Depression and Anxiety

“There’s this sadness that I can’t do things that I normally would want, that make me happy. I get upset that I should be able to feel emotions to the people I care about. But I can’t. And then a lot of my feelings are centered around feeling ashamed or embarrassed.” Joseph E.


Depression and anxiety are distinct conditions, but can also feel like two sides of the same coin. It’s common for depression and anxiety to occur together – about 60% of people who have one of them also have the other.

It’s not surprising why – feelings of anxiety and fear can cause us to withdraw, to stop doing things we enjoy, to feel less connected to people we care about, and to feel ashamed. Having depression can cause us to worry more about what the future holds. These two conditions can create a self-sustaining negative cycle that is hard to break out of.

It’s important to understand the details of depression and anxiety, as well as how they work together, in order to make sure you’re getting the right help.


What is Anxiety?

Anxiety is a natural reaction to stress or the anticipation of stress. It’s often talked about in terms of the flight or fight response, our body’s natural reaction to gearing up for something stressful. Having an impending job interview or an important presentation coming up make many people nervous or uncomfortable. But an anxiety disorder is different. An anxiety disorder is often diagnosed when these types of feelings are extreme or last for many months.

According to the National Institute of Mental Health, anxiety disorders affect 18 percent of the adult U.S. population – over 40 million Americans. That makes anxiety the most common psychiatric diagnosis.

In order to be diagnosed with general anxiety disorder (GAD) the American Psychiatric  Association suggests a patient will have specific symptoms:

  1. Excessive anxiety and worry about not just one, but many issues, individuals, or events
  2. Difficulty in controlling the feelings of worry, often without control in shifting from one topic to another
  3. At least three additional symptoms from the following list:
    • General restlessness
    • Fatigue or the feeling of being easily tired
    • Difficulty concentrating
    • Trouble sleeping
    • Irritability
    • Muscle aches or soreness

Anxiety vs. worry

We all worry. Many of us worry a lot. We worry about the future and about finances. Women worry about relationships and generally worry more than men.  Counter to stereotypes, older people worry less than younger people, and older people often report that their single biggest regret in life is that they spent too much time worrying.

Is worrying helpful? The answer is: “Sometimes.” Worrying typically falls into two categories.

  1. Productive or instructive worrying that can help us solve problems or at least take us in the right steps to solve problems
  2. Pathological worrying that involves worrying a lot about future negative outcomes without a problem solving approach.  Pathological worriers tend to be unable to control their worrying. The lack of helpful solutions leads to more pathological worrying

And worrying a lot has an impact. Dr. Simon A. Rego, a board certified Cognitive Behavioral Psychologist says: “A growing body of scientific literature suggests that consistent worrying can have both short-term and long-term effects on your well being,” affecting things like sleep, the ability to make effective decisions, or even just enjoy life.

When worrying makes life feel out of control and begins to interfere with daily functioning, mental health professionals consider a diagnosis of anxiety disorder. Anxiety can be situation specific like social anxiety or a phobia. It can also be generalized and include a pervasive, non-specific feeling of worry or dread.  Sometimes the anxiety is continuous, and sometimes the symptoms come in sharp spikes, presenting as panic attacks. Many people describe their anxiety as feeling like a car alarm that goes off intermittently and without warning.


How are anxiety and depression connected?

Depression has low mood and inability to experience pleasure at its core, while anxiety has feelings of nervousness and uncontrolled worry at its core. Being depressed can make us feel anxious, and feeling anxious can make us depressed. In fact, it’s estimated that 60% of people with depression also have anxiety.

There are many overlapping symptoms and experiences between the two conditions, including nervousness, irritability, and problems sleeping and concentrating.

According to Brightside Chief Medical Officer Dr. Mimi Winsberg, “Distinguishing depression from anxiety can be difficult, and it is not uncommon for them to coexist in the same patient at the same time. There is some overlay in symptoms between the two diagnostic entities, and prolonged anxiety or stress can lead to a sense of helplessness and then despair. Additionally, depression can present with anxious features. In these cases, it is important for the provider to try to understand which came first (the chicken or the egg so to speak).”

How is anxiety treated?

Like depression, primary treatments for anxiety include antidepressant medication, therapy, and self care.

According to Dr. Mimi Winsberg, “generalized anxiety is usually treated with certain antidepressant medications. Panic disorder and other forms of anxiety also respond well to certain antidepressants. There is an overlap in treatment between anxiety and depression but patients should ask for help in managing their anxiety when worrying or feelings of nervousness are interfering with their day to day life.”

The best outcomes are often achieved with a combination of treatments, including medication, therapy, and self care.


What should I do?

Depression and anxiety are common and treatable illnesses. Getting care can feel confusing and intimidating, but it’s worth it – most people get better with treatment.

To determine the best path forward for you, it can be helpful to start by taking an assessment to see where you stand with depression and anxiety. From there, you can talk to a professional about the treatment plan that’s right for you.

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