Anxious Depression: What You Need to Know

Major depressive disorder (or MDD) can take different forms, with recent studies finding that certain cases of depression are marked by symptoms of anxiety, as well. Individuals contending with this form of depression, dubbed “anxious depression,” face a shared set of challenges. Read on to find out more about this newly discovered variation on a mental health staple.

Depression: The Phantom of a Former Loss

A mood disorder, depression mainly influences the individual’s emotional world, with many of those facing it describing a deep sadness, and the feeling that something precious has been lost. 

According to the American Psychiatric Association (APA), the two key symptoms of major depression are a consistently low mood and an inability to feel joy or content. Additional symptoms include hopelessness, guilt, and in some cases, self-harm and suicidality. 

Patients contending with these and other symptoms often ask themselves, “Why am I depressed or anxious?” 

Risk factors for depression include a genetic predisposition, exposure to intense trauma during childhood, and gender—with women 1.5-3 more likely to develop depression than men. 

Together with anxiety, depression constitutes the top two most common mental health disorders, with one in 15 adults (6.7%) battling this condition. Roughly 350 million individuals of all age groups are believed to have faced this condition across the globe. The World Health Organization (WHO) cites depression as Number 3 in its burden of disease ranking, and expects it to ascend to the top spot by 2030.

Anxiety: Fearing the Possibility of a Threat

Unlike depression, which is mainly characterized by deep sadness or a lack of joy, anxiety is more of a system overload. Individuals contending with an anxiety disorder report feeling an adverse sense of hyperarousal, as they remain tense and alert to the possibility of a threat, even when no such threat exists.

The anxiety disorders family is considered the most common group of mental health disorders, with one in 13 individuals facing one or more of these conditions. 40 million US adults, or 18.1%, reportedly contend with an anxiety disorder.

Anxiety and depression go hand in hand, and are found in high comorbidity with depression. Over 50% of individuals facing depression or higher also battle an anxiety disorder, making it more likely to experience anxiety with depression, than not.

The APA outlines the anxiety family in the latest edition of its Diagnostic and Statistical Manual (DSM-V). In it, the APA states that anxiety disorders are primarily differentiated from one another through their triggering situation (as opposed to their respective symptoms): phobia, for instance, is defined as anxiety from a specific trigger or situation. Agoraphobia, on the other hand, refers to anxiety derived from such situations as open spaces, closed spaces, or public transportation. Social anxiety is marked by anxiety from situations where the individual fears they will be scrutinized. And generalized anxiety disorder, as the least specific of the anxiety disorders, refers to persistent anxiety relating to several activities (such as giving a speech) or life domains (such as school).

A More Anxious Shade of Depression

To receive an official major depressive disorder diagnosis, one must meet a certain number of symptomatic criteria. As a result, differing depressive profiles can exist, at times in stark opposition to one another. Anxious depression is one such suggested profile, with one of its definitive features being comorbidity with certain symptoms of anxiety.

Anxious depression is generally applied to cases where the patient has been diagnosed with depression, in addition to symptoms of anxiety. Research has shown that many cases of major depression include symptoms of anxiety, as well.

Patients who, on the other hand, have been officially diagnosed with both anxiety and depression, would be considered having a comorbidity of anxiety and depression, instead of anxious depression.

The FDA has recognized the ability of treatments such as Deep TMS to safely and effectively bring about anxious depression symptom relief. Research on anxious depression suggests applying this definition to cases where the criteria of an official major depression diagnosis have been met, as well as the existence of subthreshold anxiety. Studies continue to suggest referring to cases where an anxiety diagnosis and a depression diagnosis are both given, as comorbidity.

Shared Symptoms of Major Depression with Anxiety Disorders

Going beyond its exact definition, anxious depression is composed of the shared symptomatology of both anxiety and depression. As such, anxious depression is shaped by anxiety symptoms included in the DSM definition for major depression.

The following depressive symptoms are indeed also found among anxiety disorders:

• Restlessness. Depression can be marked by an inability to relax, and leave one’s worries behind. Anxiety often includes restlessness, as well as its more extreme iterations—nervousness, excessive worrying, and being overwhelmed by one’s own concerns.
• Easily Tired. Depression commonly induces feelings of lethargy, grogginess, and a general lack of energy. Though anxiety is, at its base, a hyperarousal disorder, its effects on the individual constantly experiencing such heightened alertness can be quite draining.
• Sleep Disturbance. As a result of either depressed mood or continued, adverse arousal, individuals can find it difficult to fall or remain asleep. This can result in fragmented or shallow sleep, hypersomnia or insomnia, all of which can greatly impede their ability to function.
• Irritability. Children and adolescents with major depression often exhibit irritability, and not sadness. This tendency to lash out and lose one’s patience can also stem from the hyperarousal that characterizes anxiety disorders.
• Difficulty Concentrating. Not as well-known as the emotional symptoms of depression, the (primarily) mood disorder can nevertheless cause patients cognitive issues, as well. Among them is a loss of focus, with patients fighting depression finding themselves more easily distracted. Patients with anxiety have similarly reported difficulty regarding concentration, as their heightened awareness of possible threats in their environment can translate to broken trains of thought and a tendency to jump between stimuli.

As more is discovered about anxious depression, and its attributes and response to available treatments are further clarified, it is important to bear in mind the variability that continues to exist within supposedly rigid mental health categories. Each individual is unique, each with their own story, perspective and formative experiences. Studies on anxious depression will hopefully help elucidate these and other particulars, as the field of mental health continues to grow in richness and depth.