Is it Depression, Anxiety, Both, or Neither?

“Co-morbidity” refers to the incidence of overlap of two or more medical conditions and/or psychiatric conditions. When disorders are co-morbid they are co-occurring—one doesn’t necessarily cause the other but we know that they tend to show up together. Alcohol addiction for example, is often co-morbid with anxiety, but does anxiety cause alcoholism or vice versa? There isn’t a causal explanation but we know that it is likely that at the very least, there is an interaction happening that strengthens the relationship—and so the more someone drinks likely the more anxious they feel, and a cycle emerges.

Depression and anxiety are one of those classic duos in modern day psychiatry. If you consult with a psychiatrist for anxiety there is a fair chance he or she will prescribe you an SSRI that is commonly used for depression. Even at the medication level, what works for depression often works for anxiety. So what does this mean exactly when we know that the experiences of depression and anxiety are fundamentally different? As constructs they certainly have their own set of characteristics that set them apart. Anxiety often feels like a more manic, intense emotional state and depression often feels slower, more fatigued, and in a state of stuck-ness we can’t get out of. Some people genuinely struggle with both though what is increasingly common is anxiety at the idea of being depressed, or an increase in anxiety because there are deeper, unexpressed emotions that remain dormant.

Subsequently people often mistake anxiety and depression for one another. They often describe feeling anxious because they are depressed or feeling depressed because they are anxious. It’s particularly difficult to admit to oneself I’m feeling depressed. Though the term “mental health” (which has become oddly synonymous with mental illness) is thrown around more frequently as stigma is supposedly challenged, there is a character weakness that we associate with psychological pain. Many times what people are actually saying is that they feel depressed—or there is an inner conflict that is causing distress—and they don’t want to be, because confronting one’s sadness is difficult. Furthermore anxiety, for whatever reason, seems to hold a more positive valence than depression or sadness. To be anxious can still mean being a high-achiever. “I have anxiety” doesn’t carry the same negative implications as “I have depression.” Recently Kendall Jenner appeared in a series of Youtube videos where she discussed her anxiety with a psychologist. Would the campaign have been as popular if she talked about feeling depressed? To many, one is a cop-out or an excuse to not work hard, though truthfully many people function very well with depression. The other—anxiety—is somehow more easily accepted; why wouldn’t we all feel nervous in our treacherous pursuit of success?

Ironically, anxiety can be extraordinary crippling. Even moderate anxiety often renders people unable to make decisions efficiently. When you’re feeling anxious you’re likely over-thinking everything and ruminating over outcomes. When you’re depressed, you’re likely feeling confused or sluggish, unable to take the first steps to make a decision that you know will benefit you, but aware at least of what you need to do.

Of course, depression and anxiety can and often coincide with one another, though they may have different psychological roots. If you’re feeling depressed for example, and are self medicating with drugs or alcohol, there is a high chance that at least intermittently you will feel anxious. Or, if you’re go-to coping mechanism for depression is unhealthy (i.e. binge eating) you will certainly feel anxious as a result because now there is a new stressor added to the overall state of malaise and emptiness that you are likely already feeling.

Begin with considering what you’re doing that is exacerbating symptoms and what you’re doing that is ameliorating them. Depression for example, is highly unlikely to change until something is consistently added to your life that involves effort and reward. Adding one small activity (for example taking a walk after work) and reducing one unhealthy coping mechanism (i.e. high sugar in your diet or getting off social media) can work wonders for your mental health.