Anxiety and depression
Depression and anxiety disorders are not the same thing.
Still, as many as 60% of people with depression often experience anxiety and as many people with anxiety, experience depressive symptoms.i In fact, depression and anxiety are two of the more common co-occurring conditions in mental health.ii There is no evidence one disorder causes the other.iii Yet, there is clear evidence that each disorder has its own causes, its own emotional and behavioral symptoms, and that many people suffer from both, separately and combined.iv
There are several theories as to why these two diseases are often paired together. One theory is that they work similarly within the brain, so they are likely to appear together.v Another theory is that because their symptoms overlap, people tend to meet the diagnostic criteria for both.vi However, no one really knows for sure. What is known is that people experiencing both anxiety and depression need to seek out help from someone who understands how to treat both at the same time.
In this article, we will clearly and broadly identify the different symptoms of depression and anxiety, along with various treatment options including medication and supplements.
Difference between anxiety and depression
Depression, also called clinical depression or major depressive disorder, is a common, serious mood disorder that affects how you feel, think and are able to function in your day-to-day life.vii Anxiety on the other hand is characterized by lengthy preparation for a real or perceived threat.viii
Symptoms of depression and anxiety
Signs of depression and anxiety vary between individuals and between the types of depression or anxiety disorder that they experience.
Depressive episodes are classified as mild, moderate and severe major depressive disorders based on the number, type and severity of symptoms the person experiences, as well as the impact that the depression has on their ability to function.ix For a health care provider to diagnose an individual with depression, the individual must have symptoms for at least two weeks.
Signs of depression include:x
- Lasting feelings of unhappiness or hopelessness
- Loss of interest in things or activities that once were enjoyed
- Feeling tired, sleeping all of the time or sleeping poorly
- Aches and pains
- Loss of appetite or sex drive
- Trouble concentrating, restlessness or irritability
- Memory lapses or trouble making decisions
- Thoughts of death or suicide or attempts at suicide
People with chronic depression may also experience persistent physical symptoms, such as headaches, stomach problems or pain that do not respond to treatment or have no other cause.
As there are different types of depression, there are different types of anxiety. People with generalized anxiety disorder (GAD) experience excessive anxiety or worry, most days for at least six months.xi Worries can include anything, and even the most mundane worries can cause significant problems in their lives. Generalized anxiety disorder symptoms include:xii
- Restlessness, worrying or being on-edge
- Fatigue
- Difficulty concentrating
- Irritability
- Muscle tension
- Difficulty falling or staying asleep
People with panic disorder have recurrent, unexpected, periods of intense fear that come on quickly and reach their peak within minutes.xiii During a panic attack, people may experience:xiv
- A pounding heartbeat
- Sweating
- Shaking
- Shortness of breath
- The feeling that something bad is going to happen soon.
Phobias are fears of specific objects (like needles) or situations (like flying) that are out of proportion to the actual danger caused by the situation or object.xv People with a phobia tend to:xvi
- Excessively or irrationally worry about encountering the feared object or situation
- Take active steps to avoid whatever it is they fear
- Experience immediate intense anxiety when in the presence of the feared object or situation
Treatment for anxiety and depression
Medication for anxiety and depression are often the same medications. Additional anxiety and depression medicine may be used depending on the circumstances. In either case, it is important to note that any of these medications may take up to four weeks to begin having an effect, and up to 12 weeks to reach full effect. Also, it's common to have to try various medications or doses of medications to find out what works for you.
Medications used to treat both depression and anxietyxvii, xviii
| Therapeutic group | How they work/when they're used | Medication names |
|---|---|---|
| Selective serotonin reuptake inhibitors (SSRIs) | Increase levels of serotonin, a brain chemical |
|
| Serotonin and norepinephrine reuptake inhibitors (SNRIs) | Increase levels of the brain chemicals serotonin and norepinephrine |
|
| Tricyclic antidepressants | Older medications that are used when other antidepressants have not worked |
|
| Monoamine oxidase inhibitors (MAOIs) | Older medications that can be effective when other antidepressants haven't worked |
|
| Therapeutic group | Selective serotonin reuptake inhibitors (SSRIs) |
|---|---|
| How they work/when they're used | Increase levels of serotonin, a brain chemical |
| Medication names |
|
| Therapeutic group | Serotonin and norepinephrine reuptake inhibitors (SNRIs) |
|---|---|
| How they work/when they're used | Increase levels of the brain chemicals serotonin and norepinephrine |
| Medication names |
|
| Therapeutic group | Tricyclic antidepressants |
|---|---|
| How they work/when they're used | Older medications that are used when other antidepressants have not worked |
| Medication names |
|
| Therapeutic group | Monoamine oxidase inhibitors (MAOIs) |
|---|---|
| How they work/when they're used | Older medications that can be effective when other antidepressants haven't worked |
| Medication names |
|
Additional medications used to treat depressionxix
| Therapeutic group | How they work/when they're used | Medication names |
|---|---|---|
| Norepinephrine-dopamine reuptake inhibitors (NDRIs) | Increase brain levels of dopamine and norepinephrine |
|
| Second-generation antipsychotics or atypical antipsychotics | Used for treatment-resistant depression |
|
| Therapeutic group | Norepinephrine-dopamine reuptake inhibitors (NDRIs) |
|---|---|
| How they work/when they're used | Increase brain levels of dopamine and norepinephrine |
| Medication names |
|
| Therapeutic group | Second-generation antipsychotics or atypical antipsychotics |
|---|---|
| How they work/when they're used | Used for treatment-resistant depression |
| Medication names |
|
Additional medications used to treat anxietyxx
| Therapeutic group | How they work/when they're used | Medication names |
|---|---|---|
| Benzodiazepinesxxi | Promotes relaxation and reduces muscular tension | alprazolam, clonazepam, diazepam, lorazepam |
| Buspironexxii | The mechanism of action is unknown. Buspirone does not exert anticonvulsant, muscle relaxant or sedative effects. | Only generic versions of Buspar are available in the US |
| Miscellaneousxxiii | Multiple medications that are approved for other uses but prescribed for the treatment of anxiety.
|
|
| Therapeutic group | Benzodiazepinesxxi |
|---|---|
| How they work/when they're used | Promotes relaxation and reduces muscular tension |
| Medication names | alprazolam, clonazepam, diazepam, lorazepam |
| Therapeutic group | Buspironexxii |
|---|---|
| How they work/when they're used | The mechanism of action is unknown. Buspirone does not exert anticonvulsant, muscle relaxant or sedative effects. |
| Medication names | Only generic versions of Buspar are available in the US |
| Therapeutic group | Miscellaneousxxiii |
|---|---|
| How they work/when they're used | Multiple medications that are approved for other uses but prescribed for the treatment of anxiety.
|
| Medication names |
|
Natural remedies for anxiety and depression
Meditation therapy and relaxation techniques have demonstrated small to modest benefits for people with anxiety-related symptoms or depression.xxiv Unfortunately, there is a lack of studies with adequate statistical power in people with clinically diagnosed disorders, which makes it difficult to draw firm conclusions about their usefulness in treating these diseases.xxv,xxvi However, both of these practices have minimal side effects and may help the individual in some way.
Natural supplements for anxiety and depression
Some people find that taking vitamins for anxiety and depression lessens the symptoms of their mental illness, and may help a person's mood overall. Likewise, some people with mental illness have been shown to have low folate levels and may benefit from treatment with additional folate.xxvii Folate, also called folic acid or vitamin B9, is a vitamin that the human body cannot make on its own, yet is required to perform many essential processes on a day-to-day basis.
Other popular natural supplements include the use of chamomile and lavender, but findings so far are inconclusive.xxix Melatonin does have an impact on sleep and is helpful. Kava, derived from a pepper, may have an effect on anxiety, but is linked to severe liver disease and should be used only with the monitoring of a health care provider.xxxi
There has been extensive research on St. John's wort, especially on its use for depression. While the results on its effectiveness are mixed, it has been clearly shown that St. John's wort can interact in dangerous, sometimes life-threatening ways with a variety of medicines, and should not be taken without the supervision of a knowledgeable health care provider.xxxii
S-Adenosyl-L-methionine (SAMe) is a chemical that is found naturally in the body and sold as a dietary supplement. SAMe has been studied primarily for depression, osteoarthritis and liver diseases. Although there is some hint that it might be helpful for depression, the evidence is not conclusive.xxxiii Make sure to consult a health care provider before taking SAMe if you are pregnant or nursing, if you take medicine or other dietary supplements, if you have bipolar disorder or Parkinson's disease, if you're HIV-positive, or if you're considering giving SAMe to a child.xxxiv
Valerian is used as a dietary supplement for anxiety and depression among other conditions. Studies suggest that valerian is generally safe for use by most healthy adults for short periods of time, but there is not enough evidence to allow any conclusions about whether valerian can relieve anxiety or depression.xxxv
Anxiety and depression are serious, common, complex conditions that frequently co-occur. Whether experiencing anxiety, depression, or depression and anxiety together, it is important to seek the help of a mental health professional to navigate treatment and optimize your recovery.
Published on October 18, 2019
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