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Anxiety vs. Depression: How the Two Are Different

The two mood disorders often occur together

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Depression, you could argue, is a mostly “dialed down” mental health condition: Common symptoms are profound feelings of sadness and hopelessness, low energy and feeling detached and unengaged.

Anxiety, in contrast, could be seen as a “dialed up” condition: Often, it manifests itself as a racing heart, tense muscles and a cascade of worried thoughts and impulses.

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How, then, is it that such seemingly opposite mood disorders go hand in hand? And yet they do. Almost half of people grappling with depression also have anxiety, according to a 2020 summary in The American Journal of Psychiatry. And older adults are not immune. In a 2023 survey by AARP, about a quarter of respondents 50-plus said a health professional had told them that they had an anxiety disorder and/or depression.

The short answer is that people with anxiety often avoid outings and interactions with others, which can push a person into a depressed state. And the converse is also true: A chronically depressed mood can make a person more vulnerable to anxiety. There are also shared biological, familial, genetic and brain risk factors for depression and anxiety. Plus there are many underlying medical conditions that can lead to depression and anxiety, such as diabetes, heart disease, cancer and others.

When a person suffers from both conditions, the effects can be debilitating. “Depression and anxiety kind of work together to create the cycle of feeling, thinking and behaving that ... keeps a person trapped,” says Craig Sawchuk, professor of psychology at the Mayo Clinic.

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Here’s what you need to know about each, how they interact and how you can break the cycle:

What is anxiety?

You mostly know the answer to that: It’s a feeling of excessive and unrealistic worry that triggers not just strong emotions but physical symptoms as well, as if your body is readying itself for a fight or to run away as fast as it can. For most of us, anxiety is an occasional and expected visitor in our lives. It’s normal to feel jittery before giving a speech or going on a first date, for instance. But routinely experiencing fear in response to low-risk events can signal a problem. Letting chronic worry and dread take over so that you opt not to socialize, go to the supermarket or leave home altogether may be a sign of an anxiety disorder.

Doctors acknowledge several types of anxiety disorders. Two examples are social anxiety disorder, involving intense fear in social situations, and panic disorder, in which a panic attack hits, often without warning, causing shortness of breath, dizziness and even chest pain. The most common type of anxiety is simple phobias — of heights, spiders, getting injections and other common fear-inducing situations. They are typically treated with psychotherapy and/or medications.

What is depression?

Depression is diagnosed when a person feels persistent sadness, low energy, feelings of hopelessness and an inability to experience pleasure. These symptoms frequently combine with changes in appetite and sleep. They also combine with overall malaise, or a general sense of being unwell, often accompanied by fatigue and diffuse pain. Occasionally, depression can also present with agitation.

Depression is not a passing thing. We all go through low times, but depression sticks around for at least two weeks and interferes with daily activities. In cases of suicidal thoughts or decreased ability to enjoy things, it is important to seek mental health care or call 988, the Suicide & Crisis Lifeline.

For both anxiety and depression, the key is to ask yourself whether your reactions are temporary and proportional to the situation. Mourning the loss of a loved one, for instance, often involves deep sadness and grief. But when the depression lingers to become a permanent problem in your daily life, it’s probably time to talk with a health care professional.

While anxiety and depression can develop at the same time, one can come on before the other. It is more common for anxiety to show up first, often in childhood, says psychiatrist Mary E. (Beth) Salcedo, M.D., medical director of the Ross Center, a mental health clinic in Washington, D.C.

In people with a long history of anxiety, there is often a “wear-and-tear effect,” Sawchuk says. It can get to a point where people become more disconnected from social supports, then “they become more vulnerable to depression.” A person with long-term depression may be more prone to anxiety in later years, especially as their circumstances change. For instance, the uncertainty of a move is more likely to trigger anxiety in someone with depression, who is already sensitive to stressful life events.

How are both conditions diagnosed?

Depression and anxiety are the most common mood disorders, yet few health care providers screen their older patients for either disorder. In June 2023, the U.S. Preventive Services Task Force recommended that adults of all ages be routinely screened for depression. For anxiety, the group called for screening of people under 65 every year. The task force said there wasn’t enough evidence that there should be similar screens for people 65 and older, though others disagreed, calling anxiety disorders “pervasive and pernicious” in older adults, who “should not be denied the opportunity to benefit” from available treatments. If you want to be screened, talk to your health care provider. 

Screening, usually via a short questionnaire, asks about common symptoms, thought patterns and behaviors. It can help uncover the physical symptoms that often accompany anxiety and depression — inadequate, unrestful sleep, foggy memory and chronic aches and pain — that are sometimes dismissed as a normal part of aging, even by medical staff. Some of the more commonly used questionnaires are the Geriatric Depression Scale, Patient Health Questionnaire-9  and Generalized Anxiety Disorder-7

To help confirm whether or not you have a mood disorder, your health care provider might recommend a physical exam and lab tests to rule out medical issues, such as low iron and thyroid problems. Medication use is also reviewed, as some medications may cause anxiety and depression.

Treatment options for anxiety and depression

The good news is that remedies exist for depression and anxiety in older adults. “If we do diagnose depression, it’s a highly treatable condition,” says psychiatrist Mani Santhana Krishnan, chair of the Faculty of Old Age Psychiatry at the Royal College of Psychiatrists in London. After treatment, older adults “can lead a very normal life.” 

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The reality is that it will probably take some time to find the therapy that works best. Treatment approaches are similar for both anxiety and depression. For mild forms of the disorders, talking with a therapist is often enough. Cognitive behavioral therapy, or CBT, is effective for many people. During CBT, a therapist and patient work together to identify unhelpful thinking patterns and behaviors and find ways to cope better.

Some lifestyle changes can help as well, improving sleep hygiene, or trying to reduce stress by practicing yoga, tai chi or meditation, or adding supplements like vitamin B complex or vitamin D3 if you have a deficiency. For people with moderate to severe depression and anxiety, a medication such as one of the selective serotonin reuptake inhibitors, or SSRIs, may be needed along with therapy. The two have been found to be more effective together than either is separately, according to a meta-analysis published in 2016 in Psychological Medicine. In more chronic and complicated cases, it is important to see a mental health provider specializing in geriatric mental health.

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Before prescribing medications for depression and anxiety, your doctor should be aware of your medical history and the medications you are currently taking, Sawchuk says. Certain antianxiety drugs, such as buspirone, can be helpful in older adults, according to the American Association for Geriatric Psychiatry. But some drugs don’t mix well or have harmful effects specifically in older individuals. For instance, short-acting antianxiety drugs known as benzodiazepines, such as Ativan, might not be a good choice for some older adults, since the drugs can boost risk for memory impairment, unsteadiness and falls.

Ways to prevent depression and anxiety

Depression and anxiety can run in families, and stressful life situations, such as poverty, trauma or abuse, can influence your risk for both conditions, according to the Mayo Clinic and other researchers. Genetics and past experiences are out of your control, but there are several risk factors you can change. These include social isolation and loneliness, a lack of meaningful activities, stress and poor sleep.

  • Stay engaged and purposeful. The best thing you can do, Krishnan says, is to enjoy hobbies and keep working or volunteering for as long as possible to keep the mind and body active. There are so many worries troubling older adults, about their health and their children, he says. Older adults with lots of time and not much occupation will start mulling over these worries, and that’s when the anxiety risks developing into depression.
  • Minimize stress by staying socially connected, practicing mindfulness and exercising regularly to help reduce the likelihood of developing a mood disorder and to manage the symptoms of an existing one.
  • Get a good night’s sleep consistently, getting 7 to 8 hours, and reduce screen time before bed. Avoiding alcohol before bedtime also helps.

The symptoms of depression and anxiety can be crushing, but both conditions are very treatable. Older adults who struggle with anxiety or depression may wonder why they should bother taking their medication or scheduling another therapy session, Sawchuk says. “But reaching out for help is absolutely important and essential.”

Be honest with yourself, your loved ones and your health care provider about how you’re feeling. There is no shame in admitting you need help; everyone needs a hand now and again. Your symptoms are temporary and with proper treatment, you can return to your normal life, rekindle your relationships and reconnect to your passions.

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