Dear Dr. Eva,
What’s the difference between depression and anxiety? I was told at different times that I have both. Is it just two names for the same thing?
Depression and anxiety are two different conditions and involve two different sets of problems, but it isn’t unusual for a person to have both conditions. Both depression and anxiety are disorders of mood, called “affective disorders” in medical language. For most people who have both depression and anxiety, one of the two conditions is more severe, which leads to diagnoses like “depression with features of anxiety,”or “anxiety with features of depression.” Many people with depression have problems that are common in anxiety disorder as well, like nervousness, irritability, problems concentrating and trouble sleeping. Still, anxiety and depression are not the same thing.
- being nervous, irritable or “on edge”
- fear of approaching danger, panic or death
- rapid heart rate
- rapid breathing (hyperventilation), and
- increase in sweating.
Anxiety disorders are the most common mental disorders in the United States. About three out of every 10 Americans will have an anxiety disorder in adulthood. All types of anxiety disorders cause excessive fear and worry. Other common signs of anxiety include:
Anxiety increases a person’s awareness of body sensations, which often results in worry about one’s health. A person who fears that every chest twinge is the beginning of a heart attack and every abdominal cramp is a sign of cancer very likely has anxiety. General Anxiety Disorder (GAD) is the most common type of anxiety. People with less common types of anxiety may have more specific fears, also called phobias. These include fear of leaving the house (agoraphobia), fear of social gatherings (social phobia) and fear of enclosed spaces (claustrophobia). Even more specific forms of anxiety include test anxiety and fear of spiders, called arachnophobia. Panic disorder and post-traumatic stress disorder (PTSD) are other types of anxiety disorder.
Just as excessive worry is the key sign of anxiety, persistent sadness or irritability and loss of interest or pleasure in life are the key signs of depression. Like anxiety, there are different forms of depression. Major Depressive Disorder (MDD) is the most common type. While both anxiety and depression can severely affect a person’s ability to function in daily life, depression is more likely to cause disability and much more likely to lead to death, through suicide. Depression is the leading cause of disability in the US among people ages 15 to 44. (Statistics from the 2016 National Survey on Drug Use and Health, National Institutes for Mental Health.) About two out of every ten Americans will have depression in adulthood.
Major depression is present when a person has at least five symptoms of depression for more than two continuous weeks, and one of the symptoms is either a deep feeling of sadness or a loss of interest in most activities the person used to enjoy. Other signs of major depression include:
- change in appetite (decreased or increased)
- not sleeping well or excessive sleeping
- physically slowing down – slower speech, moving slower or, less often, agitation (overactivity)
- constantly feeling tired
- feeling worthless
- feeling hopeless
- recurrent thoughts of death (even if there are no thoughts of committing suicide)
- problems in thinking, like difficulty concentrating or making decisions
- worsening social, work, or school activities. For example, the person may start missing work or school, or may stop their usual social activities. They may isolate themselves from others.
For both depression and anxiety, talk therapy and medication are helpful. The combination of talk therapy and medication helps the most. The most useful types of talk therapy are:
- cognitive behavioral therapy, which teaches how to adjust your thoughts and actions
- interpersonal therapy, which shows you how to communicate better
- problem-solving therapy, which teaches you skills to manage your symptoms
Because the brain chemical imbalances involved in depression and anxiety are similar, the same medicines work for both conditions. Useful medications include SSRIs (selective serotonin reuptake inhibitors), SNRIs (serotonin-norepinephrine reuptake inhibitors), and others such as bupropion (Wellbutrin.) Some common SSRIs are fluoxetine (Prozac), sertraline (Zoloft), paroxitine (Paxil), citalopram (Celexa), and escitalopram (Lexapro). Some examples of SNRIs are duloxetine (Cymbalta) and venlefaxine (Effexor).
- Eva Hersh is a family physician. Send your comments and questions to her by email at email@example.com