For starters, you now know that what you’re feeling has a name. You also know you aren’t alone. It is an actual ‘thing.’ And maybe, just maybe, there is a silver lining.
A diagnosis of anxiety and/or depression is increasingly common, especially post-global pandemic.
But what does it really mean to be diagnosed with anxiety or depression?
One thing it might mean is that you recognize you haven’t been feeling ‘yourself.’ It could also reflect observations from family and friends that you don’t seem like your (regular) self.
Perhaps you’ve met with your primary care doctor and/or a mental health professional; perhaps a psychiatrist, social worker, or psychologist. And perhaps that person has diagnosed you with anxiety or depression.
A diagnosis puts you one step closer to healing.
How can you ‘fix’ a problem if you don’t know what the problem is?
A diagnosis can be clarifying.
Thank goodness you asked for help. That in and of itself is a win!
As the saying goes, you gotta name it to tame it.
Being diagnosed with anxiety or depression can be the start of actually feeling better than you have in a long time. (Hello, silver lining.)
A diagnosis helps you know what you need to feel better. More emotional support? Therapy? Medication? Perhaps some combination?
This video clip speaks to the value of treatment.
There are treatments available for anxiety and depression.
Providers of a variety of disciplines are available to offer you their expertise and recommendations.
We’re definitely not talking about a “one size fits all” approach.
Some interventions target both disorders.
For example, many different forms of psychotherapy are available to treat anyone diagnosed with anxiety and/or depression.
For instance, Cognitive Behavioral Therapy (CBT) is a method of treatment with high success rates for people with both anxiety and depression or with symptoms of one or the other.
Certain medications, such as Selective Serotonin Reuptake Inhibitors (SSRIs), have antidepressant and antianxiety effects.
People diagnosed with anxiety or depression are more likely to have first-degree relatives with mental health challenges.
Whether or not those mental health problems were identified ‘back then’ is a different story.
At least in modern day, people are generally more comfortable seeking help than were their predecessors.
Fortunately, stigma surrounding mental health is beginning to lessen, especially post-COVID. (You’re part of a stigma-reducing force, effecting change in the world.)
Bottom line: Treatment improves prognosis.
That said, sometimes successful treatment is a bit of “trial and error”. For instance, maybe the therapist you meet with is not a good match for you.
The chemistry isn’t there. Or the therapy approach doesn’t jive with your style.
Perhaps the therapist’s office or mannerisms make it hard for you to feel comfortable.
Medication may be another source of “trial and error”.
Neurochemical advances make the selection of medication a bit less daunting.
Tests are available in which you send saliva to a lab, and a report comes back, indicating which medications are likely a good match for your particular brain chemistry
Regardless of the type of formal treatment, you can try lots of things on your own to help yourself. The hardest part can be finding the wherewithal to try them.
Ironically, the very things you know would help can be just too hard to motivate yourself to do. Perhaps you don’t have the motivation (in the case of depression) or are too stressed-out (in the case of anxiety).
Additional suggestions if you’ve been diagnosed with anxiety or depression:
- Attend to the basics: sleep, nourishment, movement, and emotional support.
- Practice doing experiments: Check in with yourself just before and then after an activity (e.g. a 10 minute walk). Chances are you will feel better after than before the activity.
- Self-validate: Recognize your efforts and give yourself credit. Be on your own side.
- Remind yourself you are not alone: Anxiety and depression are part of shared humanity.
Building blocks of physical and emotional health really do matter. Depression or anxiety can be a nudge to strengthen your self-care.
Pursuing help for an anxiety or depression diagnosis is an empowering form of taking charge of your life. Maybe even a wake-up call to enhance meaning and quality.
Take some breaths and just one step at a time, remembering that every step in the right direction is progress.
I am Dr Elayne Daniels, a psychologist in the Boston area who helps HSPs, people with eating disorders, and/or those with anxiety or depression to move forward in their lives and THRIVE!
Ever wonder what steps to take to heal anxiety and depression?
The kind of anxiety and depression I’m focusing on here is not the everyday type, but the kind that is diagnosable.
Let’s start with the fundamentals.
Anxiety and depression are feelings. Feelings exist in the body.
As humans, most of us believe we’re cognitive, rational beings who sometimes feel.
However, we’re more like emotional beings who on occasion think.
Feeling emotions can be uncomfortable. Even painful. For many of us, a natural reaction is to turn away from emotion.
There’s at least one problem with the turn-away method. Turning away makes things worse. It will not help heal anxiety and depression.
Even benign attempts at distraction are very limited in effectiveness. If they do help, the relief tends not to last long.
A much better option is to lean into the emotion.
In other words, feel it to heal it.
Keep in mind that emotions have a beginning, middle, and end.
Emotions are like tunnels. If you go all the way through them, you get to the end.
If you get stuck in a tunnel, you don’t reach the end. Maybe you can’t find your way out. Or you get lost.
And so it is with feelings. When you get stuck in them, they stagnate.
A “stuck” feeling doesn’ get to the end of the tunnel. It leaves you smack in the middle of the anxiety and depression. Yuck!
Anxiety and depression: They’re just feelings.
Not finding your way completely through. Getting lost. That’s one way to think about anxiety and depression.
They are normal human emotions.
Feelings are just that – feelings. They rise from chemical changes in your body, and they’re neither good nor bad. They simply are.
Certain feelings are definitely more pleasant than others. Some feelings are more comfortable to have then others. That’s different than feelings being good or bad.
Feeling anxious is a natural reaction to stress. And stress may be more about what you’re telling yourself than about what actually is.
Your perception of something easily becomes your reality. The ‘what if’s’ and other forms of catastrophizing are good examples of cognitive distortions that lead to beliefs and then anxiety and depression.
If depression and anxiety become chronic, interfere with your life and relationships, and/or cause other problems for you, consider professional help. There is nothing wrong with that! Reaching out for help is courageous and wise.
Let’s say you decide to heal everyday forms of anxiety and depression on your own. Or perhaps you want to work on healing your anxiety and depression at the same time you’re in formal treatment.
Here are 6 steps for healing anxiety and depression:
1. Validate your own feelings.
Whatever you’re feeling is valid. Even if what you’re feeling is different from what others feel (or simply what you perceive they feel). You may prefer to feel some other emotion than what you are feeling. Acknowledge what it is you do feel. You have a right to feel whatever it is you feel.
2. Name it to tame it.
Identify with specificity the emotion(s) you’re feeling. Instead of “I feel bad”, try words that are more descriptive of the actual emotion. Does feeling “bad” mean you feel like you could crawl out of your skin? Or more like a sense of hopelessness? Defeat? Some combination?
The fancy name for this technique is emotional granularity.
Examples of emotional granularity may help clarify this important point. Different aspects and levels exist for both anxiety and depression.
For example, anxiety could be described as angst, apprehension, fear, stress, uneasiness, suffering, nervousness, freaking out, panic, restlessness, uncertainty, or dread.
In fact, a Google search found close to 100 synonyms for anxiety!
Even more synonyms exist for depression (at least according to Google). Examples include melancholy, sadness, gloom, sorrow, unhappiness, defeat, down in the dumps, woe, tiredness, and weariness.
A great strategy for emotional granularity is to use an emotion wheel.
3. Create new neural pathways, and let other pathways fill in to heal anxiety and depression.
Specifically, the neural pathways that are traveled most often are the ones you’re strengthening. What the heck does this even mean?
Your old stories (“I’m not good enough,” “I suck”) are literally keeping you stuck.
Each time you think a particular thought, you deepen that thought’s circuit. So you are always practicing and deepening something.
Rick Hanson puts it succinctly when he says, “Where your attention goes, neural firing flows and neural connection grows.”
So, whatever you pay attention to, wherever you put effort — that’s what you get more of.
With your thoughts — just by thinking — you are always strengthening something.
So, think negatively, and you’ll get more automatic negative thinking including more anxiety or depression or both.
In contrast, move from a place of strength, gratitude, or competence, and you will see more of your strengths and notice more reasons to be grateful..
Even thinking neutrally can be helpful.
4. Feel the feelings that exist in your body.
Use your body as an instrument to assist with processing the feeling “through the tunnel.” Find what works for you, which may vary depending on the feeling and context.
Mindfulness, defined as nonjudgmental awareness in the present moment, with acceptance of what you feel, may be helpful. “Welcome the feelings in for tea,” some Zen masters suggest.
Notice sensations associated with different emotions, as well as where the sensations are located. Doing so is a practice. The ease of identifying feelings and their location will vary over time and situations.
5. Move it.
Because feelings are located in the body, moving your body can be very helpful in processing feelings. This doesn’t have to be intense or considered “exercise”. Rather, just move around. Doing so activates serotonin neurons.
Why not take a walk in your neighborhood? Or groove to the beat of your favorite tunes?
6. Provide self–compassion. Give yourself some grace!
You CAN heal from anxiety and depression. Be kind to yourself. Not in a woe-is-me, pity party kind of way., but in a way that reminds you of the shared humanity, the universality, of what you’re experiencing.
Practice using tools that help you personally heal anxiety and depression. If the tools work for others but not so much for you, that’s ok. Keep practicing until you find what feels helpful.
Connect with other people in whose presence you feel supported. Consider yoga,meditation, journaling –something that is you-focused and can easily be a daily practice
Remind yourself that you will not ALWAYS feel anxious or depressed. This moment isn’t all moments. It’s just right now.
You won’t always feel this way,even if it feels in the moment as if you will.
Over time you’ll learn what helps to heal your anxiety and depression.
When you start to feel early signs of anxiety and depression, you may recognize that as an opportune moment to access your tools.
Include your body in the healing of anxiety and depression. Mind-body-spirit are star players on “Team Heal”.
What’s The Cure For Depression And Anxiety?
Ever wonder about a cure for depression and anxiety? You’re in good company if so.
Depression and anxiety are often misunderstood. And both are more common than you might think.
In fact, depression affects more than 16.1 million American adults over 18 every year.
And, while struggles with depression can develop at any age, 32.5 years is the median age of onset. According to the National Center for Health Statistics, depression is most common in people ages 18 to 25.
Worldwide, 322 million people live with depression. That is according to the World Health Organization. Yikes! That’s a lot of people.
Speaking of a lot of people….
Anxiety disorders are the most common mental health problem in the U.S., affecting 40 million adults over 18.
The ways to cure depression and anxiety overlap.
What is depression?
Everyone feels sad at times.
It’s part of being human. For people with depression, though, sadness is more intense, far-reaching, and persistent. It’s so much more than “just sadness.”
Depression negatively affects how you feel, think, and act. When depressed, you may question if you’ll ever feel better. Sometimes there’s a triggering event, but not always.
Clinicians categorize depression by type. The most commonly diagnosed clinical form is Major Depressive Disorder.
Other symptoms of depression may include:
- Lack of interest in things you usually enjoy
- Feeling down or sad
- Trouble concentrating
- Low motivation
- Sleep problems (difficulty falling or staying asleep, sleeping too much and still feeling tired)
- Appetite/eating changes
- Thoughts of death – your own, someone else’s, or in general
- Feeling badly about yourself (e.g. you are a failure or disappointment)
- Walking/talking more slowly or rapidly than usual,
How about some good news? Depression is treatable.
“Treatable” means symptoms can be alleviated. Although there is no clinical cure for Depression, it can go into remission.
Definitions of remission vary, but generally have to do with no longer having symptoms. In other words, the disorder is “at rest.”
Please hear this:
Speaking clinically about depression is one thing. But how you live your life and feel is another.
Treatment options for depression include (among others):
Some treatment approaches require working with a professional. There are also many things you can do on your own.
A catch-22 with depression is that the very things you know would be helpful are the same things you have a hard time motivating yourself to do.
Start small. What can you do?
The more your lifestyle is geared toward a healthy mind and body, the better you’ll be able to cope with symptoms of depression (and with life in general).
Examples of lifestyle changes:
- Social connection
- Caring for a pet
- Meditation or yoga practice
- Time in nature
- Meaning and purpose in the everyday
- Eliminating use of alcohol, tobacco, and other ‘vices’
One of the best lifestyle changes you can make is to ditch dieting. In my experience, quality of life soars when Diet Culture rules no longer hold you hostage. Try Intuitive Eating instead.
There are many different forms of therapy and lots of experts to choose from. Providers vary in their credentials and theoretical approach.
Cognitive behavioral therapy (CBT) is a common and effective psychotherapy for treating depression, anxiety, eating disorders, and other issues.
CBT focuses on changing a person’s thoughts and beliefs. It also highlights the impact of thoughts and beliefs on mood and actions. (More information on this is below.)
Participating in a support group can be an excellent way to help you feel better.
People with depression meet as part of a psychotherapy group to talk about their experiences. Usually there is a mental health professional who is the group leader. Group members provide each other encouragement, understanding, and support.
Being in a support group is different from talking with supportive friends and family. People who have had similar experiences often have a deeper understanding of what you’re going through. They know firsthand what depression feels like.
The main benefits of joining a depression support group include:
- Ongoing social contact with people in a similar position
- Opportunities to share struggles and solutions
- Advice from mental health professionals/co-facilitators
Depression medications are grouped into categories based on how they work.
The most common antidepressant categories include select serotonin reuptake inhibitors (SSRIs), selective norepinephrine reuptake inhibitors (SNRIs), and atypical antidepressants.
- SSRIs work by increasing levels of serotonin in the brain. Examples: Zoloft, Paxil, Prozac
- SNRIs work by increasing levels of serotonin and norepinephrine in the brain. Examples: Cymbalta, Effexor XR, Pristiq
- Atypical antidepressants work by increasing dopamine and norepinephrine in the brain. Examples: Trazodone, Wellbutrin XL, Remeron
Every person’s body is unique and metabolizes medications differently. Trial-and-error is often needed to find a medication that works. A good place to start is with a medication that a first-degree relative has had a good response to.
People often ask about side effects with antidepressants. As with every medication, there may be some. The most common side effects are constipation, diarrhea, nausea, headache, dizziness, sexual dysfunction, difficulty sleeping, and drowsiness.
Another common question is how long a medication will take to work. If it works, you’ll know within a month or so. Even when you find the “right” medication, you might not notice an improvement in how you feel right away.
What is Anxiety?
Most people know what anxiety feels like because at some point they’ve felt anxious.
Anxiety is a natural human emotion that includes worry, tension, and changes within your body such as increased pulse. As a species, we’re wired to respond to fear (by our fight, flight, or freeze response). That’s how we’ve survived as a species.
So anxiety can be a good thing. It helps you recognize potential threats and keeps you alert.
For some people, anxious feelings quickly come and go. For other people, not so much. They may have an Anxiety Disorder, for which more formal treatment is available.
Anxiety is normal, not a flaw. However, people may get into coping patterns that make anxiety feel like something is very wrong, especially when anxiety is persistent and overwhelming. When anxiety interferes with daily activities, it’s considered a disorder.
Anxiety can take different forms. Symptoms of anxiety, for example, exist as part of several mental health conditions, such as mood disorders and eating disorders.
Anxiety Disorders are highly treatable, yet only 36.9% of those suffering receive treatment. How sad is that?
The seven most common “official” anxiety disorders include:
- Generalized Anxiety Disorder (GAD)
- Panic Disorder.
- Social Anxiety Disorder.
- Post-Traumatic Stress Disorder (PTSD)
- Obsessive-Compulsive Disorder (OCD)
- Separation Anxiety Disorder
Are there treatments for anxiety?
Yes! Treatment categories for anxiety are the same as those for depression:
The specific type of anxiety determines the best course of treatment.
There are things you can do to help manage anxiety. They are useful to consider, and many are common sense. Things like getting enough sleep, exercising regularly, having a mindfulness practice, and eating foods that benefit the brain are healthful habits regardless of anxiety. But they become game-changers for the person suffering from anxiety.
Psychotherapy is another effective way to manage different types of anxiety.
One of the best approaches to help with anxiety is Cognitive behavior therapy. The same CBT that is recommended for treating depression is helpful to treat anxiety.
Thoughts affected by depression or anxiety are often negative. You may not even realize that the way you think is problematic. Even though the negative thoughts bring you down and interfere with your daily life, you may think of them as facts.
We commonly accept our thoughts as facts. But they aren’t necessarily facts. They’re cognitive distortions, aka thinking mistakes that you can correct.
Examples of cognitive distortions include:
- All-or-nothing thinking: “I have to be perfect, or I suck.” Or “I ate a ______ so now I can’t eat the rest of the day.”
- Filtering: “No one ever compliments me” (disregarding the times people have complimented you).
- Catastrophizing: “My friends did not invite me to join them. They hate me.”
These are just a few of the several categories of cognitive distortions. When you know how to identify distortions, you can more easily recognize them in your self-talk. In other words, name it to tame it!
And, upon recognizing the distortions, you can reframe them so the thoughts are more neutral and realistic.
Reframing is not about being a Pollyanna. Nor is it toxic positivity. It’s about removing exaggerations and subconscious conclusions that aren’t based in reason or fact so you can “soften the edge” that you experience as anxiety.
Depending on the type of anxiety, medication may be prescribed.
While meds don’t cure anxiety, they can help with symptoms so you can function well and feel better in your day-to-day life.
Many types of medications are available. Because every person is different, your doctor may have to prescribe several different medications before finding the one that’s right for you.
Common medications for treating anxiety include:
SSRIs are used to help improve symptoms of depressed mood and anxiety. Examples include:
- Fluoxetine (Prozac) is used to treat OCD, Bulimia, Panic, and Depression
- Escitalopram (Lexapro) is used to treat Generalized Anxiety Disorder
- Sertraline (Zoloft) is used to treat OCD, PTSD, Social anxiety, Panic Disorder, and Depression
- Fluvoxamine (Luvox) is used to treat OCD, PTSD, Depression
- Paroxetine (Paxil) is used to treat OCD, Social Anxiety Disorder, and Depression
ANXIOLYTICS are used to relieve anxiety and promote sleep. An example is:
- Buspirone (Buspar) is used to treat anxiety. It works as well as benzodiazepines, but with fewer side effects. Also, it’s not habit-forming like benzodiazepines are and can be used in addition to an SSRI.
Benzodiazepines are used to help calm your mind. Doctors prescribe them to treat different types of Anxiety Disorders, including Panic Disorder, Generalized Anxiety Disorder, and Social Anxiety Disorder.
A downside of benzos is that they can be habit- forming. They also tend to increase drowsiness and worsen balance and memory.
- Alprazolam (Xanax)
- Clonazepam (Klonopin)
- Diazepam (Valium)/
- Lorazepam (Ativan)/
Other resources for learning more about depression and anxiety:
Mental Health America (MHA) is a community-based nonprofit that helps people living with mental illness. Its mission is to promote overall mental health.
The Depression and Bipolar Support Alliance (DBSA) is a national peer-oriented mental health organization. Their mission is to provide support and education.
Anxiety and Depression Association of America is geared toward improving quality of life for people with anxiety, depression, OCD, and PTSD through education.
Chances are you or someone you love has been or will be affected by depression and anxiety. So learning more is important. Awareness and knowledge are empowering and provide a solid base for getting help, whether for you a friend, a loved one, or a colleague.
Depression and anxiety can (and do) happen to anyone. Sometimes it’s obvious when someone is struggling with depression or anxiety. However, many people hide it well. They may deny anything is wrong, even though their struggles are beyond what other people deal with. Stigma can make it harder for people to be honest about feeling depressed or anxious.
While there is still no permanent clinical cure, the way you deal with depression and anxiety is its own type of “cure.” And, even as you read this, clinicians are working to find a permanent clinical cure. It’s just a matter of time.
In the meantime, you have resources within you to help you through.
If you are feeling unsafe, contact the National Suicide Prevention Lifeline at 1‑800‑273‑TALK (8255). It’s available 24 hours a day, 7 days a week, and all calls are confidential.
How To Avoid Burnout If You Have High-Functioning Anxiety And Depression
Anxiety, depression, and burnout zap the joy out of life. Sometimes they co-occur and can be difficult to distinguish from each other. Avoiding burnout if you have high-functioning (or not-so-high-functioning) anxiety or depression can be extra tricky, especially with overlapping signs and symptoms.
Because anxiety and depression lower your resistance to stress, your threshold for staying engaged in life is also diminished. This becomes the perfect storm for burnout.
What is burnout? How do you know if you are burned out?
This is a good question. You need to know what you’re looking for in order to identify it and do something about it.
Burnout can happen to anyone and goes deeper than merely feeling tired and stressed. When burned out, people feel mentally, physically, and emotionally exhausted. Drained. They tend to be pessimistic and feel like they have nothing left to give. Dealing with everyday responsibilities becomes too much. Even getting out of bed is daunting.
Burnout happens as a result of chronic stress.
A common example is caretaking while juggling other home and work demands. Exposure to negative health or political news day after day can also take a cumulative toll.
The recent political climate surrounding the 2020 election led to burnout for many, as has living through the coronavirus pandemic.
Along with an increase in burnout rates, anxiety and depression rates have also increased during this time.
Burnout tends not to go away on its own.
Signs of burnout include exhaustion, isolation, anxiety, depression, and feeling numb. The emotional, physical, and mental exhaustion of burnout worsens the symptoms of depression and anxiety.
When a battery loses its charge, it must be recharged in order to function. Burnout creates the same scenario for us humans.
What is high-functioning anxiety?
The term “high-functioning” anxiety is not a real thing in the world of official diagnoses. There are no objective criteria. But we all kind of know what the phrase is referring to.
For some people, high-functioning anxiety may refer to a person who worries, stresses out, and has episodes of physical signs of anxiety. Physical indications include symptoms like increased heart rate, headaches, and racing thoughts — all effects that are undetected by the outside world.
For others it may mean periodic anxiety symptoms that do not last long enough or become intense enough to interfere with their day-to-day lives.
Let’s say a person with high-functioning anxiety does not appear anxious on the outside. In fact, she appears to have her act together. She is kind, friendly, productive, and organized. This hypothetical high-functioning person with anxiety does not appear anxious. However, on the inside she overthinks everything and often believes she can’t measure up. She’s filled with self-doubt and has difficulty saying ‘no’ to requests.
What is high-functioning depression?
The term “high-functioning” depression, just like “high-functioning” anxiety, is neither clinically valid nor diagnostically existent. In other words, it has no standard definition. Different people may mean different things by the phrase “high-functioning”.
For some, it may suggest having symptoms of depression, such as sadness, low energy, appetite changes, and insomnia. However, that person purposely doesn’t display any outward signs of depression. Instead, on the outside, the person appears to be functioning well in life – at work, home, and with friends and family.
High-functioning depression could also refer to people who have bouts of depression that are short-lived, relatively mild, and not conducive to much derailment in their lives.
While anxiety and depression are considered psychiatric conditions, burnout is a reaction to stress.
There are treatments for anxiety and depression. The usual ‘treatment’ for burnout is to take time off or ‘recharge your battery’ in some other restful, restorative way. Unfortunately, that’s not always possible. The majority of people don’t have the kind of finances, job security, or back-up contingencies to enable that kind of elective time off.
The emotional, physical, and mental exhaustion of burnout worsens the symptoms of depression and anxiety.
The ways to avoid burnout are similar, whether you have high-functioning anxiety and depression or not.
How can you avoid burnout if you have high-functioning anxiety and depression?
If you’re already anxious and depressed, you’re more prone to burnout. Recognizing and addressing anxiety and depression before they are worsened by burnout is difficult but certainly ideal. If your stress tolerance is low due to anxiety and depression, going below that bar into the burnout zone doesn’t take much.
Self-awareness is key to avoiding burnout. So is self-care.
You decrease the likelihood of burnout by prioritizing self-care. Maybe that means going for more walks, talking more often with friends, or saying ‘no’ more consistently to requests at work. Maybe it’s even that Netflix series you watch while your puppy is snuggled up next to you. Whatever it is that helps you to replenish.
My favorite form of restoration? Getting out into nature.
Go outside and get a few breaths of fresh air. Look around at the trees, smell the flowers, feel the breeze on your cheeks.
Self-care is often more of a mindset than a prescription for pedicures and bubble baths. (But those are ok, too!)
Self-care is about being on your own side and treating yourself as you would a loved one.
The likelihood of burnout decreases when self-care is part of your daily routine — even if you’re working long hours or taking care of elderly parents. Your obligation is to add moments of joy and/or peace into each day.
Small self-care gestures can stop stress from taking over and causing burnout. And those same gestures – talking with loved ones for support, being playful, finding things to laugh about, being outside in nature – are also helpful for your general well-being.
When approached with moment-by-moment loving choices, self-care becomes a mindset, not a destination. And burnout falls by the wayside.
I am a Massachusetts-licensed psychologist in private practice. If you’re struggling with anxiety and depression and would like to learn more about working with me, please contact me here.
Anxiety and Eating Disorders often co-occur. Anxiety can begin before an Eating Disorder, around the same time, or after the onset of an Eating Disorder. This chronology has led many to wonder about the real relationship between anxiety and Eating Disorders.
So, let’s unpack this. First, anxiety.
Think of anxiety as on a continuum.
On one end is minimal anxiety. On the other end is severe anxiety. As anxiety approaches the ‘severe’ end of the continuum, it becomes an Anxiety Disorder. To be a disorder means symptoms interfere with daily life and impair functioning.
There are many different kinds of Anxiety Disorders.
They include: Obsessive Compulsive Disorder, Generalized Anxiety Disorder, Simple Phobia, Panic Disorder, Social Anxiety Disorder, and Post-traumatic Stress Disorder.
To have an official disorder of any type means you meet specific criteria outlined by the Diagnostic and Statistical Manual (DSM). This is true for Anxiety Disorders and Eating Disorders. The DSM is THE official handbook that outlines and describes all psychiatric conditions.
In the DSM category of Eating Disorders, three main types include Anorexia nervosa, Bulimia nervosa, and Binge Eating Disorder.
Eating Disorder symptoms are challenging to treat. Plus, people with an Eating Disorder often have other psychological conditions too.
Guess which DSM diagnosis occurs most frequently among people with a DSM diagnosed Eating Disorder?
You guessed it: Anxiety!
Anxiety is the most common condition people with an eating disorder have.
In fact, 48-51% of people with anorexia nervosa, 54-81% of people with bulimia nervosa, and 55-65% of people with binge eating disorder are also diagnosed with an Anxiety Disorder.
Far more people with an Eating Disorder have anxiety, but to a lesser degree than someone with a DSM Anxiety Disorder.
By the way, there is little research on the prevalence of Eating Disorders among people with an Anxiety Disorder.
One of the most common forms of anxiety that co-occurs with Eating Disorders is Obsessive Compulsive Disorder (OCD). In fact, OCD usually occurs first and is considered by some a risk factor for developing an Eating Disorder.
Anorexia nervosa is the Eating Disorder than most often overlaps with OCD.
Actually, Social Anxiety Disorder is the anxiety disorder that occurs most often among people with any type of Eating Disorder (not only Anorexia.).
Think about the implications of co-occurring Social Anxiety Disorder and Eating Disorders.
When someone has Social Anxiety Disorder, they may be that much more reluctant to seek treatment. Having Social Anxiety makes getting help for an Eating Disorder (and the for Anxiety Disorder for that matter) that much harder. And less likely.
Delaying or avoiding treatment worsens the prognosis for someone with an Eating Disorder. Or with an Anxiety Disorder. Or with both.
Let’s put the pieces together: Anxiety Disorders seem to occur more often in people with an Eating Disorder than in the general population. We also have evidence that Anxiety Disorders likely emerge before an Eating Disorder.
What does this mean?
The sequence suggests that early onset anxiety may increase the risk of developing an Eating Disorder. This is especially true of Social Anxiety Disorder.
The research on the relationship between Eating Disorders and anxiety is difficult to interpret. One reason is because of all the combinations of different Eating Disorder and Anxiety Disorder diagnoses. (As outlined in the beginning of this article.) There are methodological problems in some of the research that also makes it tough to evaluate.
So the inconsistencies complicate the understanding of co-occurring anxiety and Eating Disorders.
Regardless, though, treatment for one often benefits the other.
For example, Cognitive Behavior Therapy (CBT) is one of the treatments of choice for Eating Disorders and Anxiety Disorders.
CBT is based on the idea that psychological problems are the result of distorted ways of thinking and unhelpful behavior. Through the use of specific techniques, CBT helps people learn to cope better with everyday kinds of things. Improved coping decreases their need to use Eating Disorder behaviors. The same sort of techniques are useful in treating Social Anxiety Disorder.
Another plus to mention is that certain medications called Selective Serotonin Reuptake Inhibitors (SSRIs) can be helpful. They are often part of an effective treatment plan for Anxiety and Eating Disorders. SSRI’s were originally developed to treat depression. (They help treat depression too!)
So what is the REAL relationship between Anxiety and Eating Disorders? It depends on which research findings you read.
My professional experience is that anxiety is practically always present before an Eating Disorder develops.
Anxiety can be one of the reasons why an Eating Disorder develops in the first place.
How so? Well, in an attempt not to feel anxious, a person turns to Eating Disorder symptoms. Usually this is not conscious.
Anxiety may then decrease, but only artificially. It is still there. An Eating Disorder masks it. But, the person no longer feels as anxious. The more she relies on Eating Disorder symptoms, the less anxiety she feels. An entrenched cycle has begun.
Anxiety also occurs during an Eating Disorder. Maybe because of sneaky behaviors that are involved. Or due to malnourishment.
Anxiety also occurs after an Eating Disorder and as part of recovery. Why? Well, change can be scary. Feelings are no longer numbed by an Eating Disorder. Instead, CBT and medication provide more skillful ways to be in the world. But learning and changing take time. There is no quick fix.
Both Anxiety and Eating Disorders are treatable. To be you, without symptoms of Anxiety or of an Eating Disorder is possible. Whichever type of Anxiety Disorder or Eating Disorder you have, seek treatment that addresses both. Doing so will be one of the best investments you will ever make.
Dr Elayne Daniels is a private practice psychologist in Massachusetts, specializing in providing treatment to people with eating disorders and co-occurring conditions.
Anxiety and Depression are common and treatable. But how do you determine your best treatment for anxiety and depression? It is definitely not a one-size-fits-all kind of thing. And, there is no reliable blood test. (But, there will be one day soon.)
At least initially, anxiety and depression often present as physical ailments rather than as classic mood symptoms. No surprise that many patients turn to their primary care physicians for care. Primary care doctors really do need to be well versed in recognizing how mental health conditions manifest– and in making appropriate treatment recommendations.
Treatment absolutely can improve quality of life. But, success of treatment varies…widely. So does the length of time before you feel better. And, of course, what is helpful for you may not be for your friend.
Let’s talk about the good news and then the less than good news.
The good news in the treatment world for anxiety and depression:
1. Treatment for anxiety and depression can be similar.
Cognitive Behavior Therapy (CBT) is a highly effective therapy for both conditions. CBT has considerable scientific evidence that its methods actually lead to improvement in mood and functioning. Its core principles have to do with changing thinking patterns. CBT tends to be short- to moderate-term. Its focus is on the present.
Psychopharmacology (medication) is another common treatment, and often the same medication (e.g. a Selective Serotonin Reuptake Inhibitor or SSRI, or a Selective Norepinephrine Reuptake Inhibitor or SRNI) is helpful for anxiety and depression. Examples of SSRIs include Prozac, Zoloft, and Paxil. Effexor and Cymbalta are examples of SNRIs.
There are other types of medications to treat depression alone, or anxiety alone.
There is some evidence that combining psychotherapy and medication works best for treatment of depression.
For anxiety disorders, CBT, antidepressant medications and anti-anxiety medications (e.g. Buspar) are helpful. Some research suggests psychotherapy is more effective than medications to treat anxiety, and that adding medications does not significantly improve outcomes from psychotherapy alone.
2. Many people find treatment helpful.
The benefits of therapy vary. For both disorders, CBT is the most effective form of psychotherapy.
The benefit of medication depends on lots of factors. One is the severity of the depression or anxiety. In general, the more severe the symptoms, the more likely the medication will help. In other words, antidepressants are more effective in treating chronic, moderate and severe depression. They don’t help much in mild depression.
Keep in mind…
3. If one treatment does not help, there are many other treatment options.
Lots of research on evidence based treatments is available. We know that sticking with the approach(es) is necessary to evaluate if what you are doing is helpful.
4. Techniques you can do on your own will help.
The kinds of things you can do are helpful throughout life, even when not suffering from anxiety or depression. These include journaling, exercising, meditating, doing yoga, doing a hobby, or playing an instrument.
The less good news:
- Trial and error are often required to find the best medication for you.
This can be time consuming, especially when you are not feeling yourself. Finding a therapist who is a good fit for you can also be challenging. The ‘chemistry’ and expertise have to feel right.
- Insurance companies sometimes encourage medication over psychotherapy.
Why? Because it is less expensive. This may be appropriate at times, but often psychotherapy is clearly indicated.
3. If you’re like many people, and you seek help from your primary care physician for anxiety and depression, know that treating mental health problems in a primary care setting can be less than ideal.
Primary care clinicians have time pressures and lots of conditions that warrant attention in every patient interaction. Their evaluation and treatment of mental health disorders may fall short of the ideal.
As with most health conditions, finding and accessing treatment is not necessarily easy. In the case of feeling anxious and depressed, pursuit of care can be extra difficult.
If you have no improvement after 4-6 weeks of treatment, discuss other options with your provider. Also, be sure to disclose any alcohol or other drug use. Both are linked to anxiety and depression, and are important to mention – especially if you are on medication.
How to determine your best course of action for anxiety and depression is specific to each individual.
In general, concrete steps to consider include:
- Contact therapists and psychopharmacologists who are on your insurance plan. Check out their website. Ask about their services. Consider looking at referral sites for names of providers who may be helpful.
- Consult your PCP for referral to a therapist and/or psychopharmacologist
- Consider using telehealth services if available.
- Read reputable articles to help you assess your symptoms, your needs, and the next best steps FOR YOU.
- Get moving! Whether cardiovascular, or strength training, exercise helps. Make it fun by dancing to music. Taking a Zumba class. Or how about yoga?
Suffering from anxiety and depression is not uncommon, especially in this post-Covid world.
There is no one-size-fits-all recommendation for how to approach treatment, or for which treatment to land on.
The two basic options are therapy and/or medication. For therapy, CBT is the treatment of choice. For meds, the treatment of choice is typically an SSRI. (There are lots of factors that determine specific treatment recommendations.)
CBT is often considered better than medication at preventing relapse. It is tends to be short term, and empowering to the person who learns it. As a psychologist, I love teaching CBT an do have a lot of respect for how helpful anti-depressants can be. If they help, it is because they are remedying a chemical deficit in your brain.
I am a MA licensed psychologist in private practice. If you’re struggling with anxiety and depression, and would like to learn more about working with me, please contact me here.
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:
- How often do they co-occur?
- Why do they co-occur?
- What’s the prognosis?
- 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
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 MA. To learn more about co-existing anxiety and depression, please contact me here.
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 MA licensed psychologist, specializing in working with men and women who know they could be deriving more – pleasure, meaning, and purpose – in their lives. To learn more, please contact me here.
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:
- Bring awareness to your breath
- Check your posture
- Move your body
- Get outside with nature
- Turn up the corners of your mouth
- Sing and dance to music you like
- Opposite action
- Talk to someone you trust
- Drink water
Strategies for the longer term:
- Zoom out the lens. Take a step back for a different perspective
- Experiment with a meditation practice
- Journal your feelings
- Change your relationship with your thoughts
- Clouds imagery
- Leaf floating down river
- Brain secretions
- “Just because I think it does not mean it is true.”
- Prioritize sleep
- Regularly exercise
- Seek Psychotherapy
- 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.
- Help someone in need
- Join a support group online
- Read inspirational, motivational quotes
- Read dark humor
- Listen to podcasts
- Find playlists of interest or create your own
- Take a Values Assessment
Here are 5 quotes to help you feel better if you are suffering from anxiety or depression:
“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.
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.