Depression: Associated Conditions - Anxiety

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Problems with anxiety commonly occur in people with depression. Up to 60% of people who experience clinical levels of depression may also have significant problems with anxiety problems at some point during their lives. What causes anxiety and depression to occur together? Part of the answer is that certain symptoms of Anxiety Disorders overlap with symptoms of depression, for example high self-criticism, social withdrawal and difficulty sleeping. It is also true that certain personality traits that make people prone to depression may also make them prone to anxiety problems. Although anxiety problems are common in many people who have depression, they are somewhat more common in women with depression than in men with depression.

Common Symptoms of Anxiety Disorders
There are different types of Anxiety Disorders. One of the most common types of anxiety problems to occur with depression is called Generalized Anxiety Disorder (GAD). People with GAD often describe themselves as “chronic worriers” or “worry-warts.” Everybody worries about things from time-to-time. However, people with GAD worry so much that they have difficulty relaxing, sleeping or enjoying their daily activities for months at a time.

Another common type of anxiety problem is Social Anxiety Disorder. People with Social Anxiety have intense fear of certain types of social situations or interactions. They may worry about appearing foolish, receiving negative evaluations, or being rejected by others. Because of these fears, people with Social Anxiety may avoid social interactions when they can, which, unfortunately, can worsen anxiety and depressive symptoms over the long-term.

Sometimes anxiety problems come in the form of intense bursts of anxiety lasting a few minutes that seem to come out of nowhere. These are called panic attacks. During panic attacks, a person may experience a pounding heart, sweating, shakiness and a sense of “losing it” or going crazy. If attacks occur repeatedly or a person becomes afraid of experiencing them, they may be diagnosed with Panic Disorder. Panic Disorder is much less common than depression, but of those who have Panic Disorder, many of them also have depression. 

When panic attacks occur, they often leave people with a strong feeling of wanting to hide or needing to escape. In more severe forms, people with Panic Disorder may become fearful of leaving the house or entering wide-open or very-crowded spaces, a problem called Agoraphobia. Similar to Panic Disorder without Agoraphobia, agoraphobia is not common overall but depression is quite common among those with Agoraphobia. This is likely due in large part to the social isolation that can come from Agoraphobia.

Differences Between Anxiety and Depression
Although there is overlap in symptoms of depression and symptoms of anxiety, there are also important differences that suggest they are indeed separate conditions. One widely studied theory (“the Tripartite Model of Anxiety and Depression”), argues that depression and anxiety both include a tendency to experience negative emotions such as sadness, fear, anger, jealousy and worry. However, in contrast to anxiety, people with depression tend to have low levels of positive emotions like happiness and excitement. One other difference is that people with anxiety tend to have higher levels of physical arousal, which means that body is more highly alert and vigilant, than in depression.

 

Another difference between depression and anxiety is on the type of negative thinking a person experiences. In general, negative thoughts in depression more commonly focus on past errors or failures (e.g. “I really blew it at that presentation yesterday, I am such a disappointment.”). This is a thought process called rumination and is common in depression. In anxiety, the content of negative thoughts tends to focus on negative expectations – worries - about situations that have not yet occurred (e.g. “I just know I’m going to screw up at my presentation tomorrow. Everyone will see how foolish I am.”). Of course, many people may experience both rumination and worry thoughts.

Common Treatment Approaches
Anxiety and depression problems occur together so commonly that researchers have examined the potential for using treatments to target both issues at the same time. For example, commonly used medications for depression such as SSRI’s and SNRI’s may also be useful for anxiety. A common form of psychotherapy, Cognitive-Behavioral Therapy (CBT) has also been adapted to target both anxiety and depression under the broader heading of CBT for Emotional Disorders.