Anxiety and Depression Are Tightly Linked: Why It Matters
One disease or two?
Posted March 15, 2023 | Reviewed by Vanessa Lancaster
- Anxiety is present in over half of patients coping with depression.
- Some researchers and therapists believe depression and anxiety can be "different sides of the same coin."
- Understanding the tight connection between anxiety and depression is important for preventing, diagnosing, and treating it.
I suffered chronic anxiety, without realizing it, for much of my childhood and early adulthood, and later developed severe depression. For me, the key to coming out of my deep depression was first tackling the perseverative thoughts that made me anxious all the time. When I overcame my gnawing anxieties, the depression just melted away.
During my long recovery, I had this weird feeling that my “brain muscle” (that’s how I thought about my mind and mood), which had atrophied under relentless, chronic stress of crippling anxiety, was, through rigorous “exercise” (therapy and meds) getting back into shape and better able to deal with the world. My brain fog slowly abated, my memory came back, and my social phobias faded into the background.
Along this journey of recovery, introspecting my feelings, I realized my anxiety and depression seemed like one disease, not two. Curious about what science had learned about the linkage between anxiety and depression, I did some digging. Here’s a very brief summary of what I learned.
Lumpers vs. Splitters
According to M. Taylor Wilmer and colleagues in a recent article in Current Psychiatry Reports, there are two opposing traditions in diagnosing mental disorders: Splitters, who focus on consistent differences among different diagnoses, vs. lumpers, who tend to view diverse signs and symptoms as part of a single disorder.
And although the DSM-V (Diagnostic and Statistical Manual of Mental Disorders ), in the tradition of “splitters,” clearly delineates depressive disorders from anxiety disorders (and further breaks down each of those into separate disorder subtypes), a growing number of researchers and mental health professionals are coming around to the point of view that anxiety and depression, if not the same disorder, are often different sides of the same coin.1,2,4,5
Taylor Wilmer et al. pointed out that:
- Over half of depressed patients also exhibit some form of anxiety.
- Genetic risk factors correlated with depression and anxiety are similar.
- Anxiety and depression often have the same environmental risk factors (e.g., childhood trauma).
- Anxiety and depression are both associated with inflammation and excessive stress hormones.
- Anxiety and depression share co-morbidities like heart disease, diabetes, Parkinson’s disease, and dementia.
- Drugs such as SSRIs, anti-inflammatories, and psychedelics that reduce anxiety also reduce depression.
Why the Link Between Anxiety and Depression Matters
Understanding that anxiety and depression are sometimes so tightly linked can be useful for preventing, diagnosing, and treating the two disorders.
For instance, anxiety often strikes patients earlier in their life than later bouts of depression, raising the possibility that, at least for some people, there might be a causal link between early anxiety and later depression. Research into stress hormones (e.g., cortisol) associated with anxiety6,7,8 suggests that chronic exposure of the hippocampus, prefrontal cortex, and other mood-related brain structures to high cortisol levels inhibits neurogenesis and leads to shrinkage and dysfunction in structures needed to sustain mood. A clear implication is that early diagnosis and treatment of anxiety could lessen the occurrence of later depression and even suicide.
Other reasons that understanding the strong link between depression and anxiety is important include:
- If you, or someone close to you, are anxious, you may not realize you are also depressed, and vice versa. This means that if you or a loved one are aware of suffering chronic anxiety, there may be a greater risk of suicide from concomitant depression than you realize.
- If you are aware of feeling both anxious and depressed, both talking therapies (especially CBT) and medications could well “kill two birds with one stone,” simultaneously alleviating both symptoms.1
- Treating depression in the presence of chronic anxiety is much more difficult than treating depression alone,1 emphasizing the importance of early diagnosis and treatment of anxiety.
- Getting simultaneous control of anxiety and depression, both associated with chronic inflammation and immune dysfunction could be key to avoiding cancer, heart disease, diabetes, and neurodegenerative disease.1,6,7
If you or someone you love suffers from anxiety and/or depression, hopefully, these insights same can help you as much as they helped me.
If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the National Suicide Prevention Lifeline, or contact the Crisis Text Line by texting TALK to 741741. To find a therapist, visit the Psychology Today Therapy Directory.
1) https://ajp.psychiatryonline.org/doi/10.1176/appi.ajp.2020.20030305 (review article)
2) https://www.researchgate.net/publication/316669820_Anxiety_and_Depression_as_Bidirectional_Risk_Factors_for_One_Another_A_Meta-Analysis_of_Longitudinal_Studies (Anxiety_Depression_predict_each_other)
3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6891252/ (genetics)
4) https://www.sciencedirect.com/science/article/abs/pii/0272735885900108 (same disease)
6) https://www.tandfonline.com/doi/abs/10.1080/09540261.2020.1764509?journalCode=iirp20 (blurred line
7) https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/stress/art-20046037 (stress)
8) https://neuro.psychiatryonline.org/doi/10.1176/appi.neuropsych.15030053 (Cortisol)
9) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8493947/ (anxiety_cause_depression)