Depression 101 with Dr. Douglas Moll (Clinical Psychologist)

Is It Possible to Have Anxiety and Depression at the Same Time?

Yes, it is not only possible but very common. Anxiety and depressive disorders have a high rate of comorbidity; this means they often exist with other disorders. In community samples, it is estimated that around 50 percent of people with depression have a coexisting anxiety disorder, such as generalized anxiety disorder and panic disorder. This is especially true in cases of a more serious or persistent depression.

Worry and anxiety are often seen in depression even if they don’t warrant an additional diagnosis. In fact, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) includes a specifier “with anxious distress” to be noted as part of the diagnosis if someone with a major depressive episode or persistent depressive disorder presents with anxiety symptoms such as feeling tense, restlessness, difficulty concentrating because of worry, and fearing that something awful may happen.

This was added because such anxiety is often seen in major depression and can be an important consideration in treatment. The DSM-5 notes that if generalized worry or anxiety is present only during the course of a depressive disorder, it should not be diagnosed separately because this is a common associated feature.

There’s not a consensus explanation for the high rate of comorbidity or why depression often presents with features of anxiety. Possible reasons include symptom overlap, similar underlying pathological processes, vulnerability to one if you have the other, genetic and environmental influences, and the theory that depression and anxiety may be different expressions of the same disorder.

Having both anxiety and depression can make treatment more complex, but the good news is that the same types of treatment, such as cognitive-behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRI) medications, can alleviate the symptoms of both types of disorders.

Is It Possible to Cure Depression?

We don’t really speak of “cures” in terms of mental health disorders, but rather of remissions. The DSM-5 classifies a major depressive episode in full remission when “no significant signs or symptoms” of the disorder are present for a 2-month period. This said, all treatment aims at reducing the severity of or eliminating the symptoms of the disorder, whether or not full remission is ultimately achieved.

Most people in treatment for depression, about two-thirds according to the research, do achieve significant symptom relief, whether this is through medication, psychotherapy, or a combination of both.

Based on personal clinical experience, depression resulting from defined environmental or situational events or stressors (such as a job loss or a breakup with a significant other) can be resolved more quickly and permanently than a depression that has a more insidious and less discernible onset.

In addition, there are many other factors that determine the success of treatment, and your motivation to feel better and engage in treatment is one that is very important and that you have some control over. Taking an active and collaborative approach in your treatment can help you make gains more quickly and create a sense of success, which can help you feel empowered to make even more positive changes.

It is important to note also that while full or partial remission of symptoms is indeed possible, someone who has experienced depression is at greater risk of experiencing another episode in the future. That is why it is so important to monitor yourself for any depressive symptoms and take action to try to prevent another episode from occurring. Therapy can teach you the skills to do this, and you can use them long after your therapy has ended.

How Can Depression and Anxiety Be Differentiated?

Around 50 percent of people who experience depression also suffer from an anxiety disorder. As a result, it can be confusing to sort out the symptoms of the different disorders, but there are both similarities and differences between them.

Both can involve more physical symptoms such as fatigue and insomnia, difficulty thinking or concentrating, and agitation or restlessness, and both also involve cognitive distortions such as “all-or-nothing” thinking and a focus on the negative to the exclusion of the positive.

In depression, however, you feel depressed (sad, empty, and hopeless) nearly all the time. You may lose interest in most or all things that you once enjoyed, you may feel worthless and guilty, and you may have recurrent thoughts of death and experience suicidal ideation or behavior.

With anxiety alone, you typically don’t see the hopelessness, sadness, and suicidal ideation, and often you are in a constant keyed-up state of worry and apprehension rather than in a state of persistent lethargy that is often seen in depression.

Another way to differentiate the two is that depression typically engrosses one in a dark and sad focus on the past, while anxiety causes fearful rumination about the future. Interestingly, some believe that depression and anxiety are actually one underlying disorder expressing itself differently depending on which direction one is looking in time.

What Can Be the Side Effects of Antidepressant Drugs?

Although the exact mechanisms of action of antidepressant medications are not yet fully understood, they are thought to decrease symptoms of depression by acting on the neurotransmitters in the brain that are related to mood regulation; these include serotonin, dopamine, and norepinephrine.

All antidepressants have side effects, including shorter and longer term, common and rare, and less serious and more serious. The degree to which one may experience and tolerate these is highly specific to the individual.

The common side effects of antidepressants vary by class of medication but can include dry mouth, nausea, headache, insomnia, weight gain or loss, tremor, drowsiness, fatigue, dizziness, and blurry vision, among others. (It is important to also note the FDA warning that antidepressants may increase the risk of suicidal thoughts and behavior in children, teens, and young adults.)

The newer classes of antidepressants, including selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Paxil, and serotonin and norepinephrine reuptake inhibitors (SNRIs), such as Effexor and Cymbalta, tend to have fewer and more tolerable side effects than older classes of antidepressants, such as tricyclics and monoamine oxidase inhibitors (MAOIs).

Oftentimes, medications and/or dosages need to be adjusted by the prescribing provider in order to achieve therapeutic success with minimal or manageable side effects. It is very important that before beginning any antidepressant, you inform your prescribing provider about any health conditions you have as well as medications or supplements you are taking and talk with him or her about the risks and benefits of taking the medication.

As a nonprescribing psychologist, I have found that, especially in more serious cases of depression, antidepressant medication can be very useful in helping to relieve some of its more physical symptoms, such as low energy, lack of motivation, and difficulty sleeping, as well as in increasing alertness, the ability to think and concentrate, and, overall, the ability to actively engage in therapy.

What Care Can Be Given to a Person Who is Suffering from Depression?

If you are seeking treatment for depression, the good news is that most people with depression do get better, although it may take some time and effort for you and your treatment providers to find the treatment that works best for you.

There are two basic forms of treatment: medication and psychotherapy. There has been a large amount of research on the efficacy of these treatments given alone and together.

Psychotherapy includes:

  • The most studied form of psychotherapy in the treatment of depression is cognitive-behavioral therapy (CBT). This therapy posits that depression results when an individual develops distorted thinking patterns in which they view themselves, the world, and the future through a dark and irrationally negative lens. They may think that they are bad people, that they have not accomplished anything, and that there is no hope for the future because it will be as bleak as the past. CBT aims to help people identify their specific patterns of distorted thinking, challenge their irrational thoughts through strategies such as Socratic questioning, and replace or modify them with thoughts that are more holistic, rational, and adaptive. Over time, this leads to a more positive perception of themselves and their circumstances, which in turn lessens their depressive symptoms.
  • Another popular and well-studied approach is behavioral activation, in which the clients are instructed to develop and follow a daily schedule of activities that promote feelings of pleasure or mastery and lessen the probability of engaging in behaviors that reinforce their depression.
  • Interpersonal therapy has also been well-studied in the treatment of depression. This type of therapy focuses on improving your relationships with others, emphasizing the social context in which depression occurs and is maintained, with a recognition that relationships often deteriorate when one is depressed.

These therapy strategies have shown success rates that are on a par with antidepressant medications and have the added advantage that, after treatment has ended, they appear to reduce the risk of relapse better than medication alone.

However, there is no one-size-fits-all approach to the treatment of depression, and any given individual may have to engage in more than one type of therapy or try several medications or combinations of medications, before they see significant improvement.

Treatment often involves both medication and therapy.

Medication may work more quickly to alleviate burdensome physical symptoms such as fatigue and lack of motivation, and this in turn can help spur gains in therapy, which can teach the client skills that will help them cope and decrease depressive thinking on their own, possibly preventing future episodes.

There is some evidence that successful treatments for depression have a similar causal pathway: an increase in awareness and control of thoughts related to increased activation of the prefrontal cortex that had been muted by depression and a possibly related reduction in emotional reactivity related to the quieting of an overactive amygdala. The outcome is that one is better able to exercise control over their thoughts and emotions. Therapy and medication may have differential effects on these mechanisms of action.

There are many other therapies and treatments for depression available, which may or may not be backed up by research. For example, a promising line of research involves exercise as a treatment for depression.

  • It has been found that regular aerobic exercise or moderate-intensity physical activity can be effective in treating mild-moderate depression.
  • Also, a growing number of therapies are incorporating mindfulness training, which can help an individual to become more aware of their thoughts and can help them detach from overly negative thinking patterns.
  • Treatment-resistant depression has also been increasingly a focus of research, and treatments found effective include electroconvulsive therapy and transcranial magnetic stimulation, among others.

The bottom line is, with so many effective treatments available for depression, you are likely going to experience significant relief from your symptoms if you seek help.

How Can a Person Cope with Depression?

Here are some of the ways to cope with depression.

Most Important: Seek Professional Help

If you are experiencing symptoms of depression (as outlined above), seek help from a qualified mental health professional (psychiatrist, psychologist, mental health counselor, clinical social worker, etc.). You can also talk to your primary care physician, who can likely refer you to a mental health professional.

Don’t Give Up

If you are in treatment and feel that you have not gotten better, don’t give up! It may take a while for your treatment to show results. Also, with so many effective treatments for depression, there is very likely going to be one or a combination of treatments that will work for you.

Actively Participate with Your Therapist

If you are in therapy, be an active participant and collaborate with your therapist in your treatment. Create treatment goals that are important to you and that you really want to work on and achieve.

If your therapist makes all the goals for you, you may not be motivated to do the work. It is your therapy after all, and it is a great opportunity to make the changes in your life that you always wanted to make. Even achieving one small goal can be the catalyst for the creation of great changes in your life.

Watch Your Thinking

Thoughts are very powerful, and through our thoughts we can be happy or miserable. Buddha taught that it is our mind and our thoughts that create the world we live in. This is echoed by other spiritualities, philosophies, and even quantum physics. Many therapies are effective because they help you gain power over your thinking, which can change feelings, lead to action, and help you create the life you want to live.

With practice, you can get to a point where you have much more freedom to choose what you think and how you feel, regardless of what is happening around you.

Change How You See the World

Many terrible things happen to us and around us every day. You can easily become depressed if you sit around and dwell on these things and think that the world is a horrible place and is only getting worse. Instead of seeing things through such a negative filter, create a positive filter.

Much of the news we watch, read, and listen to is endlessly negative and repetitive. Just try turning it off and tuning it out for periods of time. You won’t miss much and you’ll feel better. Really try to focus on the good in your life that you may take for granted or just don’t see.

Appreciate the people in your life who care about you. Be grateful if you have the basic things you need to live your life, such as a bed, food, and shelter.

Make an effort to pay attention to the good that people do for each other every day. Better yet, do good things for others and do your part to make the world a better place. Just smiling at someone or holding a door open for someone can create positive feelings for both of you. Such seemingly small acts can have powerful ripple effects for both of you and create even more good.

The bottom line is, the universe needs you, in whatever way you can contribute. Find your purpose and your meaning in it, and you will find your happiness.

Additional Tips

  • Exercise or engage in moderate physical activity most days of the week if you are able and healthy enough to do so. This has been found to be an effective treatment for depression and may help prevent it.
  • Find a reason to get out of bed every day. This can be as simple as making yourself your favorite breakfast or looking forward to talking to people at work.
  • Make goals for your day. Try not to let the day direct you, but try to direct your day. This helps you regain power and a sense of control back in your life.
  • Meditate or practice mindfulness. These practices can really help calm an overactive mind and help you become more aware of your thoughts and help you detach from negative thinking.
  • Listen to some music you love. Your brain will like it and you will feel better and maybe more energized and inspired.
  • Do something creative, such as drawing, taking photos, writing a poem, keeping a journal, painting, decorating, and gardening. It will engage parts of your brain that may have been neglected while you have been focused on the negative thoughts and may help you see things in a different light.
  • Finally, if you have had depression in the past and were successful in overcoming it, it is very important that you closely monitor yourself for any depressive symptoms that may be trying to creep back into your life. This most often happens when someone finds themselves engaging in negative or pessimistic thinking again. This can lead to a downward spiral if it is not caught quickly. Use the skills you have learned to identify these thoughts and transform them into more reality-based and healthy thoughts. This is a very effective strategy to retain control over your mood and not let depression take control of your life again.

About Dr. Douglas Moll, Clinical Psychology: Dr. Douglas Moll has acquired a full range of clinical expertise having provided cognitive-behavioral therapy in individual, group, and family settings. He has worked extensively with children and adolescents grappling with mental health, substance abuse, and criminality issues and served as liaison to a wide variety of mental health, social service, and rehabilitation agencies. Read More…

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Douglas D. Moll, Clinical Psychologist

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