Anxiety and depression are common mental health challenges. Both can affect your mood, emotions, and physical health. For many individuals, they even occur together.
Anxiety Versus Depression
Depression and anxiety may be experienced differently by different people. Here are some of the broad symptoms of these mental health concerns.
It is normal to feel down or unmotivated from time to time. However, if certain symptoms persist for more than two weeks, and these feelings are impairing an individual's ability to work or socialize, clinical depression could be the culprit. These symptoms may include:
- Depressed mood most of the day, nearly every day.
- Markedly diminished interest or pleasure in most daily activities.
- Significant changes in weight or appetite.
- Excessive sleepiness
- Fatigue or loss of energy.
- Feelings of worthlessness, or excessive guilt.
- Difficulty concentrating or indecisiveness.
- Thinking about death or suicide.
"First of all, you want to look at how differently you are functioning now than you were before," explains Maryellen Pachler Kennell, APRN, a psychiatric nurse practitioner with the Anxiety Treatment Center of Greenwich and former lecturer at the Yale University School of Nursing. A proactive step that individuals can take for assessing depressive symptoms is to physically write down (or using one of the many apps available) what has changed with respect to their mood, thoughts and behaviors. Some call it symptom tracking or mood monitoring. It is very effective for identifying negative thoughts, feelings and behaviors.
There are various types of anxiety disorders, such as agoraphobia or panic disorder. Since it comes in many distinct forms, anxiety can be difficult to define. However, anxiety disorders are united by the presence of fear or apprehension that is out of proportion to the situation.
One of the most common anxiety disorders is generalized anxiety disorder (GAD). Some of the symptoms of GAD include:
- Excessive and uncontrollable worry occurring more days than not for at least six months, about a variety of events or activities.
- Accompanying symptoms such as restlessness, irritability, fatigue, muscle tension, sleep disturbance, and difficulty concentrating.
- Physical symptoms such as a racing heart, stomach aches, or headaches.
These symptoms may impair the ability to function at home, at work, and in other areas of life.
Can Depression and Anxiety Occur Together?
According to the Anxiety & Depression Association of America, research shows that roughly half of people diagnosed with depression will also battle anxiety. Approximately 10 million Americans per year struggle with co-occurring anxiety and depression. While managing just one of these conditions can be difficult, trying to manage both anxiety and depression can be particularly challenging.
When two or more disorders are present in one individual, they are said to be comorbid. Healthcare providers often assess the presence of comorbid anxiety or depression so they can recommend appropriate treatment options and consider what medication(s) would be beneficial.
Why are Anxiety and Depression Often Comorbid?
Researchers are still trying to determine exactly why anxiety and depression have high comorbidity. However, there are some preliminary theories.
Anxiety and depression have several overlapping symptoms. For example, sleep disturbances, poor concentration, and fatigue can be symptoms of both disorders. Overlapping symptoms may increase the likelihood an individual may meet the criteria for a comorbid diagnosis.
Genetics and Biology
Genetics also play a role in comorbidity. According to EMBO Reports, depression is about 40-50% heritable, or passed down from your biological parents. Further, depression may share some of its genetic origins with GAD, which is about 30% heritable. Research shows there may be other underlying, biological mechanisms linking the two disorders as well.
The Stress Response
The body's hormonal stress response system may also connect anxiety and depression. When stress occurs, the body activates the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis sends signals from the brain, to the pituitary gland, which releases hormones, causing the adrenal glands to release cortisol. Chronic stress may lead to prolonged, elevated cortisol levels, which have been linked to depression, says Pachler Kennell.
"If you drive a car really fast for a really long time, eventually the engine's going to blow, right? So, there is an intimate relationship between anxiety and depression," she explains.
Treating Anxiety and Depression
Appropriate treatment options for anxiety and depression can include therapy and medication. According to Pachler Kennell, many treatment options can further be enhanced by practices such as yoga and other mindfulness practices, particularly meditation.
Cognitive Behavioral Therapy (CBT)
CBT is an evidence-based therapy that helps individuals identify distorted thinking patterns, see how these patterns connect to dysfunctional behaviors and emotions, and then begin to adapt healthier thoughts and behaviors. A qualified mental health professional can use CBT to help patients manage the symptoms of anxiety and depression.
Serotonin, dopamine, and norepinephrine, among others, are neurotransmitters – chemical messengers which play a role in anxiety and depression, says Pachler Kennell. That is why drugs from classes known as SSRIs (selective serotonin reuptake inhibitors) or SNRIs (serotonin-norepinephrine reuptake inhibitors) are often prescribed for these conditions.
When an individual has comorbid depression and anxiety, these concerns can often be treated with one medication, such as an SSRI. However, there are other options as well when one medication is not fully effective. "We have other medications that we can look at for adjunct use – we call them neuroleptics, or antipsychotics," says Pachler Kennell. For example, Abilify® (aripiprizole) is an antipsychotic sometimes used in conjunction with an antidepressant to treat depression and anxiety.
How Pharmacogenetics Assists in Prescribing Medication(s)
Pachler Kennell uses Genomind® Professional PGx Express™ to help her identify which medications may be most beneficial for her patients. This pharmacogenetic test is available by prescription and looks at 24 genes related to mental health treatment. It provides guidance across 10+ mental health conditions and 130+ medications to help clinicians determine:
- Which medications will be more likely to be effective
- Which medications may be more likely to cause side effects
- How you metabolize medications for personalized dosing guidance
The Genomind PGx test requires a prescription. Learn more about it here.
CYP450s and Drug Metabolism
Understanding an individual's metabolism is important in choosing medication(s) and dosage. For example, the Genomind® Professional PGx Express™ evaluates the CYP450 genes, which are responsible for the metabolism of most medications. A slower or faster metabolism can lead to side effects or alter the likelihood that a medication will be effective. With pharmacogenetic testing "we can really save a lot of time" says Pachler Kennell.
Calcium and Sodium Channels
Pharmacogenetics can also help identify where abnormal nerve cell communication is occurring, Pachler Kennell says. For example, there may be abnormal signaling at the calcium or sodium channels, where ionic communication between neurons occurs. "I have had such success knowing if there is altered neuronal signaling out of one of those channels - it really changes how I look at augmenting treatment, particularly for mood disorders," she explains.
Improving Patient's Quality of Life
Anxiety and depression affect millions of Americans each year, and many individuals may have both conditions. It is critical to seek treatment as early as possible. Although early identification typically leads to better outcomes, Pachler Kennell stresses that even if you have had the symptoms of anxiety or depression for a long period of time, you can always benefit from a proper diagnosis and treatment.
"It's important that if you think you're having symptoms of depression, even if you think it's mild, that you don't ignore them," says Pachler Kennell. "You should seek help right away." If you notice any of the symptoms of anxiety or depression, speak to your primary care physician as soon as possible. “It’s important that we all start to normalize mental health conditions, just like we do with “medical” disorders.”
About the Contributor
Maryellen Pachler Kennell is a Yale educated and trained psychiatric nurse practitioner who specializes in the treatment of anxiety and its related disorders including depression and ADHD. She uses CBT, medication management and a huge heart to help her patients improve the quality of their lives. She is the co-owner of the Anxiety Treatment Center of Greenwich and has dedicated herself to smashing the stigma of mental health disorders.