Depression and Anxiety: The Same Disorder?
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Hara Estroff Marano believes that depression and anxiety are are two sides of the same coin. Research over the past couple of years has indicated that depression and anxiety are not two separate disorders, but rather “two faces of one disorder.”
In the world of mental health care, where exact diagnosis dictates treatment, anxiety and depression are regarded as two distinct disorders. The DSM V (The American Psychiatric Association has announced that DSM-5, the new edition of the Diagnostic and Statistical Manual of Mental Disorders).
The Diagnostic Criteria for Depression (DSM V)
A. Five (or more) of the following symptoms have been present during the same 2- week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure. Note: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.
• Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
• Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).
• Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.
• Insomnia or hypersomnia nearly every day.
• Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down).
• Fatigue or loss of energy nearly every day.
• Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
• Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others).
• Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
B. The symptoms cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
C. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism).
Diagnostic Criteria for General Anxiety Disorder (DSM)
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The person finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms present for more days than not for the past 6 months). Note: Only one item is required in children.
(1) restlessness or feeling keyed up or on edge
(2) being easily fatigued
(3) difficulty concentrating or mind going blank
(5) muscle tension
(6) sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)
D. The focus of the anxiety and worry is not confined to features of an Axis I disorder, e.g., the anxiety or worry is not about having a Panic Attack (as in Panic Disorder), being embarrassed in public (as in Social Phobia), being contaminated (as in Obsessive-Compulsive Disorder), being away from home or close relatives (as in Separation Anxiety Disorder), gaining weight (as in Anorexia Nervosa), having multiple physical complaints (as in Somatization Disorder), or having a serious illness (as in Hypochondriasis), and the anxiety and worry do not occur exclusively during Posttraumatic Stress Disorder.
E. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
F. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder.
After review of the symptoms, it is clear that overlap exists between "Depression" and "Anxiety". In addition, most mood disorders present as a combination of both anxiety and depression. According to the authors research, “Surveys show that 60-70% of those with depression also have anxiety. And half of those with chronic anxiety also have clinically significant symptoms of depression.” The coexistence of anxiety and depression is known as co-morbidity or co-occurring diagnoses.
“Over the past couple of years, clinicians and researchers alike have been moving towards a new conclusion: Depression and anxiety are not two disorders that coexist. They are two faces of one disorder. They're probably two sides of the same coin," says David Barlow, Ph.D., director of the Center for Anxiety and Related Disorders at Boston University. "The genetics seem to be the same. The neurobiology seems to overlap. The psychological and biological nature of the vulnerability are the same. It just seems that some people with the vulnerability react with anxiety to life stressors. And some people, in addition, go beyond that to become depressed."
At the core of the idea that depression and anxiety are really a double disorder is the fact that there are some shared brain functioning’s that have gone awry. Marano believes that “Research points to overreactivity of the stress response system, which sends into overdrive emotional centers of the brain, including the "fear center" in the amygdala. Negative stimuli make a disproportionate impact and hijack response systems.”
According to the evidence, the best form of treatment is Cognitive-behavioral therapy (CBT) for both anxiety and depression. When used with psychotropic medication, the potential success for recovery increases. The most common medications used for both depression and anxiety are SSRIs, or selective serotonin reuptake inhibitors.
Research shows that typically, anxiety precedes depression, typically by several years. According to the Marano, “Currently, the average age of onset of any anxiety disorder is late childhood/early adolescence. Psychologist Michael Yapko, Ph.D., contends that presents a huge opportunity for the prevention of depression, as the average age of first onset is now mid-20s. "A young person is not likely to outgrow anxiety unless treated and taught cognitive skills," he says. "But aggressive treatment of the anxiety when it appears can prevent the subsequent development of depression."
Treatment is not focused on which disorder originated first. Both need to be addressed, however, if depression stems from high levels of continued anxiety, then depression can lift if the anxiety is treated. Many therapists treat both disorders simultaneously. Marano believes that "Cognitive behavioral therapy is particularly attractive because it has applications to both." Not all therapists are appropriately trained in CBT, so if you are seeking treatment for anxiety and depression or combination, it is important to know if your therapist is appropriately trained in CBT.
- Kim B.
I have realized with my over forty years of life experience that I have been through times of depression and also through times of anxiety. I had never really correlated the two as parts of a whole before, but I can clearly see where that is highly likely, especially for me. From my experience, depression and anxiety are strongly rooted in the quality of relationships that we cultivate in our lives.
I have faced the life situations that sometimes trouble us all, and we all experience difficult times in our lives. Some life events are difficult because we had too much wealth, and for others they had too little. Regardless of socio-economic status, we all have relationship struggles both in our intimate and less than intimate relationships, and that's the rub.
Think of it this way. All of us have conflicts, emotional and otherwise, with our parents. Some parents are absent and /or totally non-existent, while others are way too overbearing and intrusive into every part of life that involves their children. Next, of course, there are those parents that fall somewhere in between non-existent and totally overbearing. Sometimes these characteristics even carry over into the adulthood of their children, often because of an inability to stand up to their parents and a feeling of being crushed by their authority rather than nurtured and honored as independent free-agents.
We face these challenges not only in family relationships, but also in closer friendships, where we will sometimes allow our personalities to change based on the influence of others. This of course, could be positive, but it could also become negative for some.
We are often a product of our environment, but when do we stand on our own two feet and take responsibility for ourselves? At what point do we have the courage to break the negative cycle of our family lives or friendships? When are we able to courageously seek the help we need and balance our intimate co-dependence (co-dependence being a positive in this instance) with what we are unable to accomplish on our own? When do we say, ‘Yes, I have a problem. I want help. I am willing to do whatever it takes!’ When do we realize that our toxic relationships are making us so sick that we become are willing to forgo the benefits that they offer for our health and wellbeing? When is enough, enough?
Could it cause us to become ‘divorced’ from our families or friends? Certainly, I have experienced that. However, for the health and wellbeing of my family and myself it was worth it. Do I miss these negative relationships? In certain ways, yes, but the benefits of the relationships were far too little when compared with their toxicicity - In many circumstances, it took being out of the relationship to see how harmful it really was.
Treating these relationship deficiencies has led to very productive and lucrative television careers for people like Oprah Winfrey, Dr. Phil McGraw, Maury Povich, Montel Williams, and many others, and I myself have often referenced the need to have an Oprah moment with my own parents. I usually say that tongue-in-cheek, but sometimes I really mean it.
Anxiety and Depression Together. (n.d.). Retrieved December 18, 2014, from http://www.psychologytoday.com/articles/200310/anxiety-and-depression-together