Anxiety and depression: why they are connected
Anxiety and depression: why they are connected
Anxiety and depression: how are they related to each other? How can intergenerational patterns affect them? What happens at the neurobiological level? What can online therapy do?
Models on the anxiety-depression relationship
Let us begin by saying that the phenomena of anxiety and depression have always been topics since the dawn of time. In ancient Greece they were in fact initially treated as two separate pathologies. Only later did people begin to hypothesize a correlation between the two disorders.
I cite the article by the authors Ned H. Kelin, M.D., (2020) published in the journal “The American Journal of Psychiatry” with the title “The Critical Relationship between Anxiety and Depression”, anxiety and depressive disorders are among the most common psychiatric illnesses; they are highly comorbid with each other and are considered to belong to the affective disorders (internalizing disorders). In all psychiatric disorders, comorbidity is the rule, and this is certainly the case for anxiety and depressive disorders, as well as their symptoms. With regard to major depression, a worldwide survey reported that 45.7% of individuals with lifetime major depressive disorder had a history of one or more anxiety disorders. These disorders also commonly coexist in the same time frame, given that 41.6% of individuals with major depression over 12 months also have one or more anxiety disorders in the same 12-month period.
From the standpoint of anxiety disorders, lifetime comorbidity with depression is estimated between 20% and 70% for patients with social anxiety disorder, 50% for patients with panic disorder, 48% for patients with post-traumatic stress disorder (PTSD) and 43% for patients with generalized anxiety disorder. Anxiety and depressive disorders are moderately heritable (about 40%) and the evidence suggests a shared genetic risk.. Among internalizing disorders, the highest level of shared genetic risk appears to be between major depressive disorder and generalized anxiety disorder. Neuroticism is a personality trait or temperamental characteristic that is associated with the development of anxiety and depression, and the genetic risk of developing neuroticism appears to correlate with the risk of developing depression and anxiety disorder.
Common non-genetic risk factors associated with the development of anxiety and depression include past life adversities, such as trauma and illness. Anxiety disorders and major depression manifest during development, with anxiety disorders commonly beginning during preadolescence and early adolescence, and major depression tending to emerge during adolescence and early to mid-adulthood (16-18). Risk factors are detectable as early as childhood with childhood behavioral inhibition in response to novelty or strangers, or an extremely anxious temperament. These factors that emerge at an early age are associated with a three- to four-fold increase in the likelihood of developing a social anxiety disorder, which in turn is associated with a higher risk of developing a major depressive disorder and substance abuse.
Similarities and differences
One of the main factors that seems to unite anxiety and depression is the presence of negative affect (specifically that feeling of being little inclined, little sensitive, irritable, toward those activities usually considered pleasant).
By negative affect we therefore mean a sort of container of the most difficult feelings such as: worry, anger, shame, guilt, sadness, negative emotions, etc.
Anxiety and depression are instead differentiated by two technical characteristics: positive affect and neurovegetative hyper-activation (also called arousal).
In a depressed person we will find: low levels of positive affect (therefore positive feelings) and high levels of negative affect. When positive affect is lacking, in the medical field, we speak of an increase in tiredness, slowing down, great fatigue.
In an anxious person we will find: high levels of arousal, understood as neurovegetative physiological activation, a prompt response to stimuli, hyper-activation; and the presence of both positive affect and negative affect.
The increase in arousal can instead cause somatic disorders: muscle tension, dizziness, rapid breathing, physical and motor agitation, lack of energy, decreased attentive, memory and reasoning processing abilities (e.g., fainting), increased heart rate and blood pressure, excessive sweating.
Role of genetics
There are several studies stating that family history, with its intergenerational patterns, can be for people the greatest factor in the coexistence of anxiety and depression disorders.
For example, a large proportion of patients with anxiety and depression were more likely to have in their lineage relatives with problems of depression and/or alcoholism.
Furthermore, those who experienced both GAD (generalized anxiety disorder) and depression also found the existence of twice as many relatives being treated for depression. This compared to those who suffered from only one of the disorders.
In general, parents suffering from depression or anxiety double the chances of generating children who over time may develop depressive and anxiety disorders.
Neurobiology of anxiety and depression
Finally, alterations have been studied and found in the central nervous system that are common to anxiety and depression, in medical terms, particularly in the circuits with serotonergic, dopaminergic, noradrenergic and GABAergic components. Prolonged activation of centers that generate arousal (neurovegetative hyper-activation) could over time lead to neurotransmitter depletion that would cause depressive disorders (ipsico.it).
What can online therapy do?
Online therapy helps to place the anxiety and depression disorder when it first appears within a person’s experience. Let us remember that even if there is an intergenerational pattern of anxiety and depression; at the moment when a person decompensates and begins to have a major depression that originated from an anxious symptomatology, it is always reactive to a situation that acts as a stressor. It is therefore necessary, through online therapy, to try to place the symptom at the moment it occurs, and then to do work of understanding what has happened and of re-signification, interpreting it in the light of psychological theories based on the systemic-relational and family therapeutic approach and on brief strategic therapy. In the second instance, after having worked on what gave rise to the symptom, we will proceed to eliminate the depression and the anxiety disorder..
For information write to Dr. Jessica Zecchini.
Email contact consulenza@jessicazecchini.it, whatsapp contact 370 32 17 351.
