Stressed, panicky and worried or down, listless and pessimistic -- they seem like dissimilar states of mind. But anxiety and depression are more closely related than you'd suspect, and many people live with both conditions. Here's what happens when depression and anxiety are intertwined.
[See: Coping With Depression at Work.]
More Than Teen Angst
Meditation, visualization, breathing exercises and long walks on the beach are all good ways to relax. Or you could enter a pageant. That's what Bailey Kay, 19, of Salt Lake City, did as a high school senior, despite having anxiety and depression since she was a girl.
Diagnosed with anxiety in seventh grade and depression by the ninth, Kay takes a single medication to treat both. Nevertheless, anxiety crops up almost daily. "When I was younger I would just cry, but I've learned to deal with it better," she says. Playing smartphone solitaire, doodling and watercoloring at home take the edge off her worries.
For Kay, the depression diagnosis was unexpected. "I was young," she says. "I thought I was just going through my teenage years; I was having trouble with my friends." Kay was eating too much and sleeping too little. "I was crying over the stupidest things," she recalls. "It was my mom who actually noticed it, and it made sense once I talked to the doctors."
Entering the Miss Teen Utah International Pageant in her senior year helped in unexpected ways. Anxiety with depression became her pageant platform issue. "I wasn't used to talking about it," Kay says. "Later at night it would kind of hit me and I'd just bawl. But I got a lot better at it once I realized I was helping people."
Kay is now attending school to become a master aesthetician, preparing her to provide advanced cosmetic facial and body treatments to clients. But there's at least one beauty technique she has to forgo for herself. "I can't have my fingernails painted, ever," she says. "I'll just chip them off because I have such bad anxiety."
Fortunately, Kay's sister, who also entered the aesthetician program, can drive them both to classes. Being spared that 45-minute trip behind the wheel is a big relief for Bailey, who suffers high anxiety while driving. Her classmates are also supportive, she says: "They just put their arms around me and push me to do the best I can."
Mixture of Moods
Counseling, medication and DIY lifestyle approaches are treatment mainstays for anxiety and depression. The puzzle is putting these components together the right way for each patient. With medications, it's essential to have the correct diagnosis and even then, it takes time to determine the optimal drugs and dosages, and how they affect each condition.
"We know from our treatments that medications that are approved for depression also treat anxiety," says Dr. Neil Liebowitz, medical director of the Anxiety and Depression Treatment Center in Farmington, Connecticut. But that doesn't necessarily work the other way around. "Meds that treat anxiety alone may make some of the depression worse," he adds. "So that is a problem."
Separating anxiety and depression is a "somewhat artificial distinction," says Liebowitz, who is also an assistant clinical professor at the University of Connecticut. The goal, he says, is to understand the chemistry underlying these conditions. "The best we can do right now are medication trials to see which meds work best for [which] individuals."
Brain chemicals, or neurotransmitters -- such as serotonin and norepinephrine -- affect mood in various ways. In some cases, certain classes of antidepressant drugs -- selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors -- can treat both anxiety and depression.
Prescribing can be a fine line. "People who are overthinking problems care too much about them," Liebowitz says. "They're worrying so much they can't make a decision. You make them care a little less and then they're good." However, he adds, "Take away all their anxiety and now they're careless. And they become too flat, with no drive and no motivation, which is what we might look at as a form of depression as well."
Alcohol, which may offer temporary relief, can sabotage medication treatment. And soon after drinking, Liebowitz explains, a rebound effect kicks in, making anxiety stronger. As a depressant in itself, alcohol can worsen depression.
An added wrinkle is the possibility that another mental health condition -- bipolar disorder -- is part of the problem. Panic attacks may signal possible bipolar disorder, Liebowitz says. And while symptoms of bipolar-related and standalone depression are the same, he says, the treatments are very different.
Exercise, healthy diet and openness to different types of therapy are also valuable, he says, to help people change their worldview, challenge themselves with new experiences and redirect their lives. "The most important thing is hope," he says. "People can get better -- they do get better."
The Anxiety and Depression Association of America website provides a comprehensive resource for people dealing with both conditions.
For China McCarney, 30, a former professional baseball player, anxiety has caused more obvious distress than depression. Panic attacks, some more predictable than others, leave the Manhattan Beach, California, resident feeling an urgent need to get away.
"They happen more in social situations around big crowds," McCarney says. "Flying on a plane is very difficult because it feels like there's no escape from the symptoms. When the symptoms arise I feel like I'm going to pass out. So when I don't have a place where I can walk, it's difficult. But the randomness of it is the most frustrating part, and the hardest part to deal with and accept."
Embarrassment is one piece of the aftermath, but McCarney also describes feelings of guilt and shame stemming from his anxiety disorder -- as if he's done something wrong. "Depression has been at times the result of the anxiety," he says, from having those symptoms, and "not being able to be quote-unquote normal in social situations."
McCarney has been dealing with this for nearly 10 years. "Whenever you're battling something for a long period of time, it wears you down," he says. "That's what leads to the depression, sadness and lethargy. You just don't want to do anything."
Now, he says, his top strategy is immersing himself in his environment. "So the sights, sounds, smells -- anything to get out of my head, so I don't ruminate on my anxiety symptoms or the panic attack itself," he says. "If I'm outside, I notice the make and model of cars going by, and take deep breaths of the beautiful California air."
Counseling, including cognitive behavioral therapy, has helped McCarney deal not only with depression and anxiety, but issues from a traumatic childhood. While medication works for others, he says, an early trial with antidepressants brought on the worst panic attack he'd ever had. So he's been wary since.
From his days playing college and minor-league baseball, McCarney learned that partying with alcohol "is a great mask for about 20 seconds," he says, adding that he no longer drinks. "But it does nothing for you, mentally or physically, in the long run." Last year, he spearheaded a social media awareness and funding campaign around the conditions, and in November he founded the nonprofit Athletes Against Anxiety and Depression.
Lisa Esposito is a Patient Advice reporter at U.S. News. She covers health conditions, drawing on experience as an RN in oncology and other areas and as a research coordinator at the National Institutes of Health. Esposito previously reported on health care with Gannett, and she received her journalism master's degree at Georgetown University. You can follow her on Twitter, connect with her on LinkedIn or email her at firstname.lastname@example.org.