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Comorbidity of Depression and Anxiety

Depression. Anxiety.  Although they are two distinct conditions, many of their symptoms overlap, and many people suffer from both. There is no one-size-fits-all model, but let’s learn a bit more about how they interact with each other.


Comorbidity

Anxiety and depression have a high comorbidity, which is to say that many people are diagnosed with both of them. It is estimated that as many as 60% of people who suffer from anxiety will also experience depression, and vice versa.

Managing both at the same time presents a unique challenge. They do share a few common symptoms. Both can cause sleep disturbances, irritability, and trouble concentrating, for example. But from there, anxiety and depression are engaged in a subtle tug-of-war:

  • Anxiety may cause worry about the future. Depression may make a person lose hope in it.
  • Anxiety can initiate racing thoughts about things going wrong. The hopelessness of depression may make us feel that it is impossible to stop them.
  • Those suffering from anxiety may avoid situations that they fear would trigger it. Those suffering depression may withdraw from others because of a feeling of worthlessness.
  • Both may cause frequent thoughts of death: anxiety because of the fear of danger, depression because of the sentiment that life is not worth living.

This interplay of symptoms can make an already rough road even rockier.

What is the link between the two?

Science has not been able to answer definitively why depression and anxiety go hand in hand, but there are theories. By beginning to understand them, we may be able to get more of a grasp of the conflicts of being afflicted by both.

Science has not been able to answer definitively why depression and anxiety go hand in hand, but there are theories. By beginning to understand them, we may be able to get more of a grasp of the conflicts of being afflicted by both.

Behavior

Which comes first? It depends on the individual.

Anxiety can appear as a symptom of major depression. Feeling down may drain a person of the energy to do things they would typically enjoy. After a period of isolation, attempts to re-engage with the world may result in nervousness and anxiety.

Or a person dealing with anxiety may develop depression. Those suffering from anxiety disorders – generalized anxiety, OCD, or social anxiety, for example – may spend a great deal of time in an agitated state of mind. The huge emotional toll of this can invite depression. Anxiety might also lead to avoidance and isolation. Isolation can result in a lack of opportunity for pleasurable experiences, which then leads to low mood.

Anxiety might also lead to avoidance and isolation.

 

Biology

Some theories about the biology:

  • At the neurological level, a protein that is associated with anxiety (CRFR1) appears to increase the number of certain serotonin receptors (5-HTRs) in some regions of the brain. This could cause abnormal signaling – i.e., depression and anxiety responses.
  • Because serotonin, dopamine, and epinephrine are involved in both anxiety and depression, it is thought that fluctuating levels may account for the presence of both – whether simultaneous or sequential.

What You Can Do

One ray of hope is that certain interventions can be helpful for both anxiety and depression. If you find yourself caught in this tug of war, try any combination of these tactics that feels right.

Depression and anxiety are medical conditions. Don’t think that you’re flawed or have failed in some way if you are in the throes of conflicting emotion. It’s not caused by anything you did, or didn’t do.

Depression and anxiety are medical conditions. Don’t think that you’re flawed or have failed in some way if you are in the throes of conflicting emotion. It’s not caused by anything you did, or didn’t do.


Gain control, in small ways.

Give yourself a small, achievable task – something as simple as making your bed, for example – and let your brain feel the satisfaction of completing it. Add more tasks as you are ready. If you can build up to a daily routine, so much the better – this has been shown to empower those with depression and to ease anxiety.


Set yourself up for great sleep.

When anxiety and depression are acting up, sleeping is hard. Try to remove any factors within your control that might disturb it. Have comfortable bedding. Keep the room at a pleasant temperature. Try to remove electronics and other distractions. Minimize noise that may disturb you. If possible, have a regular bedtime and pre-sleep routine. Sleep is so essential, and you deserve the rest.

Feed your body.

Nature can help with healing. Don’t beat yourself up if you use comfort foods to cope with the hard days, but find ways to gently introduce nutritious, natural foods. One easy way, if it appeals to you, is to start each meal with one raw fruit or vegetable – like an apple, or a handful of baby carrots.

Move. 

Please don’t pressure yourself to exercise with a fitness goal in mind – you don’t need that burden right now – but do see if you can find a pleasurable way to move. Dance around the living room. Go for a walk. If it makes you feel good, you’ve got it right.

Indulge. 

Forget the idea that pleasures have to be guilty. Find something harmless that makes you feel comforted, and give yourself permission to do it. Binge watch a show. Get a pedicure. It doesn’t matter – just so it puts zero pressure on you and makes you feel good today.


Connect.

If you can, find a trusted friend or someone else who you are comfortable talking to and start a conversation. This can provide a boost. Breaking isolation can also lighten a burden of worry or hopelessness.

Any of these may work. Try to find the self-care routine that suits your needs. It’s different for everyone. Just know that it’s understood that anxiety and depression are often a very challenging two-for-one deal, but you can find a way to manage them both.


References

Glasofer,Deborah R.PhD. Reviewed by Amy Morin, LCSW.  Anxiety vs. Depression Symptoms and Treatment: Overlapping and distinguishing features of anxiety and depression. July 7, 2020. VeryWellMind.com

Holland, Kimberly. Medically reviewed by Timothy J. Legg, Ph.D., CRNP. Depression and Anxiety: How to Identify and Treat Coexisting Symptoms.  Healthline.

Rodriguez, Diana. Medically Reviewed by Pat F. Bass III, MD, MPH. How to Cope With Anxiety and Depression. July 30, 2020. EverydayHealth.com

Salcedo, Beth, MD. The Comorbidity of Anxiety and Depression. Jan. 29, 2018. National Alliance on Mental Illness.

Sawchuk, Ph.D., L.P., Craig N. Depression and anxiety: Can I have both? Mayoclinic.org

University of Western Ontario. Biological link between stress, anxiety and depression identified. April 19, 2010. Science Daily.

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