Breaking the Silence

Website for the American Mental Health Counselors Association's Breaking the Silence initiative to address mental health stigma.

Links Between Depression and Anxiety

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By contributing blogger Dr. Keith Mobley

In previous blog posts this month, we have discussed depression and anxiety separately since they can be experienced independently and have their own distinct definitions and even diagnostic criteria when one’s functioning is impacted or impaired. However, there is some overlap between anxiety and depression and the two states have a sometimes-complicated relationship. For example, one of the major characteristics of depression is a persistent feeling of sadness or anxiety, which is shared in the list of depression. Also, the physical, somatic symptoms can often overlap.

The signs that a person is experiencing both an anxiety and depressive disorder include:

  • Constant worry
  • Irrational fear
  • Physical symptoms like rapid heart rate, difficulty breathing, sweating, headaches, or fatigue
  • Irritability, restlessness, or inability to feel relaxed or calm
  • Feelings of sadness or worthlessness most of the time
  • Changes from typical sleep patterns – insomnia or hypersomnia
  • Difficulty with memory, concentration, or decision making
  • Loss of interest in usual hobbies or activities

One of the most interesting aspects of a dual diagnosis or co-occurring condition such as depression and anxiety is this: to whatever degree that our genetics or biochemistry makes us predisposed, one very strong likelihood as that, over time, anxiety and depression can change the way our brain works, both structurally and functionally. There is much evidence that the brain of a person affected by one or both of these disorders looks and works differently, and usually not because it was different before these disorders, but as a result of them. Just as our brains can change due to these conditions, the good news is there are ways that we believe we can reverse or exchange the way it works with more productive neurochemistry or structure. That’s right – our brain can change both to our detriment and for our benefit.

Since a critical aspect of these disorders is that both anxiety and depression can change the way you think, this is both the biggest challenge and the greatest asset to having these co-occurring disorders. First the challenges: these conditions can create some very real beliefs that the symptoms actually are the unchangeable reality, while in fact many of the negative aspects that someone experiences are distorted by seeing reality through the lens of the symptoms. For example, if I have fear, I see things as fearsome instead of manageable, and if I have hopelessness, then I tend to see things as hopeless. In other words, when these conditions co-exist, our thoughts can become one’s reality. Now for the way this can be an asset to treatment: scientists and researchers have mountains of evidence and experiences to show that both of these disorders, whether separate or together, are very treatable despite negative expectancies and distorted thinking. Cognitive behavioral therapies have provided strong evidence that we can change the way our brain functions, by changing the way we think. There can be ways to examine immediate thoughts in our “thinking environment” and ways to look at more complex, and fundamental belief systems about ourselves, the world, and the future to not only alleviate the symptoms of these conditions, but to prevent them in the future.

Although its tough to do justice to the complex relationship these disorders have, our hope is that you have one idea, one strategy, one other question that helps you to reach out to a clinical mental health counselor either for yourself or on the behalf of someone you care about. There is hope in seeking help and living StigmaFree

For more information, visit the National Institute of Mental Health at or take a free, anonymous online screening Or find a site to participate in person at Be sure to discuss the results with a visit to a clinical mental health counselor. Call the National Suicide Prevention Hotline at (800) 273 – TALK if you or someone you know is having suicidal thoughts.

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