A clear distinction between anxiety and depression is not evident in the light of research into the prevalence of these phenomena in the population. Epidemiological data from psychiatric practice, consultative psychiatry and general practice show that anxiety and depression co-exist more often than they were previously diagnosed.
How to distinguish between anxiety and depression?
Distinguishing anxiety disorders from depression is based on the assessment of the so-called the image of the patient's psychopathology, assessment of his premorbid personality, psychiatric history, as well as an accurate determination of the image of personal and social problems preceding the onset of the disorder. Anxiety in people with the personality of the so-called such as "avoiding", subjected to a strong and long-lasting stress - manifested in the form of an automatic nerve stimulation. In depression, the dominant symptoms may be dysphoria, guilt, and despair in patients facing frustration, loss and grief. This distinction should be made during the first examination.
In clinical practice, both of these disorders can not be easily separated for several reasons: the majority of patients with endogenous depression also suffer from anxiety approximately ¼ of all patients with major depression are anxious approximately 110 patients suffering from short depressive episodes also have symptoms of anxiety
Here is a description of the fears and depressions of one of my patients:
Morning: I fell asleep around two o'clock in the morning. During sleep, I was often woken up with nightmares, still the same. Some unknown people covered me with sand in the bottom. Every time I woke up I was woken up later. The intermittent sleep lasted very briefly, and I woke up at six in the morning. The awakening was another nightmare. The whole of the sweat, with a heart pounding like a hammer and an overwhelming feeling of fear, I tried to fall asleep for 15 minutes, but to no avail. I felt aversion to the coming day. Negative thinking dominated. Only unpleasant things that could happen to me in the coming day came to my mind. After an hour of lying motionless, fear very slowly began to subside. He was replaced by a sense of hopelessness, overpowering to the same extent as fear after waking up. I tried to free myself from this mood, but unfortunately this state was stronger than me. Another hour of negative thoughts has passed. Fear almost subsided, sadness and sadness remained. These feelings deprived me of the opportunity to create at least a bit of optimism, so needed to take the hardships of the coming day. What will the coming day look like, will my negative scenarios work? Waiting in the hope that this nightmare mood will pass. Usually he passed after a few hours, but unfortunately he returned the next morning.
Frequent coexistence of depression and anxiety disorders
Today, depression and anxiety disorders are thought to coexist in about one third of patients seeking help for one of these disorders. More than half of the patients suffering from anxiety in the form of cardiac complaints also had depression and anxiety.
In practice, family physicians, the coexistence of depression and anxiety disorders becomes even more apparent: data collected from their practice indicate that over three-quarters of patients with anxiety disorders also show some of the depressive symptoms and quite often they are intensified to a significant degree.
Anxiety-depressive states accompany other diseases
Mixed anxiety-depressive states are also observed very often in other diseases. Gastroenterologists in contact with the irritable bowel syndrome reveal the symptoms and pathogenic effects of anxiety and depression.In dermatology, many common conditions affecting the aesthetics of appearance, such as eczema, psoriasis and rosacea, cause the appearance of anxiety, shame and depressive reaction associated with an unsightly appearance.
Emergency medical services also come in contact with associated anxiety-depressive states, which often make diagnosis difficult. For the "anxiety-depressive" patient referred to, an ambulance is often called with a preliminary diagnosis of retrosternal pain suggestive of myocardial infarction - that is, to the state of sudden danger to life.
In women, the coexistence of various mental disorders is much more common
Not only depression is twice as common in women, but also two to four times more often: anxiety, phobias and panic attacks. Mixed anxiety-depressive disorders typically coexist with many mental disorders associated with the menstrual cycle in women. Premenstrual syndrome, postpartum depression and menopausal depression are syndromes in which there is often agitation and anxiety, helplessness characteristic of depression and many nagging somatic symptoms associated with anxiety.
Patients who suffer from panic attacks also have symptoms of depression
One of the possibilities to explain the frequent coexistence of anxiety-depressive states is the fact that chronic anxiety favors the appearance of discouragement, which in turn predisposes to the occurrence of reactive depression. Another way to explain this phenomenon is to assume that both anxiety and depression are manifestations of a common, pathological mechanism. The coexistence of anxiety and depression may finally be coincidental coincidence, because both these disorders are quite common in the population. In everyday medical practice, depression and anxiety coexist in different time configurations: depressive symptoms may occur in the course of ongoing anxiety disorder, major depression may be accompanied by symptoms of increased anxiety, or generalized anxiety or panic attacks may lead to secondary depression.
Genes bind depression with anxiety disorders
Genetic research and family history show significant connections between the occurrence of anxiety and depression. Studies of twins have a significant link between the occurrence of anxiety and depression, which seems to support the hypothesis of a greater bioavailability shared by both disorders. The phenomena described may constitute additional evidence of a common biochemical mechanism underlying anxiety and depression.
Sleep and the coincidence of depression and anxiety
In the course of anxiety-depressive disorder, early wake-up is characteristic. Depressive disorders are characteristic for depression, while the attachment of the anxiety component causes intermittent sleep patterns, with numerous episodes of nocturnal wake and later difficult to fall asleep, this is clearly visible especially during the first half of the night.
General reflection of the practitioner
Combined depression and anxiety states are a fact that often happens in private medical practice. These disorders are much more common in women. Often, they are mistaken for a small degree of disorder, with a mild course and a good prognosis. The connection between anxiety and depression is not yet fully clear, and a thorough understanding of the interrelationships of the associated anxiety-depressive states requires further observation and research.
Dr. Janusz Krzyżowski, MD, psychiatrist
