The image of a woman who appears to have been diagnosed with comorbid anxiety and depression

Anxiety disorders and mood disorders are common. They affect people of all ages and walks of life. When someone suffers from anxiety and mood disorders at the same time, they’re diagnosed with comorbid anxiety and depression.

Four common questions about co-occurring anxiety and depression are:

  1. How often do they co-occur?
  2. Why do they co-occur?
  3. What’s the prognosis?
  4. What’s the treatment?

In general, comorbid conditions of all types are common.

One study found that about 50% of American adults with any psychiatric diagnosis have 2 or more disorders.

Co-occurring anxiety and depression are even more common than that.

Both conditions co-occur more often than the lifetime rates of either depression (16.6%) or anxiety (28.8%) alone. More specifically, about 60% of people with depression have comorbid anxiety, and 60% of people with anxiety have comorbid depression.

A natural next question is why anxiety and depression commonly co-occur.

Researchers do not know what puts someone at risk for comorbid anxiety and depression, compared with either condition by itself.

Theories range from biological explanations to situational life events. Another possibility is overlapping symptoms, such as insomnia, link the two disorders.

Some experts suggest that having one of the disorders is a risk factor for having the other.

Identifying causes for the co-occurrence is difficult. One reason for this is the different types of anxiety and depression.

For example, Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD) are highly comorbid. They also share four symptoms:

  • Trouble sleeping
  • Difficulty concentrating
  • Being easily fatigued
  • Restlessness

MDD and GAD are considered to have to similar genetic factors.

MDD and other anxiety disorders, such as Panic Disorder, are not considered to be linked genetically.  They are less often comorbid.

Gender may be another risk factor. Females have a higher rate of each condition than males. And a higher rate of comorbid anxiety and depression too. (This could also be due to bias toward diagnosing women more often than men with the disorders.)

Age is yet another factor. Onset for anxiety disorders is much earlier than for mood disorders (11 years old vs age 30 years of age). Whether this affects comorbidity is unknown.

What is the prognosis for comorbid anxiety and depression?

Another version of this question is how comorbidity affects treatment outcome.

Remember that when anxiety and depression co-occur, they’re usually harder to treat. Why? Because the symptoms tend to be more persistent and intense when combined.

The prognosis for people with comorbid anxiety and depressive disorders is poorer than that for either disorder alone.

The more intense symptoms include increased risk of suicidality, more chronic symptoms, and more everyday impairment.

So, people with depression and anxiety have a worse response than people with depression or anxiety alone. Their illness tends to be more chronic.

So how do you treat the conditions when they co-occur?

Unfortunately there is no single best treatment.

Experts even disagree whether to treat one condition first and then the other (aka sequential treatment). Or, to treat both at the same time (aka simultaneous treatment).

Further, clinicians can recognize one mental illness relatively easily. But, it’s much harder to recognize comorbid illnesses. And to distinguish comorbid conditions from conditions such as Bipolar disorder or Substance Use disorder.

However, it is not all gloom and doom!

Medication-wise, selective serotonin reuptake inhibitors (SSRIs) are the treatment of choice in treating depression and comorbid anxiety disorders. 

In general, the SSRIs and the Selective Norepinephrine Reuptake Inhibitor (SNRI) venlafaxine are first-line medications used in the treatment of both anxiety and depression.

Examples of SSRIs include sertraline, fluoxetine, citalopram, fluvoxamine, paroxetine. They’re preferred due to their treatment effectiveness.

One downside to SSRIs is they can intensify anxiety among already anxious patients. Clinicians thus tend to start patients at a low dose and then increase the dose over the first few weeks of treatment. 

The most common psychotherapy approach is cognitive behavioral therapy, or CBT for short.

CBT is a here-and-now, solutions-oriented approach. It’s based on the idea that thoughts, feelings, and perceptions influence behavior. One of the cool things about CBT is that it is an effective treatment for either disorder. And for both when they occur at the same time.

With comorbidity, treatment providers have to make sure both disorders are being treated. For example, antidepressants may help a person’s mood, but not their anxiety. A next step may be to add CBT. Or to change the medication.

There’s still a lot to learn about recognizing and treating conditions that present at the same time. Especially in the case of anxiety and depression.

While treatment has more challenges when dealing with comorbidity, success is possible.

I am a clinical psychologist in private practice. In my experience, the majority of adolescents and adults who present for treatment have comorbid conditions, including anxiety and depression.

A photo of a tree being held up by aa hand made of wood as a symbol of support for anxiety and depression

If you have anxiety or depression, you may wonder if a support group would be helpful to you. First step? Consider the pros and cons of participating in anxiety and depression support groups.

Being part of a support group provides an opportunity to be with people with similar concerns.

To be in the presence of others who talk about their challenges can feel like a breath of fresh air. Especially because mental health challenges can be isolating.

In a support group, you’re likely to understand one another. And also recognize that not everyone is exactly the same. The main focus is on sharing experiences without focusing on the negative feelings of depression or anxiety.

Problem solving, sharing, and empowering each another can feel incredibly supportive. And really help to improve your symptoms of anxiety and depression.

In a group environment, members generate ideas for themselves and each other. The group setting is a safe place to practice skills that you can then more confidently practice in your every day life.

Many benefits of participating in a support group for anxiety or depression make it an appealing option. And well worth the effort.

For example, being in a support group may help you feel less isolated in your depression and anxiety. Recognizing that other people feel similarly to you can be such a relief. That you really are not alone.

The guidelines of the group are important and should be clearly stated from the very beginning. Basics include confidentiality, expectations (e.g.re being on time; missing sessions; safety protocols; outside of group contact), and participation. Even having an agreement or contract for all group members to sign, agreeing to the group rules, may be helpful.

The “what’s said in this room stays in this room” guideline is especially essential in order for people in the group to feel safe.

And to really be able to utilize the group fully. You want to be confident that what you are sharing in the group does not find its way outside of the group.

Expectations are also important to state at the beginning. Such things as attendance and participation. And whether group members need to be in individual therapy alongside the group therapy.

There can be disadvantages too in support groups for anxiety or depression. Especially if the group is not run well. For example, poor boundaries in the group may cause members not to feel safe. Or if there is a victim vibe, “poor me” atmosphere. Another challenge may be handling other people’s emotions.

Ideally, group members feel lighter, less burdened, more connected to others and to themselves after a group session.

So, if you want to feel less alone, and challenge yourself to go outside your comfort zone, consider an anxiety or depression support group. As is true for nearly everything in life, there is no guarantee participating in a group will help. But an open mind and a well run group may be an ideal addition to individual therapy.

I am a Boston area licensed psychologist, specializing in working with men and women who know they could be deriving more – pleasure, meaning, and purpose – in their lives.

A dog sitting on a leather sofa appearing like he is feeling depressed or anxious and is looking for what to do

Depression zaps you of joy and energy. Anxiety keeps you on edge. At some point, we all struggle with some form of depression and anxiety. Emotions are part of being human. If you are suffering from depression and anxiety, you may wonder if there are things you can do to help you start feeling better.

Spoiler alert: Yes!

Some techniques are for the “here and now”, and others help over the long term. Some are action driven, and others are about changing your thoughts.

Here are 25 things to help you start feeling better:

Strategies for the here and now if you are suffering from depression or anxiety:

  1. Bring awareness to your breath
  2. Check your posture
  3. Move your body
  4. Get outside with nature
  5. Laugh
  6. Turn up the corners of your mouth
  7. Sing and dance to music you like
  8. Opposite action
  9. Talk to someone you trust
  10. Drink water

Strategies for the longer term:

  1. Zoom out the lens. Take a step back for a different perspective
  2. Experiment with a meditation practice
  3. Journal your feelings
  4. Change your relationship with your thoughts
  5. Prioritize sleep
  6. Regularly exercise
  7. Seek Psychotherapy
  8. Refer back to a list you made of all the times you overcame depression or anxiety. Remind yourself you have felt the emotions before, and that they didn’t last forever.
  9. Help someone in need
  10. Join a support group online
  11. Read inspirational, motivational quotes
  12. Read dark humor
  13. Listen to podcasts
  14. Find playlists of interest or create your own
  15. Take a Values Assessment

Here are 5 quotes to help you feel better if you are suffering from anxiety or depression:

“You say you’re ‘depressed’ – all I see is resilience. You are allowed to feel messed up and inside out. It doesn’t mean you’re defective – it just means you’re human.”–David Mitchel

Those who have a ‘why’ to live, can bear with almost any ‘how’.
–Viktor E. Frank

Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened, ambition inspired, and success achieved.” —Helen Kelle

“That’s the thing about depression: A human being can survive almost anything, as long as she sees the end in sight. But depression is so insidious, and it compounds daily, that it’s impossible to ever see the end. The fog is like a cage without a key.” –Elizabeth Wurtzel, author

Mental pain is less dramatic than physical pain, but it is more common and also more hard to bear. The frequent attempt to conceal mental pain increases the burden: It is easier to say ‘My tooth is aching’ than to say ‘My heart is broken.’ –C.S. Lewis, author

Even though anxiety and depression are part of life, you don’t have to suffer.

Recognize that all feelings are part of shared humanity. They come and then they go. And they too shall pass.

I am a clinical psychologist dedicated to helping people find meaning and purpose in their lives. To live authentically in a world where suffering and pain exist is no easy task.

Please contact me if you want to talk about any of these ideas.

You don’t have to go it alone.

A foggy window with a small heart on it represents that it is hard to love someone with anxiety and depression, and how important it is to stay healthy

To watch someone you love suffer is painful – whether the suffering is physical or mental, or a combination. When someone you love has anxiety and depression, you may feel particularly helpless and wonder how to offer support. Especially because their pain is not visible in the way it would be with a physical wound or injury.

It is natural to wonder if loving someone with anxiety and depression could make you depressed. And to wonder if you’re selfish to even be thinking about how to stay healthy.

The hard reality is that relationships are complicated. And both you and your partner have quirks and problems of different kinds, sizes, and manifestations. You know that everyone struggles in some shape or form.

In the case of anxiety and depression, people’s suffering can be short, medium, or long term. The symptoms can manifest as a single episode or multiple. Regardless, professional help is essential. That includes psychological treatment and possibly medication. (Definitely for your loved one and maybe even for yourself.)

One thing consistently recommended is to be sure you don’t take on your loved one’s problems as if they’re your own. Because they’re not yours. Making them your own will ultimately not be helpful to your loved one. And could make it hard for you to stay healthy. It’s a lose-lose.

So what can you do to help a loved one with anxiety and depression?

Here are 4 general suggestions:


1. DO set boundaries with a loved one with anxiety and depression. If you don’t, your own health will suffer. Mentally AND physically. Instead, discuss the importance of finding a balance between supporting your loved one and carving out time for yourself.


For example, if you’re both planning to join friends for dinner, let your partner know in advance that you’ll still go even if your partner isn’t up to it when the time comes. Remind your loved one that you won’t force him/her to go, and that you want to follow through with plans because it is important to you.

2. DO Listen when a loved one with anxiety and depression talks with you. Sometimes, it is all you can do. Resist the urge to give advice. Also, guilt can be part of depression and anxiety. When your loved one’s anxiety or depression takes hold, it’s not realistic or helpful for them to pretend they’re fine. Avoid making them feel guilty about it. They already feel bad enough. More guilt just adds to their anxiety and depression.

3. DO NOT try to “fix” the anxiety or depression your loved one has. Or try to “fix” your loved one. Your loved one’s therapist and medication provider are the professionals assigned to treating anxiety and depression. After your loved one has established a solid relationship with the therapist, offer to join them for a session to learn more about how to be helpful.

4. DO NOT assume you know what your loved one with anxiety or depression is feeling. Let them know that you care about them and want to be there for them. Ask them how they’re feeling and how you can support them.

There is no one size fits all list for how to help a loved one suffering from anxiety and depression. Educate yourself about anxiety and depression through websites, podcasts, and other sources. Be a good listener. And, for your own well being, make sure you have a life outside of helping your loved one.

For more information, please contact me.

A large rainbow balloon in the treetop, against a blue sky, suggesting there is surprising and inspiring facts about anxiety and depression

Did you know that anxiety disorders are the most common mental health problem in America? About 40 million Americans have a diagnosed anxiety disorder. Depression is also common, affecting about 20 million adults in this country. Despite being so common, anxiety and depression aren’t often talked about. Here are some inspiring and surprising facts about anxiety and depression you may not know.

1. Both anxiety and depression affect how you feel and think. And how you handle daily activities, such as sleeping, eating, or working.

Most of us feel overwhelmed and even panicky at times. Especially lately, with the global pandemic.

Uncertainty tends to cause unsettling feelings. So does focusing on bad things that could happen in the future. I call future oriented thinking “What if’ing”. “What if’ing” easily leads down a rabbit hole of negative, catastrophic thoughts. And can cause anxiety or depression to skyrocket.

For our cavemen and cavewomen ancestors, “what if’ing” had major survival benefits though. It allowed our species to continue! Assuming or predicting the worse possible outcome kept our ancestors safe. As in better safe than sorry.

2. For some of us, anxiety or depression is temporary. For others, episodic or constant.

Another fact about anxiety and depression is that they show up in different forms. Examples of anxiety disorders include OCD, Phobias, Post traumatic Stress, Generalized Anxiety, Social anxiety, or some combination of any of them. Depression can be chronic and low grade, intense and episodic, related to a medical condition, or some combination thereof.

3. The good news is anxiety disorders and depression are completely treatable. Unfortunately, only about a third of people receive treatment.

Depression and anxiety are different, but symptoms of both can easily overlap. Feeling irritable, having trouble concentrating or sleeping, and being nervous are common in both.

Depression or anxiety don’t cause the other, but many people suffer from both.

Psychotherapy, medication, or a combination of both are effective ways to treat anxiety and/or depression. Certain lifestyle behaviors, such as spending time in nature, help with anxiety or depression.

4. So what are the facts about anxiety or depression that are surprising or inspiring?

Well, anxiety can actually help to keep you safe. (Kind of like it did for our ancestors.) For example, say you go for a run alone in the park. Anxiety helps keep you alert to any threat in your surroundings. So if a large, unleashed dog were to run toward you, for example, anxiety would kick in and help you stay safe. Another example is when you are preparing for a presentation, exam, or concert, feeling anxious motivates you to prepare.

As for depression, a benefit may be in what it is communicating to you. For example, maybe it is telling you that something in your life needs to change. Feeling miserable due to work or in your relationship alerts you that it’s time to make some changes.

Be aware though that there is no such thing as a geographic cure. Sometimes the cause of depression is not due to something outside of you, like a job or relationship, but due to pent up feelings.

Anxiety and/or depression are also a normal, understandable response to stressful events – like with what is happening in the world right now with the global pandemic. Anxiety doesn’t have to take over though. Nor does depression. Healthy outlets to express anxiety and depression keep them from festering.

5. Is it anxiety or ‘just stress’? Is it depression or ‘just sadness’?

Distinguishing between normal, everyday feelings and more serious conditions is not easy. Especially if feeling anxious or depressed seems like it’s just who you are.

One way to tell the difference is to keep a feelings journal for at least two weeks. Look back on it and see if there are any themes or indicators to help you recognize patterns.

If you have a family history of anxiety or depression, you’re more likely to experience either or both. However, you don’t necessarily have these conditions, nor are you are destined to suffer.

There are things you can do if you have anxiety and/or depression to help yourself feel better. Exercise, yoga, having a pet, time in nature, and being in therapy are ways people help themselves out of the abyss of depression or the whirlwind of anxiety.

Finding the balance between recognizing all feelings are normal and welcome can be tricky. Feeling anxious or depressed is a natural reaction to what life has in store at times. If however the anxiety or depression last more than two weeks, cause problems in your relationships, health, and/or career, please seek professional help.

You deserve to feel better and live a higher quality of life.

For more information about anxiety or depression, please contact me.

A sillhouette with her arm raised in victory after discovering the signs of anxiety and depression and starting therapy as a result.

How do you know if it’s time for you to seek psychotherapy for depression and anxiety?

What are key signs for you that it’s time to get help for depression and anxiety?

If you want to be in therapy, go ahead! For any reason! Just think about what you are looking for from therapy, and find a therapist!

You don’t need to be in dire straits to seek psychotherapy.

People are in psychotherapy for tons of different reasons, from personal development and growth to addressing an acute or ongoing problem.

Psychotherapy, by the way, includes many different approaches. Some are more effective than others, depending on the kind of depression and anxiety you have.

But what if the question is how do you know you should seek psychotherapy for depression and anxiety?

Mental health professionals refer to the Diagnostic and Statistical Manual — the ‘Bible’ of psychiatric disorders — to distinguish between feeling sad or stressed on occasion to having symptoms of a clinical disorder such as depression or anxiety.

The general standard for when it’s time to seek psychotherapy for depression and anxiety is if your symptoms are present for

1. More than two weeks, and

2. Interfere with living your life, and

3. Impair how you function. 

So taking these three criteria into account, how do you know if it is time for you to seek psychotherapy for depression and anxiety?

Depression

First, keep in mind that symptoms of depression vary from person to person, and even over time in one person.

No two people have exactly the same symptoms or severity of depression. This fact makes it impossible to say specifically when it is time for you to seek psychotherapy for depression and anxiety.

There is no blood test or other objective marker that it is time to seek psychotherapy for depression and anxiety.

The diagnosis of depression is based on self-report and on what other people may notice/comment about your thoughts, feelings, and day to day decisions.

There are different kinds of depression, some associated with other situations. Postpartum depression is an example. So are dysthymia (a two plus year, low grade depression with a couple of other symptoms) and Seasonal Affective Disorder (SAD). SAD occurs during winter months, when there is less sunlight, and naturally lifts around spring time, year after year.

Symptoms of depression, according to the DSM, include:

  1. Persistently sad or “empty” mood. Irritability is also common in children/teens
  2. Loss of interest or pleasure in hobbies and things you used to enjoy
  3. Feeling guilty, worthless or helpless
  4. Hopelessness
  5. Decreased energy
  6. Moving or talking more slowly than usual
  7. Trouble concentrating, remembering, or making decisions
  8. Difficulty sleeping, such as disrupted sleep, early-morning awakening, or oversleeping
  9. Appetite and/or weight changes (up or down)
  10. Aches or pains, headaches, or digestive problems with no physical cause

    Remember, the diagnosis of depression means symptoms have lasted at least two weeks, have caused additional problems, and interfere with how you function.

Here are some important facts in considering psychotherapy for depression and anxiety:

Depression is one of the most common mental disorders in the U.S and is highly treatable.

Ongoing research suggests depression is caused by genetic, biological, environmental, and psychological factors. Depending on the cause, different treatments may be more helpful than other treatments.

There is no one size fits all treatment for depression, for adults or children. As more is learned about depression, the better we will be able to match the treatment with the symptoms.

So now what about Anxiety?

Anxiety

Anxiety, like depression, varies in form and severity from person to person, and even over time in the same person.

As is true for depression, anxiety can occur for many different reasons, and it can present in different ways. It can also happen alongside other conditions.

Many forms of anxiety are described in the DSM.

Examples include Post traumatic stress, panic, phobias, obsessions, social anxiety, and generalized anxiety. Each anxiety based condition in the Anxiety Disorders chapter is unique, except some form of anxiety is part of each of them.

The common threads of anxiety of various forms include:

  • Worrying about the future, such as focusing on negative ‘what if”s
  • Bodily tension, such as fidgeting
  • Autonomic reactivity, including dry mouth, lightheadedness, sweating, rapid heart rate

Like depression, anxiety is an expected part of life. Whether before an interview, or while having a medical procedure done, feeling anxious at times is normal.

However, an anxiety disorder is so much more than temporary worry or fear.

With an anxiety disorder, anxiety does not go away easily. It may worsen over time, and can get in the way of living your life.

Psychotherapy for depression and anxiety can provide a very useful way to understand yourself. Especially your moods, coping style, and ways of thinking. The duration of therapy varies and works best the more you apply what you learn.

Think of therapy as an investment in yourself. And if depression and anxiety are what led you to therapy, you have firsthand experience of a silver lining!

I work with men and women from adolescence through adulthood who have different levels of depression and anxiety, for different reasons, and in different forms. My bias is that psychotherapy is super powerful and something to consider even if you don’t ‘have to’.

PLEASE NOTE: If at any time you are in acute distress and need to speak with someone, please contact:

Lifeline (suicidepreventionlifeline.org); 1-800-273-8255 (CHAT)

If you are concerned about someone’s safety, please contact:

NIMH » Suicide Prevention (nih.gov); 1-800-273-TALK (8255), or text the Crisis Text Line (text HELLO to 741741).

Both services are free and available 24 hours a day, seven days a week.

A woman wearing a red hat and holding her hand up to stop the physical symptoms of anxiety and depression.

There is nothing wrong or unnatural about feeling anxious or depressed. If you are a human being, you inevitably experience anxiety and depression.  That is life.

Anxiety and depression have physical symptoms associated with them. Knowing how to keep the physical symptoms of anxiety and depression from derailing your life is an important part of well being. And of life in general. Otherwise, symptoms can take over, and your quality of life will suffer. How? Socially, interpersonally, health-wise, and in all other ways you can think of.

Let’s take a closer look at anxiety, starting with a definition. 

Anxiety occurs when you feel nervous or stressed about something.

Maybe before an exam, or on a first date, you notice feeling slightly agitated or restless? Or worried, and/or a preference to avoid whatever is stressing you out?

Feeling anxious can be uncomfortable, even to the point you may wonder why the feeling exists.

Did you know that you, like everyone else, are wired to experience anxiety as a protective mechanism?

Anxiety is protective? Say what? 

Anxiety is adaptive when facing challenges. So, we don’t want to get rid of it completely.

Back in the day of our cavemen and cavewomen ancestors, feeling anxious when lions approached was a good thing. Our ancestors’ anxiety helped them to fight off the animals or run for safety. 

Anxiety kept them alive by activating the fight-or-flight mode. The same mechanism remains today as part of our brain. It prepares you for action and safety. In many cases, the fight or flight activation is a ‘false alarm’, because there are no lions or their equivalent chasing you. The threat in the present is more benign, like a first date or arriving late to an appointment. Much less is usually at stake than being attacked by a ferocious beast, but your nervous system doesn’t distinguish. 

Without the safety mechanism of anxiety, humans would not have survived.

So, you can actually thank your anxiety for the evolution of our species. 

Despite the benefits of anxiety, uncomfortable physical symptoms often occur in the body when you feel anxious. 

Remember, anxiety is normal and something most of us experience. The severity can vary, from mild to severe.  

Anxiety is considered a disorder depending on how long it lasts, how much distress it causes, or if it interferes with your life in other ways.

Physical symptoms of anxiety include:

  1. Nausea or stomach pain
  2. Rapid heart rate (maybe even feeling your heart pound)
  3. Shortness of breath (to the point where it may be hard to breathe)
  4. Fatigue
  5. Muscle tension
  6. Shaking
  7. Sweating

There are about ten different categories of anxiety, many of which have overlapping physical symptoms. Examples of the categories include Phobias, Generalized Anxiety, Social Anxiety, and Post Traumatic Stress. 

Depending on the severity of the symptoms, professional help may be the best next step. 

Here is some good news: You can take steps on your own to manage your anxiety and physical symptoms.

Five of the best ways to keep the physical symptoms of anxiety from ruining your life include:

  1. Physical activity, be it formal exercise, walking in the park, dancing in your room to favorite music, or some other movement – it all counts as being physically active. 
  1. Find time to be outside every day. 
  1. Aim to avoid or at least limit alcohol and caffeine. Avoid nicotine. All worsen anxiety.
  1. Make sleep a priority. Anxiety and sleep problems go hand in hand. Getting enough sleep is important; it may reduce anxiety AND can help you cope with symptoms if you do become anxious. 
  1. Relaxation techniques actually work. There are many different types. Discover what works for you. Maybe yoga? Guided meditation? Pick something that calms you and be sure it does not add to anxiety.

Up next is depression. Let’s define it and describe what it feels like to be depressed. 

Feeling sad is normal. We all have losses and challenges, and sadness is a natural emotion. 

Most everyone knows what feeling ‘off’ is like. Or feeling blue, sad, down in the dumps. Having these feelings on occasion is completely normal. With more moderate depression you may feel joyless and disinterested in what you usually like to do. Low energy and a bad mood can accompany depression too. 

As with anxiety, depression levels range in severity from mild to severe.

Depending on how long depression lasts, how much distress it causes, and how it interferes in your life, you may have more than ‘just’ feelings of depression.

Feeling helpless and hopeless can also be a part of depression.  This can become so central that suicidal thoughts may occur. (If this happens, call your local emergency room asap. The Samaritans are also available to talk to for support. ) Seeking professional help from a therapist and possibly a medication prescriber (aka a psychopharmacologist) is important, so that the symptoms do not become debilitating or lead to thoughts of suicide.  

Physical symptoms of depression can include:

  1. Aches and pains, such as back or joint pain
  2. Headaches
  3. Lethargy,
  4. Sleep problems, such as insomnia or awakening a lot during the night
  5. Changes in appetite
  6. Slowed speed and movement, or agitated speech and movement
  7. Digestive problems

Fortunately, there are tried and true ways to keep physical symptoms of depression from ruining your life.

The same strategies to keep physical symptoms of anxiety from derailing your life also apply to depression. These include: physical activity, time spent outside, limiting or avoiding caffeine, alcohol, and nicotine, prioritizing sleep, and practicing relaxation techniques.

Two additional recommendations for improving physical symptoms of depression are less well known. They target the sense of meaninglessness and lack of pleasure that can accompany depression.

  1. Engage in daily activities for mastery.

The bar for what is considered mastery may be low. That is ok. Even if making your bed is a mastery activity, great! The point is to do something that you really don’t feel like doing because of depression, and give yourself credit for having done it. Voila! Mastery.

This type of activity can be helpful to offset feeling like you can’t do anything right, or that you are too glum to do anything.

2. Engage in daily activities for pleasure. 

Pleasure is often absent when feeling depressed. Even if it feels like just going through the motions, purposely plan and do something each day that brings you some sense of joy, pleasure, or peace. Examples include using your favorite body cream after showering, cuddling with your pet, or lighting a candle and listening to your favorite music.

There is a lot you can do to help yourself keep the physical symptoms of anxiety and depression from ruining your life. They are all forms of self care. 

Unfortunately, self care has gotten a bad rap. Self care, ironically, is essential to well being. Rather than self indulgent, self-care helps to keep the physical symptoms of anxiety and depression away.

Self care each day may just keep anxiety and depression away!

Even if it doesn’t, self care will help you manage the physical symptoms of anxiety and depression. There is no down side to self care!

In my private practice I teach teens and adults how to navigate anxiety and depression. Please contact me if you would like more information.

How can something as easy as breathing exercises for anxiety and depression be helpful? Almost sounds too good to be true, right?

Well, first, keep in mind the utterly amazing fact that your body automatically knows how to inhale and exhale. Even when you are asleep.  Breathing is one of many cool things your body automatically does to keep you alive.

You don’t need to think about it. Breathe in. Breathe out. Voila. Breath just naturally happens.

But, breathing in a helpful way when you are anxious or depressed feels neither easy nor automatic.

In fact, you may inadvertently worsen the anxiety or depression symptoms depending on how you are breathing.

Modern day scientists discovered and fine tuned what Eastern masters knew long ago: Breathing affects health.

That is, breathing well goes hand in hand with feeling well. And with even feeling better than just ‘well’. 

So, it is safe to say that breathing exercises for anxiety and depression have been used effectively for thousands of years. As such, they have stood the test of time.

Further, a ‘fun fact’ about breath is that it is under both voluntary and involuntary control. In other words, breath is automatic, yet you can also intervene to intentionally change your breath in order to change your mood and physiology.

Thank you, autonomic nervous system!

Over the last decade or so, breathing exercises for anxiety and depression have become more widespread. And the techniques go far beyond the classic “just breath into a paper bag”. (Which is controversial at best.)

Breathing exercises designed for anxiety and depression actually work. And can be done anywhere, anytime, without any tools or pills. 

If you have ever had anxiety or depression, you know how awful every moment of existence can feel. Often, the two conditions occur at the same time. Talk about a double whammy.

The most highly recommended breathing exercises for anxiety and depression share some overlap. But, they are also different in many ways.

Breathing exercises to decrease anxiety and depression work because of how they affect heart rate and the mind. And whatever affects the mind affects the body. And vice versa.

Let’s break this down a bit. 

First up: Anxiety

Most everyone will experience anxiety at some point in their lives. The intensity varies from mild to moderate to severe. 

When you feel anxious, you experience changes in your body. For example, you may panic, hyperventilate, and/or breathe shallowly and quickly. Or your mind may start to race, and you suddenly feel woozy, nauseous, or as if you are going crazy. 

Anxiety is generally associated with breathing more shallowly and more quickly. This happens even if you are trying to do the exact opposite.  Hyperventilation can result, so less oxygenated blood flows to your brain. 

The most straightforward technique is simply to lengthen your exhale. 

Let’s call this technique the Exhalation Emphasis breath. 

Here is how to do the Exhalation Emphasis breath, either standing, sitting, or laying down:

  1. Before taking a breath in,  breath out. Push as much air out of your lungs as possible through that one exahalion. 
  2. Let your lungs naturally take in breath to fill the lungs. Do not force it. 
  3. On your next inhales/exhales, spend more time on breathing out than on breathing in. Some people count to do this. They may breathe in to the count of 3 and out to the count of 5. 
  4. Continue with the inhalation and the longer exhalation for at least a minute or so.

My favorite breathing technique to help with anxiety is called Alternate Nostril Breathing. 

The Sanskrit term is Nadi Shodhana. 

Practicing this breath will help you calm your nervous system. Just one minute of alternate nostril breathing can decrease stress and clear your mind! 

You can also try this technique when you’re feeling especially stressed or on edge.

The instructions sound complicated, but the practice is actually straight-forward. 

To do this, you will be breathing in and out through your nose only.

  1. Sit in a comfy position, perhaps with legs crossed.
  2. Place your left hand on your left knee.
  3. Bring your right hand to the area between your eyebrows.Place your index finger there.
  4. Exhale fully. 
  5. With your right thumb, close your right nostril.
  6. Inhale through the left nostril
  7. Close the left nostril with your ring finger.
  8. Open the right nostril and exhale through it.
  9. Inhale through the right nostril
  10. Close the right nostril and exhale left.
  11. Inhale through the left nostril.
  12. Close left nostril with your ring finger.
  13. Open the right nostril and exhale.
  14. Repeat for 1 or more minutes. 
  15. Finishing with an exhale on the left is recommended. 
Feeling anxious is not fun. Knowing that you can regulate  your breath in deliberate ways to help you manage anxiety is empowering. 

Depression

Depression is another psychological state that involves a lot of suffering. Breathing in particular ways can help to diminish depression. Skeptics are especially welcome to give it a try!

Cardiovascular exercise helps improve depression. Exercise creates hormonal changes associated with feeling better. However, when depressed, exercise is a big ask. It is probably one of the last things most depressed people want to do or feel capable of doing. 
Researchers have discovered that deep breathing that happens in cardiovascular exercise can be simulated through deliberate deep breathing.  

This is not your yoga teacher’s breathing. It is not chill, Zen, or about ohming. Nor is it the same as the types of breathing recommended to manage anxiety. 

Deep Breathing

Breathe in super deeply, as if you were about to go underwater. Start with your belly. Expand your lungs.  Imagine you have gills, and you are widening at your ribcage. Exhale. By doing this 20 times, you will derive similar benefits as with cardiovascular exercise. 

Equal Breathing

Research has also demonstrated that breathing in equal duration helps to alleviate depression symptoms.

Simply inhale through your nose for a count of 4 and exhale through your nose for a count of 4.

Breathing is not a panacea for anxiety or depression. However, the way you breath can  contribute to these conditions, and the use of breathing exercises for anxiety and depression can help you to feel better.

As with most things, the more you practice, the more natural what you are practicing feels. Over time, with practice, you may notice that breathing exercises for anxiety and depression occur naturally, often to the point they do not require deliberate effort. 

And that certainly can bring you a sigh of relief! (Long exhale please.)

Dr Elayne Daniels is a psychologist in private practice specializing in the interfacing of mind-body techniques to improve psychological well being.

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How many times have you said, or heard others say, they want to develop a habit or get rid of one?  

Habits such as going to bed earlier, consuming less alcohol, exercising more often, or saving more money each month are examples of habits people tend to deem  worth having.  Habits like driving too fast, eating late at night,  excessive spending, or  interrupting people when they speak are examples of habits more likely considered worth losing.

For many of us, identifying what we want to change about ourselves is  easy. Actually making changes and sustaining  them – not so easy!

Entire industries are based on promises of change.  Even a holiday, New Years, is about resolving to improve something about  ourselves,  ie to change a particular habit. 

As a psychologist, I am fascinated by what motivates people to change and how they stay motivated.

There are lots of tips out there for how to improve your chances of successful habit change. Generic suggestions typically include the importance of consistency, daily practice, keeping  it simple, hanging out with likeminded people who are already successful with the habit you are trying to build, and incorporating accountability.  Setting realistic, measurable goals and rewarding the baby steps along the way are other common recommendations.

Ideas such as these are solid. They make sense.

But not for everyone.

 In my clinical practice, I notice that generic lists are not necessarily helpful  for every individual. There are no blanket suggestions that work for all of us.  “It depends” is often the response to questions about personality.  So many factors influence our behavior in ways that make it impossible to state hard and fast facts about our inclinations.  History, experience, culture, expectations,  genetics, and family background are factors that can’t possibly be accounted for in a generic list of how to develop and  sustain  habits.

Former attorney and now author Gretchen Rubin apparently agrees. She developed a cool rubric to help people improve their likelihood of making habits stick.  She says that knowing how we respond to expectations can make the difference between success and failure.  Each of us generally falls into one of four categories — Upholder, Questioner, Obliger, or Rebel—depending on how we respond to outer and inner expectations.  When we know in which category we fall, we are better able to understand ourselves. That works to our advantage, especially when it comes to goals we set for ourselves and  habits we want to strengthen.

Here is the basic gist:

  • Upholders respond to outer and inner expectations. They tend not to disappoint others or themselves.
  • Questioners question expectations and will meet expectations only if the explanation makes sense to them.                                                                                                                                                                             
  • Rebels resist outer and inner expectations.    This is the least common category.
  • Obligers meet outer expectations, but struggle to meet self-imposed expectations.   They benefit significantly from external accountability. This is the most common category of the four.

Recognizing which tendency you have (to do this, click here to take her quiz) will guide your approach to how to make a habit stick.

This column is not a review of Ms Rubin’s theory, nor is it an endorsement of it necessarily. Her theory though highlights a basic tenet:  No one approach works for everyone. 

My take home messages are:

Know(ing )yourself is an important requirement to making effective and lasting change.  What works for you based on your personality, prior attempts, and/or reasons for wanting to make changes? This may shift over time and is going to be different from the person to your left or right.

Practice makes progress. If you fall off the horse, just get back on. No drama.

Perfection is the enemy of good.  All or none thinking (“I have to do this perfectly or I am a failure”) is a setup . Throwing in the towel due to less than perfect execution or outcome will doom any possible success.

I will sign off now.  My habit of being in bed by 10 pm must prevail.  I am an Upholder, after all!

Happiness. Ahhh. The elusive pursuit. “I just want to be happy!” say friends, family, and strangers. Magazine headlines, book titles, websites, FB posts, BLOGS (hello!) – all promise happiness. “Do this!” and you will be happy, the lists say. Advertisers suggest that if you use their product, you too will be happy (and beautiful, and successful, and fill-in-the-blank). I have been thinking of what not to do in order to increase the likelihood of feeling happy. The bottom line, regardless of the type of list:
There is only one person in life who can create your happiness: YOU
Here are ideas of happiness “DO NOTs”:

​1.DO NOT EXTERNALIZE 
By this I mean to look inside of yourself instead of basing your happiness on what you believe other people say will lead to happiness. Looking outside and at the ideas of family, friends, society, how-to lists (like this one!) – or to products – is not likely to lead to sustained joy.
2.DO NOT “SHOULD” WHAT YOU FEEL, REALLY FEEL
This may sound super corny. Corny can still be true. Often we intellectualize, acting in terms of “shoulds”, and we trump what our instincts tell us. Our instincts tend to be accurate guides. Learn to trust your built-in compass. Feel what you feel. Be in it.
3.DO NOT resist darkness
Life contains both dark and light. It sounds counterintuitive, but when you embrace the darkness, you open the door to the light. That sounds like one of those feel- good mantras – and it happens to be true. I know that it is through these dark times that I learn the most.  I breathe it all in, and I notice what it is that’s making me feel fear. I try to get curious about my internal reality and stay in the present moment.   This is hard to do when I’m feeling down. I want to run away and distract. But when I dive in, I see that the darkness is a virtual reality created by moi. I look at the fear of not having enough, and I see that what I’m afraid of is a thought I choose to entertain.
4.DO NOT say “no” to the now.
The more I try to escape the present moment, the more miserable I am. This continually surprises me. When I stay right here, right now, even the most ordinary tasks become extraordinary. Washing the dishes even feels alive. But if I try to exchange the now for the future, I lose out on a lot of opportunity. Being in the now is simply about noticing what’s here, right now. As I write this, I hear my fingers tapping on the keyboard. I notice the hum of my desktop, and I feel my butt on the chair. And above all, I feel my feelings. I’m feeling a bit anxious as I write this. And that’s okay.
5.DO NOT BE afraid of making mistakes
If I am afraid of making mistakes, I assume that I have something to lose. I also assume that there is a perfect way of doing something. Yet, I do not and cannot know any of this. I don’t know if making a mistake helps me grow. Maybe making a mistake is the necessary path for me. We live in our heads. We manufacture a reality that we believe is real when it’s not.
6.DO NOT aim for perfection
We try to be perfect.   We think it’ll bring approval from others. And then that approval will make us feel loved and feel good about ourselves. Yet, the act of trying to be perfect means dismissing ourselves. It means not loving who we are right now.
7.DO NOT chase happiness
I fall into the habit of chasing happiness. But to me, it’s more like I’m avoiding my feelings. I feel bad, so I want to be happy. I create an image of a future where I’m happy, and I long for it. I want it now. I think to myself, “If only I had that, I would be happy.” Yet, that thought keeps me stuck. The wanting happiness snatches me out of the present moment. When I let go of wanting to be somewhere else, I notice what’s right here. Sometimes it isn’t what I want, but even what I think I want is another thought. Each thought that says I need something else is an opportunity for me to stay in the present moment.
8.DO NOT try to control life
I can’t and don’t control life. Neither do you. I control my reactions and actions but not much else. When I try to manipulate life, people, and places, I end up exhausted. It’s not my domain. It’s not up to me to control outcomes. All I can do is follow my heart, my inner compass, and see what happens. I am here to experience both the good and the bad, and everything in between.
9.DO NOT put off your dreams
Dreams are scary. It can take years to muster up the courage to do the things you truly want to do. Dreams begin with one step. Start somewhere. And start before you feel ready.
10.DO NOT try to fix others
Let people travel their own path. We have mistakes we need to make. We have experiences to collect. When we see that life will take care of itself, we have no need to control others. This can been especially hard with loved ones. There is no fixing, because there is no perfection. There is only this moment.
One of the things I learned from being a psychologist is that we tend to take our thoughts too seriously.
We tend to take life too seriously.

Laugh! Lighten up on yourself!

You are worthy.

These ideas are adapted from the work of Henri Junttila