What's The Difference Between Depression and Anxiety?

Anxiety and depression are two mental health conditions that share some similarities and key differences. If you experience one condition, you are more likely to experience the other as well. 

There are similar, non-pharmacological treatments that target both anxiety and depression, including lifestyle changes, nutrition, and cognitive behavioral therapy (CBT). 

However, if treated pharmacologically, it is important to ensure the correct medication is taken as each disorder is treated uniquely. 

Here we look at the symptoms of anxiety and depression and some of the main disorders within each category. We also consider evidence-based treatments and coping strategies for these conditions.

Can you have both anxiety and depression at the same time?

Depression and anxiety are often seen as comorbidities, which means that people can experience both conditions at the same time. 

Some studies have reported that comorbid depression and anxiety occurs in about 25% of patients in general medical practice settings..

About 85% of people with depression¹ have comorbid anxiety, while approximately 90% of anxiety patients¹ have comorbid depression. 

Causes of anxiety and depression

In many cases, anxiety comes before depression. Anxiety may begin in the childhood or adolescent years. 

The occurrence of anxiety and depression together is partly explained through the similar genetic predisposition to both disorders, or by one being a by-product of the other. 

A shared hormone related to both conditions is known as corticotropin-releasing factor¹ (CRF). 

CRF regulates physical and behavioral stress responses, also known as the “fight or flight” response. This response is important for human survival because it activates all the bodily functions you need to respond to a threatening or dangerous situation. 

However, when the “fight or flight” response is activated, and CRF is released too often or in situations that really aren’t dangerous, it can lead to depression and anxiety. 

Inflammation and degeneration of areas in the brain have been more recently associated with the development of depression and comorbid conditions, such as anxiety. 

In terms of environmental factors, the first episode of depression will often occur following a major stressful life event. 

As more episodes occur, it becomes less likely that the episodes will result from an external event, and will more likely be triggered spontaneously.

The main difference between anxiety and depression

Depression and anxiety often occur hand-in-hand, and there is some overlap in their features. Both conditions involve the experience of negative emotions and distress. 

Although the experience of depression and anxiety is different for each individual and there are many psychological theories regarding the development of each, we can identify some general differences between the two.

Depression may be brought on by the loss of something important, like a goal. When it happens, you overanalyze the loss and come up with a strategy to produce a new goal or attainment. This kind of overanalyzing a situation is associated with anhedonia.

Anhedonia, a condition where you find it hard to feel pleasure in activities you used to enjoy, reduces your motivation to participate in activities. This may be an unconscious effort to conserve your energy, avoid further disappointment or discomfort, or avoid any goals that may seem unattainable  to you. 

In contrast, anxiety usually comes about when you perceive or face a threat to yourself. You respond to this threat by becoming hyper-focused on it, to the point of blocking everything else out. This is all in an effort to be able to rapidly notice if the threat becomes a reality, and then to avoid the danger it brings.

In broad terms, in depression there is often an emphasis on loss and a focus on the past, whereas anxiety is associated with a fear of something coming to pass and a focus on the future.

Depression

There are many types of depressive disorders. Here are the most common ones:

1. Major depressive disorder

Depressive symptoms are present for the majority of the time and must have been present for at least two continuous weeks to be diagnosed. The condition interferes with your ability to work, sleep, eat, and generally function. 

2. Persistent depressive disorder (dysthymia)

Less severe symptoms of depression are present for an almost continuous period of at least two years. Persistent depressive disorder can co-exist with major depressive disorder.

3. Perinatal depression

Perinatal depression is a major depressive disorder occurring during pregnancy or in the weeks to months after giving birth. 

4. Seasonal affective disorder

Seasonal affective disorder is associated with seasonal changes. It usually occurs in late autumn, persisting through winter, and then resolving in spring and summer. 

5. Depression with psychosis

This is a severe subtype of major depressive disorder, where you experience psychotic symptoms, such as hallucinations and delusions, in addition to depression.

Symptoms of depression

The symptoms of depression include:

• Persistent sad or “flat” mood 

• Persistent feelings of hopelessness

• Irritability and frustration

• Feelings of guilt

• Persistent loss of pleasure in things that would normally spark joy

• Reduced energy levels and a persistent deep fatigue

• Inability to concentrate, be decisive, or remember things

• Difficulty falling asleep and staying sleep; or in contrast, oversleeping

• Changes in appetite resulting in weight loss or gain

• Physical ailments such as aches, pains, headaches, and gastrointestinal problems, without an identifiable physical cause

• Suicidal thoughts and tendencies

Anxiety disorders

Several types of anxiety disorders can have significant impacts on daily life. Here are the common ones:

Generalized anxiety disorder

Generalized anxiety disorder (GAD) is characterized by excessive, difficult-to-control anxiety or worry for at least six months. The worry can be about work, health, social interactions, and even routine, seemingly insignificant issues. 

The symptoms of GAD can be similar to those seen in depression, including the following:

• Restlessness

• Irritability

• Fatigue 

• Difficulty focusing and remembering things

• Intense and persistent worry

• Difficulty falling and staying asleep

• Physical ailments such as stomachaches, headaches, and diarrhea

Panic disorder

People suffering from this condition have unexpected, spontaneous panic attacks that occur on a frequent basis. A panic attack is a sudden onset of overwhelming fear, which heightens and reaches its peak within minutes of beginning. 

During a panic attack, you typically experience various physical and emotional symptoms including sweating and clamminess, racing heart, shaking, shortness of breath, and a feeling of impending doom. 

Panic attacks are sometimes triggered by an object or situation, but for many people, they appear out of the blue. People with panic disorder feel anxious about when their next panic attack will occur and change their behavior to avoid future attacks.

Specific phobias (simple phobias)

A phobia is an intense fear or anxiety about specific objects or situations. Sometimes these fears seem realistic as, indeed, a real danger can be posed by some objects or situations. 

However, in specific phobias, the fear is out of proportion to the actual danger. What you will see in someone who has a specific phobia is an active avoidance of the object or situation that causes the phobia. If exposed to it, you will have an excessive reaction that could develop into a panic attack. 

These symptoms can come on suddenly and to the point that they interfere with your daily life.

Social anxiety disorder (social phobia)

Social phobia is an intense fear of social or performance-based situations. You become worried and embarrassed about being judged or watched, and that when you are, you will fail or look foolish in front of others.

To counter this, you often avoid social situations altogether. 

Agoraphobia

If you have agoraphobia, you have a fear of places where it might be difficult to escape, such as using public transport, being in open or enclosed spaces, being in a crowd or line, and being alone when outside the home. 

Basically, you fear these situations because you feel you can’t escape easily (e.g., the exits are blocked) if you were to experience panic or anxiety. This fear leads to you avoiding these situations. 

Agoraphobia sometimes occurs together with panic disorder. 

Separation anxiety disorder

Separation anxiety disorder is no longer thought of as a condition present only in children, but has also been diagnosed in adults. People with separation anxiety disorder are fearful of being separated from people they are attached to. 

In adulthood, it often presents in an intense fear of something bad happening to you or those you love and avoiding being separated from them.

Because the disorder is related to being separated from an attachment figure or something bad happening to an attachment figure, the symptoms all revolve around this. They include:

• Nightmares around a separation theme

• Reluctance to sleep away from home or have the attachment figure sleep away from home

• Reluctance to leave the home for activities such as work and school

• Fear of unfamiliar situations

• A desire to create situations that keep people close 

Similarities between depression and anxiety

Depression and anxiety can impact your life in similar ways. Both can cause intense fears, an inability to be present and productive in work and life, a persistent feeling of hopelessness, and feeling alienated from those around you. 

Common symptoms between the two conditions include physical pain and discomfort, changes in sleep patterns, decreased energy, irritability and frustration, and difficulty focusing and remembering things. These symptoms can have a huge impact on your relationships, school, work, and leisure. 

A common feature of both depression and anxiety is rumination on negative thoughts. Rumination involves negative thought patterns that often occur on repeat and reinforce the condition. 

In depression, guilt and self-blame can be powerful themes. Rumination often involves going over past events critically and blaming yourself for things that are likely outside your control. 

For instance, you may ruminate on guilty thoughts for not attending a social event due to low energy, which leads to increased feelings of depression.

For anxiety, rumination is often focused on the future. You may try to discover all the possibilities of something going wrong and be unable to stop thinking about them, despite them being outside your control.

A study in 2017 reported the significance of worry (of what is to come) and rumination (of what has happened) in reinforcing anxiety and depression,² respectively. 

The participants who showed increased tendencies to worry and ruminate participated in cognitive behavioral training to reduce this negative thinking. The results showed a reduction in their anxiety and depression symptoms.  

How anxiety and depression are treated

Anxiety

Anxiety can be treated through the use of psychotherapies such as CBT, especially if your symptoms are mild to moderate. 

In CBT,³ the therapist will help you draw links between your thought patterns, behavior, and emotions like fear and anxiety. You will learn to identify the thoughts and behaviors that may be perpetuating your anxiety, and then practice challenging them gradually. Relaxation exercises and behavioral strategies are part of the therapy. 

Toward the end of the therapy, you will work on relapse prevention by implementing lifestyle changes, maintenance techniques, and how to identify warning signs. The therapist will collaborate with you in your therapy; however, they will not do everything for you. This therapy takes work and dedication.  

Pharmacological treatment of anxiety can be beneficial and usually involves the use of antidepressants. In some cases, a low dose of benzodiazepines and atypical antipsychotic agents are used to treat anxiety. 

However, the risks and benefits have to be carefully discussed  with your doctor, as these medications can cause adverse side effects such as impaired cognitive function, drowsiness, and metabolic problems. 

Depression 

There is strong evidence to suggest CBT is beneficial for people with depression. In CBT, you will work with your therapist to identify automatic unhelpful thoughts and learn to challenge their validity. 

This process gradually reduces the intensity of negative thoughts and helps your thinking patterns become more rational, balanced, and positive. 

Behavioral strategies like activity scheduling are also helpful to improve motivation, energy, and self-confidence. 

The results of using CBT to treat depressive disorders⁴ are very promising. There is also strong evidence for other forms of psychotherapy in depression, such as acceptance and commitment therapy, mindfulness-based cognitive therapy, and psychodynamic psychotherapy.

Selective serotonin reuptake inhibitors (SSRIs) are commonly used as a first-line treatment for depression, but there are several classes of antidepressants that are commonly used as well. 

Keep in mind that most antidepressants take two to four weeks to start working, and four to six weeks to reach their peak effect. 

Treatment for both depression and anxiety often involves a combination of therapy and medication. Effective treatments can provide relief from long-standing symptoms and improve your quality of life.

What you can do to deal with depression and anxiety

Your negative thought processes and maladaptive behaviors make your depression and anxiety worse. The following strategies can help you cope with these conditions.

Journaling

Journaling can bring attention to rumination and unhelpful thoughts. It can assist you in the process of challenging your negative thoughts and practicing more balanced and rational thought patterns. It can also help you focus on the present moment and practice gratitude and positivity. 

People with anxiety find it helpful to write their worries down on paper to break the cycle of worry. Journaling can make issues feel less overwhelming and help you apply practical problem-solving techniques.

Exercise

The benefits of movement and exercise⁵ cannot be emphasized enough, especially if you are suffering from depression. 

When you exercise, endorphins (the “feel good chemicals”) are released, giving you that classic post-exercise high. However, there are also little proteins called neurotrophic factors that are released. 

These help in the growth of nerve cells in the mood regulation area of the brain called the hippocampus. These nerve cells can then make new connections that improve brain function, resulting in you feeling better. 

Neuroscientists have actually found that the hippocampus is generally smaller in people who are depressed, supporting this theory.

Mindfulness and meditation

Mindfulness⁶ is simply noticing your experiences and thoughts in the present moment. 

To practice mindfulness (and it does take practice) is to learn how to notice and accept your current thoughts and emotions as they appear from moment to moment. When they start to wander, you learn to harness them and bring them back to the present. 

This relates to depression because depression is fuelled by wandering and ruminating thoughts on something negative that has happened. By interrupting this process through mindfulness and focusing on the present moment, the rumination becomes less frequent, which can reduce feelings of depression. 

The lowdown

Anxiety and depression are common mental health conditions and often occur together. There are many similarities in the symptoms and treatments for both.

Although anxiety and depression can have a significant impact on a person’s life, treatments can be very effective in recovery and returning to normal function in school, work, relationships and leisure. If you feel you may have anxiety and/or depression based on the symptoms discussed here, consult your doctor.