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The Line between Anxiety and Depression

Looking at the list above, you can see why it can be difficult for a doctor to ascertain the cause of a person's distress. If a person goes to a doctor and reports they are feeling fatigue, loss of appetite, can't get to sleep, are having constant headaches and can't concentrate, then the doctor has to ascertain which of these is the primary cause.

The other problem is the person may report all the various symptoms they are experiencing with the anxiety eg. heart palpitations, racing heart etc and this is now effecting sleep, concentration and energy levels and also are feeling "down" as a result of this, the doctor may feel the diagnosis is depression. The diagnosis of Depression, and the subsequent treatment, may help the Depression but will do nothing to solve the underlying problem - that is, the anxiety or Anxiety Disorder. The Depression will only return again-and-again because the root cause of the distress has not been addressed. This may verify to the person that, yes, they do in fact have a chemical imbalance in the brain causing the recurrent depression episodes. It is really a catch 22.

DSMIV states the following associated feature of Major Depression:
"Individuals with a Major Depressive Episode frequently present with tearfulness, irritability, brooding, obsessive ruminations, anxiety, phobias, excessive worry over physical health, and complaints of pain."

The description above is almost identical to people who present with an Anxiety Disorder. Surely the major components of Anxiety Disorders are the major fears of physical health ("What if ..."), anxiety, phobias, obsessive ruminations, pain, and irritability, tearfulness. This is the problem. How many people with an Anxiety Disorder have been diagnosed as Major Depression?

The overlap between anxiety and depression become more confusing when we look at an important diagnostic tool, the Hamilton Rating Scale for Depression (Hamilton, 1967). This scale, still the most widely used to screen patients entering clinical trials, includes many questions about anxiety. Many people who have anxiety as the primary cause for their distress, rather than depression, will identify with these indicators and may be incorrectly diagnosed as Depressed.

The distinction between depression and anxiety is not too clear from one of the long dominant theories about the biological basis of depression, and the role of serotonin (5-HT). The "chemical imbalance of the brain" theory has been cited often as the root cause of not only anxiety and panic attacks but also depression. The theory is the same for both. "Chemical imbalance theory" is specifically identified as one of the keys to depression, but now serotonin is closely linked to "anxiety" too.

" ... a great number of new compounds, with relatively specific actions on the 5-HT system have begun to appear on the market. Are they [working on anxiety] or antidepressant or both ?... however, is an issue that is likely to be confounded greatly by the efforts of drug companies to market their products" (Healy,1991).

It is hard to sift through the data available to designate a defining line that states this is anxiety with depression as the secondary effect, or this is depression with anxiety as a secondary effect. With depression being the latest promoted "Disorder" for the 90's it will be hard for all concerned to define. Anxiety is placed in the background as a ground swell of Depression diagnosis arise.

The important point for all people who are experiencing anxiety or depression is to note that treatment for the condition is possible and that recovery is possible. We need to stay with our own individual experience. 53.7% of people with an Anxiety Disorder experienced depression as a secondary condition (Treatment Needs Research). They all agreed that the depression was as a result of experiencing an Anxiety Disorder. Your experience will tell you which came first - the Anxiety Disorder or the depression.

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