Anxiety vs. Depression: The Pillars of Mental Health

She was finding it hard to breathe again, in addition to sweating profusely and having the same thoughts repeated in her mind: she was bound to embarrass herself in class today. A sense of dread had already settled in, signaling that a panic attack was on the way. As she tried to calm herself, she wondered what brought on her anxiety, almost wishing for her baseline state of depression, with its usual sadness and lack of energy. Considering both of her “options”—anxiety vs. depression—she realized she was unsure where one disorder ended and the other began. How do you tell them apart, she wondered, and which one deserves more of my attention?

These questions are being asked by more and more individuals whose mental health struggles are defined by the above-mentioned forces. Anxiety and depression are both considered common mental health issues, and their symptoms appear as part of most mental health disorders. Yet for all of their prevalence, many of those who face anxiety or depression find it hard to associate the adverse reactions they experience with either one.

So how are anxiety and depression defined, and why are they so central to our understanding of mental illness? Read on to find out. 

Anxiety: A System Overload

Anxiety is defined by the American Psychiatric Association (APA) as a disproportionate and adverse concern over a future, possible threat. In essence, it is the drawn-out, ineffective version of fear: whereas fear is a honed survival mechanism intent on keeping you aware of an actual source of danger you are facing—say, a hungry bear—anxiety is experiencing that same hyper-awareness of your senses and environment, even when there is no bear in sight.

As a result, you could find yourself sweating, breathing quickly, or preoccupied with thoughts of an impending catastrophe, like in the above example. It might seem illogical, but your mind and body are doing this in response to a certain stimuli (internal or external) that has been marked as dangerous. The identity of this perceived threat can and should be addressed in therapy, as a way to manage and hopefully overcome your anxiety.

A few statistics: anxiety is actually a family of stress-related mental health disorders. 19.1% of the US population faces at least one anxiety disorder and 31.1% of US adults have dealt with one or more anxiety disorder during their lifetime.

According to the APA’s Diagnostic and Statistical Manual’s fifth edition (DSM-V), the anxiety family includes these disorders:

•     Generalized Anxiety Disorder: Worrying a great deal over work, your home or family life, or about other central areas of life.
•     Social Anxiety Disorder: Distress over social situations that might include scrutiny.
•     Specific Phobias: Heightened adverse feelings toward specific stimuli, objects, or scenarios.
•     Separation Anxiety Disorder: Distress over separating from an attachment figure, not applicable during relevant childhood developmental stages.
•     Panic Disorder: Extreme, repeated, and unexpected distress, until the individual experiencing them begins fearing the onset of the next attack.
•     Selective Mutism: The inability to speak publicly.
•     Agoraphobia: Fearing open or enclosed spaces, using public transportation, being in a crowd, or outside and alone during particular situations.
•     Substance/Medication-Induced Anxiety Disorder: Symptoms of anxiety developed after using medication or following substance abuse.

Depression: Shutting Down and Shutting Out the Pain

Drawing us into a state of deep and unrelenting sadness, depression counters the spike in adverse energy that characterizes anxiety, leaving many individuals cocooned inside their own powerless sense of sorrow.

Both anxiety and depression are essentially adverse responses to our fear of the unknown, with anxiety developing from the uncertainty of facing a future threat, and depression growing from a sense of mourning something precious that has been lost, without being conscious of what that is.

Additionally, while the DSM-V has spread out its perception of anxiety to include the different anxiety-based definitions mentioned above, the feeling of acute and lasting depression is mainly featured in it through a single diagnosis—major depressive disorder.

The DSM-V defines major depressive disorder (or MDD) as a mood disorder that causes a substantial decrease in the individual’s well-being. It is linked to symptoms of loss and lacking, such as a lack of happiness and sadness, low energy, low self-worth, hopelessness, emptiness, and loneliness. Decreased motor skills and cognitive abilities are additional symptoms of this condition.

Depression is a relatively common mental health disorder, with one in 15 adults (or 6.7%) of the adult population diagnosed with this condition. 17.3 million adults (or 7.1%) of US adults have experienced one or more depressive episodes.

While major depressive disorder is the most prominent condition within the depressive disorders family, it also includes:

• Dysthymia: A more persistent, at times less severe depressive disorder.
• Premenstrual Dysphoric Disorder: Marked by mood swings relating to the premenstrual cycle that improve in the following weeks.
• Substance/Medication-Induced Depressive Disorder: Depressive symptoms due to the use of medication or illicit substances.
• Depressive Disorder Due to Another Medical Condition: Depressed mood deriving from contending with a separate medical condition.

Linking Anxiety and Depression to One Another

Despite their seemingly oppositional pulls toward and away from fear and sadness, anxiety and depression are nevertheless often found together. This raises the question, how do two such forceful mental influences co-exist, and what elements bind them together?

Though it can sometimes be hard to figure out which disorder followed which, research and field work have managed to show that sometimes depression can develop as a result of continuously facing anxiety. One theory regarding this chain of events has to do with learned helplessness: after repeatedly being stricken with a seemingly random sense of panic as part of an anxiety-based disorder, the individual experiencing it might become exhausted and eventually give up on the hope of ever understanding what is causing them. This learned helplessness (or hopelessness) can become the base for major depression, as they begin to stop fighting their anxiety and sink deeper and deeper into unrelenting sorrow.

Genetics also appear to play a part in the high comorbidity rates of anxiety and depression. Specifically, the two seem to be linked through the character trait neuroticism, which has been found to be highly hereditary. The tendency to experience extremely adverse responses to internal and external stressors, neuroticism has been shown to facilitate the development of sadness, anger, and guilt, which have been linked to anxiety, depression, or both. Since neuroticism has also been shown to be a risk factor for these conditions, many researchers believe that neuroticism constitutes a key factor linking the two to one another.

Neural structures have also been shown to tie anxiety and depression together. Research in this area has focused on the amygdala: with its role in processing emotions, damage to the amygdala’s structure has been shown to cause the symptoms of both anxiety and depression, making it a likely source for the mental processes relating to these conditions.

Anxiety vs. Depression: Which Should You Treat First?

After establishing an understanding as to what anxiety and depression are, their centrality in the mental health world and their association to one another, the question remains—which one demands your attention more?

As with all mental health issues, the answer should arise from the specific case at hand. Each individual facing either anxiety or depression would likely benefit from approaching their mental health with the support of loved ones and the guidance of a mental health professional. Together, they can work to uncover the sources of the patient’s presenting symptoms, and how they relate to the life’s story, central relationships and other parts of their overall experience. As they do so, they can begin to manage their pain and see which condition demands their more immediate attention.

That said, a general (and by no means definitive) approach to this question posits that more often than not, it is depression, and not anxiety, that is the more acute concern. For all of the stress and disruption that it causes, anxiety is still at its core, a mental process intent on keeping the individual alive. And while anxiety pumps them with (adverse, unwanted) energy, depression saps them of their life force, leaving them feeling tired, dejected, and alone. Depression turns the individual’s thoughts inward, often shutting out those who wish to help. It is for this reason that in certain cases, depression is considered the more serious condition, and the one that should be approached first.