Depression and anxiety often occur together

Research studies show that anxiety and depression very often exist together. They can lead to a vicious cycle that perpetuates itself. If you have an anxiety disorder, you are 50% more likely to have also experienced depression as well. These rates are not surprising. When you consider how disheartening and exhausting it can be to live with a poorly managed or untreated anxiety disorder. People who are depressed often feel anxious and worried. One can easily trigger the other, with anxiety often preceding depression.

Feelings of hopelessness and symptoms of depression may develop as your anxiety becomes more intense and long-lasting. Anxiety and depression are both negative emotional states that are usually accompanied by a range of unhelpful thoughts, physical reactions, and behaviours. Anxiety is typically perceived as a high-energy state, whereas depression is viewed as a low-energy state. Thus, these psychological disorders are inherently distinct from each other. The main features of anxiety disorders are excessive worry, anxiety, fear and avoidance of the things that trigger anxiety, while the main characteristics of major depression are excessive sadness or emptiness, a lack of motivation, and experiencing less pleasure from the activities we usually enjoy. 

There are, however, several symptoms that commonly overlap such as fatigue, changes in appetite, difficulty concentrating, irritability and problems with sleep. Fortunately, the symptoms of depression associated with anxiety disorders often go away or lessen significantly when you receive treatment for your anxiety. Evidence-based research also suggests that both anxiety and depression can be treated at the same time.

What is depression?

Low mood, feelings of sadness, hopelessness, low self-worth or guilt, and a loss of interest in previously enjoyed activities characterise depression as an emotional state. Depression can cause various emotional and physical issues that result in decreased ability to function both at work and home.

We all have bad days and it is normal to feel sad, helpless, or inadequate at times. These feelings are completely normal responses to stressful or upsetting events that we experience, like a serious illness or injury, financial worries, a relationship break-up, or losing a beloved pet. Our negative feelings might be overwhelming and painful, but they become less intense as time goes by. Normal sadness goes away on its own.

How do we know whether we are experiencing normal sadness or depression?

Sadness is linked to a specific situation and we may feel upset, miserable, or teary when something bad happens. However, when you are sad about one thing, you can usually still feel happy about other things. Like the weather, sad feelings come and go as a natural part of life. Sadness is not a negative thing that we should avoid. In fact, happiness would not exist without sadness; joy needs an opposite. Sadness reminds us that we care about people, places and things. It is the price we pay for engaging in life.

Depression is different from having a bad day, feeling sad or going through a rough patch. Those experiencing loss often describe themselves as being ’depressed’, but the sadness that comes with grieving is not the same as having depression. This psychological disorder is more than sadness in response to life’s struggles; depression changes how you think, feel, and function in your daily activities. It can interfere with your ability to eat, sleep, study, work, love, and enjoy life. Just trying to get through the day can be a daunting challenge.

What causes depression?

Current research shows that depression does not have a single cause i.e. people become depressed for many different reasons and that the causes may vary from person to person. Depression can be triggered by a physical illness, a life crisis, or it may occur for no apparent reason. It is important to remember that depressive disorders are not the result of personal weakness or a character flaw. 

Experts have identified several factors that may increase your risk of developing depression:

Genetics

Research shows that having a close relative with depression increases your chances of experiencing depression yourself. In other words, depressive disorders have a biological basis and run in families. This means they can be inherited from one or both parents, similar to eye colour, allergies, or the risk for heart disease. However, this does not mean that you will automatically experience depression if a parent or close relative has had the condition.

Biology

Many brain researchers argue that changes in the brain’s physical structure or an imbalance of chemicals may cause mood disorders like depression. For instance, if there is a shortage of chemical messengers (neurotransmitters) in the brain, depression may develop. Serotonin, norepinephrine, and dopamine are examples of neurotransmitters affecting one’s mood.

Personality type

Individuals with certain personality traits are more susceptible to developing depression. For instance, if you have low self-esteem, are prone to stress, sensitive to criticism, perfectionistic and self-critical, or generally have a pessimistic and negative outlook, you may be at higher risk of experiencing depression.

Trauma

Experiencing severe trauma at an early age, such as child abuse or losing a parent, can increase your risk of developing depression. Childhood trauma can cause long-term changes in how our brains respond to stress and stress, and these changes may lead to depression. This does not mean that you will automatically develop depression if you had traumatic experiences as a child.

Stress

Everyone encounters stress, but long or intense periods of unresolved stress can increase your chances of developing depression. For example: work pressure and long working hours, being unemployed, and money problems. Prolonged stress takes a toll on our bodies and is strongly related to mood disorders (see page 21).

Sudden and traumatic life events, like the death of someone you love or a divorce, can trigger depression. Positive life events such as starting a new job, graduating, getting married, or having a baby may also lead to depression. Our past experiences and the ways we have learned to cope with them will influence which situations we find stressful and how we deal with them now.

Negative thinking

Negative thinking (‘I’m going to fail’, ‘I can’t cope’, ‘it is hopeless’) often reduces our ability to cope with life’s challenges and may lead to depression.

Medical factors

A life-threatening physical health condition, such as cancer or a chronic painful illness, may cause mood symptoms or make them worse. Thyroid problems are also associated with an increased risk of depression.

Social isolation

A lack of social support can be a risk factor for the development of depression. Being alone for an extended period of time, such as during the Covid-19 lockdown, may increase symptoms of depression or trigger a mood disorder.  

Sex or gender

Women are twice as likely as men to have a depressive disorder. Hormonal factors may be one of the reasons for this statistic, but researchers argue that cultural stressors also play a role. This is because women often have unequal status and power in society and are more likely to experience abuse.

Hormone changes

Hormonal fluctuations during the menstrual cycle, pregnancy and menopause can play a role in the development of depression.

Use of an illicit substance

The chemical effects of alcohol and certain drugs (such as cocaine) may lead to symptoms of depression. In addition, many people struggling with depression also have drug and alcohol problems. 

Certain prescription and over-the-counter (OTC) medications may cause symptoms of depression, such as sleeping pills, blood pressure medication, birth control medication, and hormone replacement therapy.

If you consider the above factors, you are more likely to develop depression if you are a divorced, menopausal woman who has a history of childhood trauma, and alcohol abuse. However, depression can affect anyone and may develop without an obvious external cause.

Different types of depressive disorders

Everyone feels low, sad, upset, or unmotivated from time to time and this is normal. Depression is different from feeling down in the dumps because of stressful life events. If you have depression you experience intense and overwhelming feeling of sadness, isolation and despair that do not go away on their own, and affect how you think, feel and act. These distressing feelings often become more frequent and intense and may lead to thoughts of suicide.

Although the exact cause of depression is unknown, a biological vulnerability or a traumatic event may trigger it. Alternatively, it may have little to do with what is happening around you. Even if you have a loving family, caring friends, and a dream job, you can still experience depression. Depression is a mood disorder that can occur at any time and affects people of all ages, races, and socioeconomic classes. 

There are several types of mood disorders and symptoms can range from relatively minor (but still disabling) through to very severe. 

The most common are:

Major Depressive Disorder

Clinical depression or unipolar depression, also known as Major Depressive Disorder, is the most common type of depression. The main symptoms of this psychological disorder are low mood and a lack of interest in daily activities. If you have Major Depressive Disorder, you are likely to experience these symptoms every day and for most of the day. The constant feeling of sadness or loss of interest in life can lead to a range of physical symptoms, such as changes in sleep, appetite, energy level, and concentration. People with Major Depressive Disorder often experience recurrent episodes throughout their lives.

Dysthymia

The symptoms of Dysthymia are very similar to those of Major Depressive Disorder, but they are less severe and last longer. You must have this milder form of depression for more than two years to be diagnosed with Dysthymia.

Bipolar Disorder (Manic Depression)

Bipolar Disorder was previously known as Manic Depression because people with this diagnosis experience alternating periods of depression and hypomania/mania, with periods of normal mood in between.

Cyclothymia

Cyclothymia is often described as a mild form of Bipolar Disorder. The symptoms of Cyclothymia are very similar to Bipolar Disorder, except that they are less severe and do not last as long.

Antenatal (Prenatal) Depression

Antenatal Depression occurs during pregnancy. Common symptoms include a lack of excitement about the pregnancy, feeling disconnected from the developing baby, and an inability to feel any kind of bond with the baby growing in your womb. It often negatively affects the relationship between the mother and the baby after childbirth. Research studies suggest that depression during pregnancy may be even more common than Postnatal Depression (depression after pregnancy). However, some women may experience both as Antenatal Depression increases the risk of Postnatal Depression, if left untreated.

Postnatal (Postpartum) Depression

Many new mothers feel a bit down, tearful, or anxious during the week after childbirth. They call it the “baby blues” and consider it normal because it is so common. However, some new mothers experience a more severe and long-lasting form of depression, known as Postnatal Depression. They cry excessively, feel very depressed or experience severe mood swings. They have difficulty bonding with their new baby, and often fear that they will hurt their child. Postnatal Depression is a fairly common problem that affects at least 1 in every 10 women. It can start at any point during the first year after childbirth and may develop gradually or suddenly.

Seasonal Affective Disorder (SAD)

SAD is a mood disorder that follows a seasonal pattern and usually occurs in winter. A lack of natural sunlight is believed to trigger this type of depression. If you have SAD, you are likely to eat and sleep too much. You may experience weight gain, a lack of energy, and mood disturbances (either periods of depression or mania) that begin and end in a specific season. SAD is usually diagnosed after you have had the same symptoms during the same season (usually winter) for two or more years. 

Treating depression and anxiety

The good news is that depression is treatable. Cognitive behavioural therapy (CBT) is a very effective therapeutic technique that is used all over the world to treat a range of mental health conditions, including depression. In the treatment of depression and anxiety, researchers have found CBT to be equally, if not more effective than medicine.

Many therapists combine CBT with Dialectical Behavioural Therapy (DBT), when working with depressed clients. The main goal of DBT is to help you to manage your emotions. During DBT groups you will learn skills such as mindfulness and distress tolerance techniques. These will help you to accept the present moment with willingness, rather than despairing an unchangeable reality. 

Developing essential life skills (such as assertiveness, healthy boundaries, effective communication, activity scheduling, stress management and self-care) is an important part of a successful treatment programme for depression. Our occupational therapist will help you to identify and build the skills that you need for psychological wellbeing.