What is the link between depression and anxiety?

Medically reviewed by Timothy J. Legg, Ph.D., CRNP

Written by Rachel Nall, MSN, CRNA

Both depression and anxiety can be debilitating. Also, it is not unusual for these conditions to occur together. When this happens, it can be particularly challenging.

This article explores how depression and anxiety may be linked, as well as the treatment options available.

Links between anxiety and depression

According to one 2017 study, around 71.7% of people who experienced depression also experienced anxiety.

People can experience mental health conditions that include feelings of both depression and anxiety.

Two examples include mixed anxiety and depressive disorder (MADD) and anxious distress (AD).

At the moment, neither of these conditions are diagnosable in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

MADD

This condition causes a person to experience symptoms of both depression and anxiety.

If a person is experiencing stronger symptoms of either depression or anxiety, a doctor may treat that condition first.

AD

According to a small 2018 study, AD has a strong association with depression.

There are five specifications for AD, including:

• feeling tense
• feeling restless
• finding it hard to concentrate due to worry
• fearing a loss of control
• fearing that something terrible is going to happen

This anxiety may be difficult for a person to control, and as a result, a person may go on to experience depressive feelings.

Common causes

Depression and anxiety may share some common causes. These might include:

• genetics
• stress
• brain chemistry
• medical conditions
• trauma

How do they differ?

According to one 2017 review of past research, despite having similar symptoms, anxiety and depression can affect people’s thinking in different ways. The sections below discuss this in more detail.

Attention bias

People experiencing anxiety may have a tendency to focus on the negative aspects of a problem, situation, or thought.

They may even ignore the other aspects of a situation, which means that this can feed their anxiety and provide a one-sided view of their anxiety-inducing situation.

Depression does not tend to be associated with attention bias.

Perception of events

People experiencing anxiety may also have a tendency to focus on what may happen to them in the future.

Those experiencing depression may have a tendency to focus on what is currently happening in their life or what has happened to them in the past.

Also, people with anxiety have a stronger tendency to perceive the future as psychologically closer than those experiencing depression.

Memory bias

A person experiencing depression is more likely to focus on negative memories.

Anxiety does not appear to be associated with a negative memory bias.

Worry and rumination

The presence of worry is a significant symptom of anxiety.

People with anxiety may worry about many things, such as when they will feel better, what their health will be like in the future, and several other things.

On the other hand, people with depression may not experience a constant sense of worry. They tend not to believe that their life will get better, so they may not focus as much on their future.

Symptoms

The symptoms of anxiety typically persist for several months and can affect a person’s daily life.

Anxiety symptoms may include:

• excessive fear
• excessive worry and difficulty controlling it
• irritability
• muscle tension
• problems concentrating
• problems sleeping
• restlessness

The symptoms of depression can also persist for several months. There are several key differences, however.

Depression symptoms may include:

• feelings of guilt or worthlessness
• feelings of sadness and hopelessness
• loss of interest in activities a person once enjoyed
• low energy levels
• problems concentrating
• suicidal thoughts or thoughts of self-harm

Treatments

The treatment options for anxiety, depression, or both depend upon a person’s individual symptoms and how their condition affects their quality of life.

A doctor may treat both conditions with psychotherapy, medications, or a combination of both.

Medications

In many states, a nurse practitioner of psychiatry will prescribe antidepressants to treat depression or anxiety.

Examples of such medications include:

• selective serotonin reuptake inhibitors, such as fluoxetine or escitalopram
• serotonin-norepinephrine reuptake inhibitors, such as venlafaxine or duloxetine
• tricyclic antidepressants, such as amitriptyline or nortriptyline

Some doctors may prescribe a short-term dosage of anxiolytic medications to help treat anxiety. These include alprazolam and diazepam. However, they tend not to suggest using these drugs for a very long time, as they are associated with abuse.

According to an article in the journal Dialogues in Clinical Neuroscience, an estimated 55–94% of people with anxiety in the United States take benzodiazepines. However, these can cause dependence and do not offer a long-term solution.

Most medications have side effects, so doctors should be sure to discuss the potential risks and benefits of taking these medications.

Therapy

According to an article in the journal Dialogues in Clinical Neuroscience, cognitive behavioral therapy is a therapeutic approach that has the most substantial level of evidence related to its effectiveness in treating anxiety.

This is a type of therapy that involves a person reflecting on their thoughts and behaviors, then identifying how they can make changes that improve their symptoms.

Herbs and supplements

According to a 2017 systematic review, researchers have studied the benefits of several herbs and supplements in treating anxiety and depression.

Some commonly studied herbs include:

• kava-kava
• lavender oil
• chamomile
• valerian extract

Herbal remedies may be helpful for some people, but research suggesting that they are as effective as pharmaceutical medications is currently lacking.

Tips and lifestyle changes

Adopting a healthful, balanced lifestyle may help a person cope with depression, anxiety, or both.

Some examples of lifestyle changes to make include:

• getting enough sleep
• eating a healthful diet
• avoiding caffeine, nicotine, and alcohol
• engaging in regular physical exercise

If a person finds themselves feeling very anxious, they can also try these tips:

• Take a break: A person can try to separate themselves from their problem to give themselves a brief respite.
• Take deep breaths: Inhaling and exhaling slowly may help a person start to feel calmer.
• Slowly count: Slowly counting to 10 may help a person calm down.
• Talk to a trusted person: If a person feels anxious, talking to someone they trust may help.

When and how to seek help

Anxiety and depression do not have to be normal states of being for anyone. Help is available.

People should seek immediate help if they experience thoughts of self-harm or suicide.

A person should also seek help for depression or anxiety any time their symptoms start to interfere with their daily lives.

The National Institute of Mental Health provide information on how a person can find a healthcare provider or treatment options, as well as advice on what to do if someone is in an immediate crisis.

Suicide prevention

• If you know someone at immediate risk of self-harm, suicide, or hurting another person:
• Call 911 or the local emergency number.
• Stay with the person until professional help arrives.
• Remove any weapons, medications, or other potentially harmful objects.
• Listen to the person without judgment.
• If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.

Summary

Anxiety and depression are conditions that can occur simultaneously in some people.

Though some of the symptoms of depression and anxiety are similar, they can affect people’s minds in different ways.

If a person’s symptoms are interfering with their daily life, they can talk to their doctor.

SOURCE: MEDICAL NEWS TODAY