What is the Difference Between Depression and Anxiety?

“What is the difference between depression and anxiety? I went to one doctor, and he said that I have depression. I went to another doctor, and she said that I have anxiety. They both prescribed the same medication. What do I do now?” 

However simple this question might seem, it is really quite complicated. First of all, anxiety can be a disorder in and of itself; however, it can also be a symptom of a number of other mental disorders, including mood disorders such as depression and bipolar disorder. This should have been better explained by both of the doctors you saw. Were you seen by a family doctor, internist, or psychiatrist? A well versed psychiatrist would be my choice for an initial diagnosis.

An anxiety disorder, in its simplest terms, is an unreasonable reaction of fear, distress or uneasiness in terms of activities, events and/or behaviors. Anxiety is a relatively common problem. According to the National Institute of Mental Health, each year over 40 million people are diagnosed with an anxiety disorder. The anxiety needs to have persisted for six months or more. When one is suffering from anxiety, he/she is unable to deal with certain life events, with a disruption in productivity, and a lessened quality of life. The person might avoid the anxiety provoking activities and/or ruminate about them excessively. Sometimes, the anxiety spreads and affects a great number of activities. The term for this particular condition is generalized anxiety disorder.

On the other hand, the anxiety might well be a symptom of depression. In this case, the behavior is the same, but the etiology is different. One might be depressed and spend long hours doing little or nothing, perhaps staying in bed all day. This will contribute to a general feeling of distress, including anxiety. Persons who are depressed often exhibit extreme anxiety, with interrupted sleep patterns and repetitive activities such being on the computer for long hours. Some who are depressed may be so anxious that they pace endlessly and are sometimes unable to leave their homes.

Depression is also widespread. Again, the National Institute of Mental Health indicates that the severity, frequency and duration of symptomatic behavior, such as feeling sad and anxious, experiencing an empty mood, feelings of guilt or worthlessness, loss of interest in pleasurable activities, sleep disturbances, excessive weight gain or loss and thoughts of suicide are important diagnostic considerations for depression and anxiety. One can see that one of the characteristics of anxiety is a transitory reaction to life events. Depression is usually associated with feelings of loss of meaning in life and is usually more serious.

I have mentioned the importance of life events. Have there been any particular changes recently, especially negative events? People often feel fearful in reaction to change and can develop anxiety. Again, in many cases, there is no physical component to the reaction, and it is simply situational anxiety, not a diagnosable illness. With clinical depression, there are both physiological and psychological components. There exists a biological predisposition to depression and so negative life events have a far greater effect on the depressed person’s sense of well being. It is as if, over time, the person suffering from anxiety usually has the resiliency to “snap out of it,” while the person with clinical depression is unable to “bounce back.”

In summary, anxiety and depression often go hand in hand. Treating one without giving some attention to the other may be ineffective. The best suggestion I can give is to have a complete physical examination, with the results forwarded to a psychiatrist who has experience with mood disorders. This psychiatrist can then assess the possibility of your symptoms having a physiological as well as psychological basis. If so, certain medications should help alleviate the symptoms. If not, certain other medications might be indicated for a relatively shorter period of time. Regardless of the medication prescribed, you must be patient. It may take several weeks or longer for the medication to become effective. You may even have to try several combinations of medication to find an effective “cocktail.” The possible length of this process can certainly exacerbate your anxiety or depression, so patience is an important virtue. In an attempt to help the treatment process and further decrease symptoms, I would also recommend a cognitively based regimen of group psychotherapy to treat the psychological and potential social aspects of the depression and/or anxiety.

~Dr. Manuel S. Silverman, PhD