Leon F Seltzer Ph.D.
The most common type of depressed person therapists encounter suffer from what’s frequently called “agitated depression” (another term for which might be “anxious depression”). Such a distraught state is made up of roughly equal amounts of helplessness (anxiety) and hopelessness (depression). And just as you can think yourself into anxiety by assessing your situation as precariously out of control, so can you ponder your way into the depths of depression by telling yourself that your situation leaves no room for hope.
People afflicted by what the therapists’ diagnostic manual DSM-IV designates “Generalized Anxiety Disorder” frequently experience symptoms that mirror those of depression quite as much as they do anxiety. For along with their diffuse, overblown and irrational fears, they can also manifest a sense of hopelessness, fatigue, inability to enjoy things, and a frustrating lack of motivation.
To me, the essential tie-in between those plagued with anxiety and those burdened by depression is that they both deal similarly with stress. If we define stress as simply the fight-or-flight reaction to some perceived threat, it’s clear that anxiety and depression stand at the pole of flight–whereas the kindred emotions of anger and rage line up at the opposite pole. To elaborate, experiencing anger puts you in attack mode. Confident that you can defeat your antagonist, you’re ready to confront them (though today any ensuing battle is far more likely to be verbal than physical). On the contrary, feeling anxious or depressed in the face of perceived danger stems from your concluding that you can’t successfully defeat your adversary (whether subject or object, real or imagined). Which, of course, catapults you into retreat mode.
It can hardly be overemphasized that, more than anything else, anxiety is characterized by avoidance. After all, if you’re afraid someone will attack you and you won’t be able to adequately counterattack or defend yourself, you’ll naturally seek to stay away from them. If that’s not possible, you’ll try to refrain from doing anything that might provoke them. Likewise, if you’re afraid you’ll fail at some project, it’s probable that you’ll back off from undertaking it. And if you’ve already begun the activity or pursuit, any fears you may have about successfully completing it will increase the chances that you’ll decide, prematurely, to abandon it.
To give some additional examples, if you’ve been in a serious car accident, and thus become deeply sensitized by the scary experience, you might seek to avoid driving at every opportunity. Frightened by an exceptionally turbulent flight, you might feel impelled to do everything you can to get out of future air travel. Or unexpectedly freezing while speaking in front of a group–and so gravely embarrassing yourself–going forward you’ll likely shyaway from such public exposure. At the core of all phobias and panic attacks lies unmanageable levels of anxiety. And in every instance the knee-jerk coping response is the disengaging one of avoidance.
When we speak of depression, the term we use isn’t avoidance: it’s withdrawal. Yet these two terms are clearly “first cousins” (if not identical twins). So, if you’re convinced you can’t succeed at something, you’re likely to stop trying–for the prospect of failure may simply be too painful. Or if you’ve got a weak ego and have experienced many rejections in direct attempts at self-marketing, you’re likely to shut down efforts at face-to-face presentation entirely.
In general, you refrain from doing things that threaten to make you feel bad–or worse–about yourself. However, the unfortunate result of such self-suppression or withdrawal is that such a passive coping response is likely to make you even more depressed–just as the greatest cost of anxiety-induced avoidance is that it only leads your fearfulness to spread and deepen, thereby creating even more (maladaptive) avoidance. In a sense, it might be said that with both anxiety and depression your self-protective “cure” ends up taking a much greater toll on your life than the “diseased” emotion or mood itself.
Unquestionably, both anxiety and depression have the potential to be debilitating. As an example, individuals with agoraphobia may get to the point where they literally can’t leave their house–similar to those so severely depressed that they can’t get themselves out of bed. And in both instances such physical paralysis can lead only to further demoralization.
Underlying the stress-induced flight response linking these two powerfully negative emotions, moods, or states of mind is the gut experience of being overwhelmed. Preparing for a difficult licensing exam, for instance, could bring about either emotional state if you doubt you have what it takes to pass it. It’s just that with anxiety your obsessions about failure are fear-laden, whereas with depression your ruminations reflect profound discouragement, to the point of hopelessness or despair. But in both cases you’re feeling overwhelmed because of a woeful lack of self-confidence. And that’s the real issue behind feeling overwhelmed, which in turn leads either to anxiety, depression–or a veritable “stew” of these two painful emotions.
Moreover, anxiety and depression “compounded” together eventuate in a particularly powerful sense of feeling overwhelmed. R. Morgan Griffin(link is external), writing for WebMD, quotes Dean F. MacKinnon, MD (of Johns Hopkins Hospital) as saying: “When you’re in the grip of depression and anxiety, it can feel like the misery will never end, that you’ll never recover”; and that “if you’re already depressed, anxiety is a multiplier of suffering.” So it should be obvious that experiencing symptoms of both disturbances simultaneously can be nothing short of disabling. And undoubtedly, being besieged by such alarming sensations as shortness of breath, heart palpitations, or chest pain can only add to the inner turmoil of your situation.
Finally, let’s conclude Part 2 of this post by zeroing in on, and further clarifying, the many symptoms of anxiety and depression that frequently co-occur–and which, collectively, suggest the profound interrelationship between these two so-problematic mental/emotional states. (Many of these similarities have already been noted in a piece entitled “The Line Between Anxiety and Depression(link is external).”)
• Sleep disturbance (whether it’s difficulty falling asleep or staying asleep, the basic problem relates to feeling all keyed up and not being able to let go of distressing, ruminative, or excessively self-absorbing thoughts);
• Restlessness (which is intimately connected to the inner agitation found in so many people with anxiety [a] or depression [d]);
• Irritability (a certain element of anger exists in both a & d, though such crabby bad-temperedness is typically directed mostly toward the self and not really meant to be taken personally by others–who, nonetheless, frequently can’t help but feel hurt or offended);
• Fatigue (both a & d, in being extremely stressful, can easily sap your energy; and needing to get by on less sleep only adds to this state of enervation or depletion);
• Difficulty concentrating, or your mind’s going blank (compelling emotions like a & d inevitably disrupt your attention and distract you from the matter at hand; and additionally, with depression your mind literally slows down);
• Obsessively pessimistic and painful thoughts (about the future, as well as the past: you can’t move comfortably forward because your thoughts–whether linked to a or d–are too defeatist);
• Worry (although this tendency is routinely associated with anxiety rather than depression, fears about your health, family, job, financial prospects, etc. are quite common in depressives as well);
• Irrational or excessive feelings of guilt (closely tied to self-denigrating thoughts; but also stemming from being disappointed with yourself for not being able to gain control over your emotions–or to keep them from putting a strain on your relationships);
• Tearfulness (being so overcome by distressful emotions that you’re easily–and spontaneously–moved to tears over your situation, which feels so helpless and hopeless);
• Loss of appetite (but sometimes overeating as a desperate coping response to feelings of a & d; considered generally, eating disorders are not uncommon in either a or d);
• Loss of sexual drive or desire (which–unless your bloodstream is supersaturated with testosterone–is simply incompatible with the feelings and mood of a or d);
• Loss of pleasure in things that previously interested you–or apathy about living in general (because of not being able to subdue negative, dispirited, or dejected thoughts–and/or being preoccupied with unsettling a- or d-related physical symptoms);
• Loss of motivation and ambition (because your defeatist thoughts overwhelm you with doubts about your capacity to succeed at whatever you might undertake; and this self-deprecation also helps to explain why people with a or d are typically indecisive);
• Loss of self-esteem and -confidence (because of how your avoidant/withdrawal reactions undermine your day-to-day functioning);
• Associated feelings of self-blame, -devaluation, and worthlessness (again, because of all the discouraged, downbeat assumptions and beliefs linked to your a & d); and
• Various aches and pains–particularly headaches (most commonly, tensionheadaches; and note that protracted states of “internal friction” may underlie many, if not most, of the physical symptoms you may be suffering because of a & d).
Note 1: Whereas Part 1 of this post delineated the broad distinctions between the syndromes of anxiety and depression, Part 3 will expand on the present section by describing the various negative beliefs about self and one’s place in the world that engender both these distressful mental/emotional states. Part 4 will investigate research findings on this subject, as well as their theoretical implications. And, finally, Part 5 will deal with how medication and talk therapy can be used in devising the best treatment possible for those suffering from combined anxiety and depression.