Anxiety and depression are two of the most commonly diagnosed mental health issues amongst Canadian adults. In any given year, 1 in 5 Canadians will have a mental health issue, with 5.4% of the Canadian population diagnosed with major depression and 4.6% of the population diagnosed with an anxiety disorder. With such prevalence, it is important to know the signs of anxiety, depression, how they interact, and best methods of treatment.
What causes depression?
Depression is a common mental health disorder that can affect anyone at any age. Depression is complex and can have many possible causes. While the exact causes are not fully understood, researchers have identified several factors that could contribute to someone developing depression. Here are some of the most common causes:
- Genetics: Research has suggested that there could be a genetic component to the development of depression. People with a family history of depression may be more likely to develop the condition themselves. Some research has also shown a few genetic mutations may lead to a higher possibility of the development of depression.
- Brain chemistry: Depression is often associated with imbalances in brain messenger chemicals called neurotransmitters. Serotonin, norepinephrine, and dopamine are three neurotransmitters that are associated with regulating mood.
- Environmental factors: A number of environmental factors can contribute to the development of depression. Stressful life events, such as the death of a loved one, a divorce, or financial problems, can trigger the onset of depression. Exposure to trauma, abuse, or violence can also increase the risk of depression.
- Medical conditions: Certain medical conditions, such as chronic pain, heart disease, and cancer, can increase the risk of depression. Neurodiversity, used to describe conditions such as ADHD and autism, are also associated with depression. Additionally, medications used to treat these conditions can sometimes cause depression as a side effect.
- Substance abuse: Substance abuse, including alcohol and drug abuse, can contribute to the development of depression. Substances fundamentally change brain chemistry and trigger changes in mood, sometimes beyond the period of active use.
- Personality traits: Certain personality traits, such as neuroticism, introversion, and low self-esteem, have been associated with an increased risk of depression.
- Hormonal changes: Changes in hormone levels, such as those that occur during pregnancy or menopause, can contribute to the onset of depression.
The causes of depression often interact in complex ways. For example, a person may have a genetic predisposition to depression, but may only experience symptoms after a stressful life event triggers the condition. Similarly, a person with chronic pain may develop depression as a result of the physical toll of their condition along with the interpersonal stressors it can also cause.
When addressing depression, it is important to refrain from blaming anyone for their circumstances. There is a huge amount of stigma surrounding depression, including misconceptions that it is just laziness or a bad mood. Stigma contributes to shame, particularly around feelings of suicide. If you or someone you know is feeling suicidal, seek professional help immediately.
What causes anxiety?
Anxiety is a common mental health condition that can affect anyone, regardless of age or background. It is characterized by feelings of worry, nervousness, and apprehension, and can be accompanied by a variety of physical symptoms. There are several factors that contribute to the development of anxiety, although its exact cause in any person is unknown. Anxiety shares many potential causes with depression. Here are some of the most commonly recognized causes of anxiety:
- Genetics: Research has suggested that genetics may play a role in the development of anxiety. People with a family history of anxiety disorders may be more likely to develop the condition themselves. Studies have also identified certain genetic variations that may increase the risk of anxiety.
- Brain chemistry: Anxiety is often associated with imbalances in neurotransmitters. GABA, serotonin, and norepinephrine, three types of neurotransmitters, play important roles in regulating mood and anxiety. If these chemicals become imbalanced, anxiety may develop.
- Life events: Life events are a huge contributor to the development of anxiety. Stressful life events, such as a big move, a divorce, or illness, can trigger the onset of anxiety. Exposure to trauma, abuse, or violence can also increase the risk of anxiety.
- Medical conditions: Certain medical conditions, such as heart disease, diabetes, and thyroid disorders, can increase the risk of anxiety. Neurodiversity, used to describe conditions such as ADHD and autism, are also associated with anxiety. Additionally, medications used to treat these conditions can sometimes cause anxiety as a side effect.
- Substance abuse: Substance abuse, including alcohol and drug abuse, can contribute to the development of anxiety. Substance abuse fundamentally changes the way the brain works and can induce feelings of anxiety even outside active use and withdrawal. This includes caffeine and nicotine.
- Personality traits: Certain personality traits, such as neuroticism and introversion have been associated with an increased risk of anxiety.
- Cognitive factors: Negative thinking patterns and cognitive distortions, such as catastrophizing and overgeneralizing, can contribute to the development of anxiety.
- Environmental factors: Certain environmental factors, such as high noise levels, crowded living conditions, and exposure to violence or trauma, can contribute to the development of anxiety.
It’s important to note that anxiety can have multiple causes, and these causes can often interact in complex ways. For example, a person may be genetically predisposed to anxiety, but also grow up in a family culture that promotes anxiousness. Anxiety may develop without any obvious cause but could also be closely associated with a certain subject or event.
Panic attacks are commonly associated with anxiety disorders. Panic attacks are the sudden onset of extreme distress, including sweats, chest pain, heart palpitations, and feelings of worry. For those who have never experienced panic attacks, they may resemble other, more serious medical conditions. If you are experiencing panic attack symptoms that mirror serious conditions such as heart attacks or paralysis, seek medical attention.
Post Traumatic Stress Disorder, Depression, and Anxiety
Post-traumatic Stress Disorder (PTSD) is a mental health disorder that can occur after someone experiences or witnesses a traumatic event, such as combat, sexual assault, or a natural disaster. Complex PTSD (C-PTSD) is a specific type of PTSD that involves long-term, chronic, and intricate traumas, often experienced in childhood. PTSD and C-PTSD can have a significant impact on an individual’s mental health and well-being, often resulting in symptoms of anxiety and depression. C-PTSD is also associated with low self-esteem, which is a large contributing factor to both anxiety and depression.
Anxiety is a common symptom of PTSD. Individuals with PTSD may experience excessive worrying or fear, have difficulty sleeping, or feel on edge or easily startled. These symptoms can be triggered by reminders of the traumatic event, such as a loud noise or certain smells, which can lead to anxiety, panic, or flashbacks. These feelings or flashbacks can lead to extreme aversion. This aversion increases risk of both depression and further anxiety.
Depression is also common in individuals with PTSD. Symptoms of depression may include feelings of sadness or hopelessness, loss of interest in activities, changes in appetite or sleep, and difficulty concentrating or making decisions. Depression may be caused by the traumatic event itself or by the ongoing stress and strain of dealing with the symptoms of PTSD, such as flashbacks or hypervigilance. For those with Complex PTSD, feelings of worthlessness and hopelessness may be fundamental parts of their identities.
Panic attacks can also be a significant symptom of PTSD. Panic attacks involve sudden, intense feelings of fear or anxiety, accompanied by physical symptoms such as rapid heartbeat, sweating, and shortness of breath. Panic attacks can be triggered by a variety of factors, including reminders of the traumatic event or feelings of helplessness or loss of control.
Complex PTSD, also known as developmental trauma disorder, is a type of PTSD that occurs when someone experiences repeated or prolonged trauma, such as ongoing physical or sexual abuse, neglect, or violence. Individuals with complex PTSD may experience symptoms similar to those with PTSD, such as anxiety, depression, and panic attacks, as well as additional symptoms such as difficulties with emotion regulation, dissociation, and interpersonal relationships.
The intersection between PTSD, anxiety, and depression can be complex and deeply intertwined. For example, an individual with PTSD may experience anxiety symptoms such as hypervigilance and fear of certain situations or triggers, which can contribute to feelings of depression and hopelessness. Similarly, someone with depression may experience feelings of helplessness and hopelessness that can exacerbate the symptoms of PTSD.
Panic attacks can also play a role in the intersection between PTSD, anxiety, and depression. For example, someone with PTSD may experience panic attacks in response to reminders of the traumatic event or feelings of helplessness, which can contribute to feelings of anxiety and depression and keep the affected person in a cycle of distress. However, with the right treatment and support, individuals with PTSD, anxiety, and depression can recover and regain control of their lives.
Symptoms of PTSD
PTSD has a variety of symptoms. Not every person who experiences trauma will be diagnosed with PTSD, but for those with that diagnosis may experience some of the following symptoms. Patients might also experience symptoms not listed here:
- Intrusive memories, such as flashbacks or nightmares, of the traumatic event.
- Avoidance of reminders of the traumatic event, such as places or activities associated with the trauma.
- Negative thoughts or feelings related to the traumatic event, such as guilt, shame, or fear.
- Hyperarousal or heightened anxiety, such as being easily startled, feeling on edge, or having difficulty sleeping.
- Re-experiencing symptoms, such as physical reactions to triggers or sensations similar to those experienced during the traumatic event.
- Avoidance of activities, people, or situations that may trigger memories of the traumatic event.
- Increased irritability or anger, including outbursts of anger or physical aggression.
- Feelings of detachment or numbness, including an inability to feel pleasure or a sense of being disconnected from oneself or others.
- Difficulty concentrating or remembering details, including difficulty focusing or retaining information.
- Feeling a sense of disorientation or confusion, including feeling lost or disoriented in familiar environments.
Symptoms of C-PTSD
Not everyone who experiences a difficult childhood or an extreme, intense, harmful relationship will be diagnosed with Complex Post-Traumatic Stress Disorder. Complex PTSD shares symptoms with PTSD. However, due to its deeply interpersonal and long-lasting manner, there are a few symptoms that are unique to Complex PTSD. The symptoms of C-PTSD include:
- Difficulty regulating emotions, including intense or prolonged emotional reactions to triggering situations or events.
- Negative self-concept, including feelings of worthlessness, shame, or guilt.
- Difficulty forming and maintaining close relationships, including a tendency to isolate oneself from others or struggle with interpersonal conflicts.
- Hypervigilance, including a heightened sense of awareness of potential danger or threats in one’s environment.
- Dissociation, including feeling disconnected from oneself or one’s surroundings, or experiencing “out of body” sensations.
- Chronic feelings of emptiness or despair, including a sense of hopelessness about the future.
- Difficulty managing and coping with stress, including difficulty sleeping or managing symptoms of anxiety or depression.
- Changes in self-perception, including feeling distorted or inconsistent views of oneself or one’s place in the world.
- Difficulty managing or regulating behavior, including self-destructive or impulsive behaviors, or difficulty following through with goals and plans.
- Difficulty managing or regulating thought processes, including recurrent and intrusive thoughts or beliefs about oneself, the world, or others.
What causes depression and anxiety to appear together?
Anxiety and depression can commonly co-occur within the same person. While they are distinct conditions with different symptoms, they may have closely related, overlapping causes that would lead to both showing up in one individual. Researchers have not yet been fully able to explain why anxiety and depression seem to often be in cahoots with one another, but there seems to be a few reasons at play.
One possible explanation for the anxiety-depression duo is that they both involve dysregulation and disruption of the same neurotransmitters in the brain. Neurotransmitters are chemicals that allow nerve cells in the brain to send messages to one another. Serotonin and norepinephrine are two neurotransmitters that regulate mood. Imbalances in these chemicals can contribute to both anxiety and depression. For example, it is very common to see low levels of serotonin associated with both anxiety and depression.
Another possible explanation is that both anxiety and depression can be triggered by a combination of genetic, biological, environmental, and psychological factors. Research has suggested that there may be genetic components to both conditions, meaning that some individuals may be more predisposed to developing anxiety and depression than others. Additionally, environmental factors such as stress, trauma, or substance abuse can trigger the onset of anxiety and depression in susceptible individuals. Biologically speaking, certain medical conditions may also lead to the co-occurrence of anxiety and depression. More specifically, ADHD, autism, pain disorders, and hormonal disorders like hypothyroidism and PCOS have all been named as medical disorders that are associated with both anxiety and depression. Psychological factors such as negative thinking patterns, low self-esteem, or a history of anxiety or depression can also contribute to the development of both conditions. It’s also possible that certain personality traits, such as neuroticism or introversion, may lead to both anxiety and depression developing in one person.
Ironically, in some cases, just the mere presence of one of these disorders can be enough to develop the other one. For example, people with anxiety disorders may be more likely to experience depression because of the chronic stress and fear that comes with anxiousness. Similarly, people with depression may experience symptoms of anxiety because of the sense of hopelessness and helplessness that can accompany the condition. It can be a vicious cycle of living in fear of the past while also fearing the future.
What are the symptoms of anxiety?
You may experience all of the following symptoms of anxiety or very few. You should consult a doctor if these symptoms are impacting your day-to-day functioning.
Symptoms of Anxiety
- Excessive worry or fear about everyday situations
- Feeling restless or on edge
- Difficulty concentrating or focusing
- Irritability or agitation
- Muscle tension or tightness
- Trouble sleeping or staying asleep
- Fatigue or exhaustion
- Sweating or trembling
- Rapid heart rate or palpitations
- Shortness of breath or hyperventilation
- Nausea or stomach problems
- Panic attacks or feelings of impending doom
- Avoidance of certain situations or activities due to fear or anxiety
- Obsessive thoughts or compulsive behaviors
- Feeling detached or disconnected from reality
Symptoms of Panic Attacks
Panic attacks are commonly associated with Panic Disorder and other anxiety disorders, such as Generalized Anxiety Disorder or Agoraphobia. You may experience some of these symptoms with your anxiety. Please consult a medical professional if you have never experienced these symptoms before, as it is important to rule out any other cause for these symptoms. A panic attack may be short-lived and mild, or longer lasting and severe. For more information, please read our article on anxiety and panic attacks.
- Sudden and intense feelings of fear or terror
- Rapid heart rate or palpitations
- Sweating or trembling
- Shortness of breath or hyperventilation
- Chest pain or discomfort
- Nausea or stomach upset
- Feeling dizzy or lightheaded
- Chills or hot flashes
- Tingling or numbness in the extremities
- Fear of losing control or going crazy
- Fear of dying
- Sense of detachment from oneself or surroundings
- Feeling like one is choking or suffocating
- Rapid thoughts or racing mind
- Avoidance of situations or places associated with previous panic attacks
What are the symptoms of depression?
Major Depressive Disorder, the most commonly diagnosed depressive disorder, has a number of symptoms that range from mild to severe. If any of these symptoms begin to affect your daily functioning, including school, work, hygiene, or socializing, please consult a medical professional. It is important to take any thoughts of suicide seriously and seek help immediately. Suicidal thoughts are a medical emergency, and there are resources available to help those who are struggling with depression and suicidal ideation.
Symptoms of Depression
- Persistent feelings of sadness, emptiness, or hopelessness
- Loss of interest or pleasure in activities that were once enjoyable
- Changes in appetite or weight (either decreased or increased)
- Sleep disturbances (either insomnia or hypersomnia)
- Fatigue or loss of energy
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating or making decisions
- Restlessness or irritability
- Physical symptoms such as headaches, body aches, or digestive problems
- Thoughts of suicide or self-harm
- Withdrawal from social activities or relationships
- Decreased sex drive or sexual dysfunction
- Difficulty getting out of bed or performing daily tasks
- Feeling numb or emotionally disconnected from others
- Agitation or slowed movements.
What symptoms of anxiety and depression overlap?
Although anxiety and depression are two separate diagnoses, some of their conditions overlap, which may make it difficult to differentiate what problem you are currently facing. Here are some of the symptoms that overlap and how they can apply to both conditions:
- Sleep disturbances: Both depression and anxiety can cause changes in sleep patterns. Insomnia, or difficulty falling or staying asleep, is a common symptom of both disorders. On the other hand, hypersomnia, or excessive sleeping, can also occur in both depression and anxiety.
- Difficulty concentrating: People with depression and anxiety may both experience difficulty focusing or concentrating. This can lead to problems with work, school, or other daily activities. This is often one of the first symptoms to indicate a larger issue at play.
- Changes in appetite and weight: Depression and anxiety can both cause changes in appetite. Some individuals may experience decreased appetite and weight loss, while others may experience increased appetite and weight gain.
- Fatigue: Both depression and anxiety can cause feelings of fatigue or low energy. This can make it difficult to carry out daily tasks and may lead to social withdrawal and isolation.
- Irritability: While depression is often associated with feelings of sadness, irritability is also a common symptom that can overlap with anxiety. Irritability can manifest as a short temper, easily becoming frustrated, or low patience with others.
- Physical symptoms: Anxiety and depression can both cause physical symptoms such as headaches, muscle tension, and digestive issues. These symptoms can often worsen during times of stress.
- Negative thinking patterns: Both depression and anxiety can involve negative thinking patterns such as pessimism, self-criticism, and feelings of worthlessness. These thoughts can be difficult to break out of and can contribute to both conditions.
What should I ask my doctor about treating anxiety and depression together?
Consulting with a medical professional can be extremely beneficial in figuring out options for addressing your anxiety and depression symptoms. Here are some questions that may help guide your conversation.
- Are there any medical reasons that I might be experiencing anxiety and depression symptoms?
- Do you need to run any tests?
- What types of medications are prescribed for anxiety and depression? How do they work?
- What are the potential side effects of these medications?
- How can I manage any side effects?
- Are there any natural or alternative treatments for anxiety and depression that you recommend?
- How long will it take for the medications to start working? How long will I need to take them?
- Are there any lifestyle changes I need to make to help my anxiety and depression?
- Do I need to go to therapy?
- How effective is therapy with medication versus without?
- How often will I need to see you for follow-up appointments?
- Are there any medications or substances I should avoid while taking anxiety and depression medications?
- Is medication entirely necessary?
- How can I tell if my treatment is working? What should I do if it isn’t?
- What steps can I take to manage and reduce stress in my daily life?
- Are there any long-term risks or effects from taking anxiety and depression meds for a long time? What are they?
- Do you have any local recommendations for a psychiatrist, therapist, or psychologist?
What medications are out there?
There are several types of medications that can be used to treat both anxiety and depression, including antidepressants, benzodiazepines, and atypical antipsychotics. Each medication has its own benefits and drawbacks, and the choice of medication will depend on the individual’s specific symptoms, medical history, and doctor discretion.
Antidepressants, also called anti-anxieties, are commonly used to treat both anxiety and depression. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are two types of antidepressants that are often prescribed. These medications work by increasing the levels of serotonin and norepinephrine in the brain, which can help alleviate symptoms of anxiety and depression. They are generally considered safe and effective, but can take several weeks to reach their full effect and may cause side effects such as nausea, dry mouth, and sexual dysfunction. Doctors will typically prescribe these types of medications for daily use to establish a new baseline of operation for the patient. Some name brands include Lexapro, Paxil, and Prozac.
Benzodiazepines are another type of medication that can be used to treat both anxiety and depression. They work by enhancing the effects of a neurotransmitter called gamma-aminobutyric acid (GABA), which can help reduce feelings of anxiety and promote relaxation. While they can be effective in the short-term, benzodiazepines can be habit-forming and may cause side effects such as drowsiness, dizziness, and impaired coordination. Doctors will typically prescribe these types of medications for panic attacks and suggest patients only use these medications on an as-needed basis. Some name brands include Ativan, Xanax, and Kolonopin.
Atypical antipsychotics are a third type of medication that can be used to treat both anxiety and depression. They work by affecting the levels of dopamine and serotonin in the brain, which can help alleviate symptoms of anxiety and depression. While they can be effective, atypical antipsychotics can cause side effects such as weight gain, metabolic changes, and movement disorders. These medications are rarely used for Generalized Anxiety Disorder or Major Depressive Disorder and are instead typically used for schizophrenia or bipolar disorder treatment. One of the more commonly used atypical antipsychotics is called risperidone.
Medication should always be prescribed and monitored by a qualified healthcare provider, such as a medical doctor or psychiatrist. While medication can be helpful in treating both anxiety and depression, it is often most effective when used in combination with therapy, lifestyle changes, and other forms of support.
What is the best way to treat anxiety and depression?
Anxiety and depression can have a significant impact on a person’s life, making it difficult to carry out daily activities, maintain relationships, and enjoy life. When anxiety and depression occur together, they can be challenging to treat. However, with the right approach, it is possible to manage these conditions effectively.
The first step in treating anxiety and depression together is to seek professional help. A mental health professional, such as a psychologist or psychiatrist, can assess the severity of your symptoms and recommend appropriate treatment options. Treatment usually involves a combination of therapy, medication, and lifestyle changes.
Therapy is a key component in treating anxiety and depression. Cognitive-behavioral therapy (CBT) is the most effective form of therapy for these conditions, although other styles of therapy have also been proven to be quite effective. CBT helps individuals identify and challenge negative thought patterns and develop healthy coping skills. It teaches individuals how to recognize and change negative thoughts, behaviors, and beliefs that contribute to their anxiety and depression.
Medication can also be helpful in managing anxiety and depression. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are commonly prescribed to treat these conditions. These medications work by increasing the levels of serotonin in the brain, which can improve mood and reduce anxiety symptoms. Benzodiazepines such as Xanax or Ativan may be prescribed for short-term use to relieve severe anxiety symptoms. Typically, doctors will prescribe an SSRI for daily use while suggesting benzodiazepines for use on an as-needed basis. Patients should be aware that benzodiazepines can be habit-forming and should only be used under the guidance of a healthcare provider.
Lifestyle changes can also be beneficial in managing anxiety and depression. Regular exercise, a healthy diet, and good sleep hygiene can help improve mood and reduce anxiety symptoms. Engaging in relaxation techniques, such as deep breathing, meditation, or yoga, can also be helpful. It is also essential to avoid or limit alcohol and caffeine, which can worsen anxiety symptoms.
Support from family and friends can be crucial in managing anxiety and depression. Having a strong support system can provide a sense of comfort and reassurance during difficult times. Joining a support group or online community can also be helpful in connecting with others who are experiencing similar challenges. Isolation and shame can be dangerous, particularly when it comes to depression.
In addition to these approaches, there are other alternative therapies that can be helpful in managing anxiety and depression. These include acupuncture, massage therapy, and herbal supplements. However, it is important to discuss these options with a healthcare provider before trying them.
Treating anxiety and depression together takes time and effort. It is not a quick fix, and there may be setbacks along the way. However, with the right treatment plan, it is possible to manage these conditions effectively and improve your overall quality of life.
If you are in the Toronto area and feel you may be struggling with anxiety or depression, we can help you! Email us at firstname.lastname@example.org, or visit our online booking portal to schedule a free, no-obligation consultation.