Shane Park

PSY 2300

Anxiety and Depression: Almost Inseparable

Overview

If you were asked what psychological condition is most diagnosed, what would be your

answer? Many would likely believe that depression and anxiety are the most diagnosed

psychological condition. I have known many people throughout my life who have to deal with

depression, and a few who have anxiety. I know at least one person who suffers with both

depression in addition to anxiety. This subject hits close to home for me since many of my

closest loved ones suffer with these conditions and it is difficult to me to see them hurt so

much and not be able to provide help or relief in the way that I wish I could. However,

understanding these disorders and how they work will help anyone who has a loved one that

suffers with one or both. For this paper, I will discuss generalized anxiety disorder as well as

persistent depressive disorder.

Persistent Depressive Disorder (PDD or Dysthymia)

The fifth edition Diagnostic and Statistical Manual of Mental Disorders, or DSM-V,

clearly lays out the diagnostic criteria for this devastating mental disorder. There are 8 areas of

diagnostic criteria for PDD. In order to be diagnosed with PDD, an individual must meet the

diagnostic criteria as explained within the DSM-V. The first criteria states that the individual

must experience a depressed mood for most of the day, for more days than not, as either

indicated by subjective account or observation by others, for at least two years (one year for

children and adolescents). Second, the individual must experience two (or more) of the

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following while depressed: poor appetite or overeating, insomnia or hypersomnia, low energy

or fatigue, low self-esteem, poor concentration or difficulty making decisions, feelings of

hopelessness. Third, during the two year period (one year for children and adolescents), the

individual has not been without the symptoms in the first or second criteria for more than two

months at a time. Fourth, the criteria for major depressive disorder may be continuously

present for 2 years. Fifth, there has never been a manic episode or a hypomanic episode, and

criteria have never been met for cyclothymic disorder. Sixth, the disturbance is not better

explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other

specified or unspecified schizophrenia spectrum and other psychotic disorder. Seventh, the

symptoms are not attributable the physiological effects of a substance, or another medical

condition. Eighth, the symptoms cause clinically significant distress or impairment in social,

occupational, or other important areas of functioning. In addition to the basic diagnostic

criteria, there are also several specifications that must be made.

Essentially, you are sad for the majority of the time for at least two years. Now, it is

normal for everyone to experience some level of sadness at certain points throughout life. The

key to this diagnosis is that the sadness is persistent, it doesnt go away. If the sadness does

subside, it returns quickly and is never far away. The 12 month prevalence for this disorder in

the U.S. is 0.5%, and 1.5% for chronic depressive disorder (the DSM-IV diagnosis). PDD typically

has an early and insidious onset, and by definition has a chronic course. The DSM-V states the

degree to which persistent depressive disorder impacts social and occupational functioning is

likely to vary widely, but effects can be as great as or greater than those of major depressive

disorder (2013). Because this disease has such a long lasting effect, it is important to seek help

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from professionals. In an article for Metro, a British newspaper, Francesca Kentish shared her

experience being diagnosed with PDD and receiving much needed help:

One night I was overwhelmed with a feeling of hopelessness and took a pill overdose.

Luckily, I was found before it was too late and rushed to hospital, where I remained for

the weekend under scrutiny of psychiatric doctors and nurses. A doctor gave me my

diagnosis and for the first time everything made sense. I came to understand that my

feelings were valid, but they didnt have to stay that way. With the support of my

friends and family, therapy and medication I now no longer feel how I used to. I am still

who I always was and have the occasional bad day (like most people do), but I am happy

with my life, I see a point to it and my self-esteem is better than it has ever been (2015)

Although the effects of PDD can be mild or major, the condition is very treatable.

According to the Mayo Clinic there are two main treatments for individuals with PDD;

medications and talk therapy. The best treatment approach will depend on each individual

case. For children and adolescents, psychotherapy may be the first recommendation. The types

of antidepressants commonly used to treat PDD include SSRIs (selective serotonin reuptake

inhibitors), TCAs (tricyclic antidepressants) or SNRIs (serotonin and norepinephrine reuptake

inhibitors. (2017) Individuals who suffer from this condition should discuss with their provider

what the best method of treatment would be for their situation.

Generalized Anxiety Disorder

Another mental disorder that is commonly diagnosed to individuals who also have PDD

is generalized anxiety disorder (GAD). The DSM-V explains the diagnostic criteria for GAD as

follows. First, the individual has excessive anxiety and worry (apprehensive expectation),

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occurring more days than not for at least 6 months, about a number of events or activities,

(such as work or school performance). Second, the individual finds it difficult to control the

worry. Third, the anxiety and worry are associated with three (or more) of the following six

symptoms (with at least some symptoms having been present for more days than not for the

past 6 months): restlessness or feeling keyed up or on edge, being easily fatigued, difficulty

concentrating or mind going blank, irritability, muscle tension, and sleep disturbance (difficulty

falling or staying asleep, or restless, unsatisfying sleep). Fourth, the anxiety, worry, or physical

symptoms cause clinically significant distress or impairment in social, occupational, or other

important areas of functioning. Fifth, the disturbance is not attributable to the physiological

effects of a substance or another medical condition. And sixth, the disturbance is not better

explained by another mental disorder.

A person who suffers from GAD is constantly on edge, worried about what could happen

next in any given situation. They may be anxious or worry about a number of events or

activities. Not only are they anxious about an event or activity, the intensity, duration, or

frequency of the anxiety and worry is out of proportion to the actual likelihood or impact of the

anticipated event. Adults with GAD often worry about every day, routine life circumstances,

such as possible job responsibilities, health and finances, the health of family members,

misfortune to their children, or minor matters (such as doing household chores or being late for

appointments).

The 12-month prevalence of GAD is 0.9% in adolescents and 2.9% among adults in the

general community of the United States. It ranges from 0.4% to 3.6% in other countries.

Interestingly, females are twice as likely as males to experience GAD. Many individuals with

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GAD report feeling anxious and nervous all of their lives. The age at onset is spread over a very

broad range, however the median onset age for GAD is 30 years. The symptoms of GAD tend to

be chronic and wax and wane across the lifespan, fluctuating between syndromal and

subsyndromal forms of the disorder. Rates of full remission are very low.

It can be difficult to live with this disorder. Everyone experiences some form of anxiety

at various times throughout life. For individuals with GAD, those feelings of anxiety are near

constant and can greatly impact their functioning in normal daily life. In an article written for

the Huffington Post, Marisa Lancione described what it is like to live with anxiety:

People often ask me: What sets off your anxiety? It can be a variety of things or nothing

at all. For example, grocery shopping is a massive anxiety trigger for me. This may sound

absolutely ridiculous to you. But the idea of figuring out what to eat, making a list,

picking out products, and enduring the actual shopping trip induces extreme anxiety in

me. I once had an anxiety attack trying to pick out napkins because there were too

many varieties and I burst into tears in the middle of the aisle. Another time the crowd

of people was too much for me and I abandoned my cart and resigned myself to take-

out. This is the joy of having an anxiety disorder. Things that are simple or no-brainers

for others cause me extreme anxiety. (2015)

Tasks that for most people seem simple and achievable, to a person with GAD can be

monumental and terrifying to even consider doing.

While generalized anxiety disorder can be difficult to live with, it is treatable. According

to the Mayo Clinic treatment decisions are based on how significantly the disorder is affecting

the individuals ability to function in daily life. The two main treatments are psychotherapy and

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medication. Most people benefit from a combination of the two methods of treatment. The

individual can work with a therapist to reduce anxiety symptoms. Cognitive behavioral therapy

(CBT) is the most effective form of psychotherapy for GAD, though it is generally a short term

treatment teaching skills to the individual to directly manage their worries and help them

gradually return to the activities they had once avoided because of anxiety. Several types of

medications are also used to treat GAD. Individuals should talk with their providers about

benefits, risks, and possible side effects. Commonly used medications include antidepressants

(SSRIs or SNRIs), which are typically the first line medication treatments. Another kind of

medication used is buspirone, which is an anti-anxiety medication that may be used on an

ongoing basis. In limited circumstances, doctors may prescribe a benzodiazepine for relief of

anxiety symptoms. These sedatives are generally used only for relieving acute anxiety on a

short term basis. These medications can be habit forming and are therefore not a good choice

for individuals who have or have had problems with alcohol or drug abuse.

Conclusion

Many people will suffer periods of depression and anxiety at various times throughout their life.

However, when the depression or anxiety persist and get in the way of living everyday life, it may be

time to speak to a professional about potentially getting help. Though an individual may suffer with

persistent depression disorder and/or generalized anxiety disorder, there is hope for a return to a

normal life. There are people out there who are ready and willing to give the help that these people

may need. And a big part of the help may simply be understanding how these disorders work and how

we can best help those we love who may suffer with them.

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References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th

ed.). Arlington, VA: American Psychiatric Publishing.

Kentish, F. (2015) Living with persistent depressive disorder taught me that even the smallest

problem deserves help. Retrieved from http://metro.co.uk/2015/10/09/living-with-

persistent-depressive-disorder-taught-me-that-even-the-smallest-problem-deserves-

help-5427840/?ito=cbshare

Mayo Foundation for Medical Education and Research (MFMER). (2017). Persistent Depressive

Disorder (dysthymia). Retrieved from https://www.mayoclinic.org/diseases-

conditions/persistent-depressive-disorder/diagnosis-treatment/drc-20350935

Lancione, M. (2015). What Its Like to Live with Anxiety. Retrieved from

https://www.huffingtonpost.com/marisa-lancione/living-with-anxiety_b_8452658.html

Mayo Foundation for Medical Education and Research (MFMER). (2017). Generalized Anxiety

Disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/generalized-

anxiety-disorder/diagnosis-treatment/drc-20361045

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