Anxiety and depression, unfortunately, often go hand in hand. Comorbidity between these two disorders is incredibly high, with as much as half of patients with depression also presenting with symptoms of anxiety. Furthermore, patients who struggle with both anxiety and depression tend to have a less optimistic prognosis as those with either disorder, and don’t respond quite as well to pharmacological intervention as patients with either disorder alone.
If you have depression and anxiety, you’re more likely to struggle to find medication effective, and you may have a harder time getting the right treatment. So why is it so common, and why to certain treatments often fail for patients with depression and anxiety?
Understanding how anxiety and depression interact and why this specific combination occurs so commonly can help patients and their loved ones better understand what direction their treatment needs to take, and what they can expect for the future.
When One Leads to The Other
The goal for any psychiatric professional or medical practitioner when working with a patient with depression and/or anxiety is to achieve total lasting remission. That means finding a way for each patient to completely recover, and achieve a normal, balanced mood, as well as develop the tools necessary to deal with surges in anxious thinking, depressed thinking, and more.
There is no quick or straightforward way to achieving lasting remission. Depressive disorders and anxiety disorders require a holistic, multimodal approach. In other words, doctors have to consider the entire patient, with their given circumstances and current life, before and during the treatment process. Treatment has to be biopsychosocial, considering a person’s relationships, diet and physical health, daily stresses, family history, and more. And finally, doctors and therapists have to work to identify the link between each patient’s anxiety and depression.
Patients can present with symptoms of anxiety and depression, but there are many different diagnoses for both symptoms of anxiety as well as symptoms of depression. Some symptoms can indicate an underlying cause that is not necessarily psychiatric, such as an endocrine disease. Some patients don’t present with psychiatric symptoms at first, and instead suffer from somatic symptoms such as chronic pain and stress-related injuries and complaints.
More often than not, anxiety comes first and leads to depressive thinking. Sometimes, this can trigger or cause a full-blown depressive disorder. This is because anxiety in and of itself includes negative thinking. People who struggle with a form of anxiety in essence tend to worry. The scope of a patient’s anxiety depends on the disorder they’re struggling with, and the specific symptoms they exhibit. But it is in the nature of worrying to think of the worst possible outcomes and feel anxious about them – this can lead to thoughts of self-deprecation, blame/guilt over unrelated issues or past perceived mistakes, as well as other thoughts that essentially trigger a low mood.
Anxiety gives way to depression quite often. Outside of psychiatric and behavioral pathology, there is also the consideration that neurobiology plays a role in both the development of anxiety as well as depression. In essence, if certain inheritable traits determine whether a person is prone towards worrying and experiencing symptoms of anxiety and post-traumatic stress, these inheritable traits may also make a person more prone towards falling into periods of depression, both short-term and long-term. We generally understand that depression can be caused by abnormal functions within certain sections of the brain, including the serotonergic system. This system is also associated with schizophrenia, bipolar, and anxiety.
Endocrine function and the release and production of certain hormones also heavily influences behavior and cognitive function, including cognitive disorders like anxiety and mood disorders. Thyroid diseases as well as disorders in the neuroendocrine system may account for some cases of depression and anxiety, including disorders and syndromes related to the menstrual cycle, such as PMS and PMDD.
Anxiety and depression are tied by way of the brain, neurotransmission, hormone function, and the fact that one behaviorally and emotionally feeds into the other. While the pairing of these two issues can complicate recovery, recovery is still possible. There are different ways to help patients who face both anxiety and depression.
Identifying Anxiety and Depression
Anxiety and depression are only diagnosable through the help of a psychiatric professional. It’s generally ill-advised to try and self-diagnose any mental illness. However, there are telltale signs that help determine whether you should visit a professional in the first place. Here are a few signs that you or your loved one may be struggling with anxiety, depression, or both:
- Constant worry
- Increased pain, rapid heartrate, hot flashes, increased sweating
- Loss of interest in old hobbies
- Panic attacks
- Consistent low mood/feelings of worthlessness
- Difficulty concentrating
Signs That It’s Getting Worse
If you or your loved one are diagnosed with depression and/or anxiety, then knowing when things are getting better and getting worse is important. Keeping a journal at hand or using some other means to keep track of daily thoughts and emotions can be incredibly helpful. This is especially true for when you feel stuck, as it can help you track your emotions and determine whether you’re making positive progress or not. Some signs to watch out for when determining whether things are getting worse include:
- Not doing chores/taking care of basic hygiene habits
- Frequent and extreme mood shifts
- Aggressive behavior
- Substance abuse
- Talking/thinking about suicide in the context of attempting it
Treatment for anxiety and depression is built around each individual patient’s case and circumstances. Medication, psychotherapy, changes in environment, family therapy, changes in the daily schedule, and alternative/complementary treatments such as yoga, relaxation techniques, meditation and mindfulness training can all play a role in the treatment of depression and anxiety.
Pharmacological medicine is usually the front line in the fight against mood disorders and anxiety. Selective serotonin reuptake inhibitors as well as serotonin and norepinephrine reuptake inhibitors are commonly prescribed to patients with both conditions. Non-pharmacological medicine, such as surgical interventions and non-invasive neuromodulation can drastically change a patient’s condition, especially if they’re treatment-resistant (in the sense that medication does not work). Transcranial magnetic stimulation in particular has been helpful in the treatment of depression and can be applied to target different portions of the brain to elicit an effect, without any adverse side effects or invasive procedures.
Ultimately, what works and doesn’t work will be different for each individual patient. It’s important to try things out and consult a professional before attempting any home remedies for anxiety/depression, including herbal supplements and the like.