Depression and anxiety are two of the most common mental health issues in the US and affect 1 in 5 people according to the Center for Disease Control (CDC.) Most people at some time will experience symptoms of one or both. And half of those who deal with depression, experience  anxiety as well. You may wonder what is the difference between the two and when should you seek help? In this post I will lay out some basic information about depression and anxiety and some signs that you should seek professional guidance.

Depression or Anxiety?

Let's start with the fact that almost everyone experiences some of the symptoms of depression and anxiety without qualifying for a diagnosis of a clinical disorder. You have probably felt nervous, irritable, had difficulty sleeping or felt down in the dumps. This is all part of life. But when feeling bad feels like a way of life and gets in the way of living your life, you may be dealing with something more.

Although depression and anxiety do not really look alike, on the surface they can share some common symptoms. I have had clients who sought treatment for anxiety when actually the underlying issue turned out to be depression. For example, fatigue, sleep disturbance, difficulty concentrating, and a sense of restlessness are symptoms of both generalized anxiety disorder and major depressive disorder.  The difference is that with anxiety disorders you experience excessive fear and anxiety that interferes with functioning, while with depressive disorders you experience sad, empty or irritable moods, along with cognitive changes that significantly affect your capacity to function.

It has become commonplace for people to casually remark "I'm depressed" or "I have anxiety" but typically they are referring to a temporary state of feeling low or feeling worried, not a disorder. There are however some basic criteria for determining if the symptoms meet the criteria of a disorder. A key criteria for depressive and anxiety disorders is that the symptoms are interfering with your ability to function in your life. Are you able to get the job done at work, at school? Are you maintaining your relationships? Are you fulfilling your responsibilities as a mother/father or caregiver? A loss or significant reduction of functioning within relationships or work/school is a red flag for a underlying problem that should be treated.

Depression

Depression is a condition where a person typically feels sad or irritable, experiences little or no pleasure in life, and feels a general sense of hopelessness. They may think about death or may have thoughts of suicide. If you experience this condition daily or almost every day for two weeks or more and it gets in the way of your normal functioning (i.e. school, work, relationships), you should seek help right away. Even you are not dealing with a disorder, clearly you are in pain and the earlier you get to the bottom of what is going wrong for you, the better your prognosis.

There three basic types of clinical depression for adults: Major depressive disorder; Persistent depressive disorder (formerly called dysthymia) and premenstrual dysphoric disorder. Also, keep in mind that depression like states are frequently associated with substances of abuse, some medications and several medical conditions. This is another reason it is important to see your doctor for a health screening if you experience symptoms of depression. It is always important to rule out any underlying medical conditions that could be the cause of your depressive symptoms.

The common features of all depressive disorders is the presence of sad, empty, or irritable mood, accompanied by somatic and cognitive changes that significantly impact the individuals capacity to function - Diagnostic and Statistical Manual, 5th Edition

Depressive disorders involve at least some of the symptoms below in varying degrees and frequency:

• Persistent depressed mood (i.e. feels sad, empty, hopeless). In children/adolescents can be irritable mood.
• Psychomotor agitation or retardation - either a sense of inner restlessness (brought about by mental tension) that causes unintentional, repetitive purposeless movement (pacing, fidgeting, etc.) or the opposite - slowed and reduced movement, cognitions etc.
• Noticeable loss of interest or pleasure in all or almost all activities (including sex)
• Feelings of worthlessness or excessive guilt
• Decreased energy, fatigue, feeling "slowed down"
• Diminished ability to think or concentrate, or indecisiveness
• Insomnia, early-morning awakening, or oversleeping
• Low appetite and weight loss or overeating and weight gain
• Recurrent thoughts of death or suicide, suicide plans or attempts

Many people who develop depression have a history of an anxiety disorder, but there is no evidence that anxiety causes depression or that depression causes anxiety. It is clear that people do often suffer with both however.

Anxiety

Anxiety and fear are normal states that almost everyone experiences; they are normal biological responses to stress and threat. Yet when these states become persistent, overwhelming and get in the way of functioning it starts to look more like an anxiety disorder. Anxiety disorders are the most common mental health issue for adults and children in the US according to the Anxiety and Depression Association of America. Although anxiety disorders are highly treatable, only about 1/3 of those affected receive treatment.

Anxiety disorders share features of excessive fear and anxiety and related behavioral disturbances; Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat. - Diagnostic and Statistical Manual, 5th Edition

Many anxiety disorders tend to develop in childhood and persist if not treated and most occur in females vs. males (2:1 ratio) (DSM 5). The broadest type of anxiety disorder is generalized anxiety disorder (GAD). GAD shows up as persistent (generally 6 months or longer) and excessive worry about everyday things that is difficult to control and includes physical symptoms such as muscle tension, feeling keyed up and difficulty concentrating for example. Other anxiety disorders include panic disorder, social anxiety disorder and phobias. 

Symptoms below that have generally lasted six months or longer in adults (less in children) and also cause significant distress or impairment in important areas of functioning may indicate an anxiety disorder:

• Excessive and unrealistic worry (fear and anxiety that is out of proportion) and is difficult to control
• Chronic/constant muscle tension (clenching and flexing of bodily muscles)
• Trouble falling or staying asleep due to worry
• Irrational fear of and avoidance of objects or situations (overwhelming and out of proportion to the actual risks involved)
• Overwhelming fear, anxiety or avoidance of social situations where there is possible  social scrutiny
• Repeated panic attacks
• Being easily fatigued
• Restlessness or feeling keyed up or on edge
• Difficulty concentrating or mind going blank
• Irritability

Key features of anxiety disorders are excessive and unrealistic worry about everyday aspects of life and also may be connected to specific objects or rituals such as fear of spiders or driving over bridges. If fear and dread become overwhelming, feel out of control and or get in the way of your daily life, it is time to seek help.

Causes of Anxiety and Depression

Bear in mind that life stressors such as a death, illness, or job loss can trigger symptoms of anxiety and depression. You could deal with these symptoms at a level that interrupts your ability to function for a period of time while you deal with the aftermath of a stressor. Once you have had time to heal, you may move on and never experience that level of depression or anxiety again. Symptoms of depression and anxiety are normal responses to stressful life circumstances; they are your systems way of getting your attention so that you can attend to healing.

There are many factors which determine how likely you are to suffer from symptoms severe enough to be considered a disorder. Genetics (family history) and environment (stressors) are both involved, but no one really knows the degree to which each is connected to causing a disorder. What is known is that both are treatable and people who deal with anxiety and depression can (and do!) experience, functioning, productive, satisfying and beautiful lives. 

Treatment and education are both vital to thriving in the presence of anxiety and depression. When you are in a position of understanding the condition you are dealing with  -  including knowing the limits of understanding that exist in the community of experts - then YOU can be the arbiter of your own healthcare decisions, including which treatments are right for you.