Understanding the Relationship Between Anxiety & Depression

We’ve all experienced moments late at night where we worry we’ve forgotten that one important task at work, or to pack our kids’ lunches, or to shut off the oven – or moments when sadness overtakes us at the loss of a job or an unexpected disappointment. But there are also times in millions of Americans’ lives where everyday fear, worry, and sadness become larger disorders that disrupt the ability to function. It can be hard to navigate the space between daily emotions and true disorders, or for that matter, between the feelings of anxiety and depression, but the differences are important and vital to a proper diagnosis for those who may be suffering from a mood disorder.

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“First Cousins”

According to the National Institute of Mental Health (NIMH), around 40 million American adults have an anxiety disorder, while approximately 14.8 million Americans struggle with major depressive disorder.

The NIMH describes anxiety disorders as multifaceted, because there are many different types, and each one manifests itself uniquely depending on the person. Anxiety disorders can include panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and phobias. On the other hand, major depressive disorder manifests itself in feelings of hopelessness or a lack of motivation and disinterest in everyday life. If these feelings last longer than two weeks or if they interfere with day-to-day living, they may be signs of major depressive disorder according to the Anxiety and Depression Association of America.

“One thing I think is important to clarify is that the terms ‘depression’ and ‘anxiety’ are extremely non-specific,” says Dr. Michael Osborne, a psychiatrist at Parkridge Valley’s Adult & Senior Campus. “There are many types of mood and anxiety disorders and we have to try to determine which one a person is suffering from in order to recommend the best treatment.”


Often coupled together, depression and anxiety are referred to as “first cousins.” In spite of their close link, it’s important to distinguish between the two. Neither causes the other directly, as is often mistakenly assumed – it’s usually far more complicated than that. But they may occur simultaneously and often reinforce one another.

Dr. Tim Jennings, a psychiatrist at TMS Chattanooga, explains the link between anxiety and depression as a kind of reinforcing loop. He explains that anxiety causes stress and inflammation in the body, both of which cause changes in the brain that may contribute to depression. “Then when someone is depressed, the higher circuits of the brain that calm the fear circuitry become inactive, and that can reinforce the anxiety,” he says.

This seemingly vicious cycle of reinforcement does not tell the whole story about anxiety and depression. Each disorder carries its own symptoms and unique causes. Understanding those symptoms and causes may give you the information you need to begin the process of a diagnosis.

Recognizing Symptoms

Although there are many types of anxiety disorders, general anxiety disorder (GAD) is the disorder most often joined by depression. According to the Anxiety and Depression Association of America (ADAA), the symptoms of GAD may include:

  • Unrealistic Worry – everyday tasks become unmanageable and cause intense fear and worry
  • Bodily Fatigue – tense muscles, and overall general fatigue
  • Living on Edge – an inability to get to sleep at night or an edginess at work or home
  • Trouble Managing Day-to-Day Living – when simple tasks like tidying a bathroom or running to the supermarket seem insurmountable


Are you living life on-edge—never feeling peaceful, never calm? Do you agonize over your fear and worry about everyday tasks and events? It may be time to schedule an appointment with a psychiatrist to determine if you are suffering from an anxiety disorder.

Those who suffer from depression often exhibit similar symptoms, as documented by the ADAA. These symptoms often include:

  • “The Blues” – feeling down and out for more than two weeks at a time
  • Fatalistic Outlook – seeing the glass as permanently half-empty and an inability to see the bright side of a situation
  • Neglecting Old Loves – when something you enjoyed or loved becomes uninteresting
  • Fatigue – energy loss and that on-edge feeling also associated with anxiety
  • Despair – contemplation of suicide or death
  • Unusual Sleep Patterns – inability to get a good night’s sleep or getting too much sleep
  • Low Self-Worth – feeling like you are not good enough and not worth anything
  • Feelings of Indecision – inability to make clear-cut decisions or concentrate on a task at hand


If day-to-day activities feel too difficult to manage, if it’s hard to get out of bed or hard to get your brain to shut off, if your outlook on the world has turned very dark and there seems to be no hope wherever you turn, these feelings may indicate major depressive disorder.

Examining the Causes

The close relationship between anxiety and depression can be traced back to the causes of both disorders. The disorders may arise out of similar causes and risk factors. We often hear depression and anxiety referred to as issues of “chemical imbalance.” Dr. Osborne asks us to consider a more nuanced approach to the cause of these disorders. “In my own practice, I don’t use the term ‘chemical imbalance’ because it’s not very accurate,” he says. “It’s easy to think that because antidepressants elevate levels of certain neurotransmitters, that means the person has a deficiency of one of those chemicals— but this is faulty logic.”

Dr. Jennings agrees. “It’s a common misconception that ‘depression is due to a lack of serotonin’ when it’s actually a complex brainbody disease,” he says. “It affects the endocrine system and the immune system, which ultimately affects the body as a whole.”

Dr. Osborne explains that truly effective treatment involves identifying someone’s unique set of contributing factors – and then addressing those factors. “I will talk to people about what risk factors they may have,” says Dr. Osborne. “We see familial patterns suggesting genetic risks, childhood trauma or chaotic family environments, medical problems like thyroid abnormalities or heart disease, and stressful life events. Frequently, the cause of depression is all of this coming together. How much each one contributes is dependent on the individual case.”

In agreement with Dr. Osborne and Dr. Jenning’s assessments, the NIMH points to a “combination of genetic, biological, environmental, and psychological factors” as causes of depression.

General anxiety disorder is similarly caused by a combination of factors that range from genetic to environmental. Like  depression, anxiety is a disorder of the brain, and brain imaging has revealed some physical factors that are involved when a person is suffering from an anxiety disorder. According to the NIMH, the part of the brain that processes and interprets sensory information and the part of the brain that creates memories are both involved in the increase of fears and anxiety.

“The body’s anxiety circuits fire when something is upsetting to us,” says Dr. Jennings. “That alert signal is sent to the part where we reason and think. There is a direct relationship between fear circuitry and the reasoning part of the brain. But with anxiety, this gets disrupted.”

Getting Treated

Many experts believe the two disorders ought to be treated together, but all treatment ought to be determined and monitored by a licensed psychiatrist who understands you or your loved one’s specific experience with anxiety, depression, or both.

According to the Mayo Clinic, treatment for anxiety and depression will often include one or more of the following:

  • Medication
  • Psychotherapy
  • Lifestyle Changes: Sleep, Exercise, Nutrition


Although the treatments may include some or all of these resources, their implementation will look different in every case and situation. “I think it’s important to emphasize that psychotherapy can be very helpful,” says Dr. Osborne. “There is very good evidence that mild to moderate depression can be effectively treated by counseling alone. However, many times we recommend combined treatment with medication and counseling. I often tell patients that this is the most potent treatment strategy.”

Because every situation is unique and requires specific forms and combinations of treatment, it’s crucial that anyone experiencing an anxiety disorder or depression seek help from a licensed specialist. If a mood disorder is misdiagnosed and treated with certain medications, a person’s symptoms can actually be exacerbated.

Sound Familiar?

As you’ve read the last few pages, are you reminded of yourself or someone you love? The Anxiety and Depression Association of America provides online screening tools to screen yourself or a loved one who you suspect may suffer from anxiety or depression. Of course, these screening tools are no substitute for the opinion of a psychiatrist and they are not to be taken as official medical advice or diagnosis.

“People need to see a specialist for depression because there are multiple contributing factors,” says Dr. Jennings. “They need to understand the specific contributing factors that cause the depression and develop a comprehensive plan that addresses those factors causing the depression.”

Dr. Jennings’ caution applies equally to anxiety disorders. Online tools may point you and your loved ones in the right direction, but they are in no way equitable with the careful diagnosis of a specialist.

If you are concerned that you or someone you love may have a mood disorder, it’s essential that you see a trained psychiatrist for a proper diagnosis. Do not rely on yourself, a website, or even an article like this one to make the diagnosis for you. Anxiety and depression are very treatable disorders and there is no need to wake up every day feeling anxious, worried, and hopeless. One extra appointment with a licensed psychiatrist could mean the difference between peace of mind and an uncontrollable disorder—hope is just around the corner.

Michael Osborne, M.D.

Psychiatrist, Parkridge Valley Adult & Senior Campus

Tim Jennings, M.D.

Psychiatrist, TMS Chattanooga; President, Tennessee Psychiatric Association; Vice President of the Southern Psychiatric Association

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