worry about events that may happen in the future as they tend to believe that everything will continue to be bad (or a monotonous, flat line) in their life. Those with anxiety demonstrate fear about the future and often worry too much about what is coming (which they fear will be something terrible).
The differences between anxiety and depression can be very nuanced, and the underlying causes of each can be obscure and complex. With the help of an experienced and compassionate therapist, both conditions can be better understood and properly treated.
On a global scale, the World Health Organization (WHO) reports that 1 in every 13 people struggle with a form of an anxiety disorder (more than 300 million people) while depression is the leading cause of disability around the world.
The sad news is that nearly 2/3 of the individuals with mental disorders that live in developing countries remain untreated, and almost one million fellow citizens terminate their lives every year after battling with untreated depression.
Despite the millions of us who are dealing with anxiety and depression, as individual human beings we can still feel very alone when we are experiencing these conditions ourselves. We might think that we’re not the “type” of person who has a “mental illness” – and so we may minimize the symptoms that we are experiencing and try and “muscle through” on our own. This go it alone mentality is nothing to be ashamed of and can be a very common reaction to the symptoms of anxiety and depression; however, it can often have the opposite effect that we hope for, and can prolong or even worsen our feelings of anxiety and depression.
The knowledge, support, and skills of an experienced and compassionate therapist can help us understand these conditions for what they are – common, manageable, and treatable. Working one-on-one with a professional therapist we can then begin to achieve our goals of feeling better, happier, and more fulfilled in our lives.