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Despite progress in combating the stigma surrounding mental health, individuals still face challenges accessing necessary help for depression and anxiety. One factor contributing to this is the insufficient mental health education in the U.S. A 2021 study conducted during the first year of the COVID-19 pandemic revealed that American adults have limited mental health literacy, making it difficult for them to identify symptoms and find suitable treatment options.
You don’t need to read scholarly articles to recognize that our society struggles with understanding mental health. Simply browse social media or tune into a show on your favorite streaming platform. For example, some people may casually claim they are 'depressed' after a tough day—and while we empathize, it’s important to understand that depression is far more severe than that.
'Depression is often misunderstood, and brief periods of low mood caused by a difficult day are frequently exaggerated as 'depression,'' explained psychiatrist Dr. Benjamin Janaway in an email. 'From a clinical perspective, depression is clearly defined and involves a persistent sense of sadness, reduced energy, interest, and a range of other symptoms, such as changes in appetite, sleep patterns, socializing, and a loss of hope, among others.'
In general, depression and anxiety can be hard to comprehend, making it difficult to determine whether someone's experience is just a normal part of life or if they might need professional support. Janaway emphasizes that assessing the individual’s behavior and experience is one of the most important factors in this determination.
'In my practice, I have one simple rule (and I don’t have many): If the person seeks help, or if they or someone else is at risk, then we should consider it a concern,' said Janaway. 'We also have to acknowledge that emotions are an inherent part of the human condition, but it is their intensity and severity that guide whether action is needed.'
Here’s what you need to understand about the symptoms and treatments for anxiety and depression, which impacted 25.4% of American adults aged 18 and older in 2019.
What is anxiety?
Despite nearly a decade of working on my own mental health, I’ve found it challenging at times to find the right words to explain what I was feeling—and this struggle is not unique to me. Jonathan Stea, a clinical psychologist and adjunct assistant professor at the University of Calgary, clarified that the term 'anxiety' is complex, as it is used in many different contexts. For instance, 'anxiety' can be casually applied to everyday stress, but its clinical meaning differs. In short, Stea explained, anxiety is the anticipation of a potential future threat.
Anxiety can appear in individuals through anxious thoughts and physical sensations like sweaty palms or a racing heart. It can also affect people’s actions during episodes of anxiety, with some choosing to flee, freeze, or avoid the situation altogether. It’s crucial, however, not to assume that everyone experiences clinical anxiety. Remember, anxiety is a normal response—within reason.
'It’s important to recognize that anxiety is a normal and evolutionarily beneficial reaction that we developed to protect ourselves from danger. We are meant to feel anxiety in certain situations,' explained Stea. 'The issue arises when anxiety becomes excessive, persistent, overwhelming, and disproportionate to the actual threat. In these instances, a person may be dealing with an anxiety disorder, which can present in various forms.'
Janaway, the psychiatrist, also pointed out that hormonal or chemical changes in the body can contribute to anxiety. For example, someone with hyperthyroidism might experience heightened agitation and an increased heart rate. This is why psychiatrists typically request blood tests first to rule out any physical causes.
'You can’t resolve an overstimulated thyroid with therapy,' he stated.
What is depression?
Similar to anxiety, Stea points out that 'depression' is another umbrella term. However, as previously mentioned, clinical depression goes far beyond simply feeling sad for a short period.
'It can involve normal, expected feelings of sadness or a loss of interest or pleasure, such as after a notable stressor like the loss of a job or relationship. It can also refer to psychiatric conditions where a person shows these symptoms alongside clinically significant distress, impairment, and a loss of functioning,' he explained.
Moreover, Stea emphasized that depression is complex, as its symptoms can appear in the context of other psychiatric conditions, like bipolar disorder or substance-induced depressive disorder, among others.
Janaway further clarified that depression is a pattern of emotional, physical, and social changes triggered by loss. It can also result as a side effect of physical or chemical changes in the body caused by illness, genetic predisposition, or medications.
'Most depressive episodes can only be explained by a combination of all these factors, and simplifying it to 'one cause' is not productive,' Janaway stated.
In more severe cases of depression, individuals may lose touch with reality or project their internal struggles onto the world around them. This can cause them to develop false beliefs and sensations that are difficult to manage. Suicide is also a significant risk that psychiatrists treat with the utmost seriousness in cases of depression.
You can experience both anxiety and depression simultaneously
Stea noted that distinguishing between anxiety and depression can be challenging for many: 'Mental health literacy is an acquired skill, one that involves understanding mental disorders and their treatments, learning how to foster and sustain positive mental health, knowing how to seek help, and reducing stigma.'
Both Stea and Janaway emphasized that it is possible for someone to experience anxiety and depression at the same time.
'Naturally, if someone is fearful about the future, they will feel down. Conversely, if someone is feeling low and powerless, they will likely experience anxiety about moving forward in life. This makes more sense when considering the individual's personal journey and the circumstances that led them to this point,' said Janaway.
However, Janaway explained that typically one disorder will dominate in a person, and so doctors prioritize treating that first. He emphasized that there is strong evidence supporting the effectiveness of combining medication with therapy, or using each treatment individually. The treatment approach must be tailored by doctors in collaboration with the patient.
When to seek help
As both Stea and Janaway pointed out, worry and sadness are natural aspects of being human, which can make it difficult for people to recognize when they should seek help. 'I generally recommend seeking help when someone feels their mental health struggles are affecting their daily life,' Stea explained. 'In other words, when mental health issues become overwhelming and debilitating, hindering a person’s ability to function, it’s a sign that reaching out for help is crucial.'
Janaway agreed, highlighting that seeking help is necessary when emotions like sadness or anxiety, or behaviors like withdrawing from social activities, become alarming. People should also take into account whether their loved ones are expressing concern.
'This could indicate that others are worried about your safety, that the situation has persisted for too long, or that your behavior is not typical for you,' he noted. 'For instance, feeling down and contemplating ending your life after a breakup is not a usual response.'
Treatment for anxiety and depression
Treatment methods for anxiety and depression may overlap in some areas while differing in others. For instance, Stea notes that cognitive-behavioral therapy (CBT)—a type of talk therapy aimed at helping patients alter negative thought patterns to improve their emotional state—is a well-supported treatment used for both anxiety and depressive disorders. He also mentioned that there are specialized forms of CBT designed to address specific issues, such as exposure-based therapies for anxiety and behavioral activation for depression.
Janaway pointed out that, contrary to what many believe, psychiatry isn't solely focused on medication and biology. Instead, it seeks to address the biological, psychological, and social factors involved in the 'disorder,' 'symptom,' or 'problem.' He clarified that while there are various evidence-based treatments for anxiety and depression, the choice of medication or therapy is tailored to the individual case.
Stea stressed that both mental health professionals and patients must be proactive in the treatment process.
'Treatment plans should be developed together with the patient, taking into account various factors such as medical and therapy history, as well as the specific mental health concerns that led to seeking treatment,' Stea explained.
The connection between anxiety, depression, and suicide
Discussing suicide can be a challenging topic, yet it's essential for understanding the serious risks anxiety and depression pose to those we care about. Individuals battling depression and anxiety are at a greater risk for suicide, and mental health experts are highly vigilant in addressing these risks. As Janaway emphasized, their primary aim is to 'help people protect themselves.'
'Suicide can arise from various motivations,' he said. 'Sometimes it is seen as the only escape from overwhelming pain (though it never truly is). In other instances, it may be a form of fantasy, granting the person a false sense of control over their destiny, or even a means of exacting revenge or punishment upon others.' He stressed that regardless of the reason, we must ask, 'Would this person normally take such an action?' And in every case, the answer is undeniably no.'
Stea further highlighted that the causes of suicide are multifaceted and deeply complex. While mental health struggles can be a contributing factor, they are just one part of a larger picture. Other societal influences, such as child abuse, racism, and poverty, significantly heighten the risk of suicide.
How to support loved ones struggling with anxiety and depression
One way to support loved ones who may be struggling with anxiety and depression is by talking to them, according to Janaway. It's important to ask them what kind of help they need or suggest they consult a doctor.
'If you’re deeply concerned about their safety, don’t hesitate to seek emergency help, visit the emergency department, or contact a local crisis service,' Janaway emphasized. 'Never dismiss your concerns or belittle their symptoms. Mental illness is often intricate, deceptive, and hidden, so if you’re worried, take it seriously.'
It’s also crucial to seek assistance from qualified, licensed mental health professionals. While you may have good intentions, you are not a trained expert, and turning to social media wellness influencers is not the solution during times of mental distress.
'It’s vital to reach out to qualified mental health professionals, not armchair critics or fringe experts,' Stea said. 'While this might sound blunt, the bluntness is necessary because the potential harm is real.'
