Anxiety vs. Depression

Can someone who is very anxious have an underlying depression?

Posted Jun 09, 2012 commonly prescribe anti-depressants to patients who are complaining primarily of anxiety or of panic attacks. Sometimes an argument follows. The patients may deny that they are depressed, meaning that they are not feeling sad. The problem is that the word depression is used in a number of different ways. In ordinary usage, feeling depressed does, indeed, mean feeling sad. Someone may feel sad over being fired, or after a relationship comes to an end, or even after some minor disappointment. We all know what it is to be sad, or depressed, for a period of time after such a loss. When the loss is severe, let’s say after the death of someone in the family,  that feeling may persist for a longer period of time. Such an emotional state is called grief. There are others who may feel depressed for much of their lives. If they have low self-esteem, or think of themselves as failing or unappealing in some way, they can feel, and seem to others, to be sad all the time. They may be said to be suffering from a neurotic depression. This condition grows out of distortions in perspective that come from childhood experiences. Drugs are not helpful. It responds, when it does respond, to psychotherapy over a prolonged period of time. But there is such a thing, also, as a clinical depression.

In its most typical form, a clinical depression (what used to be called an endogenous depression, meaning coming from within) presents with a constellation of physical and emotional symptoms. Among those symptoms is usually, but not necessarily, a feeling of sadness. This illness, sometimes called a unipolar depression, tends to run in families. It can appear at any age, but usually for the first time in the late teens or the twenties. It is a relapsing and remitting disorder. Life being what it is, there is always some immediate stress that can be used to explain why the illness suddenly worsens when it does, but this is probably an illusion. Left untreated the condition comes back from time to time unpredictably and for no good reason. It is possible that a particular attack can be triggered by a physical illness such as hypothyroidism or by some other endocrine problem, or by certain viral conditions, such as infectious mononucleosis ; but spending a lot of time looking for direct causes is a waste of time.

The Symptoms:

Anyone who is depressed, for whatever reason, is likely to be withdrawn or irritable. Such a person may develop vague physical symptoms. The depressed person loses the ability to enjoy accustomed pleasures. Commonly, he/she will feel sad. So much is true for anyone who is depressed for any reason. The critical and distinctive indicators of a unipolar depression are the so-called vegetative signs. This is an illness, and it manifests itself in certain physiological indicators. 

  1. A very characteristic sleep disorder. Unless the depressed person is very depressed, or unless there is some particular worry troubling him or her, there is no trouble falling asleep. But sleep is typically interrupted during the night. The depressed person wakes up repeatedly, agitated or restless, sometimes from a bad dream, then returns to sleep only to wake up prematurely, unable to get back to sleep. This is called early-morning awakening, and it can go on day after day and week after week.
  2. On waking up, the depressed person feels bad. That particular bad feeling varies from person to person. Usually it is a sad feeling, but not always. Sometimes it is an agitated, even a panicky feeling. The panic attack, if that it is the way it is experienced, is likely to last longer than the panic attacks of an uncomplicated panic disorder. And it tends to be there every morning. This bad feeling lessens during the course of the day, so that evenings may be more comfortable.
  3. Usually, there is a loss of appetite to the point of losing weight. Sometimes, less commonly, there is an increase of appetite, in which case the depression is said to be atypical.
  4. There is a loss of sexual interest.

This last example of a depression, the major depression, responds very well to anti-depressant drugs, although often requiring more than one drug at a time. It is a well-defined condition, but the predominant feeling may be of anxiety rather than sadness. For this reason, it is not necessary to remind the psychiatrist repeatedly that the troubling symptom a depressed person has is not depression, it is anxiousness. The illness is a depression, and there is good reason to be optimistic about its treatment. Unfortunately, it is likely to be three or more weeks before the drugs work satisfactorily. © Fredric Neuman 2012  Follow Dr. Neuman’s blog at