Chy
06-24-2008, 08:11 PM
Provided by Psychology Today
Are you anxious or are you depressed? In the world of mental health care, where exact diagnosis dictates treatment, anxiety and depression (http://www.medicinenet.com/script/main/art.asp?articlekey=342) are regarded as two distinct disorders. But in the world of real people, many suffer from both conditions. In fact, most mood disorders present as a combination of anxiety and depression. Surveys show that 60-70% of those with depression also have anxiety. And half of those with chronic anxiety also have clinically significant symptoms of depression.
The coexistence of anxiety and depression--called comorbidity in the psych biz--carries some serious repercussions. It makes the course of disorder more chronic, it impairs functioning at work and in relationships more, and it substantially raises suicide (http://www.medicinenet.com/script/main/art.asp?articlekey=24418) risk.
Over the past couple of years, clinicians and researchers alike have been moving towards a new conclusion: Depression and anxiety are not two disorders that coexist. They are two faces of one disorder.
"They're probably two sides of the same coin," says David Barlow, Ph.D., director of the Center for Anxiety and Related Disorders at Boston University. "The genetics seem to be the same. The neurobiology seems to overlap. The psychological and biological nature of the vulnerability are the same. It just seems that some people with the vulnerability react with anxiety to life stressors. And some people, in addition, go beyond that to become depressed."
They close down. "Depression seems to be a shutdown," explains Barlow. "Anxiety is a kind of looking to the future, seeing dangerous things that might happen in the next hour, day or weeks. Depression is all that with the addition of 'I really don't think I'm going to be able to cope with this, maybe I'll just give up.' It's shutdown marked by mental, cognitive or behavioral slowing."
At the core of the double disorder is some shared mechanism gone awry. Research points to overreactivity of the stress (http://www.medicinenet.com/script/main/art.asp?articlekey=488) response system, which sends into overdrive emotional centers of the brain, including the "fear center" in the amygdala. Negative stimuli make a disproportionate impact and hijack response systems.
Mental health professionals often have difficulty distinguishing anxiety from depression, and to some degree they're off the hook. The treatments that work best for depression also combat anxiety. Cognitive-behavioral therapy (CBT) gets at response patterns central to both conditions. And the drugs most commonly used against depression, the SSRIs, or selective serotonin reuptake inhibitors, have also been proved effective against an array of anxiety disorders, from social phobia (http://www.medicinenet.com/script/main/art.asp?articlekey=90009) to panic and post-traumatic stress disorder (PTSD). Which drug a patient should get is based more on what he or she can tolerate rather than on symptoms.
And therein lies a problem. According to physicians Edward Shorter of Canada and Peter Tyrer of England, the prevailing view of anxiety and depression as two distinct disorders, with multiple flavors of anxiety, is a "wrong classification" that has led the pharmaceutical industry down a "blind alley." It's bad enough that the separation of anxiety and depression lacks clinical relevance. But it's also "one reason for the big slowdown in drug discovery in psychiatric drugs," the two contend in a recent article published in the British Medical Journal. It's difficult to create effective drugs for marketing-driven disease "niches."
Who is at risk for combined anxiety and depression? There's definitely a family component. "Looking at [what disorders populate] the family history of a person who presents with either primary anxiety or depression provides a clue to whether he or she will end up with both," says Joseph Himle, Ph.D., associate director of the anxiety disorders unit at University of Michigan.
The nature of the anxiety disorder also has an influence. Obsessive-compulsive disorder, panic disorder (http://www.medicinenet.com/script/main/art.asp?articlekey=440) and social phobia are particularly associated with depression. Specific phobias are less so.
Age plays a role, too. A person who develops an anxiety disorder for the first time after age 40 is likely also to have depression, observes Himle. "Someone who develops panic attacks for the first time at age 50 often has a history of depression or is experiencing depression at the same time."
Are you anxious or are you depressed? In the world of mental health care, where exact diagnosis dictates treatment, anxiety and depression (http://www.medicinenet.com/script/main/art.asp?articlekey=342) are regarded as two distinct disorders. But in the world of real people, many suffer from both conditions. In fact, most mood disorders present as a combination of anxiety and depression. Surveys show that 60-70% of those with depression also have anxiety. And half of those with chronic anxiety also have clinically significant symptoms of depression.
The coexistence of anxiety and depression--called comorbidity in the psych biz--carries some serious repercussions. It makes the course of disorder more chronic, it impairs functioning at work and in relationships more, and it substantially raises suicide (http://www.medicinenet.com/script/main/art.asp?articlekey=24418) risk.
Over the past couple of years, clinicians and researchers alike have been moving towards a new conclusion: Depression and anxiety are not two disorders that coexist. They are two faces of one disorder.
"They're probably two sides of the same coin," says David Barlow, Ph.D., director of the Center for Anxiety and Related Disorders at Boston University. "The genetics seem to be the same. The neurobiology seems to overlap. The psychological and biological nature of the vulnerability are the same. It just seems that some people with the vulnerability react with anxiety to life stressors. And some people, in addition, go beyond that to become depressed."
They close down. "Depression seems to be a shutdown," explains Barlow. "Anxiety is a kind of looking to the future, seeing dangerous things that might happen in the next hour, day or weeks. Depression is all that with the addition of 'I really don't think I'm going to be able to cope with this, maybe I'll just give up.' It's shutdown marked by mental, cognitive or behavioral slowing."
At the core of the double disorder is some shared mechanism gone awry. Research points to overreactivity of the stress (http://www.medicinenet.com/script/main/art.asp?articlekey=488) response system, which sends into overdrive emotional centers of the brain, including the "fear center" in the amygdala. Negative stimuli make a disproportionate impact and hijack response systems.
Mental health professionals often have difficulty distinguishing anxiety from depression, and to some degree they're off the hook. The treatments that work best for depression also combat anxiety. Cognitive-behavioral therapy (CBT) gets at response patterns central to both conditions. And the drugs most commonly used against depression, the SSRIs, or selective serotonin reuptake inhibitors, have also been proved effective against an array of anxiety disorders, from social phobia (http://www.medicinenet.com/script/main/art.asp?articlekey=90009) to panic and post-traumatic stress disorder (PTSD). Which drug a patient should get is based more on what he or she can tolerate rather than on symptoms.
And therein lies a problem. According to physicians Edward Shorter of Canada and Peter Tyrer of England, the prevailing view of anxiety and depression as two distinct disorders, with multiple flavors of anxiety, is a "wrong classification" that has led the pharmaceutical industry down a "blind alley." It's bad enough that the separation of anxiety and depression lacks clinical relevance. But it's also "one reason for the big slowdown in drug discovery in psychiatric drugs," the two contend in a recent article published in the British Medical Journal. It's difficult to create effective drugs for marketing-driven disease "niches."
Who is at risk for combined anxiety and depression? There's definitely a family component. "Looking at [what disorders populate] the family history of a person who presents with either primary anxiety or depression provides a clue to whether he or she will end up with both," says Joseph Himle, Ph.D., associate director of the anxiety disorders unit at University of Michigan.
The nature of the anxiety disorder also has an influence. Obsessive-compulsive disorder, panic disorder (http://www.medicinenet.com/script/main/art.asp?articlekey=440) and social phobia are particularly associated with depression. Specific phobias are less so.
Age plays a role, too. A person who develops an anxiety disorder for the first time after age 40 is likely also to have depression, observes Himle. "Someone who develops panic attacks for the first time at age 50 often has a history of depression or is experiencing depression at the same time."