Even though we’ve made strides in the fight against mental health stigma, it can still be a struggle for people to get the help they need when it comes to depression and anxiety. Part of that is because of the lack of mental health literacy in the U.S. A 2021 study that analyzed this topic during the first year of the COVID-19 pandemic found that mental health literacy among American adults is poor, and that individuals are not able to readily identify mental health symptoms and appropriate treatment options.
You don’t have to read studies in scientific journals to know that our society struggles with mental health literacy, though. Just scroll through social media or watch a show on your favorite streaming platform. For instance, some folks might say they are “depressed” because they had a bad day—and I feel for you, because we’ve all been there—but depression is a lot more serious than that.
“Depression is generally badly understood, and brief bouts of low mood due to a bad day are often hyperbolized to be ‘depression,’” psychiatrist Dr. Benjamin Janaway said in an email. “Depression, from a psychiatric standpoint, is well demarcated, and includes a near constant feeling of lowness, reductions in energy, interest, and a host of other things, such as eating, sleep, socializing and a loss of hope, amongst others.”
Overall, depression and anxiety can be difficult to understand, and as such, it can be challenging to know if what a person is going through is just part of life or if they might need to get professional help. According to Janaway, analyzing the person’s experience and behavior is one of the keys.
“In my own practice, my rule (and I don’t have many) is, ‘If the person wants help, or they or another person is at risk, then we can call things a concern,’” Janaway said. “At the same time, we must also realize that emotions are part of the human experience, but it is the extent and severity which denotes whether we need to act.”
Here’s what to know about the symptoms and treatment of anxiety and depression, which affected 25.4% of American adults aged 18 and older in 2019.
What is anxiety?
Even though I’ve been fighting to improve my own mental health for nearly a decade, it’s been difficult for me at times to find the words to accurately describe what I was feeling—and this isn’t unique to my experience. Jonathan Stea, a clinical psychologist and an adjunct assistant professor at the University of Calgary, explained that the word “anxiety” is a loaded term because it’s a word people use in different ways. For instance, “anxiety” can be used colloquially in the language we use about everyday stressors, but its meaning is different clinically. In a few words, Stea said, anxiety is the anticipation of a future threat.
Anxiety manifests in people via anxious thoughts and bodily sensations, such as sweating palms or a racing heart. It can also influence peoples’ behavior when they’re experiencing anxiety. Some folks might try to run away from the situation, freeze up, or avoid it. Before you start thinking that everyone in the world must be suffering from clinical-level anxiety, it’s important to remember that anxiety is normal—to an extent.
“It’s important to understand that the experience of anxiety is normal and an evolutionarily adaptive response that we developed to protect ourselves from danger. We’re supposed to feel anxiety in some life situations,” Stea said. “The problem is that for some people, anxiety can become excessive, persistent, debilitating, and out of proportion compared to the actual threat—in these cases, a person might be experiencing an anxiety disorder, which can take many forms.”
Janaway, the psychiatrist, added that hormonal or chemical changes in the body can also result in anxiety. For instance, someone with hyperthyroidism could be more agitated and develop a faster heart rate. That’s why psychiatrists always ask people for blood tests so they can rule out physical causes first.
“You cannot fix an excited thyroid with therapy,” he said.
What is depression?
Like with anxiety, Stea points out that “depression” is another an umbrella term. However, as mentioned above, clinical depression is a lot more than just feeling sad for a short amount of time.
“It can include normal, expected feelings of sadness or loss of interest or pleasure, say, after an identifiable stressor, such as job or relationship loss—and it can also refer to psychiatric disorders, whereby a person exhibits these symptoms along with clinically significant distress, impairment, and loss of functioning,” he said.
Furthermore, Stea underscored that depression is complicated because depressive symptoms can show up in the context of different psychiatric disorders, such as bipolar disorder or substance-induced depressive disorder, among others.
Janaway also explained that depression is a pattern of emotional, physical, and social changes that occur in response to loss. And it can manifest as a side effect of a physical or chemical change in the body due to illness, genetic risk, or medications.
“Most depressive episodes can only be explained by a combination of all these factors together, and to reduce it to ‘one cause’ is not helpful,” Janaway said.
In addition, people with severe states of depression may begin to lose touch with reality or project their experiences to the outside world. This can lead them to form false beliefs and sensations that can be very difficult to live with. Suicide is also a risk with depression that psychiatrists take very seriously.
You can have both anxiety and depression at the same time
Understanding the differences between anxiety and depression can be confusing for some people, Stea said: “Mental health literacy is a skill to be learned and practiced over time, and refers to understanding mental disorders and their treatments, learning how to obtain and maintain positive mental health, learning how to get help, and decreasing stigma.”
And Stea and Janaway both pointed out that people can experience anxiety and depression at the same time.
“Of course, if one is scared of the future, they will feel low, and if one is low and feeling disempowered, they will feel anxious about moving forward in life. It begins to make sense with the story of how the person came to be in the situation they are in,” Janaway said.
However, he said that one disorder will usually predominate in an individual, so doctors treat that one first. Janaway underscored that there is good evidence to show that combinations of medication and therapy, or each alone, are helpful. Doctors have to work with the patient to decide the right approach.
When to seek help
As both Stea and Janaway mentioned, worry and sadness are a part of the human experience, which can make it hard for individuals who are struggling to identify when and if they should get help. “I tend to recommend seeking help when a person begins to feel that their mental health concerns are interfering with their life,” Stea said. “In other words, when mental health concerns start to feel overwhelming and debilitating, and they begin to impair a person’s ability to function, then it’s definitely worth reaching out.”
Janaway agreed, underscoring that people should seek help when experiences (such as sadness or worry) or behaviors (which can include not eating, going out, or talking) become concerning. Individuals should also consider whether others have become concerned about them.
“This could mean people are worried about your safety, or that it has gone on too long, or that this is not normal for you,” the psychiatrist explained. “For example, feeling low and making plans to end your life after a breakup is not a common experience.”
Treatment for anxiety and depression
Treatment approaches for anxiety and depression can look similar in some ways and different in others. For example, Stea points out that cognitive-behavioral therapy, or CBT—a form of talk therapy that teaches patients how to change negative patterns to improve the way they feel—is one evidence-based treatment approach that is used for both depressive and anxiety disorders. The psychologist added that there are advanced branches within CBT that focus on different problems, such as exposure-based therapies for anxiety and behavioral activation strategies for depression.
When it comes to medications, Janaway pointed out that contrary to popular belief, psychiatry is not all about medications and biology, but “based on addressing biological, psychological and social issues involved in the ‘disorder,’ ‘symptom,’ or ‘problem.’” He explained that there are many evidence-based approaches for treating both anxiety and depression, but the specific type of medication or therapy may differ. It all depends on the case.
Stea emphasized that mental health providers and patients should both play active roles in the treatment plan.
“Treatment plans should be made in collaboration with patients and depend on many factors, such as medical history, psychotherapy history, and the particular mental-health-related reasons that people are seeking treatment,” Stea said.
The connection between anxiety, depression, and suicide
Talking about suicide can be difficult, but it’s important if we want to understand the risks that anxiety and depression can pose to our loved ones. People with depression and anxiety are at a higher risk for suicide, and mental health professionals don’t mess around in this area. They work to “help people protect themselves,” Janaway said.
“Suicide can have many motivations,” he said. “Sometimes it is about escaping pain and is seen as ‘the only option’ (and in reality, it never is) or it can be a fantasy designed to empower the person with a sense of control over their fate, or can even form a function of revenge or punishment to others.” He stressed that no matter what an individual’s motivation may be, “we must ask ourselves whether this is something the person would ‘normally do,’ and in 100% of cases, the answer is no.”
Stea also said that the causes of suicide are many and are extremely complex. While experiencing mental health concerns can be one variable among many that are related to suicide, other important societal causes also increase the risk of suicide, including child abuse, racism, and poverty.
How to support loved ones struggling with anxiety and depression
Talking to loved ones who might be struggling with anxiety and depression is one way to help them, Janaway said. You can also ask what help they need or recommend they see a doctor.
“If you are very concerned about their safety, ask for emergency help, attend the emergency department, or call the local crisis service. Never feel that your worry is unvalidated, nor their symptoms unimportant,” Janaway stressed. “Mental illness is complicated, seditious, and often concealed, so if you worry, take it seriously.”
Furthermore, it’s important to ask for help from experienced and licensed mental health experts. You are likely not a professional and social media wellness gurus are also not experts you should turn to in times of mental hardship.
“It’s important to reach out to bonafide mental health professionals, not armchair and fringe experts,” Stea said. “I know that sounds harsh, but the harshness matches the potential harm.”