Since anxiety describes the feeling generated by elevated stress hormones and the autonomic nervous system, it is a descriptive term and should not be considered a diagnosis. Neither is the term “relaxed” a diagnosis when you are laying in the sun with your body being bathed with oxytocin, serotonin, GABA chemicals, and dopamine. It is the core of the unconscious automatic survival response, which is far more powerful than the rational brain.
Since mental threats create the same reaction as a physical threat, exposure to stress hormones may be sustained. This response cannot be controlled, but there are ways of modulating the input.
Why is depression the expression of sustained anxiety?
All people with depression have anxiety (although it can be suppressed by anger), but not everyone with anxiety has depression.
- One of the earliest signs of depression is waking up in the morning and not being able to fall back asleep. This is usually from racing thoughts—connected to anxiety.
- Then you can’t fall asleep. Again, from disruptive thoughts, but also from your body being full of stress chemicals. You are on high alert, which isn’t conducive to falling asleep.
- You’re not sleeping—a cardinal symptom of depression.
- Eventually, you have trouble concentrating, which is a combination of your racing thoughts and insomnia.
These symptoms define a minor to moderate depression, and relentless anxiety continues to become increasingly intolerable. From a survival perspective, the intention of the anxiety response is to create such an unpleasant feeling that you are compelled to take action to escape the threat. But humans have a problem in that mental threats are perceived by your brain in a similar manner as physical ones.
But we can’t escape our thoughts. Being trapped by anxiety creates feelings of frustration and despair. Where is the endpoint?
More advanced symptoms include:
- Loss of appetite and weight loss—adrenaline decreases the blood supply to your GI tract.
- Lack of energy—being full of these chemicals keeps your body on high alert, which wears you down. It is similar to attempting to sprint a mile.
- Multiple, diffuse physical symptoms—a direct effect of your body’s hormones on the different organ systems (Abass).
- Social isolation—It is well documented that social isolation causes chronic pain. Emotional pain is processed in the brain in a similar manner to physical pain (Eisenberger). Rejection hurts. Anxiety blocks people from reaching out to others.
- Suicidal ideation, action plan, and beginning to implement it
You get the point. What we are calling depression is really a set of symptoms created by sustained levels of stress chemicals (anxiety).
Why change the language around these diagnoses?
To successfully treat depression, the focus must be on the root cause, which is the anxiety. Anxiety is not a diagnosis, but a term that describes a heightened neurochemical state. Since this unconscious survival response is hundreds of thousands of times more powerful than the conscious brain, it cannot be controlled by isolated rational interventions.
So, how do you decrease anxiety? You decrease the levels of the stress chemicals.
The two general ways of accomplishing this are direct methods that calm the nervous system. Some of the techniques include mindfulness, meditation, martial arts, exercise, and short-term medications. The other category is dampening the chemical reaction by stimulating neuroplastic changes in your brain. Instead of automatically reacting to stress, you create some “space” between the stimulus and response and then redirect your attention to a more functional choice.
One classic example is cognitive-behavioral therapy, which creates an awareness of your cognitive distortions; you categorize them and then substitute a more rational response. Visualization tools allow you to create alternative reactions and, with repetition, change your brain’s circuitry.
The language matters
A large paper (deHeer) looked at a national registry of patients in the Netherlands. They looked at 2,980 participants, categorized them in the following manner, and then looked at the correlation with chronic pain.
- No psychopathology
- Remitted depressive and/or anxiety disorder
- Current depressive disorder
- Current anxiety disorder
- Current comorbid anxiety and depressive disorder
Only 5.7 percent reported no pain symptoms. One of the conclusions was, “Depression and anxiety share the same pathophysiological pathways as pain and can have a reciprocal effect on each other, which could explain these associations.” Interestingly, even patients with remitted anxiety and depression still suffered from ongoing chronic pain compared to those without psychopathology.
Change the language
Consider changing the language. Anxiety is pain. Most people deal with it reasonably well, although the actual sensation is always unpleasant. At some threshold, it interferes with your quality of life and can become intolerable. The eventual outcome is the constellation of the above-mentioned symptoms, which we call depression.
But anxiety is the problem and is not a diagnosis. Different psychological disorders are the result of attempts to cope with anxiety. This study is supporting evidence. Sustained levels of stress hormones also create multiple physical symptoms, including increased pain from faster nerve conduction (Chen) with devastating effects on your quality of life and health (Fredhaim).
By creating the separate diagnostic categories of anxiety, depression, and chronic pain, we are taking the focus off of the root cause being relentless anxiety. One alternative would be to say that remaining in a hyper-vigilant, neurochemical state results in a constellation of symptoms, one of which is depression. The manifestations of this heightened state also include chronic mental and physical pain.
The most effective way to treat depression is to utilize one of the many effective methods to calm down the nervous system.
deHeer, EW, et al. The association of depression and anxiety with pain: A study from NESDA. PLOSone (2014); 9:1-11. e106907.
Abass, A, et al. Direct diagnosis and management of emotional factors in chronic headache patients. Cephalgia, doi:10.1111/j.1468-2982.2008.01680.x
Fredheim OM, Kaasa S, Fayers P, Saltnes T, Jordhøy M, Bortchgrevink PC. Chronic non-malignant pain patients report as poor health-related quality of life as palliative cancer patients. Acta Anaesthesiol Scand. 2008;52(1):143-148.
Chen X, et al. “Stress enhances muscle nociceptor activity in the rat.” Neuroscience (2011); 185: 166-173.
Eisenberger N. “The neural bases of social pain: Evidence for shared representations with physical pain.” Psychosomatic Medicine (2012); 74: 126-135.