Anxiety disorders and Major Depressive Disorder (MDD) are the two most common mental health conditions experienced amongst the world’s population, with 301 million people living with an anxiety disorder and 280 million people living with depression (World Health Organization, 2019). According to the Anxiety and Depression Association of America (ADAA), 31.9% of adolescents in the United States have an anxiety disorder. Research has demonstrated that, if left untreated, the majority of youth struggling with an anxiety disorder will continue to meet diagnostic criteria for anxiety disorders as they mature. The general stability of these symptoms is reflective of the need for early intervention to successfully address these conditions. Amongst adults in the United States, 19.1% or 40 million people struggle with an anxiety disorder. In 2017, the National Institute of Mental Health (NIMH) estimated that around 17.3 million adults in the United States had experienced at least one major depressive episode in the last year. In the United States, it has been determined that depression is the leading cause of disability in people between the ages of 15 and 44. It is quite likely that the above estimations are lower than the actual prevalence rates, as many individuals who need mental health treatment are unable to access it and/or do not seek help.
Despite these concerning statistics, the good news is that both anxiety disorders and depression are highly treatable conditions, and individuals receiving proper treatment can make dramatic improvements and positive changes in their lives. In the last few years, the rates of treatment participation have markedly increased. A study cited by Medscape found that by the end of August 2022, the overall utilization of mental health services was nearly 40% higher than it had been prior to the start of the pandemic. This substantial increase has had a corresponding impact on decreasing the stigma associated with seeking mental health care, and overall, it has increased general levels of willingness to seek and actively participate in treatment.
The following article will define depression and anxiety disorders and their respective symptoms will be outlined. Next, the overlapping areas of both conditions will be highlighted in the domains of cognitive processes, emotions, physical symptoms, and behaviors. Finally, this article will address most commonly used treatments for these conditions.
Anxiety Disorders
Anxiety disorders are mental health conditions that are characterized by worries and preoccupations with fearful outcomes. People struggling with an anxiety disorder are fearful that something bad has, will, or did happen. They are plagued by feelings of uncertainty and experience a general unease about their worrisome doubts. They are usually avoidant of their anxiety triggers and may turn to strategies such as distraction, reassurance seeking, compulsions, or other types of avoidance to mitigate their anxious feelings. Anxiety can present in the form of racing thoughts, obsessions, and/or intrusive thoughts. It can cause a number of uncomfortable and distressing bodily sensations, such as nausea, sweating, heart palpitations, and difficulty breathing. People with anxiety disorders often struggle to be in the moment and may find that their anxiety negatively impacts their relationships, academic/work performance, and daily habits. They are typically aware that the anxiety they are experiencing is excessive and out of proportion to the situation. In general, to be diagnosed with an anxiety disorder, an individual must be experiencing symptoms for at least six months. There are some exceptions, such as in the case of Separation Anxiety Disorder (children can meet criteria in four weeks), Selective Mutism (symptoms must be present for at least one month), and Panic Disorder (a duration of one month of symptoms is needed for a diagnosis). Anxiety disorders include:
- Generalized Anxiety Disorder
- Panic Disorder with or without Agoraphobia
- Specific Phobias (e.g. needles, dogs, heights, vomiting, etc.)
- Social Anxiety Disorder
- Separation Anxiety Disorder
- Selective Mutism
Although Obsessive-Compulsive Disorder (OCD) is no longer classified under the category of anxiety disorders, the manifestations of OCD symptoms have many parallels to those of anxiety disorders and the treatments for these conditions have many similarities.
Major Depressive Disorder
Major Depressive Disorder (MDD) is a mental health condition that is characterized by low mood and sadness, which can sometimes present as agitation and irritability. Individuals with depression often endorse anhedonia, which is a loss of interest or pleasure in doing things that they normally would enjoy. Additional symptoms may include or decreased appetite as well as corresponding changes in weight. Sleep disturbances typically accompany depression and can present as insomnia (trouble falling or staying asleep or awakening earlier than intended) or hypersomnia (excessive sleepiness). Psychomotor symptoms, or physical/movement symptoms originating from a psychological cause, may be demonstrated in the form of agitation (feeling keyed up, restless, or on edge) or retardation (feeling slowed down, weighted down, or sluggish). Fatigue and low energy are commonly reported symptoms among people who have depression. Difficulties with concentration and decision making are often present. Individuals with depression often report feeling worthless and may endorse excessive or inappropriate feelings of guilt. Lastly, individuals struggling with depression may endorse recurrent thoughts of death and/or suicidal ideation. Symptoms of depression may be severe enough to warrant hospitalization due to an inability to care for oneself and/or safety risks connected to suicidality. In order to be diagnosed with Major Depressive Disorder, an individual must be experiencing a minimum of five of the above symptoms for at least two weeks. One of the symptoms must be depressed mood or anhedonia in order to satisfy diagnostic criteria for this condition.
Symptom Overlap Between Presentations
The relationship between anxiety disorders and depression is complex and these conditions often co-occur. Epidemiology research has demonstrated that half of the people who meet diagnostic criteria for depression are also struggling with one or more anxiety disorders. It can be difficult to determine which set of symptoms preceded the other as there are a number of parallels between these conditions. Anxiety disorders can cause a significant level of distress and severely restrict the scope of a person’s activities and interactions, which can lead to isolation and depression. On the other hand, symptoms of depression may lead people to withdraw from others and limit their ability to participate in things that they enjoy. This pattern causes feelings of loneliness and sadness to increase. The low mood and lack of energy experienced by people with depression may prevent them from utilizing their outlets, causing them to feel overwhelmed and anxious.
Overlap in Cognitive Symptoms
Individuals struggling with anxiety disorders and depression endorse difficulties with sustaining attention and concentration. Disruption in abilities to attend to information generally results in poor recall because if we are unable to pay attention to information, we will be unable to remember details at a later point in time. People with anxiety disorders and/or depression report difficulties with making decisions, which is partially accounted for by doubts and/or negative predictions, but may also stem from issues with working memory, or the ability to mentally manipulate information in order to reach a conclusion or decision. Another overlapping symptom between the conditions is mental preoccupation. In depression, the focus tends to be ruminating on past events, whereas people with anxiety disorders are more preoccupied with future events. Individuals with depression may view the future as hopeless, whereas individuals with anxiety are more likely to view the future as foreboding or stressful. In either case, individuals are viewing future events as being outside the scope of their management, which precipitates feelings of fear and/or hopelessness. This perspective might be due to the presence of cognitive distortions, or perspectives that are biased and do not depict situations in a balanced or fair manner. One example of a cognitive distortion common to both depression and anxiety disorders is overgeneralizing, or assuming that because a negative outcome occurred in one situation, any similar event that occurs in the future will render the same outcome. Additional cognitive distortions include magnifying the negative aspects of a situation, while downplaying the positives and anticipating negative outcomes (fortune telling) and/or negative interactions with others (mind reading).
Overlap in Emotional Symptoms
The emotional experiences of having depression and/or anxiety share some commonalities, including feelings of irritability. These emotional experiences likely overlap with and are partially triggered by some of the physical symptoms of these conditions, which we will address in the next section. When individuals are feeling chronically overwhelmed, their patience and frustration tolerance are understandably reduced. Their threshold for coping has become taxed and they are generally feeling more easily triggered. The agitation across these conditions can lead to feelings of guilt and/or shame as individuals typically realize that their ability to effectively manage their symptoms and solve problems has been compromised. They may express shame and guilt about their anxious intrusive thoughts, low energy, negative interactions, declining quality of work, and their inability to “snap out of it.” People struggling with anxiety and depression often endorse feelings of low self-esteem. They may set unreasonable standards for themselves and negatively compare themselves to others, which provokes self-doubts and self-criticism that contribute to low mood and anxiety.
Overlap in Physical Symptoms
The emotional distress of having an anxiety disorder and/or depression typically results in a variety of physical symptoms. Digestive upsets such as nausea, abdominal distress, and decreased appetite, and weight loss are often reported. Conversely, individuals may engage in stress eating while being less physically active, which may result in weight gain. Headaches, backaches, stomachaches, etc. may also be reported. These physical aches and pains are often compounded by sleep disturbances. Individuals may find themselves unable to sleep, waking up frequently, and/or sleeping much more than usual. Fatigue and low energy are common complaints across both conditions. These physical symptoms may result in withdrawal from daily activities, hobbies, and social interactions, which tends to pull more focus to these sensations and exacerbate these experiences.
Overlap in Behavioral Symptoms
The combination of cognitive, emotional, and physical symptoms of anxiety and depression have a negative impact on people’s actions via their daily activities, routines, interpersonal interactions, and goal-oriented behaviors. A common area of overlap may be poor task initiation and/or delays in completing a task. In depression, this symptom may be caused by low motivation or energy, whereas poor task initiation attributable to anxiety is likely fueled by concerns of completing the task incorrectly or “wrong.” Perfectionism may result in procrastination and/or doubling back to redo various parts of the task. Psychomotor symptoms, such as restlessness (anxiety) and sluggishness (depression) are often observable in the person’s speech and physical movements. In the case of depression, the person may be struggling with anhedonia, or lack of interest/enjoyment in activities. The presence of anhedonia may lead them to neglect daily tasks and decrease engagement in hobbies or recreational activities, which negatively influences mood. Individuals struggling with anxiety may exhibit a variety of avoidance behaviors, enacted to prevent feared consequences from occurring. Consequently, their output is lower as their approach to task completion becomes painstakingly slow in an effort to reduce making mistakes. The time and energy consumed by depression and anxiety can cause people to withdraw and become socially isolated. The resulting decrease in social connectedness can exacerbate anxious and depressive symptoms within each of the four symptom domains.
Treatments
As demonstrated in the previous sections, there is a notable degree of overlap in the experience and manifestations of anxiety disorders and depression. The treatments used to ameliorate these symptoms also contain a significant amount of common factors. The most commonly used treatment to address both conditions is Cognitive Behavioral Therapy (CBT). CBT is known as an evidence-based treatment, which means that there is a great deal of empirical research that has consistently demonstrated the efficacy of this treatment in reducing symptoms and improving functioning. Please see our website for more information about CBT.
The provision of CBT is often enhanced by including adjunctive therapies and interventions that fall under the umbrella of CBT, such as Exposure and Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), Dialectical Behavioral Therapy (DBT)style=”font-weight: 400;”>, behavioral activation, and self-compassion. Interventions targeting behavioral activation and self-compassion can effectively supplement all of the above-mentioned therapies. The objective of behavioral activation is to increase behaviors that facilitate improved self-care and increased engagement in enjoyable activities. The aim of behavioral activation is to target and challenge factors that maintain anxiety and depression, such as inactivity and diminished social connection. Incorporating self-compassion interventions into the treatment of anxiety disorders and depression will aid in the development of skills that promote self-compassion and decrease feelings of shame and guilt. Acquiring greater levels of self-compassion can help to boost self-esteem and positively influence goal-directed behaviors. When appropriate, the treatment of depression and/or anxiety disorders may warrant pharmacological interventions, which are overseen by a psychiatrist and work best when combined with psychotherapy.
Anxiety disorders and depression affect many people worldwide. People of all ages and backgrounds struggle with these conditions. Symptoms of anxiety and depression are pervasive and have the potential to significantly disrupt many aspects of a person’s life. More often than not, these conditions co-occur and tend to reinforce one another. The silver lining that emerges from these staggering prevalence rates is the fact that both anxiety disorders and depression are highly treatable. There is an incredible amount of research and numerous studies that have thoroughly examined the most effective treatments for these conditions. Evidence-based treatments, such as those identified above, have consistently demonstrated their ability to help patients achieve significant symptom reduction and functional improvements. These treatments have not only been proven to be reliable in achieving positive outcomes, but they also hold great value in restoring health, hope, and overall wellness.
Need Help or Support?
If you or a loved one are struggling with an anxiety disorder, Obsessive-Compulsive Disorder, or any other mental health concerns, know that you are not alone. If you are a parent or a caregiver and are seeking additional information about how you can best support your child, our office provides parent training with the SPACE program. Please see our November 2021 Newsletter for more information on SPACE.
For these or any other mental health concerns, pleasecontact The OCD & Anxiety Center at (630) 686-7886 or info@theocdandanxietycenter.comstyle=”font-weight: 400;”>. We have offices located in Oak Brook and Orland Park, Illinois and in Marietta, Georgia. Our clinicians specialize in helping individuals overcome anxiety disorders, Obsessive-Compulsive Disorders, and other co-occurring mental health conditions. We provide telehealth services that are available in Illinois, Indiana, Iowa, Florida, and Georgia.
At The OCD & Anxiety Center, we can provide treatment both in the office and at off-site locations (your home, mall, school, work etc.). We will work closely with you to create an individualized treatment plan and discuss the appropriate frequency of appointments (once a week or more, if needed). We look forward to working with you and facilitating your therapeutic journey!
Dr. Ashley Butterfield is a licensed clinical psychologist at The OCD & Anxiety Center in Oak Brook, IL. She specializes in Cognitive Behavioral Therapy and Exposure and Response Prevention Therapy for anxiety, OCD, and anxiety-related disorders. She is comfortable working with children, adolescents, and adults and is able to provide treatment both in the office and outside of the office, wherever anxiety happens.
