Why depression and anxiety are such good friends.

 

L’art de la fugue.

Depression and anxiety go well together. They will not always occur together, meaning it doesn’t have to be like that, that when you have depression, you’ll experience anxiety as well. Although they can feel very different, with anxiety you can feel all tense and ramped up while with depression you can experience low mood and loss of pleasure. This is of course a very very broad description to make the point that they are quite different.

Yet in the clinical field we see that they tend to go together[1]. Also lot of medication can be used to treat both. When I was put on antidepressants, an anti-anxiety medication was added after a few months which really propelled me into recovery.

Anxiety and depression may feel very different, as I mentioned before but they have a lot of symptoms in common[2]. Restlessness, fatigue, irritability, problems with concentration, sleeping difficulties, ….

The most noticeable symptom of anxiety is arousal or ‘being on high alert’ A symptom that usually doesn’t show up in depression. What you’ll find in depression but not in General Anxiety Disorder (GAD) is anhedonia or an inability to experience pleasure[3].

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If you are interested in the criteria for Depressive Disorders like they are described in the DSM V, you can download them here.

dsm-5_depressive_disordersDownload

If you want to read how General Anxiety Disorder is described in the DSM V, you can download them here.

dsm5_generalizedanxietydisorderDownload

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Do both disorders have a similar origin in the brain?

A lot of research was done to find a possible answer to that question. The answer that was most agreed upon is centered around the ‘fight or flight response to stress’. Psychologists often characterize anxiety as a sense of helplessness at its core and depression as a sense of hopelessness. Both could be interpret as a flight response to a stressor. Both are closely associated with an oversensitive stress response system.

Researchers think that the occurrence of both disabilities are more common in people who’d experienced childhood abuse or trauma. This could cause the stress response system to become more vulnerable. The main hormones involved in depression and anxiety aren’t always the same but the changes can occur in the same symptoms like trouble sleeping.

As I lived through burnout as well, I’ve experienced the same symptoms with that diagnosis although burnout isn’t a psychiatric diagnosis. What I’ve heard researchers say is that the same HPA-axis could be involved as in depression. Some theorists place burnout in the category of depression.

If symptoms and thought processes of both anxiety and depression have a lot in common, could the same brain chemistry be responsible for them?

A lower level of the neurotransmitter serotonin is both found in depression as in anxiety. The way the brain handles another neurotransmitter norepinephrine can be similar in anxiety and depression. To return to my observation that inspired this post, me being prescribed anti-anxiety medication, I found out that some antidepressants work on the serotonin levels and also can affect norepinephrine levels in the brain. That could explain why they’re useful for both depression and anxiety.

As depression and anxiety can occur together and intensify each other, so must treatment propose an adequate answer to both problems[4].

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Notes, credits and further reads.

Childhood trauma, the ACE-study.

Depression and the brain, how stress affects the body.

Are you at risk for burnout?

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[1] Online article. Comorbid generalized anxiety disorder and its association with quality of life in patients with major depressive disorder.

[2] Online article in Psychology Today. Depression and anxiety first cousins at least. Part 2-5.

[3] Online article. Avoidance mediates the relationship between anxiety and depression over a decade later.

[4] The Comorbidity of Anxiety and Depression.

Picture credits click here.