Anxiety and Depression: One and the Same?

[Daniel E.]

One and the Same: Anxiety and Depression
By Hara Estroff Marano
Psychology Today
March 1, 2004

Surveys show that many people with major depression also have an anxiety disorder, while half of anxiety-disorder sufferers also have symptoms of clinical depression.

It's an axiom of modern psychiatry that anxiety and depression are two distinct conditions. However, evidence is amassing that they are really two manifestations of one disorder. Looking at them that way, some experts say, could speed the development of drugs that better subdue both conditions.

Surveys have long shown that 60 to 70 percent of people with major depression also have an anxiety disorder, while half of anxiety-disorder sufferers also have symptoms of clinical depression.

Now there's evidence of genetic commonalities between the two conditions. Researchers at the National Institute of Mental Health have found that in people with both panic disorder and depression, there is a significant decrease in a type of receptor (5-HT1A) for the neurotransmitter serotonin. Other studies have shown that the stress response system is overactive in patients with both anxiety and depression. Secretions of the stress hormone cortisol, triggered by repeated trauma, reduce expression of the gene that produces the 5-HT1A serotonin receptor.

"They're probably two sides of the same coin," says David Barlow, director of the Center for Anxiety and Related Disorders at Boston University. "The genetics seem to be the same; the neurobiology seems to overlap. Some people with the vulnerability react with anxiety to life stressors and some, in addition, go beyond that to become depressed."

Anxiety precedes depression developmentally, with anxiety most commonly beginning in late childhood or adolescence and depression a few years later, in the mid-20s. Psychologist Michael Yapko of San Diego targets a flaw in thinking common in both disorders. "The shared cornerstone of anxiety and depression is the perceptual process of overestimating the risk in a situation and underestimating personal resources for coping."

Behavioral geneticist Kenneth S. Kendler of Virginia Commonwealth University in Richmond offers a new way of parsing psychiatric conditions. He sees a small cluster of genetic risk factors creating "internalizing disorders" such as anxiety and depression, which cause sufferers to be miserable. Another set of genetic factors finds expression in "externalizing disorders" such as substance abuse and antisocial behavior—conditions that make others around them miserable.

Related article:
Depression: Coping with Anxiety Symptoms

 

[Daniel E.]

Another thing they have in common is a tendency for ruminative thinking:

http://forum.psychlinks.ca/psycholo...h/8228-rumination-depression-and-anxiety.html

http://forum.psychlinks.ca/depressi...on-ruminative-vs-experiential-self-focus.html
http://forum.psychlinks.ca/depression/20310-probing-the-depression-rumination-cycle.html

 

[Daniel E.]

Fear of Fear Itself
by Christie Nicholson
Scientific American podcast: 60-Second Psych
December 1, 2009

A recent study links fear of feeling anxious to depression. Christie Nicholson reports.

Most psychotherapists would agree that depression is anger and sadness that has been repressed. And it can lead to a state where the afflicted feel there is nothing they can do to change their situation. A hopelessness emerges.

Another key characteristic is anxiety. But scientists have recently focused on a specific type of worry that is significantly linked to depression. This is anxiety about feeling anxiety. Here a person thinks that something catastrophic is going to happen if they allow themselves to feel anxious.

The scientists had 94 above-average worriers take a variety of anxiety questionnaires and two tests for levels of depression. But they controlled for worry and generalized anxiety in order to isolate specific anxiety about feeling anxious. The research is published in the December issue of the Journal of Anxiety Disorders.

The two dimensions of so-called anxiety sensitivity that are most strongly linked to depression are fear of loss of cognitive control and fear of revealing anxious symptoms in public. The other dimensions, fear of respiratory and cardiovascular symptoms showed no link to depression.

The authors note that current depression therapies focus on depressive symptoms and not anxiety sensitivity. They suggest therapists might want to consider helping people change their perception of anxious emotion, to not see it in such a negative light.

Of course, this reminds us of Franklin D. Roosevelt’s sage words at his first inaugural address: “…let me assert my firm belief that the only thing we have to fear is fear itself—nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.”

 

[David Baxter PhD]

No, I don't believe they are one and the same, although they are often "comorbid conditions".

Most psychotherapists would agree that depression is anger and sadness that has been repressed.

That is a classic psychoanalytic view but I think the claim that "most psychotherapists would agree" is a bit of an overstatement.

And it can lead to a state where the afflicted feel there is nothing they can do to change their situation. A hopelessness emerges.

This, on the other hand, is characteristic of most depressions.

 

[Daniel E.]

I think the claim that "most psychotherapists would agree" is a bit of an overstatement.

I noticed that, too, but I didn't want to seem obsessive by mentioning it :teehee:

 

[David Baxter PhD]

:lol: I on the other hand embrace my obsessiveness.

 

[NicNak]

:lol: I on the other hand embrace my obsessiveness.

Luvox may help you change that :teehee: It helped me :teehee:

 

[gardens]

I love the humour! :rofl:

 

[Daniel E.]

Another way of comparing depression and anxiety:

It may sound surprising, but conflict is at the core of both anxiety and depression. With anxiety, the core conflict is wanting a sense of safety, but feeling a threat of some type...With depression, the core conflict is a loss of motivation or energy while wanting desperately to feel the joy and enthusiasm that others experience…

We all experience conflict. You want one thing, and I want something different. But with anxiety and depression, the conflicts are more pervasive, meaningful, and irreconcilable than day-to-day conflicts.

Depressed and Anxious: The Dialectical Behavior Therapy Workbook for Overcoming Depression & Anxiety

 

[NightOwl]

Reading through this post I've found it interesting; although I haven't managed to have time to go down the links yet, I hope you don't mind my input on this. I suffer from PTSD due to trauma; when I talked to a psycho-therapist, I explained I had high anxiety but not overall feeling of depression, although depression can hit on the odd days, and in fact most days I stay relatively happy as long as I feel safe; she told me that some patients she has seen have been given anti-depressants to help them deal with everyday life but it's not always depression they are suffering from and this can increase the numbing feeling and make it difficult at times for the patient to come to terms with their feelings and try to heal.

NightOwl

 

[Daniel E.]

but it's not always depression they are suffering from

So I guess these people without a disorder may just be "stuck" on some lifestyle issues, like interpersonal issues, social isolation, burnout, etc.

 

[NightOwl]

From how I feel, anxiety and depression can be either separate or go along together, but each can come from a different route. By looking for where the route cause is coming from, gives a better perspective on how to deal with them.

Thank you for the link on the book Unstuck, it looks really interesting.

I've just got some of my course materials for my OU course yesterday, which is on Fear and Sadness, so I'm looking forward to that and a better understanding of the whole subject.

Many thanks.

NightOwl

 

[Daniel E.]

anxiety and depression can be either separate or go along together, but each can come from a different route

On that note, I just read this:

Anxious arousal causes patterns of brain activity in the right inferior temporal lobe, or just behind the ear. Chronic worry creates patterns in the left frontal lobe region that is also connected to language. Depression has previously shown to activate the brain's right frontal lobe...

People who experience the fearful type of anxiety had increased activity in the area of the brain that is also commonly activated by depression.

People with depression who were classified as worriers focused better on the task and were able to focus on the word but not become affected by the emotions connected to it.

The research suggests that fear can increase feelings of depression, but a more chronic level of concern can counterbalance the depression and reduce its effects.

"It could be that having a particular type of anxiety will help processing in one part of the brain while at the same time hurting processing in another part of the brain," Miller said in a statement. "Sometimes worry is a good thing to do. Maybe it will get you to plan better. Maybe it will help you to focus better. There could be an up-side to these things."

Good news for worriers who suffer from depression - STLtoday.com

 

[Daniel E.]

"Basically, what we're finding is that there's talk between these two receptor systems in the brain, and that if you activate the one receptor system the other becomes sensitized."

Canadian researchers find brain link between anxiety and depression
​

 

[Daniel E.]

An excerpt from The Mindfulness Solution for Everyday Problems: An Interview with Ronald Siegel, Psy.D:

Mindfulness practices are turning out to be useful for dealing with a remarkably wide range of psychological difficulties, including both anxiety and depression. This raises an interesting question: What might these problems have in common? Might mindfulness practices be addressing this common factor?

A bit of a war broke out among the researchers and clinicians writing the latest version of the DSM—the diagnostic manual used by mental health professionals. It was a war between the lumpers and the splitters. The splitters said that the major limitation in our current diagnostic system is that we’re mixing apples and oranges — we need more diagnostic categories to more accurately identify psychological problems. The lumpers said, “that’s crazy, you’re missing the forest for the trees. You’re ignoring what so many problems have in common.” So the splitters said, “oh yeah? What do they have in common?” And the lumpers said, “experiential avoidance.”

What do they mean by “experiential avoidance?” It’s the natural tendency we all have to pull away from painful experiences. And it turns out that indeed this is something that both anxiety and depression have in common.

While many people struggling with anxiety see their worried thoughts, rapid heartbeat, muscle tension, and other signs of physiological arousal as the problem, most mental health professionals realize that it is actually our maneuvers to try to get rid of anxiety that are at the core of most anxiety disorders. For example, if someone has a fear of public speaking, flying in airplanes, or catching germs from public restrooms; it’s not the fact that these situations provoke anxiety that’s the problem, it’s the fact that the person starts to avoid speaking in public, flying, and using the restroom that’s the problem.

I once heard an astronaut being interviewed by an actor who was going to play him in a movie. The actor wanted to get inside the astronaut’s head so he could play him faithfully. He said, “how were you able to get the courage to fly in those untested aircrafts—I would’ve been scared shitless.” The astronaut said, “of course, I was scared shitless every time I went up. Courage isn’t about not feeling fear, it’s about doing what makes sense anyway.”

Mindfulness practices train us to develop this kind of courage, to approach difficult experiences instead of trying to avoid them. By practicing being in the present moment, whether that moment is pleasant or unpleasant, calm or threatening, we develop the ability to bear feelings of greater and greater intensity. As we develop this skill, we become able to face a wider range of life challenges with confidence— knowing that we can bear the anxiety that may arise. Since so much of problematic anxiety involves fear of fear — worrying that a given situation will make us anxious — paradoxically, this approach in the long run makes us much less anxious. So instead of trying to “calm down,” mindfulness practices give us the courage to be with our anxiety when it arises, allowing us ultimately to be much less afraid.

I outline a number of specific exercises that we can use to develop this sort of courage in the chapter on worry and anxiety in The Mindfulness Solution. You can also learn many of these online at www.mindfulness-solution.com.

Interestingly, depression has a lot in common with anxiety. I often ask psychotherapists what they think is the difference between sadness and depression, and they come up with a variety of answers. Sometimes they suggest that depression lasts longer than sadness. But I point out that it’s perfectly possible to feel sad for days in a row and yet be quite depressed for just a few hours. Then they suggest that sadness arises in response to external events, while depression comes from the inside and has a life of its own. But I remind them that we can get very depressed after a misfortune such as the loss of a job or relationship and yet can feel sad without apparent cause.

Finally, after some discussion, they come to the conclusion that sadness feels alive and fluid and is an essential part of living a full life, while depression feels dead and stuck and gets in the way of living. This realization leads to another surprise: by helping us really be with sadness (and other emotions), mindfulness practice can keep us from getting stuck in depression.

We see here again how a psychological problem involves experiential avoidance. As long as we’re trying to not feel sad, angry, or some other emotion, we tend to shut down and not feel much of anything at all. And our body is in a constant state of stress as we tense up trying to keep these feelings at bay. This stress contributes to the difficulties with sleep, appetite, concentration, and interest that are so often a part of being depressed.

Mindfulness practices, by training us to open to our full range of emotions in the present moment, work against this depressive pattern. They help us to come alive in each moment.

Another way that mindfulness helps us to work with both anxiety and depression is by loosening our belief in our thoughts. Both difficulties involve a lot of painful thinking. In anxiety we worry about the future, in depression we may regret the past, or be full of negative, self-critical thoughts. Since mindfulness practices involve bringing our attention back to sensations in the present over and over, stepping out of the thought stream, they help to loosen our preoccupation with negative thoughts, making it easier not to believe in them so much.

 

[Daniel E.]

A couple excerpts from a five-part blog post:

To exemplify briefly how your early programming can explain your susceptibility to both anxiety and depression, consider the negative belief, "I'm not in control" (or "I'm out of control"). Not only does such a powerless self-regard (generally based on a compilation of childhood experiences) set you up to more readily react to situations as threatening or overwhelming, but such a defeatist attitude also fosters feelings of hopelessness virtually synonymous with depression.

Similarly, the negative notion, "I can't trust myself," serves to explain the passivity, indecisiveness, and inability to follow through on plans commonly observed in both anxiety and depression. And the procrastination, inaction or immobility resulting from such a lack of confidence generates even more self-doubt about being able to make the right choices. Needless to say, both anxiety and depression are de-motivating, which serves only to confirm a negative bias that may actually be quite at odds with what--potentially--you could achieve if you were able to change such antiquated ideas about yourself.

Aware of it or not, when you're anxious or depressed your thinking is invariably negative. You don't have a "can do" but a "can't do" attitude. Such a pessimistic orientation leads either to your being afraid to confront a problem (anxiety), or to despair of ever being able to solve it (depression). And regardless of whether your self-reflections eventuate in anxiety or depression, the ultimate belief about yourself can be reduced to "I'm not good enough"--though if your thinking is primarily anxiety-driven, it might be more accurate to say, "I'm afraid I won't be good enough." But aside from your underlying self-evaluation, if you're afflicted by the anxious habit of avoidance, you're destined to conclude that you simply don't have what it takes to succeed . . . which, inevitably, will make you feel depressed as well.

Anxiety and Depression--First Cousins, At Least (Part 4 of 5) | Psychology Today

How one might, for example, "evolve" from anxiety to depression:

Anxiety → Avoidance → Isolation → Loneliness → Feeling Abandoned & Alienated → Depression

Anxiety and Depression--First Cousins, At Least (Part 5 of 5) | Psychology Today

 

[rdw]

My "evolution" from anxiety to depression occured exactly as illustrated. After a series of life altering stressful events, I lost my ability to be resilient and my life spiralled downward. Thank you for that post.