The diagnosis of depression and anxiety can run along similar lines. In this article, we will look at the conundrum - where is the line drawn between depression and anxiety?
One of hardest things for people with an Anxiety Disorder is to describe exactly what is actually happening to them. When they go to the doctor, it is hard to put in words, sometimes, the full experience. When people experience panic attacks and dissociative symptoms, this can be increased a hundred fold. How do you transmit across to another person the full experience of what is happening? Obviously, it is very hard for someone who has never experienced the full impact of an Anxiety Disorder to understand. Ultimately, people relate to each other according to their own experience.
- "Oh, anxiety. We all get anxious sometimes. What's your problem?"
As for the doctor, it is difficult for a doctor to truly get to the depths of what is happening. The physical symptoms are one thing, but the emotional and psychological effects run very deep indeed.
So when we present to a doctor, they are trying to listen carefully to what we say. They see our general demeanour. They hear the physical symptoms and from that, they try to ascertain what is ailing us. After running the numerous tests to check out the cause of our suffering, they usually find that nothing is physically wrong. An Anxiety Disorders diagnosis is usually at the end of a long range of tests to ensure there are no other causes for the symptoms.
The diagnosis of depression and anxiety can run along similar lines. In this article, we will look at that the conundrum - where is the line drawn between depression and anxiety?
what's the difference
Recently, there has been an incredible amount of media on depression and how prevalent it is in society. It is named as the most prevalent Mental Health problem in the Western world. If we take a look at our society today, we can certainly see the root causes of why this would be so. But what is the underlying issue of depression? Does anxiety have some contributing factor to the depression people are being diagnosed with? In particular, are the diagnoses of "anxiety" and "depression" distinguishable ?
People who experience an Anxiety Disorder often experience depression as a secondary condition. That is, if you are experiencing panic attacks, for instance, then it would be logical that the huge physical and emotional impact of this ongoing experience is going to effect you, and you may develop depression. When we live in a cramped cage of fear and anxiety, our system will react to the loss of personal freedom. In our research on Treatment Needs for Anxiety Disorders, 53.7% of people reported they also experienced major depression as a secondary condition. When asked whether they felt this depression was as a result of having an Anxiety Disorder, they all responded "Yes". This ties in with the Diagnostic Manual DSMIV. It states Major Depression can be secondary to the primary problem - the Anxiety Disorder.
The other side of the coin is that the researchers also state people who are severely depressed do become anxious. Depression can be the primary cause and people then react to the depression with anxiety. This is true of people diagnosed with Bipolar (Manic Depression). Certainly the constant roller coaster, from deep depression to manic high, can create anxiety in a person's life.
Other theories believe they are different parts of a single disorder. Still others believe they are distinct disorders, but overlapping. DSM-IV includes a formal definition of "Mixed Anxiety-Depressive Disorder".
So when a person presents to a doctor with symptoms of depression and anxiety, what is the diagnosis? The coin can flip either way. In the case of Panic Disorder (the root cause is the spontaneous panic attacks), Obsessive Compulsive Disorder (OCD), Social Anxiety and Post Traumatic Stress Disorder - the diagnosis seems clear. It is the Anxiety Disorder which is primary.
The grey line comes in with Generalized Anxiety Disorder. There is overwhelming anxiety - certainly, but with depression being present, the doctor may diagnose Major Depression rather than an Anxiety Disorder. The root cause may be the anxiety, but it is the secondary condition which is treated. It must be said, however, we have seen people come to us who have a diagnosis of Major Depression but are also experiencing spontaneous panic attacks. Surely the diagnosis should be Panic Disorder or Anxiety Disorder. Perhaps when the person presented to the doctor, they spoke of their symptoms and the doctor decided they were experiencing depression. Clients ask us for assistance in managing the panic attacks, but seem resolved to the fact they have been diagnosed as Major Depression and that is that. They seem to think the two are unrelated and accept they have a "chemical imbalance in the brain theory".
So when we present to a doctor and speak of our experience, our physical symptoms and general sense of wellbeing, what are we telling the doctor?
What are the defining symptoms of anxiety and depression? The tables below show the differences and the similarities.
Anxiety & Anxiety Disorder
|Feeling of fear, apprehension and excessive anxiety energy||Feeling of emptiness, deep sadness or misery, loss of hope|
|Physical feelings of agitation, muscle tension and symptoms of anxiety eg. heart symptoms, nausea, dissociation, diarrhoea, breathing difficulties etc||Slowing down of physical movement and lack of physical energy|
|General sense of being tense and rigid||Physical body slumped|
|May be a perfectionist and is concerned about the results of activities (can lead to poor performance)||Loss of interest and ambition (can lead to poor performance)|
|May fear death but not focused on suicide (Suicide thoughts come only when Depression is a secondary effect of Anxiety Disorder)||Suicidal thoughts present in deep depression|