Monday, 13th May, 2019

Depression and anxiety: what's the difference?

The terms ‘depression’ and ‘anxiety’ are now used far more often in everyday speech than they used to be.

If your friend is feeling down after not getting their dream job, they might say, ‘I’m so depressed!’ Similarly, your friend might say that their anxiety flared up before their interview, causing them to get flustered and robbing them of the opportunity to shine.

While it’s great to see these terms being used more openly, we need to remember that depression and anxiety are clinical terms describing very real mental health conditions. They are not fleeting moods that are easily quelled with a good cup of tea, nor are they inconsequential reactions to stress and change that can be dismissed with a flick of the wrist. But neither are untreatable diseases.

The two conditions do share a few similarities, but there are also stark differences.

We’ve set down some thoughts on how we might best differentiate between depression and anxiety, based on the differences in the ways the two conditions make you feel, how they make you behave, and how they affect your brain.

How you feel living with depression or anxiety

On an emotional level, depression and anxiety have quite different effects on an individual’s personality. (It is possible to have both depression and anxiety, but this article will treat the two as the two separate conditions that they are in order to clarify the differences between them).

The most simplistic (and perhaps common) way of viewing depression is to see it as an extension of the feelings experienced by people living with anxiety. For instance, it’s easy to imagine that extreme anxiousness and constant worry will lead to exhaustion, a feeling of hopelessness, and eventually, depression.

But depression and anxiety are separate disorders, and though anxiety can lead to depression, the two are not one-and-the-same.

The Differences

As the diagram below indicates, the most pronounced commonality between anxiety and depression, at least in terms of emotion, is a feeling of intense energy that is very consuming and hard to shake off.

Echo-NHS-Healthcare-Venn-Diagram

But the noticeable difference between anxiety and depression is the way that this intense energy manifests itself on a phenomenological scale (i.e. the way it makes you feel on an emotional level).

While a person living with anxiety will feel more worried and apprehensive about the near and distant future, someone experiencing depression will tend to have bypassed the stage of nervousness and fear, and will instead feel a bleak certainty that the future will be full of negative events and that there is little they can do to change this. This is potentially an explanation as to why suicidal thoughts occur more frequently in people living with depression than those living with anxiety.

But for all those reading this article and living with anxiety or depression, please know that any negative feelings that come with your condition are treatable, and you can reclaim your senses of hope, happiness and positivity with help and treatment.

You can read more about the emotions that characterise depression and anxiety on the NHS webpages for depression and anxiety and NCBI web journal entries also offer information on the symptoms of depression and anxiety.

How your behaviour is affected by depression or anxiety

Energy levels are helpful in discerning the differences between anxiety and depression.

While you can think of anxiety as the feeling you have before making a speech, multiplied by 100 and experienced constantly, you can think of depression as a cool, slow-moving lava that slows down those caught in its path, preventing them from having fast physical reactions and causing a sense of existential hopelessness.

The combination of emotional and physical reactions to depression and anxiety lead to an unhappy mix of varying behaviours that do not match each other exactly.

Behavioural responses to anxiety are influenced by feelings of fear and apprehension, so bodily reactions can include shaking (from adrenaline), sweating, an elevated heart rate, bowel issues and hyperventilation. These responses are linked to our primal fight or flight response, which is activated more frequently and more starkly in people who experience anxiety.

Echo-NHS-Healthcare-Running-Fast

By contrast, people living with depression tend to feel drained of all their energy owing to mental fatigue and lower serotonin levels released in the brain. (Serotonin also plays a role in shaping the symptoms of anxiety, but more on that later).

Depression suppresses an individual’s ability to feel emotions as fully as they may have before experiencing the condition, and it can also lead to lethargy, noticeable shifts in appetite and insomnia.

How your brain is affected by depression or anxiety

Clinical depression and severe anxiety are both influenced by complications with neurotransmitters in the brain.

The relationship between depression and anxiety and the neuro transmitting chemicals in your brain is reciprocal. This means that your condition can affect the functionality of your brain chemicals, and your brain chemicals can affect your condition. (The relationship works both ways, vice versa).

Serotonin, a neurotransmitter that passes messages from one part of the brain to another, has long been thought to play a major role in determining the severity of a person’s depression or anxiety.

But more recent studies have suggested that an increase in serotonin levels does not perfectly correlate with alleviated mental health symptoms.

In fact, it has long been acknowledged that SSRIs (or selective serotonin reuptake inhibitors), only work for 60% of people taking them, and serotonin therapy continues to be one of the most debated fields in psychology and pharmacology.

Aside from serotonin, levels of adrenaline and noradrenaline, as well as dopamine (a pleasure-inducing brain chemical) also play a part in determining the severity of a person’s mental health condition(s).

High levels of adrenaline will induce high levels of fear or apprehension in people living with anxiety, while low levels of dopamine will reduce the capacity for sustained happiness and joy in a person experiencing depression.

Echo-NHS-Healthcare-Plastic-Model-of-Brain

Treatments for depression or anxiety

In spite of the clinical differences that exist between depression and anxiety, they are often treated using very similar methods.

Your GP may start off by recommending a self-help course or group therapy session to help you treat your depression or anxiety. If you feel that this isn’t working, your GP may then go on to recommend CBT (Cognitive Behavioural Therapy).

CBT is a process by which a therapist works with a client on a one-to-one basis to re-train the way their brain reacts to or interprets different situations, and the way in which these interpretations go on to influence behaviours.

Echo-NHS-Healthcare-Woman-Thinking-at-Desk

According to the Royal College of Psychiatrists, CBT continues to be one of the most effective treatments for anxiety and depression, and the organisation also says that CBT is as effective as antidepressants for mild, moderate and severe depression.

Clinical medicinal treatments for depression and anxiety mostly come in the form of SSRI’s and SNRI’s (both of which are antidepressants).

SSRIs (or selective serotonin reuptake inhibitors), work by increasing serotonin levels in the brain. The medicine blocks the reuptake, or reabsorption, of serotonin by certain nerve cells, so that more serotonin can reach more nerve cells. NHS web pages for anxiety medication note that SSRIs take a few weeks to take effect, and that you should consult your GP or mental health practitioner if you feel no benefits from taking SSRIs for four to six weeks.

SNRIs (or serotonin-norepinephrine reuptake inhibitors) increase the amount of serotonin and the amount of noradrenaline in your brain. Noradrenaline is a neurotransmitter that has many effects, one of which is to widen your air passages, making you better able to deal with stress.

The NHS website for antidepressants notes that:

“It's important to continue treatment, even if you're affected by side effects, as it will take several weeks before you begin to benefit from treatment.”

How Echo Pcan help you

If you have recently been diagnosed with anxiety or depression and you need help staying on top of your new medications, you can read our article on 20 Tips for managing your medication like a champ.

Alternatively, download the Echo app for free to receive daily reminders to take your medication and reminders for ordering your prescriptions when they’re due for refill. You can also sign-up to our website. 

You should always consult your doctor or GP or if you have any queries about changing your medication.