Experiences of Depression: Anxiety and Agitation

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.

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Jimmy

    Jimmy

    August 10th, 2011 at 4:36 AM

    This kind of anxiety in life can be utterly debilitating. You are sad and you are down, but instead of being in a fog it is like your mind super concentrates on everything and everyone around you and the worry won’t go away. I have had little sleep in episodes like this because I can’t focus on one thing, I am focusing or trying to focus on a million. You kind of get to a place where you are not sure which way is up anymore.

  • harold

    harold

    August 10th, 2011 at 1:16 PM

    while depression and anxiety touch the lives of one and all at some point of time,some people just have it a lot harder I guess.I mean, just being disillusioned and depressed like this seems alien to me.I know there must be many people that are just in the clutches of depression and anxiety but I can never imagine that happening to me.some of us just have it easier I think.While I do not know what the reasons for the same are,it would really help if some particular common things in such people are identified and studied.

  • Cynthia Lubow, MFT

    Cynthia Lubow, MFT

    September 3rd, 2011 at 5:18 PM

    I have often puzzled over whether it is more Hell to be depressed or anxious, and it’s like the chicken and egg dilemma–there is no answer. Both are Hell!

  • Ann

    Ann

    March 31st, 2017 at 2:50 AM

    Agitated depression really bad, dont know how to deal with it, tried some ssris but not worked. Lithium, lamictal, pregabalin, any of these help?

  • Chris

    Chris

    April 21st, 2017 at 12:11 PM

    Try seroquel or an atypical antipsychotic to calm the agitation. Helps your mind to feel clearer.

  • Mia Cuttswerth

    Mia Cuttswerth

    September 28th, 2011 at 8:18 PM

    Severe depression for me felt like unmanageable, overwhelmingness in everything that I did. Debt, paperwork, physical weight and clutter all piled up to the point where just thinking about it made my head hurt and my heart race. All day would be spent not taking action but just thinking about how hopeless my situation was.

    This constant worrying wasn’t like sadness but much more inline with anxiety. It had all the attributes of anxiety. My problem was exactly what was stated in this article. Not completely anxiety but not depression either, I was stuck somewhere in between. My therapist wasn’t good enough to identify my problem which can be a really scary thing. Luckily this is fixed now and I am almost back to normal, I’m glad this article has been posted as it good help spread the word to others in similar situations.

  • Katherine

    Katherine

    June 6th, 2016 at 11:53 AM

    I just came across this article and it describes my situation so well. I get these “episodes ” every three years for about three- four months. What did you do to get better??

  • Juliana

    Juliana

    October 23rd, 2017 at 3:07 PM

    Yes, this article best describes what has been happening to me, also. I have had major depressive disorder for decades now. I was put on just about every SSRI, the SNRIs, and tried on almost every atypical antipsychotic. These episodes of terror and agitation just started within the last 6 months. It is so bad while it is happening, I have been close to killing myself just to make it stop. I used to take clonazepam, and this never happened. But then my doctor retired, and no one will give me benzodiazepines because I use pain meds. Can anyone help me? If not, I humbly ask people who pray to please pray for me.

  • JoJOe

    JoJOe

    October 18th, 2015 at 6:08 AM

    Anxiety for me is not getting the information or the question answered.
    I strongly feel most of us with anxiety are being ingnored by people who are ignoring our requests for information.
    This leads to feelings of anger, frustration, lowered ability to trust our questions.
    It’s like feeling victimized and self critical and plays havoc on our personal respect and and self confidence.
    To remedy anxiety.
    Write down the top questions you have.
    You will be surprised that these questions have lead you to your anxiety because they are floating around in your head ALL THE TIME
    And they may be simple or large questions.
    Will I get the job?
    Should I move?
    Is my headache a tumor?
    Will the company train me within a certain time?
    How is my pay cheque calculated?
    Will my significant other leave me?

    Write them down and cross out the questions that our out of your control.
    Meaning it’s up to another person, or it’s up to the universe or the law or politics.
    Then take the top 3 and make a call, write an email, research it online, phone a doctor for an appointment or ask your lover what their intentions are within your relationship.
    Then do it. It’s empowering and it’s calm. It’s just a question.
    It will make you feel progressive for asking thus increasing your self worth and esteem.
    It will make you more in control for putting it out there and getting it out of your head.
    It will inform others that you have your best interests at heart, thus they will trust you to have theirs.
    Go and ask your questions, as I call it, Scraping Your Plate.
    Put it out there and out of your head.

  • Chris

    Chris

    April 21st, 2017 at 12:14 PM

    Great advice. Thanks

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