A Deeper Look at Anxiety and Depression
If you want the moon, do not hide from the night. -Rumi
More times than I can count I have had a client come to their first session and say something reminiscent of “I don’t know if I have anxiety, depression or both”. Many come with a diagnosis of anxiety and depression, different outcomes from different courses of therapy throughout their lives. Others still come with multiple diagnoses from the same time in therapy.
Can people be diagnosed with both? Sure. Do I have folks in my practice who meet criteria for both. Absolutely. A diagnosis is made based on a group of symptoms that impact your functioning. The way the DSM-V breaks it down is clear: if you meet x amount of the criteria listed for x amount of time identified and the symptoms create “clinically significant distress”- BOOM you’ve got a disorder.
The DSM is the diagnostic tool most all social workers, psychologists and psychiatrists use and while it provides a framework for a diagnosis, is extremely limited in its conceptualization of mental health. Many people will oscillate between “anxiety symptoms” (such as racing thoughts, catastrophic thinking and rigid behaviors) and “depressive symptoms” (such as loss of meaning, little motivation, loss of interest in things they used to love to do.)
There is a wild overlap in the symptoms and sometimes one set of symptoms can “cause” the other; in the case of your having persistent and repetitive thoughts about your lack of productivity or having a really low mood because you are always feeling frazzled and overwhelmed. There is a growing body of research and thinking that supports the idea that the mechanisms of these symptoms are not actually that different and that anxiety and depression are, in fact, two sides of the same coin.
When I explain this to clients I like to use a (poorly drawn) diagram, which shows anxiety symptoms as existing on one side of a continuum, depressive symptoms on the other and, on the middle of the spectrum existing a “healthy realm of functioning.” From a nervous system perspective the two sides, the extreme symptoms in both directions, can reflect the nervous system gone awry and its attempts at regulation.
What if your symptoms are really important messengers that are trying to deliver you information? What if you were to listen to the meaning underneath these symptoms? Let’s assume there is an underlying purpose of these symptoms. In therapy, we look at what numbing and dissociation have provided- an escape from suffering perhaps. We look at what anxiety and worry have provided- maybe the hyper vigilance to protect yourself. Sure, symptoms go left, lose their usefulness and sabotage your conscious life but it is important to honor these magical processes and where they came from.
This is all very theoretical, but stick with me here. The art of therapy is case conceptualization: the where, how and why these symptoms exist. This is mental health in context-in relation to the whole living, breathing, beautifully complicated person. It is not lost on me how important it is to reduce symptoms, to improve functioning and help people feel better. It is, however, my life’s work to listen deeply, to keep digging and to hold space for whatever arises.