Most people experience feelings of anxiety or depression at times. Grief, loss of a job, divorce, illness, and other stressors can lead to feelings of sadness, worry, frustration, and loneliness. These are normal reactions to difficult life situations.
Some people experience these feelings daily, without a known stressor. This can interfere with the ability to carry out every day activities such as getting to work on time, proper self-care, or caring for children. In this case, people might be suffering from depression, anxiety, or a combination of the two.
Depression and anxiety can co-occur. Studies show that between 10% and 20% of adults in any given 12-month period will visit their primary care physician during a depressive or anxiety disorder episode, and that nearly 50% of them will suffer from a co-morbid, secondary depressive or anxiety disorder.
The presence of co-occurring depressive and anxiety disorders is associated with greater chronicity, slower recovery, increased rates of recurrence, and psychosocial disability.
It’s always helpful to know what symptoms to watch for and the most effective treatments.
Symptoms of major depressive disorder
The essential feature of major depressive disorder is a period of two weeks during which there is either depressed mood most of the day nearly every day or loss of interest or pleasure in nearly all activities. Other potential symptoms include:
- Significant weight loss when not dieting or weight gain and changes in appetite
- Insomnia or hypersomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- Fatigue or loss of energy nearly every day
- Feelings of worthlessness or excessive guilt
- Impaired ability to think or concentrate, and/or indecisiveness
- Recurrent thoughts of death, recurrent suicidal ideation without a plan, or a suicide attempt or suicide plan
The symptoms of major depressive disorder cause significant distress or impairment in social, occupational, or other areas of functioning.
Symptoms of Generalized Anxiety Disorder
The essential feature of generalized anxiety disorder is excessive anxiety and worry about a number of events or activities. The intensity of the worry is out of proportion to the likelihood of the anticipated event. The excessive worry or anxiety occurs more days than not for a period of at least six months.
Anxiety and worry are associated with at least three (or more) of the following symptoms, with at least some symptoms present more often than not during the six-month period:
- Restlessness or feeling keyed up or on edge
- Easily fatigued
- Difficulty concentrating or mind going blank
- Muscle tension
- Sleep disturbance
To meet the criteria for generalized anxiety disorder, the anxiety, worry, or physical symptoms cause significant distress in social, occupational, or other areas of functioning.
There are several features that separate generalized anxiety disorder from nonpathological anxiety.
- Worries are excessive and typically interfere with psychosocial functioning
- Worries are more pervasive, pronounced, and distressing
- Worries have longer duration
- Worries are more likely to be accompanied by physical symptoms (restlessness, keyed up)
People with generalized anxiety disorder are likely to experience somatic symptoms (sweating, nausea, diarrhea), muscle tension, and an exaggerated startle response.
Treatment of anxiety and depression
A treatment plan for co-occurring anxiety and depression should be designed to help the person manage and reduce symptoms of both disorders at the same time.
Several forms of psychotherapy are widely available and effective for both anxiety and depression.
- Cognitive Behavioral Therapy (CBT): This short-term therapy works to replace negative and unproductive thought patterns with more realistic and useful ones. This treatment focuses on taking specific steps to manage and reduce symptoms.
- Interpersonal “talk” therapy: This attachment-focused therapy centers on resolving interpersonal problems and symptomatic recovery.
- Problem solving therapy: This treatment helps people learn tools to effectively manage the negative effects of stressful life events.
Both anxiety and depressive disorders respond to treatment with selective serotonin reuptake inhibitor (SSRI) and serotonin norepinephrine reuptake inhibitor (SNRI) medications.
Long-term, combined treatment (psychotherapy and medication management) is typically recommended for people with co-occurring anxiety and depression.