# Anxiety and Depression: One and the Same?



## Daniel (Oct 29, 2009)

One and the Same: Anxiety and Depression
By Hara Estroff Marano
_Psychology Today_
March 1, 2004
*
Surveys show that many people with major depression also have an anxiety disorder, while half of anxiety-disorder sufferers also have symptoms of clinical depression.*

It's an axiom of modern psychiatry that anxiety and depression are two distinct conditions. However, evidence is amassing that they are really two manifestations of one disorder. Looking at them that way, some experts say, could speed the development of drugs that     better subdue both conditions.

Surveys have long shown that 60 to 70 percent of people with major depression also have an anxiety disorder, while half of anxiety-disorder sufferers also have symptoms of clinical depression.

 Now there's evidence of genetic commonalities between the two conditions. Researchers at the National Institute of Mental Health have found that in people with both panic disorder and depression, there is a significant decrease in a type of receptor (5-HT1A) for the neurotransmitter serotonin. Other studies have shown that the stress response system is overactive in patients with both anxiety and depression. Secretions of the stress hormone cortisol, triggered by repeated trauma, reduce expression of the gene that produces the 5-HT1A     serotonin receptor.

"They're probably two sides of the same coin," says David Barlow, director of the Center for Anxiety and Related Disorders at Boston University. "The genetics seem to be the same; the neurobiology seems to overlap. Some people with the vulnerability react with anxiety to life stressors and some, in addition, go beyond that to become depressed." 

Anxiety precedes depression developmentally, with anxiety most     commonly beginning in late childhood or adolescence and depression a few years later, in the mid-20s. Psychologist Michael Yapko of San Diego targets a flaw in thinking common in both disorders. "*The shared cornerstone of anxiety and depression is the perceptual process of* *overestimating the risk in a situation and underestimating personal resources for coping*."

Behavioral geneticist Kenneth S. Kendler of Virginia Commonwealth University in Richmond offers a new way of parsing psychiatric conditions. He sees a small cluster of genetic risk factors creating "internalizing disorders" such as anxiety and depression, which cause sufferers to be miserable. Another set of genetic factors finds expression in "externalizing disorders" such as substance abuse and antisocial behavior—conditions that make others around them miserable.
_
Related article:
_Depression: Coping with Anxiety Symptoms


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## Daniel (Oct 30, 2009)

Another thing they have in common is a tendency for ruminative thinking:

http://forum.psychlinks.ca/psycholo...h/8228-rumination-depression-and-anxiety.html

http://forum.psychlinks.ca/depressi...on-ruminative-vs-experiential-self-focus.html
http://forum.psychlinks.ca/depression/20310-probing-the-depression-rumination-cycle.html


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## Daniel (Dec 3, 2009)

Fear of Fear Itself
by Christie Nicholson_ 
__Scientific American_ podcast: _60-Second Psych_
                   December 1, 2009

*A recent study links fear of feeling anxious to depression. Christie Nicholson reports.*

Most psychotherapists would agree that depression is anger and sadness that has been repressed. And it can lead to a state where the afflicted feel there is nothing they can do to change their situation. A hopelessness emerges. 

Another key characteristic is anxiety. But scientists have recently focused on a specific type of worry that is significantly linked to depression. This is anxiety about feeling anxiety. Here a person thinks that something catastrophic is going to happen if they allow themselves to feel anxious.

The scientists had 94 above-average worriers take a variety of anxiety questionnaires and two tests for levels of depression. But they controlled for worry and generalized anxiety in order to isolate specific anxiety about feeling anxious. The research is published in the December issue of the _Journal of Anxiety Disorders_.

The two dimensions of so-called anxiety sensitivity that are most strongly linked to depression are fear of loss of cognitive control and fear of revealing anxious symptoms in public. The other dimensions, fear of respiratory and cardiovascular symptoms showed no link to depression.

The authors note that current depression therapies focus on depressive symptoms and not anxiety sensitivity. They suggest therapists might want to consider helping people change their perception of anxious emotion, to not see it in such a negative light. 

Of course, this reminds us of Franklin D. Roosevelt’s sage words at his first inaugural address: “…let me assert my firm belief that the only thing we have to fear is fear itself—nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.”


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## David Baxter PhD (Dec 3, 2009)

No, I don't believe they are one and the same, although they are often "comorbid conditions".



> Most psychotherapists would agree that depression is anger and sadness that has been repressed.



That is a classic psychoanalytic view but I think the claim that "most psychotherapists would agree" is a bit of an overstatement.



> And it can lead to a state where the afflicted feel there is nothing they can do to change their situation. A hopelessness emerges.



This, on the other hand, is characteristic of most depressions.


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## Daniel (Dec 3, 2009)

> I think the claim that "most psychotherapists would agree" is a bit of an overstatement.


I noticed that, too, but I didn't want to seem obsessive by mentioning it :teehee:


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## David Baxter PhD (Dec 3, 2009)

:lol: I on the other hand embrace my obsessiveness.


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## NicNak (Dec 3, 2009)

David Baxter said:


> :lol: I on the other hand embrace my obsessiveness.



Luvox may help you change that :teehee:  It helped me :teehee:


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## gardens (Dec 3, 2009)

I love the humour!  :rofl:


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## Daniel (Mar 26, 2010)

Another way of comparing depression and anxiety:



> It may sound surprising, but conflict is at the core of both anxiety and depression.  With anxiety, the core conflict is wanting a sense of safety, but feeling a threat of some type...With depression, the core conflict is a loss of motivation or energy while wanting desperately to feel the joy and enthusiasm that others experience…
> 
> We all experience conflict.  You want one thing, and I want something different.  But with anxiety and depression, the conflicts are more pervasive, meaningful, and irreconcilable than day-to-day conflicts.
> 
> Depressed and Anxious: The Dialectical Behavior Therapy Workbook for Overcoming Depression & Anxiety


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## NightOwl (Mar 26, 2010)

Reading through this post I've found it interesting; although I haven't managed to have time to go down the links yet, I hope you don't mind my input on this. I suffer from PTSD due to trauma; when I talked to a psycho-therapist, I explained I had high anxiety but not overall feeling of depression, although depression can hit on the odd days, and in fact most days I stay relatively happy as long as I feel safe; she told me that some patients she has seen have been given anti-depressants to help them deal with everyday life but it's not always depression they are suffering from and this can increase the numbing feeling and make it difficult at times for the patient to come to terms with their feelings and try to heal.

NightOwl


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## Daniel (Mar 26, 2010)

> but it's not always depression they are suffering from


So I guess these people without a disorder may just be "stuck" on some lifestyle issues, like interpersonal issues, social isolation, burnout, etc.


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## NightOwl (Mar 26, 2010)

From how I feel, anxiety and depression can be either separate or go along together, but each can come from a different route. By looking for where the route cause is coming from, gives a better perspective on how to deal with them. 

Thank you for the link on the book Unstuck, it looks really interesting. 

I've just got some of my course materials for my OU course yesterday, which is on Fear and Sadness, so I'm looking forward to that and a better understanding of the whole subject.

Many thanks.

NightOwl


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## Daniel (Apr 15, 2010)

NightOwl said:
			
		

> anxiety and depression  can be either separate or go along together, but each can come from a  different route



On that note, I just read this:


> Anxious arousal causes patterns of brain activity in the right inferior  temporal lobe, or just behind the ear. Chronic worry creates patterns in  the left frontal lobe region that is also connected to language.  Depression has previously shown to activate the brain's right frontal  lobe...
> 
> People who experience the fearful type of anxiety had increased activity  in the area of the brain that is also commonly activated by depression.
> 
> ...


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## Daniel (Apr 19, 2010)

"Basically, what we're finding is that there's talk between these two  receptor systems in the brain, and that if you activate the one receptor  system the other becomes sensitized."
Canadian researchers find brain link between anxiety and depression
​


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## Daniel (May 9, 2010)

_An excerpt from The Mindfulness Solution for Everyday Problems: An Interview with Ronald Siegel, Psy.D__:_*

Mindfulness practices are turning out to be  useful for dealing with a remarkably wide range of psychological  difficulties, including both anxiety and depression. This raises an  interesting question: What might these problems have in common? Might  mindfulness practices be addressing this common factor?*

A bit of a war broke out among the researchers and clinicians writing  the latest version of the DSM—the diagnostic manual used by mental  health professionals. It was a war between the _lumpers_ and the _splitters_.   The splitters said that the major limitation in our current diagnostic  system is that we’re mixing apples and oranges — we need more diagnostic  categories to more accurately identify psychological problems. The  lumpers said, “that’s crazy, you’re missing the forest for the trees.   You’re ignoring what so many problems have in common.” So the splitters  said, “oh yeah? What do they have in common?” And the lumpers said, “_experiential  avoidance_.”

 What do they mean by “experiential avoidance?” It’s the natural  tendency we all have to pull away from painful experiences. And it turns  out that indeed this is something that both anxiety and depression have  in common.

While many people struggling with anxiety see their worried thoughts,  rapid heartbeat, muscle tension, and other signs of  physiological  arousal as the problem, most mental health professionals realize that it  is actually our maneuvers _to try to get rid of_ anxiety that  are at the core of most anxiety disorders. For example, if someone has a  fear of public speaking, flying in airplanes, or catching germs from  public restrooms; it’s not the fact that these situations provoke  anxiety that’s the problem, it’s the fact that the person starts to  avoid speaking in public, flying, and using the restroom that’s the  problem.

I once heard an astronaut being interviewed by an actor who was going  to play him in a movie. The actor wanted to get inside the astronaut’s  head so he could play him faithfully. He said, “how were you able to get  the courage to fly in those untested aircrafts—I would’ve been scared  shitless.” The astronaut said, “of course, I was scared shitless every  time I went up. Courage isn’t about not feeling fear, it’s about doing  what makes sense anyway.”

Mindfulness practices train us to develop this kind of courage, to  approach difficult experiences instead of trying to avoid them. By  practicing being in the present moment, whether that moment is pleasant  or unpleasant, calm or threatening, we develop the ability to bear  feelings of greater and greater intensity. As we develop this skill, we  become able to face a wider range of life challenges with confidence—  knowing that we can bear the anxiety that may arise. Since so much of  problematic anxiety involves fear of fear — worrying that a given  situation will make us anxious — paradoxically, this approach in the  long run makes us much less anxious. So instead of trying to “calm  down,” mindfulness practices give us the courage to be with our anxiety  when it arises, allowing us ultimately to be much less afraid.

I outline a number of specific exercises that we can use to develop  this sort of courage in the chapter on worry and anxiety in _The  Mindfulness Solution_. You can also learn many of these online at www.mindfulness-solution.com.

Interestingly, depression has a lot in common with anxiety. I often  ask psychotherapists what they think is the difference between sadness  and depression, and they come up with a variety of answers. Sometimes  they suggest that depression lasts longer than sadness. But I point out  that it’s perfectly possible to feel sad for days in a row and yet be  quite depressed for just a few hours. Then they suggest that sadness  arises in response to external events, while depression comes from the  inside and has a life of its own. But I remind them that we can get very  depressed after a misfortune such as the loss of a job or relationship  and yet can feel sad without apparent cause.

 Finally, after some discussion, they come to the conclusion that  sadness feels _alive and fluid_ and is an essential part of  living a full life, while depression feels _dead and stuck_ and  gets in the way of living. This realization leads to another surprise:  by helping us really be with sadness (and other emotions), mindfulness  practice can keep us from getting stuck in depression.

We see here again how a psychological problem involves experiential  avoidance. As long as we’re trying to not feel sad, angry, or some other  emotion, we tend to shut down and not feel much of anything at all. And  our body is in a constant state of stress as we tense up trying to keep  these feelings at bay. This stress contributes to the difficulties with  sleep, appetite, concentration, and interest that are so often a part  of being depressed.

Mindfulness practices, by training us to open to our full range of  emotions in the present moment, work against this depressive pattern.  They help us to come alive in each moment.

 Another way that mindfulness helps us to work with both anxiety and  depression is by loosening our belief in our thoughts. Both difficulties  involve a lot of painful thinking. In anxiety we worry about the  future, in depression we may regret the past, or be full of negative,  self-critical thoughts. Since mindfulness practices involve bringing our  attention back to sensations in the present over and over, stepping out  of the _thought stream_, they help to loosen our preoccupation  with negative thoughts, making it easier not to believe in them so much.


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## Daniel (Sep 30, 2010)

A couple excerpts from a five-part blog post:



> To exemplify briefly how your early programming can explain your susceptibility to both anxiety and depression, consider the negative belief, "I'm not in control" (or "I'm out of control"). Not only does such a powerless self-regard (generally based on a compilation of childhood experiences) set you up to more readily react to situations as threatening or overwhelming, but such a defeatist attitude also fosters feelings of hopelessness virtually synonymous with depression.
> 
> Similarly, the negative notion, "I can't trust myself," serves to explain the passivity, indecisiveness, and inability to follow through on plans commonly observed in both anxiety and depression. And the procrastination, inaction or immobility resulting from such a lack of confidence generates even more self-doubt about being able to make the right choices. Needless to say, both anxiety and depression are de-motivating, which serves only to confirm a negative bias that may actually be quite at odds with what--potentially--you could achieve if you were able to change such antiquated ideas about yourself.
> 
> ...





> How one might, for example, "evolve" from anxiety to depression:
> 
> Anxiety → Avoidance → Isolation → Loneliness → Feeling Abandoned & Alienated → Depression
> 
> Anxiety and Depression--First Cousins, At Least (Part 5 of 5) | Psychology Today


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## rdw (Oct 1, 2010)

My "evolution" from anxiety to depression occured exactly as illustrated. After a series of life altering stressful events, I lost my ability to be resilient and my life spiralled downward. Thank you for that post.


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