Generalised Anxiety Disorder And Depression

Introduction

Generalised anxiety disorder (GAD) is characterised by persistent and excessive anxiety or worry  leading to significant interference with daily life. On the other hand, Depression is a type of mood disorder characterised by persistent feelings of sadness which can have a profound impact on emotions, thoughts and behaviour. These mental health disorders are becoming increasingly common and affect a large proportion of the population.

While GAD and depression have distinct symptoms and treatment approaches, both these disorders often co-occur, meaning that if you have one disorder you are more likely to develop the other. Understanding the relationship between the two disorders allows your healthcare provider to tailor interventions to treat both anxiety and depression simultaneously thereby improving your mental health if you are facing these challenges

Generalised anxiety disorder (GAD)

Definition of GAD

Anxiety is a natural response to stress that helps our body adapt to the challenges we are facing. When worrying becomes intense, excessive and persistent it can be a sign of an anxiety disorder. An anxiety disorder can make you worry and fear everyday situations more than necessary, negatively impacting your quality of life and well-being 

There are different types of anxiety disorders that can be acute (short term) or chronic (long term), triggered by  various situations. 

Generalised anxiety disorder (GAD) is characterised by persistent and excessive anxiety or worry towards activities, objects or events that can interfere with daily life, and be triggered both directly and implicitly without warning.¹ Unlike occasional worry or fleeting anxiety, people with GAD experience worry disproportionate to the actual circumstance, struggling to control their racing mind, and affecting their physical and psychological health. This form of anxiety may be experienced over the course of months, if not years, and can become an ongoing issue

Symptoms of GAD

There are various physiological and psychological symptoms associated with GAD that can affect each individual differently. Below are some common symptoms:

• Excessive worry about everyday things
• Sense of dread or fear
• Irritability and difficulty concentrating
• Difficulty sleeping, fatigue and exhaustion
• Twitching, trembling and sweating
• Rapid heartbeat, dry mouth

Causes and risk factors for GAD

Whilst the precise causes of GAD remain unclear, it is widely agreed upon that a combination of factors are at play in the disorder’s development.²

Research suggests that the following factors contribute towards the development of GAD:

• Exposure to stressful or traumatic experiences (e.g., domestic violence, abuse or bullying)³
• Genes inherited by one’s parents^{4, 5}
• Family history of anxiety⁶
• Certain health conditions (e.g., thyroid problems, arthritis)
• History of drug or alcohol misuse
• Excessive use of caffeine or tobacco

Treatment of GAD

Reaching an effective treatment plan that works for you requires the expertise of a qualified healthcare professional. Additionally, treatment plans often consist of a number of measures to help ensure that both the presenting symptoms of the disorder as well as the underlying causes are addressed.

Traditional treatments for GAD typically involve:

• Cognitive Behavioural Therapy (CBT) – A form of psychotherapy that works by cognitively reframing how you perceive and think about the anxiety-inducing stressor so that it no longer causes you as much anxiety as it originally did⁷
• Acceptance and commitment therapy (ACT) – A newer, action-oriented form of psychotherapy that aims to develop and expand psychological flexibility through the use of alternative strategies, in particular mindfulness and goal setting, to reduce anxiety and fear⁸
• Antidepressant medication – Notably Selective-Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) help to treat GAD symptoms. They take a couple of weeks to take effect and are accompanied by side effects. However, they help improve the way the brain uses certain chemicals to improve mood and reduce stress⁹
• Anti-anxiety medication – Notably, benzodiazepines help relieve anxiety and are faster acting than antidepressant medication.¹⁰  They work by enhancing the activity of the neurotransmitter GABA (Gamma-Aminobutyric acid, a brain chemical) which helps promote feelings of calm. This medication has potential for addiction so it is rarely used routinely in the treatment of GAD.
• Medication used for other treatments but are still effective in anxiety, such as pregabalin (an anticonvulsant)¹¹ and propranolol (a beta-blocker)¹²

Depression

Definition

Depression is classified as a mood disorder that can have a profound impact on your feelings, thoughts and behaviours. Whilst sadness is something that we all experience from time to time, depression is characterised by persistent sadness that lasts for weeks or months. Consequently, to be diagnosed with depression, symptoms must be present in an individual for a duration of at least two weeks.

Depression can manifest in various forms, arising from specific circumstances or as a more general mood. Here, we are focussing on major depressive disorder, also referred to as clinical depression.

Symptoms of depression

Symptoms of depression typically range from mild to severe. In its mildest form, one may feel continuously low in spirit, whereas, in its severe form, one may feel suicidal. That being said, depression affects individuals in various ways therefore there are a wide range of physiological and psychological symptoms that are classed under depression, these include:

• Feelings of sadness or low mood
• Anhedonia (i.e., reduced ability to experience pleasure)
• Loss of interest in usual activities
• Changes in appetite and weight
• Difficulties in sleeping
• Fatigue and low energy
• Inability to focus or concentrate
• Unusually slow or agitated movements
• Suicidal ideation or attempts

Again, symptoms must be present in an individual for a duration of at least two weeks for a diagnosis.

Causes and risk factors for depression

Whilst the precise causes of depression remain somewhat ambiguous, it is widely agreed upon that a combination of factors are at play in the disorder’s development.

Research suggests that the following factors contribute towards the development of depression:

• Exposure to stressful or traumatic experiences (e.g., domestic violence, abuse or bullying)¹³
• Genes inherited by one’s parents,¹⁴ and family history of depression
• Deficient/Dysfunctional neurotransmitters (e.g., serotonin and norepinephrine)¹⁵
• Certain personality traits (e.g., low self-esteem and being overly self-critical)¹⁶
• History of drug or alcohol misuse
• Feelings of loneliness often associated with social isolation
• Certain health conditions (e.g., cancer, head injuries)

Treatment of depression

Once again, reaching an effective treatment plan for an individual requires the assistance of a qualified healthcare professional. 

Traditional treatments for depression typically involve:

• Cognitive Behavioural Therapy (CBT) – A form of psychotherapy that works by cognitively reframing how you perceive and think about the causative situation so that it no longer causes you as much distress as it originally did¹⁷
• Antidepressant medication – Notably Selective-Serotonin Reuptake Inhibitors(SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors(SNRIs) help to treat depressive symptoms. They take a couple of weeks to take effect and may cause side effects,but help improve the way the brain uses certain chemicals to improve mood¹⁸
• Brain stimulation therapies – Work by activating or inhibiting the brain using artificial electrical signals. Specific examples include Electroconvulsive therapy (ECT), Repetitive Transcranial Magnetic Stimulation (rTMS), and Deep Brain Stimulation (DBS)
• Alternative non-traditional treatments include Vitamin-D, St. John’s wort, light therapy and mindfulness

The relationship between generalised anxiety disorder and depression

​​Comorbidity refers to the simultaneous presence of two or more disorders or conditions in the same individual. Generalised anxiety disorder and depression are two mental health disorders that are highly comorbid with one another.¹⁹ Because of this, they are noticeably prevalent together, they share similar symptoms, have overlapping features, as well as common risk factors and mechanisms. Nevertheless, these are distinct disorders with their own diagnostic criteria, and understanding how they are interrelated is vital when it comes to providing an effective treatment plan.

Shared symptoms and overlapping features

Despite being two distinct mental health conditions, GAD and depression share symptoms and have overlapping features.

Ultimately, both GAD and depression significantly impact an individual’s quality of life and functioning. Additionally, beyond these similarities, the main difference separating the two is that GAD involves excessive worry about a range of more general issues in one’s life, whereas depression involves persistent feelings of sadness, hopelessness, and worthlessness.

Common risk factors and mechanisms

The exact causes and risk factors of GAD and depression are rather distinct to each disorder, with both being thought to be the result of a combination of factors. Here are some common risk factors associated with both disorders:

• Genetics – Thought to be a hereditary element with reference to genetic factors
• Brain chemistry – Neurotransmitters (i.e, chemical messengers in the brain), notably Serotonin and Norepinephrine, are significantly involved in regulating anxiety and mood. Imbalances or dysfunction in these neurotransmitters are involved in the development of GAD and depression
• Environmental factors – Examples include traumatic events, adverse life events, and chronic stress
• Personality traits – Such as negative thinking, pessimism, and excessive worry
• Medical conditions – Such as chronic pain, cancer, and heart disease
• Substance abuse – Such as alcohol and drug misuse

In general, both disorders implicate the body’s stress response system. It is thought that the dysregulation and hypersensitivity of this system causes persistent feelings of anxiety, worry, sadness and hopelessness.

Impact of one disorder on the development and course of the other

It is widely agreed upon that depression can have a significant impact on the development and course of GAD, and vice versa.²⁰ Below are some of the ways in which this one disorder can affect the other:

• Increased risk of developing a comorbid disorder – Due to shared genetic and environmental factors
• Greater severity of symptoms – Commonly in physical symptoms such as fatigue, muscle tension, weight fluctuations and sleep disturbances
• Poorer treatment outcomes – Treatment becomes harder in those with comorbid disorders, requiring longer and more intensive treatment
• Increased risk of relapse – Following treatment, having one disorder can make it harder to manage the symptoms of the other, thereby increasing the risk of relapse

Overall, having one of the disorders can significantly impact the development and course of the other disorder. Consequently, it’s vital for individuals with both conditions to receive an integrated treatment plan that addresses both disorders adequately.

Treatment plans

On the whole, both GAD and depression have treatment options that consist of the same methods. The whole main pillars of treatment for both GAD and depression are:

• Psychotherapies (i.e., talk therapies) – Cognitive Behavioural Therapy (CBT), and Acceptance and Commitment Therapy (ACT)
• Antidepressant medication 

Nevertheless, due to individual variability in how they manifest and deal with each disorder, a tailored treatment plan should be agreed upon with the help of a healthcare professional.

Summary

It is evident that both generalised anxiety disorder (GAD) and depression are highly impactful mental health disorders.. The co-morbidity of these disorders demonstrates how similar mechanisms underlie each disorder. Knowing more about this co-morbidity is of substantial benefit to (1) help people better understand what mental health disorders they have and how they are affecting them and (2) devise an optimal treatment plan that best helps affected individuals when considering the complexity of their situation.