What comes first Anxiety or Depression?

In the past, each mental illness was seen as a separate entity that had specific boundaries and clinicians attempted to place a patient within one category. Today, we know that it is not so clear cut and that there is a great deal of overlap between different diagnoses.

Anxiety and depression, for instance, can co-exist. Sometimes a client has both sets of symptoms at the same time. At other times, the symptoms alternate. That is why a patient can receive different diagnoses at different times and from different clinicians.

Understanding the link between anxiety and depression therefore is complicated. However, recent research uncovered a clear link between anxiety and post natal depression. Pregnant women, who were anxious, were more likely to develop post natal depression than other new mothers.
Does this mean that anxiety is a precursor for depression generally or only in pregnant women? Should anyone suffering from anxiety be on the lookout for depressive symptoms?

The answer is yes. Anxiety and depression are linked and prolonged anxiety can lead to depression. My patients report that suffering with anxiety symptoms in the long term (breathlessness, heart racing, imagination on fire and a general feeling of fear), wears them down. As the weeks go by, they become disheartened, sad, helpless and hopeless – all common symptoms of depression.

The key is to treat the anxiety as soon as possible and before the symptoms become severe. Cognitive Behavioural Therapy has been shown to be very effective. Traditionally, medication is not a popular option for anxiety treatment.

Practicing the techniques for anxiety reduction should be done on a daily basis, indefinitely, to prevent a recurrence and/or a decline further into depression.

If the anxiety goes untreated, there is a strong likelihood that depressive symptoms will appear. They may override the anxiety symptoms or they may alternate with them.
Anti-depressant medications may be indicated when the symptoms are severe but patients must ensure that they receive the correct medication: anti- depressants that also treat anxiety. Cognitive Behavioural Therapy should be sought whether or not medication is taken. However, the long term aim is that medication will be stopped.

As a clinician, I have found that putting a patient into a specific category has little value except when choosing medication. For the rest, patients need to be assisted to learn tools and strategies to cope with their specific symptoms.

Anxiety symptoms can manifest in practically any part of the body and are often hard to separate from apparent physical ailments. Therefore, what I advise is to notice when you, or your family member, start to feel qualitatively different about life. When you experience negative feelings or inexplicable bodily discomfort in an ongoing manner, seek professional advice.

If anxiety is diagnosed, treat those feelings and symptoms immediately to avoid declining into depression.

Author: Renee Mill 2012