ANXIETY AND DEPRESSION

Numerous studies have suggested that chronic anxiety can cause biochemical variations in the brain which reproduce the psycho-physiological conditions typical of depression. From a psychological point of view, it is moreover known that difficulties encountered in struggling against the effects of prolonged anxiety can lead to a state of demoralization and thus to a situation which may result in depression. The diagnosis of an episode of depression is in fact determined in subjects who, for a fairly long period of time (at least 15 days), have continuously complained of a sense of fatigue, lack of strength and energy, lack of concentration, worry about their health, and a total lack of interest in eating, work, leisure activities or sexual pursuits.

Anxiety and depression can thus co-exist. When this happens one speaks of a depressive-anxiety disorder, which is a form of mild depression accompanied by the symptoms of anxiety. In this disturbance, besides a lowering of mood, which will cause all of the consequences listed above, the predominant symptom is anxiety. Other concomitant presentations are pessimism, feelings of incapacity, a tendency to be sorry for oneself and to blame others for one’s problems. Depressive-anxiety also involves the development of other symptoms, including considerable difficulty in concentrating, the sensation of the mind being completely ‘empty’, sleep disorders and nightmares, the incapacity to keep still and excessive tiredness.

The clinical picture of presenting symptoms however may vary quite considerably on the basis of the prevailing of the anxious symptoms over depressive symptoms or vice versa. The question of comorbid depressive and anxious symptoms has been recently discussed in various quarters in order to clarify whether there are relations of causality between them, whether they represent different manifestations of a single disorder or whether they are totally independent. Various interpretations have been presented. In some cases it is admitted that the patient may have developed a depressive disorder following the presence of a series of anxious symptoms (e.g., Panic Disorder).

In other cases, authors refer to the comorbidity of two independent disorders (e.g., Major Depression and Panic Disorder). Very often the attempted clarification of such situations will be based on careful observation of the signs and symptoms involved and a reconstruction of their development over time. Occasionally, those suffering from a depressive-anxiety disorder may only present symptoms of anxiety in the first phase of the disorder, following which there will be a reduction in the intensity of the symptoms of anxiety and an increase in more typically depressive behaviour.

In a further group of cases, an episode of Major Depression may be associated (in the final phase) with numerous symptoms of anxiety, and, after remission of the depressive episode, there may be a residual anxiety disorder of varying intensity. Nowadays, and increasingly at the specialist level, there is a tendency to consider many clinical patterns of anxiety as manifestations of a depressive condition. It often occurs that anxious subjects undergo lengthy treatment with tranquilizers, however these are in fact depressed patients, who would quickly respond when specific therapy for depression is provided.

The following characteristics are typical of depressive-anxiety:

• depressed mood, but less marked with respect to Major Depression;
• accentuated anxiety, resulting to a large extent in psychosomatic phenomena: that is, with anxiety being expressed through physical pain and discomfort in various parts of the body which the person complains of repeatedly and with considerable concern;
• physical restlessness;
• tendency to be full of self-pity and to blame others for one’s condition;
• pessimism and feelings of incapacity and uselessness;
• lack of energy with a tendency to become tired very easily;
• insomnia: difficulty in falling to sleep and, in particular, easily disturbed
• sleep, nightmares and frequent reawakening;
• irritability and apprehensiveness;
• disorders of concentration and a sensation of one’s mind being completely ‘empty’.

See also Anxiety and Self-esteem.

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