Find the Hidden Anxiety in Your Depression

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If identifying anxiety and depression were easy, simply asking people if they were anxious or depressed would lead to straightforward answers. Unfortunately, recognizing your own mood disorder is not that simple.

People who struggle with sleep problems, poor concentration, low energy levels, loss of interest in usual activities, weight loss or weight gain, guilt, and social withdrawal may very well have depression. Still, that label often does not come to mind. We tend to think a depressed person is someone immobilized by their condition, not working 50 hours a week and managing a busy household.

One of the biggest challenges for healthcare providers is helping patients connect the dots between their physical symptoms and the functioning of their minds.

A person with gastrointestinal upset, headaches, tightness of the chest, difficulty breathing, and muscle aches in their shoulders and neck may not realize they are highly anxious.

Emergency department staff regularly explain to patients who believe they had a heart attack that they are physically fine; it can be unwelcome news that a person with severe chest pain has a mental health problem rather than an apparent medical condition.

The challenge of recognizing one’s depression or anxiety has yet another barrier to overcome. Sometimes anxiety occurs with depression.

We usually think of depression as a low-energy state and anxiety as a high-energy state of arousal, making the two conditions incompatible. Yet, studies suggest that about 50 percent of individuals with major depression also have an anxiety disorder. How does that work?

The Anxiety-Depression Cycle

When we look at the development of mental health problems, anxiety often begins during preadolescence, while depression more likely occurs in later adolescence and early adulthood.

The most common contributors to early childhood anxiety are environments in which children experience unstable homes, trauma, uncertainty, and loss. Early life experiences impact brain health through the chronic exposure of cortisol to the hippocampus, prefrontal cortex, and amygdala. These brain changes alter the structures needed to create and maintain a positive mood.

Experiencing anxiety for extended periods will eventually make it difficult to experience a normal range of emotions and lead to an increased risk of depression.

In addition to early adverse childhood events, our thoughts also contribute to the experience of both anxiety and depression.

Anxiety is associated with thoughts of helplessness in the face of adversity.

Using performance anxiety as an example, imagine a person anticipating a potential threat to their ego, such as attending a board meeting at work. They worry they will be asked to speak during the meeting, and if that occurs, they believe they will perform poorly. Poor performance is viewed as unacceptable and terrible.

The thoughts that lead to performance anxiety might go something like this: “I should perform well, but if I don’t, that would be terrible. I am no good if I perform poorly. I should be able to control my emotions. If I can’t control them, that is terrible. I cannot stand being anxious. Others might look at me and notice I’m anxious—that, too, would be terrible. I could not bear others not approving of me.”

With extreme, rigid thinking that demands a person must do well and others should treat them well, they quickly feel helpless in the face of such overwhelming demands for perfection and approval.

Depression, on the other hand, is more closely linked to thoughts of hopelessness.

The anxiety-depression cycle begins with anxiety interfering with everyday life.

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With anxiety, a person feels helpless in the face of a potential threat. As time progresses, an anxious person can look back on those struggles to overcome life challenges and conclude they are now stuck—life will always be hard. This is when the helplessness of anxiety shifts to the hopelessness of depression. They view themselves as powerless to build a better life for themselves in the future.

As thoughts of hopelessness take over, thinking is characterized by pessimistic predictions of the future, ruminating on past failures, and viewing the self as controlled by life circumstances.

Depression begins to interfere with the effective handling of life challenges, which then triggers anxious thoughts of poor performance and the negative appraisals of others.

Breaking the Cycle

Several factors influence mood disorders like anxiety and depression, including environment, genetics, adverse childhood experiences, thinking patterns, nutrition, and brain chemistry. Treatment itself should be multifaceted.

Here are three avenues of change to pursue if you find yourself struggling with depression mixed with anxiety.

• Being: Learn to be present. You likely already have some skills in handling negative thoughts and emotions—which is a problem. You may have learned the skill of not talking about what is wrong, not thinking, not feeling, or not trusting yourself or others. It is time to upgrade your skill set! Consider learning the skill of observing your thoughts and emotions with openness and curiosity. This is called mindfulness. In a recent article on how paying attention changes the brain, you can learn more about mindfulness.
• Thinking: Change your assumptions. When we tell ourselves that we must do well, others should approve of us, and life ought to be as we desire, we make assumptions about our ability to handle such disappointments. It is normal to want to do well, be approved, and have a good life. And it is disappointing when that is not the case. Those facts will never change. What we can change is the belief that it is terrible when things don’t go well and that we cannot handle it if they do. Be honest: You have been handling disappointment your whole life, which has not stopped you. Learn to accept yourself as a fallible person; you are a mixture of good and bad, like everyone else.
• Doing: Pursue your values. When we struggle with depression and anxiety, our attention gets shifted to our distress and away from what is important. As a result, we completely lose sight of the direction we want to be heading. Your values represent what is truly important to you—friendships, family, making a contribution, solving problems, love, creativity, taking a stand, and health might be some of your core values. Listen to what you long for and pursue it. You do not have to wait for your problems to be solved before you do what is important—you can start today.

While this may sound counterintuitive, try to let go of your efforts to control your anxiety and depression. Picture your struggles as something that you bring along as you take steps in the direction you want to be heading.

As we move toward health, we move away from dysfunction and disorders. If you need help, contact a mental health or medical professional.

To find a therapist near you, visit the Psychology Today Therapy Directory.