Anxiety vs. Depression Symptoms and Treatment

The Relationship Between Anxiety and Depression

Anxiety and depression share a biological basis. Persistent states of anxiety or low mood like those experienced by people with clinical anxiety and mood disorders involve changes in neurotransmitter function. Low serotonin levels are thought to play a role in both, along with other brain chemicals such as dopamine and epinephrine.

While the biological underpinnings of these problems are similar, anxiety and depression are experienced differently. In this way, the two states might be considered two sides of the same coin.

Anxiety and depression can occur sequentially (one in reaction to the other), or they can co-occur. When anxiety and mood problems reach the threshold for clinical diagnosis simultaneously, the specific diagnoses are considered comorbid conditions.

Mental Differences: Anxiety vs. Depression

Anxiety and depression have distinct psychological features. Their mental markers (symptoms or expressions of the condition) are different.

Mental Markers of Anxiety

People with anxiety may:

• Worry about the immediate or long-term future
• Have uncontrollable, racing thoughts about something going wrong
• Avoid situations that could cause anxiety so that feelings and thoughts don’t become consuming
• Think about death, in the sense of fearing death due to the perceived danger of physical symptoms or anticipated dangerous outcomes

Depending on the nature of the anxiety, these mental markers can vary. For example, someone with generalized anxiety disorder (GAD) may worry about a variety of topics, events, or activities. A person with social anxiety disorder (SAD), on the other hand, is more apt to fear negative evaluation or rejection by others and to be apprehensive about meeting new people or other socially challenging situations.

Obsessions are unrealistic thoughts or mental impulses (sometimes with a magical quality) that extend beyond everyday worries. They are the hallmark mental manifestation of anxiety in people with ​obsessive-compulsive disorder (OCD).

Mental Markers of Depression

People with depression may:

• Be hopeless, assuming that nothing positive will happen in the future for themselves, for others, or for the world
• Believe it is not worth trying to think or feel differently, because of this hopelessness
• Feel worthless, as if who they are or what they do is not valuable
• Think about death due to a persistent belief that life is not worth living or that the individual is a burden on others. In cases of moderate to severe depression, more specific suicidal thoughts can be present.

In major depressive disorder (MDD), these types of thoughts are persistent most of the day and more days than not for weeks on end. If a person vacillates between a very low and very high mood state, then a diagnosis of bipolar disorder may apply. For any variant of a mood disorder, the low mood state is likely to be characterized by the type of thinking described above.

Physical Differences: Anxiety vs. Depression

The physical symptoms of both anxiety or depression can be exhausting for the afflicted individual.

Physical Signs of Anxiety

The physical state of anxiety can be conceptualized overall as that of heightened arousal. Specific characteristics include:

• Difficulty concentrating due to state of agitation or racing thoughts
• Difficulty falling or staying asleep due to racing thoughts or other physical symptoms
• Dizziness
• Gastrointestinal distress (e.g., nausea, diarrhea, or constipation)
• Increased heart rate, blood pressure, sweating
• Muscle tension
• Shortness of breath

Physical Signs of Depression

Depression is primarily characterized by changes in usual physical processes from baseline, such as:

• Difficulty with concentration, focus, and memory due to ruminative thought processes or other physical symptoms
• Lack of energy
• Loss of appetite or a significant increase in appetite
• Moving or talking more slowly than usual
• Physical achiness without cause
• Sleeping much more or much less than is typical due to ruminative thought processes or low energy

Symptom Severity

It is not unusual to experience brief periods of low mood or anxiety, particularly in response to certain life stressors (for example, loss of a loved one, receiving a diagnosis of a physical illness, starting a new job or school, experiencing financial problems, etc.).

To meet the diagnostic threshold of an anxiety disorder, however, symptoms must be persistent (often for several months) and impairing.

To assess the severity of your symptoms:

1. Ask yourself some key questions about how much the symptoms are getting in the way of your day-to-day functioning. You might also ask trusted friends and family members if they have noticed changes in you and your behavior, and if so, what those changes are.
2. Read about typical presentations of mild, moderate, and severe versions of depression or anxiety.
3. Track your psychological and physical symptoms for a week or two to get an accurate representation of fluctuations in mood and anxiety.

Treatment for Anxiety and Depression

Even if you decide that your anxiety or mood problem is a low-grade issue for you, it is still worth working on. Consider how much it is interfering with your life, and in what ways, to determine what kinds of interventions might be helpful.

Self-Help Approaches

If your symptoms are mild, tending to ebb and flow, or if you have had formal treatment previously and are concerned about relapse, self-help interventions can be a reasonable place to start.

These approaches can include self-help books and phone apps that adapt evidence-based psychotherapies or offer a way to practice skills that target a symptom (such as mindfulness meditation for anger or anxiety).​

Psychotherapy

For depression and/or anxiety problems, there are several types of talk therapy. In structured psychotherapy, like cognitive behavioral therapy (CBT), the treatment approach for anxiety and depression can vary slightly. For both issues, CBT will teach you how to work with unhelpful thought traps. And, for either problem, CBT is likely to ask that you do more behaviorally.

For anxiety, the goal is to minimize avoidant behavior and to help you disconfirm a feared consequence. For depression, the goal is to help you experience positive emotion, a surge in energy (even if briefly), or another type of pleasant interaction with the world. The theory is that activating behavior, even when—or especially when—your energy or mood is low, can result in some type of positive reward.

In psychodynamic talk therapy, sessions for anxiety and depression may look more alike than different. You will be asked to speak freely about the past and the present in order to become aware of unconscious thoughts and conflicts underlying your symptoms.

Do not despair if you think you are experiencing separate, co-occurring anxiety and mood symptoms. There is an overlap in effective psychotherapies for these problems.

Medications

A group of medications known as selective serotonin reuptake inhibitors (SSRIs) has been shown to be helpful for both anxiety and depression. Other medications that may be used depending on your symptoms include tricyclic antidepressants (TCAs), selective norepinephrine reuptake inhibitors (SNRIs), and anti-anxiety medications.

How to Seek Help

When seeking more formalized help for anxiety or depression, start by speaking with your primary care physician.

You can also research local referrals via national organizations including:

• The Anxiety and Depression Association of America
• The Association for Behavioral and Cognitive Therapies
• The Association for Contextual Behavioral Science
• The American Psychiatric Association             

Bear in mind that while effective treatment for anxiety or depression need not be a long-term commitment, it is likely to require regular, ongoing appointments at least in the short term (say, six to 12 months). Therefore, it is critical to find a professional you trust and with whom you feel comfortable speaking about your symptoms.

It is equally important to make sure that you find a clinician that you can afford. Before making the commitment to ongoing care, you may want to meet with a couple of providers to get a feel for their therapeutic styles and their treatment recommendations. You can then use this information to determine which path forward feels best to you.