The Comorbidity of Anxiety and Depression

By Beth Salcedo, MD | Jan. 19, 2018

 

When a person experiences two or more illnesses at the same time, those illnesses are considered “comorbid.” This concept has become the rule, not the exception, in many areas of medicine, and certainly in psychiatry. Up to 93% of Medicare dollars are spent on patients with four or more comorbid disorders. The concept of comorbidity is widely realized but unfortunately not well-defined or understood.

In mental health, one of the more common comorbidities is that of depression and anxiety. Some estimates show that 60% of those with anxiety will also have symptoms of depression, and the numbers are similar for those with depression also experiencing anxiety.

While we don’t know for certain why depression and anxiety are so often paired together, there are several theories. One theory is that the two conditions have similar biological mechanisms in the brain, so they are therefore more likely to “show up” together. Another theory is that they have many overlapping symptoms, so people frequently meet the criteria for both diagnoses (an example of this might be the problems with sleep seen in both generalized anxiety and major depressive disorder). Additionally, these conditions often present simultaneously when a person is triggered by an external stressor or stressors.

While clinicians can typically recognize one mental illness relatively easily, it’s much more difficult to recognize comorbid disease. They must pay careful attention to symptoms that could suggest other disorders such as bipolar disorder and look for other factors such as substance abuse. This requires time with the patient, possibly their families and other collateral sources of information. The health care system today makes this level of assessment difficult, but not impossible.

Unfortunately, most research today focuses on patients with one illness, and treatments are then guided by this research. In result, there are many well-researched treatments available for mental illnesses, but not for comorbid mental illnesses. There is a lot that we still need to understand about how we recognize and treat conditions when they present at the same time.

There are several things we do know about comorbid anxiety and depression, however, and they underscore this need for accurate assessment. When anxiety and depression present together, these illnesses can often be harder to treat. This is because both the anxiety and depression symptoms tend to be more persistent and intense when “working” together.

This means that those experiencing both anxiety and depression will need better, more specialized treatments. Professionals and caregivers providing treatment may need to get creative, like adding one treatment onto another to make sure that both underlying disorders are responding. For example, if antidepressants are helping improve a person’s mood, but not their anxiety, a next step would be to add cognitive behavioral therapy to the treatment plan.

More research is needed to fully understand why some patients experience comorbid conditions and others do not. Until then, it is vitally important that those experiencing one, two or multiple mental illnesses engage in treatment early, and find a provider they can work with to reach their goals. While treatment may have more challenges when dealing with comorbidity, success is possible.

 

Mary E. (Beth) Salcedo, MD, Medical Director of the Ross Center for Anxiety and Related Disorders, is a psychiatrist with expertise in diagnostic assessment and psychopharmacologic management of anxiety and mood disorders in adults. She completed her Psychiatry Residency at The George Washington University School of Medicine and Health Sciences, where she was Chief Resident in her fourth year. She has been the Medical Director of The Ross Center since 2002, and has been with the center since 1997. She has consistently been named in Washingtonian Magazine’s “Top Doctors” since 2010. Dr. Salcedo is the President of the Anxiety and Depression Association of America (ADAA) having been an active member since 2004 and a board member since 2014. A 20-year member of the American Psychiatric Association, Dr. Salcedo was awarded the title of Distinguished Fellow in 2015.

Comments
Trisha
For the people suffering here, a webinar entitled "Dopaminergic Medications in Treatment Resistant Depression" Tuesday, August 12, 2014. Here's the link: https://www.bbrfoundation.org/event/dopaminergic-medications-treatment-resistant-depression
7/7/2018 12:22:54 PM

Israel H
For the last couple of years i have been suffering from severe panic and anxiety attacks, and for years i have been trying to find solutions online to help me with this issue. It was early this year that i stumbled across 'Stress Management Activities' which ensured me that i would make a full recovery from my depression and i can happily say i have not suffered from an attack in over 2 months. I fully recommend checking this out it can change your life like its changed mine.

https://goo.gl/HY7asj
2/25/2018 2:10:27 AM

judie tyler-russell
I have been treating for years for my mental health, depression, anxiety and ptsd, I have found that the system does not take enough time to deakl with a person with multiple issues, the doctors just want to change meds or re-diagnois. or both, the availability of a good shrink that you can stay with and will help you, is almost impossible. the mental health system is still very broken!if I had cancef, it would be a different story. mental illness is a silent illness! not everyone understands hoe horrible it is for all of us who suffer!! a change needs to be made- AFFORDABLE MENTAL HEALTHCARE!!
2/3/2018 6:44:36 AM

Seamstress
I have been the caregiver for my mother for 14 years since my fathers passing. She suffers from depression and anxiety. I have learned that when she suffers an anxiety attack to be more submissive to her needs by sitting with her, talking softly about positive things, a little laugh to brighten her spirits and lastly if none of the aforementioned are providing relief then we resort to a small dose of Xanax. I continue to sit with her until the medication takes affect. I remove myself and we both go on with life as God has given us.
2/1/2018 10:32:31 AM

Charles Minguez
Well-written, indeed. Thank you for mentioning CBT. I was diagnosed with major depression back in my teens but also experienced anxiety due to traumatic events happening in the home. The combination of anxiety and depression landed me with a misdiagnosis.

It wasn't until I was in my thirties and I began seeing a therapist practicing CBT techniques combined with a personal meditation practice that I was able to get my anxiety under control.
2/1/2018 9:22:20 AM

Oliver Lu
This article seems to neglect the possibility that the very notion of singular illnesses (or even worse "diseases") in the field of "mental health" is itself flawed.
2/1/2018 8:58:09 AM

Ann
There are so many layers to this diagnosis. Meds & therapy can seem experimental and of long duration. The only relief fo my daughter was a residential placement (body/mind/soul) along with a varied set of therapeutic strategies. Really good residential programs are expensive and if of low to moderate economic means, the tortuous road to access them seems cruel. Even then, Insurance companies push to keep residential stays short. I feel skilled diagnoses and treatment is out of reach for so many.
1/31/2018 11:55:16 PM

Keith C Lauver
Dr. Salcedo,

I live in central PA, with my 28 year old son comorbid anxiety, depression, PTSD from a year of incarceration, and he chooses to self-medicate. He is employed, quite bright, but the “system” here does not seem to work ~ I am beyond exhaustion, resources & he will NOT be helped by a re-incarceration.

What alternatives should I consider, as he needs in-patient treatment, but so many regulations prevent him from getting the help he so desperately needs.
1/25/2018 9:41:41 AM

Lizanne Corbit
Insightful, well-written read. Having, and understanding, important information like this is one of the most effective tools we have at thoroughly making changes possible and really making progress in terms of knowing our selves, and our feelings. Thank you for sharing.
1/22/2018 2:56:48 PM

Cynthia Garcia
depression and anxiety I feel hopeless
1/22/2018 11:12:12 AM

Cynthia Garcia
i am taking escitalopram and mirtazapine and its not helping. I need help
1/22/2018 11:11:40 AM

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