Expert Opinion ~ Take a pledge on World Sleep Day… Let's sleep to a better health!

Dr Pablo Vandenabeele, Clinical Director for Mental Health at Bupa UK, tells us more about the link between these two conditions. Anxiety and depression can be seen as two very broad terms. From a general point of view, anxiety may be seen as feeling nervous or uneasy. Depression, on the other hand, is a term that we associate more closely with our mood. Although they are separated as different conditions – associated with their own groups of disorders and symptoms – we often refer to them together. But what’s the link?

Understanding anxiety

Everyone gets anxious from time to time – it’s not uncommon. To a certain extent it can be helpful, allowing us to prepare and go about things with a necessary amount of caution. But sometimes anxiety can become too much. If anxiety is affecting you to a point where it’s not helpful and affecting your daily life, you might have an anxiety disorder.

There are lots of different anxiety disorders. Some anxiety disorders are linked to certain things or situations while others are ‘free-floating’ with no apparent cause. If you have anxiety, you might dread and purposefully avoid certain situations. You might experience panic and have palpitations (a quick or irregular heart beat) or feel faint as a result.

Understanding depression

Depression is an affective or ‘mood’ disorder. If you have depression, you may feel down, hopeless and lack interest or pleasure in doing things. You’ll have these feelings most days and for the majority of time for at least two weeks. You might also have other symptoms of depression such as:

  • a lack of energy
  • trouble concentrating or making decisions
  • tiredness
  • trouble sleeping
  • a loss of appetite
  • feelings of worthlessness and guilt
  • thoughts about death or suicide

An episode of depression can be mild, moderate or severe, and depression itself can form part of other mood disorders. Depression can also be recurrent, meaning that after a period of feeling OK your symptoms come back.

The link

 Anxiety and depression can co-exist. In fact, it’s quite common. You may have:

  • a depressive or anxiety disorder with either anxiety or depressive symptoms respectively
  • the two disorders together
  • symptoms of both depression and anxiety, but neither is predominant enough to make a single diagnosis – this is known as mixed anxiety-depression

Despite anxiety and depression being grouped as different conditions, involving different outlooks and sometimes symptoms, there are some similarities. Similarly to depression, anxiety can cause you to:

  • have trouble sleeping (do read our article on why sleep is so important)
  • have difficulty concentrating
  • feel tired and lack energy

Interestingly, the same treatments are also used for both depression and anxiety, suggesting a similarity between them. Treatments include psychological interventions such as cognitive behavioural therapy (CBT) and anti-depressant medicines. In particular, it’s thought that selective serotonin re-uptake inhibitors (SSRIs – a type of antidepressant medicines) work in a similar way to treat both conditions. To add to this, there’s also some evidence that SSRIs have been effective when used to treat people with mixed anxiety-depression.

But, what comes first – anxiety or depression?

The answer isn’t so clear cut. It’s thought that struggling to cope with anxiety can lead to depression, but this isn’t always the case. Many people with an anxiety disorder report having depression first. Overall, based on their similarities, it’s thought that anxiety and depression are variations of the same disorder. We don’t know the ins and outs, but it’s thought that they could be linked by a common risk factor, which is influenced by our DNA and the emotional centre in our brain called the amygdala.