Often anxiety and depression travel together, so they are sometimes confused even by sufferers. In fact, in common language the terms anxiety and depression are easily used to indicate in general a condition of psychological malaise that interferes with daily life. But for psychiatrists these are two very distinct states, which nevertheless can occur in comorbidity, that is, be present in a person at the same time. Anxiety and depression are widespread: around 30 percent of people will experience periods of anxiety during their lives and nearly 20 percent will experience periods of depression. Several studies also indicate that about 70 percent of people with depression also meet the diagnostic criteria of an anxiety state and that nearly 80 percent of those suffering from anxiety disorders will have periods of depression along their existence.
The Coronavirus scale
Not to mention that the arrival of the Covid-19 pandemic has generated new anxious-depressive states, due both to the fear of contracting the disease, and to the reduction of social support and emotional relationships, so much so that the Department of Psychology of Christopher Newport University has developed a specific test, the Coronavirus Anxiety Scale.
Yet there is no clear definition of the optimal treatment for comorbid anxiety and depression, says Jan Spijker of the Depression Expertise Center in Nijmegen, The Netherlands, in a clinical review published with collaborators in the journal JAMA Psychiatry. Should we deal with two disorders sequentially, first one then the other, or in parallel, simultaneously? Should we start a single integrated treatment focused on both disorders or a transdiagnostic treatment targeting the underlying mechanisms present in both conditions?
The neurobiological alterations
Indeed, anxiety and depression can both represent a unique response to the same life events, and be linked to similar neurobiological alterations, such as an imbalance in the brain’s limbic system. This characteristic means that, by treating one, indirectly, one could say, inevitably, the other also begins to improve following the same step, as has been shown by recent systematic reviews.
It is true that treating depression with psychotherapy improves the symptoms of anxiety and that treating anxiety disorder with cognitive behavioral therapy improves the symptoms of depression, says Spijker. Medicines are also available today that allow you to kill two birds with one stone. In fact, some antidepressants have an anti-anxiety action, such as serotonin reuptake inhibitors (Ssri) and serotonin and norepinephrine reuptake inhibitors (Srni). Psychotherapy may decide to focus on the more serious disorder of the two, rather than both at the same time, according to the authors of the JAMA Psychiatry study. The data indicate that one treatment focused on the more severe disorder almost inevitably generates a simultaneous improvement in the other.
Anxiety and depression each have their own symptoms, but there are also symptoms that are common to both conditions. Anxiety is characterized by excessive preoccupation with life events, exaggerated fear responses, muscle tension, hyperactivity of the autonomic nervous system, which involves, among other things, an acceleration of the heartbeat and breathing rate. Depression, on the other hand, is characterized by a depressed mood and a feeling of lack of hope for the future, the loss of one’s own interests, reduced appetite, motor slowdown, a sense of worthlessness and guilt, gloomy thoughts.
Symptoms in common
Some other symptoms are common to both anxiety and depression. For example, a feeling of easy irritability, which leads to colliding with other people, associated with an inner agitation that makes it impossible to be well anywhere. Difficulty in concentration can be very marked, so even a potentially relaxing activity such as reading cannot help. Finally, the sensation of psychophysical fatigue and insomnia are very frequent. The latter can have different characteristics in those who are depressed, who tend mainly to wake up very early in the morning, and in those who are anxious, who, on the other hand, have difficulty falling asleep and awakening at night.
February 21, 2021 (change February 21, 2021 | 20:50)
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