Anxiety vs Depression

By Ho Shee Wai

Director / Registered Psychologist

Anxiety vs Depression

Do you know the difference between anxiety and depression? Can you only get one or the other or can you get both? Here’s all your frequently asked questions answered.

Diagnostic Criteria for Anxiety and Depression

Many people tend to get confused between anxiety and depression. Are these two conditions the same or similar? And do their symptoms overlap? Let’s first look at the diagnosis criteria of both anxiety and depression.

Anxiety

The DSM (Diagnostic & Statistical Manual) 5 Diagnosis criteria for Anxiety is:

1. The presence of excessive anxiety and worry about a variety of topics, events, or activities. Worry occurs more often than not for at least 6 months and is clearly excessive. Excessive worry means worrying even when there is nothing wrong or in a manner that is disproportionate to the actual risk. This typically involves spending a high percentage of waking hours worrying about something. The worry may be accompanied by reassurance-seeking from others.

2. The worry is experienced as very challenging to control. The worry may shift from one topic to another.

3. The anxiety and worry are associated with the following physical or cognitive symptoms:

• Edginess or restlessness

• Tiring easily; more fatigued than usual

• Impaired concentration or feeling as though the mind goes blank

• Irritability (which may or may not be observable to others)

• Increased muscle aches or soreness

• Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep)

• Sweating, nausea, or diarrhea.

Depression

The DSM-5 criteria for a major depressive episode are as follows:

• Depressed mood (subjective or observed); can be irritable mood in children and adolescents, most of the day;

• Loss of interest or pleasure, most of the day;

• Change in weight or appetite. Weight: 5 percent change over 1 month;

• Insomnia or hypersomnia;

• Psychomotor retardation or agitation (observed);

• Loss of energy or fatigue;

• Worthlessness or guilt;

• Impaired concentration or indecisiveness; or

• Recurrent thoughts of death or suicidal ideation or attempt.

As can be seen, these are 2 different conditions.  While there might be overlapping symptoms (like fatigue, difficulties concentrating, difficulties sleeping), the main symptoms are different.  For anxiety, the focus is on worrying.  For depression, the focus is on the low mood.

What is the difference between worry and anxiety? Sadness and depression?

It is more helpful to see these as a continuum. For example, anxiety is Excessive worry and depression is Excessive sadness. The differentiation is when these normal emotions get too much such that it is making hard for the person to carry out day-to-day activities and responsibilities, or it may cause problems in relationship, at work or in other important areas in the person’s life.

What is the purpose of anxiety or depression?

Anxiety

Anxiety or panic is a natural reaction of our body to protect us from danger (or perceived danger).  When face with danger, our Autonomic Nervous System kicks in and before we have time to realize we were in danger, the body reacted on its own (commonly known as “flight, fight, freeze”).  Many of these reactions occur during any activation of the body, not only in the state of anxiety or panic (e.g., during sexual excitement, physical exercise, intense happiness, etc).

Depression

Depressed people often think intensely about their problems. Numerous studies have also shown that this thinking style is often highly analytical. They dwell on a complex problem, breaking it down into smaller components, which are considered one at a time. This analytical style of thought, of course, can be very productive. Each component is not as difficult, so the problem becomes more tractable. There are evidence that people who get more depressed while they are working on complex problems in an intelligence test tend to score higher on the test. It becomes more challenging when the person is unable to figure out a solution to the problem or they can only see negative outcome for their solutions.

How can anxiety & depression affect a person's life?

Anxiety

Having anxiety is like carrying a little voice around who keeps pointing out all the potential and possible danger (real or imaginary) that a person can encounter.  They constantly feel scared and that impacts their sleep.  Due to anxiety, they freak out easily, they over-check and over-think things, they don’t go to social engagement, they let opportunity pass, etc.

Depression

Depression can be crippling in that the person loses enthusiasm, meaning, purpose, and passion for life.  They have a grey cloud always hanging over them.  In its most severe form, a person is unable to do simple function like getting out of bed, dressing themselves, etc.  The most dangerous impact is the person may actively choose/seek to end their lives.

Can I use self-help strategies to overcome my anxiety & depression?

There are many self-help resources available with effective techniques that can alleviate anxiety or depression symptoms. It is definitely helpful for you to practice some of these self-help strategies. However, an important thing to note that symptoms relief is not the same as treatment. Psychological therapies are evidence based psychological treatments that can help improve your health. This is called psychological practice. They help you make changes to your thinking, behaviour and relationships.

What are some common medical and non-medical treatments for anxiety and depression?

For Depression and Anxiety, there are medication (anti-depressant & anti-anxiety) that can alleviate some of the symptoms and addresses the biological cause (if any).  However, it is important to receive counselling of psychotherapy with a Psychologist, Counsellor or Psychotherapist in order to find the root cause of the anxiety and depression, as well as find ways to cope and deal with the anxiety and depression when they occur.  The goal is not necessary to “get rid” of the anxiety or depression, as previously mentioned, they come from normal emotions of worry and sadness, but to manage it so that it doesn’t interfere with the functioning of your daily life. Therapeutic approaches that has been found to be effective for anxiety and depression include CBT, EMDR, ACT, etc.