Anxiety and Depression:
Which one do I have?

by Dave Carbonell, PhD

People are often unclear about the differences between anxiety and depression, and confused as to which is their primary problem. Here's an explanation of the differences between anxiety and depression, and some comments on the recovery process. However, as always, if you have the troubles described in this article, you are well advised to discuss these problems with a professional therapist.

Anxiety Disorders

Anxiety Disorders are characterized by a sense of doubt and vulnerability about future events. The attention of anxious people is focused on their future prospects, and the fear that those future prospects will be bad. Anxiety Disorders are characterized by a variety of symptoms involving anxious thoughts, unexplained physical sensations, and avoidant or self protective behaviors.

Depression

A person whose primary problem is depression, rather than anxiety, generally doesn't show the same fear and uncertainty that people do with anxiety disorders. Depressed people are not so preoccupied with worrying about what might happen to them in the future. They think they already know what will happen, and they believe it will be bad, the same bad stuff that's happening to them now. The key symptoms of depression include:

* Feeling sad, and/or hopeless
* Lack of interest and enjoyment in activities that used to be fun and interesting
* Physical aches and pains without physical cause; lack of energy
* Difficulty concentrating, remembering, and/or making decisions
* Changes in appetite and weight
* Unwelcome changes in usual sleep pattern
* Thoughts of death and suicide

Depression may come on as a relatively sudden and severe problem, or it may consist of a longer term set of symptoms which are less severe.

Bipolar Disorder

Bipolar disorder, formerly called manic depression, is quite different from both anxiety and depression. It's characterized by moods which shift from very high moods to very low. Sometimes these shifts can be quite sudden.

In the high (manic) mood, people may experience racing thoughts, less need of sleep, unusually high energy, poor judgment, abnormally high levels of enthusiasm and optimism, lots of rapid talking, ideas that they are powerful and all-knowing, and seemingly impulsive actions which cause trouble with others.

In the low (depressed) mood, a person experiences the symptoms of depression described above.

It sometimes happens that a person who starts taking an anti-depressant will start exhibiting the signs of manic mood. In such cases, it's believed that the person had a latent, or hidden case of bipolar disorder which only became evident when the depressive mood was relieved by medication. Jane Pauley, the television reporter and talk show hostess, has written of her personal experience with this problem.

The treatment of bipolar disorder is much more likely than that of anxiety and depression to include the use of medication.

Why People Get Confused
About Anxiety and Depression

People get confused about the distinction between anxiety and depression for several reasons. The first is that, if they are receiving medication for an anxiety disorder, they're probably getting an anti-depressant medication. A group of anti-depressant medications known as the Selective Serotonin Reuptake Inhibitors (SSRI) have been demonstrated to be helpful with both anxiety and depression, and are now the preferred medication treatment for people who receive medication for anxiety disorders. Sometimes people with anxiety disorders receive these medications, find out they're taking an anti-depressant, and then wonder if that means they're depressed. It doesn't, not by itself.

Feeling Depressed in Reaction to
Your Problems with Anxiety

It's also common for people who are having a difficult time with an anxiety disorder to feel depressed as a result of the way anxiety is interfering with their lives. It's my experience that most patients who experience this will find that their depression lifts naturally as a result of doing better with anxiety, and no special treatment for the depression is necessary.

There are two circumstances under which an anxiety patient may need specific help for depression. One is if he or she has become so depressed in response to anxiety that they no longer have the energy and motivation to overcome the anxiety disorder. In this case, either medication or cognitive behavioral methods can be used to help overcome the depression. The second is the case of a person who experienced a severe depression before the anxiety disorder appeared, a depression which was not just a reaction to the troubles imposed by the anxiety disorder. This depression, called a primary depression, is likely to require medication treatment.

If you find yourself confused about your symptoms of anxiety and depression, and what kind of trouble they may indicate, don't struggle in silence with the confusion. Ask your doctor or therapist directly about your diagnosis.

Thoughts About Death

People with chronic anxiety disorders may find themselves having lots of thoughts about death, and worry this means they are suicidal, or even homicidal. People with Panic Disorder often have lots of worrisome thoughts about dying, particularly of heart attacks and terrible diseases. People with OCD may have thoughts in which they wonder what stops them from committing some terrible crime, like killing people they love. People with Generalized Anxiety Disorder may have "what if" thoughts in which they worry about becoming so anxious and hopeless that they become suicidal.

If you have such thoughts, and find them disturbing, it's a good idea to discuss them with a qualified therapist. People often want to keep these thoughts to themselves, because they feel ashamed of them, and worry that a therapist will over-react and want to hospitalize them. However, these thoughts are a common part of anxiety disorders, and a therapist who is well versed in the treatment of anxiety disorders will probably be able to evaluate these thoughts and come to a realistic understanding of what they mean and don't mean. So review these with a therapist, in the same way you would review all the other symptoms you experience.