Dr. Anita Bansal is a board-certified psychiatrist with the Mid-Atlantic Permanente Medical Group. She sees patients at the Kaiser Permanente Shady Grove Medical Center.
Anxiety and depression, combined, affect tens of millions of Americans each year. As a board-certified psychiatrist, I regularly treat people for both conditions. What I have found is that many people would like more information on the difference between anxiety and depression, and they want to understand when they should reach out for help.
Understanding Generalized Anxiety Disorder
There are several different types of anxiety. Generalized anxiety disorder is the most common type, affecting nearly 6 percent of adults at some point in their life, according to the National Institute of Mental Health.
Generalized anxiety is characterized by feelings of excessive worry that occur more often than not for at least six months.
What does that look like?
It could be worry that is affecting different aspects of your life, such as school, work, home, or relationships. The worry often affects multiple parts of your life (such as work and home), rather than just one. People with generalized anxiety disorder have difficulty controlling their worries. The mind starts racing and ruminating, taking over the logical side of our ability to handle stressors.
To diagnose generalized anxiety disorder, I look to see if a patient has at least three of the following six symptoms, more often than not, over a six-month time period:
- Restlessness
- Fatigue
- Concentration problems
- Irritability
- Muscle tension
- Sleep problems
If you or a loved one are experiencing these symptoms, reach out to your doctor to discuss next steps.
Depending on the severity of the anxiety, treatments can include talk therapy, cognitive behavioral therapy — a type of therapy in which people learn how to distinguish between realistic and unrealistic concerns — and anti-depressants, such as SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin and norepinephrine reuptake inhibitors).
Other Types of Anxiety
There are several other forms of anxiety:
Obsessive compulsive disorder. OCD isn’t just about repeatedly washing hands or checking to make sure the stove is off. Symptoms tend to revolve around counting steps or objects, feeling a need for symmetry and order, being fixated on certain numbers, being concerned about contamination and repeated checking.
Panic disorders. Panic disorders are diagnosed when people have repeated panic attacks. Symptoms of a panic attack include chest pain or tightness, a rapid heartbeat, and difficulty breathing. Attacks can be triggered by a feeling of stress or fear, or they may happen for no apparent reason.
Phobias. Phobias are intense fears of something, such as spiders, airplanes, or closed spaces.
Post-traumatic stress disorder. PTSD can occur after any traumatic or stressful event, including serving in the armed forces, being a victim of abuse or receiving a serious health diagnosis.
Social anxiety. People with social anxiety have difficulty in unfamiliar situations, such as talking to other people or giving a speech.
Understanding Depression
People who are depressed experience low moods, a down in the dumps feeling.
To diagnose depression, I look at whether the patient has either a depressed mood or a loss of interest in previously enjoyed activities for at least two weeks. I also look at whether the patient has at least four of the following symptoms:
- Weight changes — either weight loss or weight gain — and changes in appetite
- Sleep problems
- Fatigue
- Lethargy/decreased energy
- Feelings of guilt and/or worthlessness
- Concentration problems, including difficulty making decisions
- Suicidal ideation. If you or a loved one have thoughts of suicide, call 988, the Suicide and Crisis Lifeline, or seek other immediate medical attention.
Some of these symptoms, such as concentration problems and fatigue, can be a sign of depression or anxiety. But a key difference between anxiety and depression is the person’s overall emotional state. Having a persistently low mood and/or persistent loss of interest in previously enjoyed activities are hallmarks of depression, not anxiety.
People with anxiety tend to describe themselves as worriers, thinking that the worst possible thing will happen.
It’s important to note that for every two people with major depression, one of them will also experience some form of anxiety.
Just as with anxiety, if you or a loved one are showing signs of depression, reach out for help. Mental health conditions are easier to treat in earlier, milder stages. Getting help when symptoms begin can lead to better outcomes and and overall improved quality of life. At Kaiser Permanente, we annually screen adult patients for depression.
Treating depression takes time and patience. Medications often take a couple of weeks to be effective. Therapy alongside medication can be helpful. People with mild depression may benefit from outpatient therapy sessions. People with moderate or severe depression may need intensive outpatient therapy or inpatient treatment. If we are concerned that patients may hurt themselves or others, inpatient treatment usually is strongly recommended. In addition to thinking about suicide, hurting yourself may also include not eating and neglecting basic hygiene.
Electroconvulsive therapy can be an effective and rapid treatment for patients with severe, major depression and/or treatment resistant depression (meaning the depression hasn’t improved with therapy or medication). ECT usually is administered in 6 to 12 sessions over two to four weeks, under anesthesia. Patients start seeing improvement very quickly.
I encourage patients not to let a diagnosis of depression or anxiety define them. I encourage them to focus on their role as a family member, student, or employee.
No Stigma in Seeking Help
For generations, people have resisted seeking help for mental illnesses such as anxiety and depression because of the stigma associated with doing so. Fortunately, as more people seek help, the stigma is lessening. I want to emphasize there is no stigma in reaching out for help. Talk to a friend, family member, or trusted doctor. Mental illness is treatable.
Feature image, stock.adobe.com
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