This article is part of a series that explores the ways that specific “clusters” of depression symptoms manifest to create different experiences of depression. The previous article in this series discussed the self-attack experience.
Anxiousness and agitation create an experience of depression that especially confuses people. Most people expect that depression will look like sadness, self-hate, despair, lack of ambition, and suicidal thoughts. All of these are indeed ways that depression is experienced—for some people, at some times. But for other people, depression manifests more like anxiety than anything else.
People with this type of depression usually have trouble sleeping. They may pace, be unable to sit still, and worry constantly about everything. Their minds may race with worry or fear. They may have a sense of doom. At its worst, they may feel too anxious to go to work, talk on the phone, make decisions, take medication, or function at all. Generally the fear experienced is not focused on one specific thing, like snakes or bridges, though it may have themes that reflect the person’s life or personality.
This kind of anxiety is different than anxiety disorders. Anxiety disorders tend to be continuous over long periods of time, while anxiety that is part of depression tends to come in episodes, like major depression does. Also, depression-anxiety often weaves in and out of other symptoms of depression. The anxiety that comes with depression tends to be relieved by anti-depressants, whereas anxiety disorders generally is not. This leads researchers and clinicians to think that this form of anxiety is really the same illness as depression.
Anxiety can take many forms. Depression doesn’t have to be present for people to have phobias, posttraumatic stress, panic attacks, chronic worrying, or other anxiety disorders. But when anxiety is an expression of depression, the two often feel related. Sometimes people tell me, for example, that they are afraid to get relief for their anxiety because they fear they will instead become terribly depressed. Sometimes anxiety and depression take turns, the anxiety giving the person more energy and ambition to do things while the depression calms them. Neither one does these jobs well, because anxiety can also paralyze people, even if it offers more movement than depression does. Depression may calm anxiety, but at a terrible cost of suffering.
I have a friend who has thus far experienced four episodes of very incapacitating depression in her six decades of life. Each time she has an episode, it starts with increasingly debilitating anxiety. She starts to worry about what people think, hurting people’s feelings, and every terrible thing that could possibly result from everything she does and doesn’t do. She feels so overwhelmingly anxious that she can’t answer the phone, go to work, or even leave her apartment. She can’t make a decision, because she can think of all the worst possible outcomes of each choice. She obsesses about regrets from the past and feels terrified of the future. If it gets bad enough, she starts to worry about medications or even food poisoning her.
If this goes on for a few weeks, or sometimes months, it eventually turns into utter despair and complete loss of energy or motivation to even walk or eat. She can’t remember anything good about her life and has no hope for anything ever being good again. Despite how affected she is by this “switch flipping in her head,” she doesn’t think of herself as worthless, unlovable, or disgusting. She also doesn’t feel sad—or anything else, other than terrified and then despairing. Mostly, she feels numb. A very small percentage of her life has been like this, and between episodes, she is happy, optimistic, energetic, charming, and capable. Between episodes, she may have anxieties, like anyone does, but she isn’t paralyzed by them—she can use cognitive restructuring and see them in a more positive, relaxed light.
The lesson to take from this is that if you, or someone you know, suddenly starts to worry or anxiously obsess in an extreme and uncharacteristic way, or seems agitated, driven in circles, or paralyzed by anxious thoughts, it is important to get a professional evaluation. The cause may be serious depression.
© Copyright 2011 by Cynthia W. Lubow, MS, MFT, therapist in El Cerrito, California. All Rights Reserved. Permission to publish granted to GoodTherapy.org.
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