Anxious Depression

Anxiety and depression often manifest together, and their presentation can vary. At times, anxiety can give rise to depression, stemming from conditions like obsessive-compulsive disorder, where overwhelming thoughts or persistent rituals dominate one's mind. Additionally, individuals may experience generalized anxiety disorder, characterized by intense worry and fear. Some individuals may even have such severe anxiety that they start their day by feeling nauseous or burdened by a constant heavy weight on their shoulders. Some individuals experience the sensation of their throat closing throughout the day, which can be incredibly distressing, particularly when there isn't a clear cause for their anxiety. Continuous feelings of anxiety without an apparent reason can lead to self-doubt and questioning of one's own well-being, ultimately contributing to the development of depression over weeks or months. In such cases, individuals may find themselves dealing with both an anxiety disorder and depression simultaneously.

In another scenario, an individual's primary concern might be depression. They may experience a profound lack of joy, a sense of hopelessness, and a significant decrease in their energy levels, making it challenging to engage in daily activities. Instead of feeling the weight on their chest that is commonly associated with anxiety, their predominant experience may be the heaviness and numbness of depression. When someone experiences pure depression, they may feel a constant welling up of tears behind their eyes, ready to flow at any moment. However, the act of crying doesn't always provide the expected emotional release or a sense of relief from pain. Even after shedding tears, the underlying hurt persists. This is a common manifestation of depression, but often individuals also experience overlapping symptoms of anxiety.

In some cases, the anxiety may not reach the level of a distinct anxiety disorder like panic disorder or generalized anxiety disorder. However, its presence can significantly impact the nature and experience of depression. This occurrence is referred to as depression with anxious distress, where the combination of anxiety and depression creates a unique set of challenges for individuals.

Anxious distress is considered a core specifier that provides more specific information about how depression appears and behaves. In the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, certain criteria are outlined to identify the presence of anxious distress. These criteria apply to both major depressive episodes and persistent depressive disorder, previously known as dysthymia, which is a chronic, long-lasting form of depression lasting for at least two years.

To meet the specifier for anxious distress, an individual should experience at least two of the following symptoms on most days during a depressive episode or persistent depressive disorder:

1. Feeling keyed up or tense

2. Unusual restlessness

3. Difficulty concentrating due to excessive worry

4. Fear of something terrible happening

5. Feeling that one may lose control

These symptoms help distinguish the presence of anxious distress within the context of depression or persistent depressive disorder. Losing control can manifest in various ways and it is important to understand the levels of anxiety and distress associated with it.

While extreme behaviors can be imagined when anxiety is present, losing control can also be manifested in subtler forms, such as feeling unable to stop oneself from engaging in destructive actions like quitting a job. These behaviors can be indicators of anxious distress.

In terms of assessing the severity of anxious distress, there are different levels based on the number of symptoms experienced. Experiencing two symptoms would fall under the mild level, while three symptoms would be considered moderate. If one experiences four to five symptoms, it can range from moderate to severe, and if motor agitation is present, it is considered severe.

It is important to recognize that anxious distress and losing control are complex and personal experiences. If you are concerned about your own levels of distress or anxiety, I would recommend consulting with a mental health professional who can provide you with appropriate guidance and support tailored to your specific situation.