BY VAALPARK MHU | September 3, 2021

Blog By

Dr Melané van Zyl

Is anxiety and depression the same? Tips to understand the difference

Patients often ask me what the difference between anxiety and depression is. Or is it the same thing?

What is the definition of anxiety and depression?

Anxiety is a core symptom of any of the Anxiety Disorders (e.g. Panic Disorder, Post Traumatic Stress Disorder). Depression is a symptom of the Mood Disorders (Major Depression and Bipolar Mood Disorder). From an academic point of view depression and anxiety comes from two different categories of disorders.
In real live it becomes much more complicated. People often do not have the ‘language’ to describe what they feel. They just feel bad, stressed, or ill.

Can you have anxiety but not depression?

Yes, you can be anxious but not depressed. I see this quite often, especially if the anxiety has not been present for a long time. You can also be depressed and not anxious. However, as time goes on most of my patients develop a combination of anxiety and depression.

Can I have both depression and anxiety?

Unfortunately, it is common to have a combination of symptoms. Remember, these two conditions share a biological basis. In extremely oversimplified language I usually explain that both anxiety and depression develop because of the same chemical imbalance- a serotonin deficit. I also think the one condition leads to the other one because they both make your life miserable. Eg, if you have regular panic attacks, your life will be much more difficult, you will probably be much less able to do and enjoy your usual activities. This will eventually make you feel depressed.

Is anxiety a risk factor for depression?

For the reasons stated above, yes. This is also supported by research. However, I usually tell my patients that all illnesses work like this. If you have one illness, it is usually a risk factor for other illnesses. It is like dominoes. The best approach is to try and stop the vicious circle.

Anxiety, depression, and stress- why the differences matter

The differences might seem slight, but they have treatment implications. This, however, is the worry of your psychiatrist or psychologist. Examples of how the differences might influence our approach include:

• Prioritising. If the patient is at risk for suicide, we will manage this first.
• Choice of antidepressant. If the patient is depressed and anxious, we will choose a different antidepressant than when the patient is not anxious.

How does anxiety and depression lead to suicide?

There is always a risk of suicide for people suffering from depression. Patients who have panic attacks are afraid of dying, but the combination of severe anxiety and depression can increase the complexity and severity of the depression, and therefore increase suicide risk.

Treatment of depression and anxiety

The good news is that many of the treatment modalities for depression and anxiety overlap. This means the patient can often get better on one medication- an antidepressant. This antidepressant will be one that increases the availability of serotonin in the brain, like a SSRI (Selective Serotonin Reuptake Inhibitor) or SNRI (Serotonin Norepinephrine Reuptake Inhibitor).

The psychotherapy approach will also be similar, where a technique like CBT (Cognitive Behavioural Therapy) is effective for both conditions.

How can I manage anxiety and depression by lifestyle changes?

This is of course an enormously big topic. Things that you can try include:

• Do not use too much (if any) drugs, alcohol and caffeine
• Get some exercise
• Get enough sleep
• Eat a healthy diet- look after your gut
• Try meditation or yoga
• Keep in contact with friends and family

Dr Melane Van Zyl