Why Anxiety and Depression Are Often a Package Deal
Anxiety is struggling to keep your head above the water. Depression is losing hope that you will stay afloat. Dealing with one or the other in isolation is difficult enough, but when combined, it can feel like a tug of war between panic and hopelessness. Prevalence in both anxiety disorders and depression have significantly increased in the past decade, so it’s no surprise that we are seeing more of both disorders manifesting concurrently. In one study, it was found that “nearly half of older people with depression fulfill criteria for a concurrent anxiety disorder.” Another study explains that this prevalence is similar in children as well, stating that “between a quarter and half of youth with anxiety disorders have a comorbid [co-occurring] depressive disorder.”
This is an epidemic that is widespread across generations. This could be due to greater pressures in school and the workforce than ever before, greater pressures to succeed in life, greater financial strain (from the student debt crisis to inadequate retirement funding), and greater — or at least, different — everyday life stresses presented in today’s society compared to previous decades.
You may already know that statistics on anxiety and depression have been on the rise, with rates of general psychological distress having risen by 71 percent among young adults aged 18–25. Some correlations such as an increase in social media use might be linked to this problem, as stated in the article link.
Why are Anxiety and Depression So Closely Linked?
What stands out to me the most is that depression and anxiety are believed to possibly share a common neurobiological pathway, with evidence of serotonin and norepinephrine dysfunction in both disorders. Serotonin regulates mood and social behavior, while norepinephrine deals with mood, alertness, and energy. The same article also states that sustained arousal from frequent anxiety may deplete neurotransmitters, which can contribute to the emotional and physical symptoms of depression. That’s to say that chronic anxiety could lead to the onset of depression, rather than depression leading to anxiety, at least for this reason.
In my personal experience with anxiety and depression, I’ve found this to reflect my experience. If my anxiety is at bay for a while, then I usually find my depression to be at bay as well. But as soon as my anxiety starts to act up consistently for a while, I do find my depression soon catching up. I’ve dealt with both for a good chunk of my life, and I do believe it was disordered anxiety that affected me first, going as far back as early elementary school. Depression caught up closer to my middle school years.
How Comorbid Anxiety and Depression Affect Functioning
Those suffering from anxiety disorders are more likely to disengage from social events and activities like going out with friends to avoid distress. Especially with social anxiety, it can feel uncomfortable and stress-inducing to interact with groups of people and push yourself to be more involved, so the natural response is to retreat. However, this avoidant behavior ultimately leads to isolation which in turn, evokes depressive symptoms. In a study about the functioning of patients with comorbid Major Depressive Disorder (MDD) and Social Anxiety Disorder (SAD), it was found that “these patients were more severe on several variables related to social functioning, work functioning, MDD symptoms (e.g., suicidal ideation), and comorbid alcohol abuse/dependence, compared to patients with MDD.” Social functioning is of course additionally impacted by Social Anxiety Disorder on top of Major Depressive Disorder due to the additional struggles with social interaction.
This also makes sense in leading to functioning issues in the workplace, especially if your job involves heavy customer interaction. Not only are you facing struggles like feeling unmotivated to show up to work and do your best due to depressive symptoms, but you are also facing anxiety about the expectations around interacting with customers, coworkers, and management. And when it comes to a work culture mismatch or particularly negative work environment, this would be unpleasant for most people. But for those struggling with anxiety and depressive disorders, it can feel absolutely unbearable.
Treating Comorbid Anxiety and Depression
Because anxiety and depression share the same neurological pathway, there are many medications on the market that can target both disorders. Or at least, that’s the intention. Dr. Neil Liebowitz, medical director of the Anxiety and Depression Treatment Center in Farmington, Connecticut, says, “meds that treat anxiety alone may make some of the depression worse.” He explains that medications intended for depression but happen to treat anxiety are successful, but medications for anxiety alone can have adverse effects on depression. If a medication takes away all of a patient’s anxiety, they will become flat, careless, and unmotivated, which happen to be common depressive symptoms. On the other hand, sometimes anti-depressants and anti-anxiety medications don’t even work at all. SSRI’s, a commonly prescribed class of medication for anxiety and depression (think Prozac, Zoloft, Celexa, etc.), only work to completely decrease depression symptoms for about one-third of those who take it.
I am of the two-thirds of people that saw no results with SSRIs in treating either my anxiety or my depression. I never even experienced so much as a measly side effect while on these medications. If I had no awareness that I was even on these medications, I would have never known any difference, because that’s just how ineffective they were for me. You expect to respond to psychotropic drugs the same way you respond to birth control or narcotics or any other medication, but then so many of us experience nothing. It’s a confusing and infuriating process, especially when looking to treat more than one mental disorder, as with anxiety and depression. Of course, psychotherapy, adequate sleep, and getting enough exercise play a role in treating anxiety and depression too. However, we put so much trust into medication due to its physical ability to adjust the chemical imbalance that’s responsible for mental illness. Such a high failure rate in something that sounds so promising is disappointing, to say the least.
