Depression and anxiety

Anxiety is common and can be a normal part of everyday life. However, it can also be long lasting and interfere with daily activities. Anxiety disorders are among the most commonly diagnosed mental health conditions; about 30% of young adults age 18-29* have them. Depression and anxiety also often go together; 58% of people who have ever been diagnosed with a major depressive disorder also have an anxiety disorder*1. Sometimes, people with major depression have severe anxiety, but only when their depression is active. This summary focuses on the experiences people we interviewed described related to having both depression and anxiety.

The relationship between depression and anxiety

A number of people experienced their depression and anxiety as closely related. Many said they cycled between feelings they associated with depression and those they associated with anxiety. Ryan says he feels his anxiety causes his depression, and also that sometimes the hopelessness of his depression makes him feel anxious. Casey says the difference between his anxiety and his depression is that his anxiety “has not ever stopped me from doing anything” but depression is “like, I can’t do things”. Nadina describes how she notices certain behaviors when she is feeling anxious and different ones when she is feeling depressed.

Nadina describes the cycle of her anxiety and depression.
Interview Transcript

But, basically anxiety is more, like, kind of like this wasp is stinging you in the back, depression is more like, you just want to go to bed [laughs]. You just don’t want to deal with the world, you just want to be alone and isolated and I’d say that the two kind of swing back and forth like I’ll be kind of really anxious and kinda wired and doing all these things like cleaning my room or like running different errands to feel busy like I’m doing something with my time that’s worthwhile and then when I’m depressed it’s like I just want to like sit by the river and not, not deal with anyone or anything so I think that like you know, I think depression kinda sets in after I’ve had this big burst of anxiety. Because I realize, you know, wow, this an all the time thing with me, it’s just an endless cycle, it never ends.

DEP Nadina
Profile Info
Age at interview: 23
Sex: F
Age at diagnosis: N/A

Background: Nadina lives with her parents in a suburb near a small city. She completed college and works as a freelance illustrator. She is Caucasian.

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Other people talked about how feelings of depression and anxiety are hard to separate:

Kate describes the difficulty of separating her feelings of depression and anxiety.
Interview Transcript

I know that my depression causes anxiety and my anxiety causes depression. I can see how anxiety makes me want to do things and it, it makes me feel like I have to, it, it makes me feel like I have to be the best I can, or else people will judge me. And then that depression comes in like, yes, people will judge you because you are awful. So they kind of work hand-in-hand. They’re, they’re sometimes very hard to separate in my own head. I’m sure looking at me, you’d be able to say, well, yeah, that’s probably more of an anxiety thing than a depression thing. They’re both just things that I have to deal with together. They fit into each other.

DEP Kate
Profile Info
Age at interview: 21
Sex: F
Age at diagnosis: 12

Background: Kate is an actress who works in an art gallery. She lives in an apartment with a roommate and a cat. She is white.

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How anxiety feels

A few young adults we spoke to described how anxiety felt physically for them. Crystal says she feels physical pain and describes it as, “anxiety takes over my whole body, my muscles hurt and I’m not really able to move… I personally get, my legs hurt sometimes, my abdomen hurts, my arm hurts, my shoulders hurt, I get, I can get large swollen lymph nodes sometimes”.

First understandings of anxiety

Many people first experienced symptoms of anxiety when they were young, around age six or seven, before they were diagnosed with depression. A few reported first experiencing feeling nervous about starting school and having accompanying feelings of nausea. Marty described his anxiety as starting, “about the age of six or seven, being anxious about going to school and when I got there just being so nervous that I would end up running to the bathroom and throwing up, just because my anxiety would be kicking up so much”.

Maya discusses her early experiences with anxiety.
Interview Transcript

I would have to say that probably as far back as I can remember, I at least had pretty significant anxiety. I remember when I was really little if someone was late for something I would have this really bad catastrophic thinking like, “Oh no, like, they got in a car accident or they are never coming home,” or something like that. I remember being very scared to be in a room by myself, I had, you know, I had this feeling that just around the corner somebody was going to leap out and get me and pretty much I had that feeling almost all of the time. By the time I got into high school, I was pretty good at masking my feelings. I’m fairly good at, sort of, keeping up, like, a really like upbeat persona, regardless of how depressed I am. Even when I am fairly non-functional, if you see me like out and about most people think that I’m pretty confident and pretty well-adapted and they’re like, oh you know, ‘You’re a really optimistic person’ and you know ‘You’ve got it all together’ and stuff like that. And I think a lot of that for me comes from the fact that we have a fairly insincere culture when it comes to emotions. I mean, especially if you work in something like service, I mean, ‘service with a smile’ and foreigners a lot of times comment on how strangley friendly everyone in the states is and sort of how we have this sort of culturally-mandated exuberance, you know. We can’t just be like ‘Oh you know things are ok, they’ve have been kind of tough lately’. Everybody’s supposed to say ‘Great! Everything, It’s going to be the best day it’s every been and It’s the most beautiful and I am going to be so successful’. And so, I’ve sort of taken that on which I think can make it difficult sometimes because people don’t recognize that you’re suffering especially when you are able to, sort of, beat your obligations. That it can be harder for people to identify you as someone who has depression.

DEP Maya
Profile Info
Age at interview: 27
Sex: F
Age at diagnosis: 15

Background: Maya manages an adolescent program in a community center and lives with her boyfriend. She is Chinese American.

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Some people reported that they didn’t realize they had issues with anxiety until high school or college. Casey remembers discovering he had an anxiety disorder after reading about it. Natasha first discovered she had anxiety after receiving a diagnosis from a health center on campus. Before realizing she had anxiety, Crystal thought worrying about her family and future “was just my normal thought process”, but self-reflection led her to realize that she was suffering from anxiety.

Elizabeth talks about her experiences with anxiety as a child.
Interview Transcript

My anxiety really manifested was in a lot of worrying and I think, I was really anxious as a kid and I think a lot of that came from just being very sensitive, like I said, not having many coping skills and always just being worried all the time. I remember being like three years old and worrying about like, ‘is my mom having a good day at work?’, but something that a three year old doesn’t need to think about, but it’s something that happened. And I think that the uncertainty that I, that kind of came out of the anxiety fueled the depression in a way that made me feel like I was out of control, that I didn’t have a say in what was happening.

DEP Elizabeth
Profile Info
Age at interview: 28
Sex: F
Age at diagnosis: 17

Background: Elizabeth lives in a house with her husband. She works as a parent educator. She is White/Italian.

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What triggers anxiety

Specific situations trigger anxiety for many people – and school was described as a primary source. Many people said they suffer from test taking anxiety in particular.

Meghan talks about the stress of college exams.
Interview Transcript

Well I kind of am more calm about things. Like, if I am stressed out about something I, I mean easier said than done, but I just kind of make myself realize that it’s going to be okay. Like I mean, there were points in that first semester of college where that I thought that I was not going to live through an exam. Like there was an exam and I was so stressed out about it and so anxious and just sick to my stomach just leading up to that exam and during that exam. Like I mean that I was acting in such a way that I thought that it was a life or death situation and I am just so happy that [laughter].\, that is not the case anymore, because I mean that was the case with day to day activities, like I would be so anxious like academically and socially because I wasn’t myself and yeah, it just was not good [laughter].

DEP Meghan
Profile Info
Age at interview: 18
Sex: F
Age at diagnosis: 18

Background: Meghan is a college student and has a job on campus. She is Caucasian.

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People also described tendencies to be a perfectionist or have very high expectations for themselves, and linked these feelings to anxiety. Cara said she “keeps raising the bar for myself”, and when she cannot reach her goals she feels a sense of inadequacy and insecurity. Leanna said when she is in a pessimistic state, “I’ll kind of just send myself [into] like a mental self-sabotage spiral of … self-doubt”. Natasha describes how being “overly stressed” triggers her anxiety and starts a “bad cycle”.

Family issues and drug use also caused feelings of nervousness. For more about how family issues impact depression, see ‘Depression and relationships.’ For more about drug use, see ‘Depression, substance use and abuse.’

Social anxiety

Many people experienced feelings of anxiousness in social situations that they described as contributing to their depression. For some, this was related to meeting new people.

Natasha describes how bad social interactions trigger her depression.
Interview Transcript

I think, the sort of social anxiety thing where I’m like not super comfortable meeting new people that can also, like, trigger a depressive state, for me at least. Like having a bad interaction with someone, having like an awkward conversation or encounter with someone, I would feel like bad about that throughout the day andit would sort of, I guess like having those encounters over and over and over, would, they sort of get me down and if it happens enough, it sort of triggers one of the badder, longer cycles.

DEP Natasha
Profile Info
Age at interview: 20
Sex: F
Age at diagnosis: 19

Background: Natasha is a student at a large university who lives in a dorm room on campus. She is African American.

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Other young adults said avoiding social interactions contributed to their depression. Jacob would “chronically avoid social interaction” by avoiding parties or hanging out with friends. He says, “I was missing out on a lot of social opportunities that as human beings are necessary for us to be happy and fulfilled. And since I was deprived of those things, I felt like that’s, that’s probably a fairly significant cause of my depression.”

Panic attacks

A number of people we interviewed had experienced panic attacks as a symptom of their anxiety – attacks that felt “frightening” or “like I was losing my mind”. Casey said panic attacks tend to happen at times when he’s not doing well and feels like he’s not meeting his own expectations. Others said the fear of leaving their familiar home would lead to panic attacks. Panic disorders can be associated with increased suicidal thoughts and behavior*2. Leanna and Colin described how their thoughts of suicide triggered panic attacks.

Leanna talks about how her negative thoughts can lead to panic attacks.
Interview Transcript

I feel like the depression gets me to where I start questioning a lot of things and kind of like how my mindset is. I’m very pessimistic in that state and I’ll kind of just send myself like a mental self-sabotage spiral of just, doubt, self-doubt and it just sends me into that panic attack. Because then I start to feel really small and just scared about this whole life thing, it really starts freaking me out.

DEP Leanna
Profile Info
Age at interview: 23
Sex: F
Age at diagnosis: 15

Background: Leanna lives with her husband and many pets in an apartment complex in a suburb outside a large town in a rural area. She is Caucasian.

Click here to view Leanna's profile page
Colin talks about his panic attacks and their relation to his OCD and suicidal thoughts.

But I feel like when my, I definitely feel like when my obsessive compulsive symptoms were the worst my depression was the worst as well, like if one got worse the other would get worse.

And yeah, that’s I guess, they relate, they are a very direct relationship and what was I about to say. Oh and another thing that kind of helped, I had really bad anxiety issues and OCD’s an anxiety disorder just general anxiety issues and a lot of that was a driving force of my depression when I came back to school the summer after I had stopped the medication. That was that was my first time I had ever experienced panic attacks. I would have these suicidal thoughts and get so worked up and my heart would just start racing and I was so sure I was going to do it and just I’d get so panicky and anxious that I would just, thought I was going to have a heart attack and die and pass out. I couldn’t breathe. And the same psychiatrist who got me back on the Lexapro, I got a Xanax prescription that helped with the immediate panic that I would get. And then I got off of that because it’s addictive and I have a bad history with addictive substances and trying to get that out of my life [laughter].

But that actually helped a lot at first with. That was kind of the point at which I had this general anxiety mixed with OCD mixed with depression and that was like I said my really low point my, when I finally.

DEP Colin
Profile Info
Age at interview: 20
Sex: M
Age at diagnosis: 18

Background: Colin works at the college he attends and lives with a roommate. He takes medications and sees a therapist. He is White.

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Medication and skills to help cope with anxiety

People spoke about many different ways they coped with anxiety. Some used prescribed medication or drugs such as marijuana. (For more information see Depression, medication, and treatment choices.’ For more information about substance use, see ‘Depression, substance use and abuse.’)

Using the arts such as painting or drawing helped others to calm down:

Sara says journaling helps her get through times when she's feeling particularly anxious.
Interview Transcript

Between that and the medication, the journaling was a big thing. Because I would my mind is constantly going like, “What am I going to wear? What am I, am I going to look ok? Is the weather, is it going to rain or are my shoes going to get wet?” Like I don’t need to worry about all that stuff and then on top of that, “Is my grandma okay? Is my sister okay, is? What am I going to do today?” It’s just all at once. So I can just sit down and just write about what’s going through my head even if it’s just, “I want a cup of coffee.” It’s not, it’s floating in my head and I’m not talking about it, if I don’t have somebody to talk to, I could just write it down and then it’s not in my head anymore and I can move on.

DEP Sara
Profile Info
Age at interview: 26
Sex: F
Age at diagnosis: 12

Background: Sara is the mother of a young daughter and was pregnant at the time of her interview. She has been living with her daughter and fiancé in various places, none of them permanent. She is Caucasian.

Click here to view Sara's profile page
Myra imagines other possibilities to the situation that she's facing and is able to cope with her feelings of nervousness.
Interview Transcript

Sometimes it, it, it is really helpful. Like I’ll picture that or sometimes if I’ve, my thoughts are racing, I’ll just picture a big, fat stop sign. That’s been really helpful to me as well. And from there, I can say, wait a minute, you’re at the stop sign, there are these other possibilities with this situation. Or it can work out this way, you know?

Not a lot of people, not a lot of people tend to do that. Not — and I actually had to train myself to do that. Like I think I just read about just how to stop an anxiety attack and that I think that was one of the, one of the coping mechanisms to picture a big stop sign and consider other options. So that, that’s a big one for me.

Now, was that something you, you invented yourself? Did you, where did you learn about that, the stop sign?

I don’t remember what article it was in.

Yeah, uh-huh.

I think it was in a magazine or something.

Uh-huh.

But, but and I tried it a few times and now it just comes like second nature. Yeah, if, if I’m, if I’m just feeling kind of down or my thoughts are racing, then I’ll try picturing the big fat stop sign and that helps a lot.

DEP Myra
Profile Info
Age at interview: 28
Sex: F
Age at diagnosis: 27

Background: Myra is a musician works as an aide to older adults. She lives with her fiancé. She is African American.

Click here to view Myra's profile page

Telling others about anxiety in contrast to depression

A few people said they felt their anxiety feelings were something they could discuss with others because “everyone knows what anxiety is”. Sara described that her mother thought with depression she “could just get out of bed” but with anxiety she should be on medication.

Seeing a health professional for anxiety

Several people said they saw a health professional such as a therapist to help manage their feelings of anxiety and to talk about their problems. Others received medication from a physician. Those suffering from social anxiety, however, found it particularly hard to reach out for help precisely because interactions with other people are so difficult.

Jacob describes how social anxiety impacted his ability to seek help.
Interview Transcript

I didn’t start that right away is because I have some social anxiety mixed in with my depression. Which made it very difficult to do anything other than just sort of reflect personally on it and I still haven’t gotten past the phase of, I don’t know if embarrassment is necessarily the right word , but I still had that reluctance of talking to anybody about it, I just wanted to keep to myself at the time.

DEP Jacob
Profile Info
Age at interview: 25
Sex: M
Age at diagnosis: 18

Background: Jacob is a software engineer at a large company. He lives with his girlfriend and a cat. He is White.

Click here to view Jacob's profile page

Anxiety and eating disorders

Some reported difficulties with eating when they felt anxious or depressed. For more about this topic, see ‘Depression and eating disorders’ and ‘Signs and symptoms of depression.’

Anxiety and self-harm

A few people felt a desire to harm themselves to relieve anxiety. (For more about self-harm see ‘Depression and self-harming’).

References

*”Behavioral Health in the United States, 2012”. Substance Abuse and Mental Health Services Administration, n.d., 7 February 2016.

*1 Kessler, Ronald C., et al. “Comorbidity of DSM-III—R major depressive disorder in the general population: Results from the US National Comorbidity Survey.” The British Journal of Psychiatry (1996).

*2 Sareen, Jitender. “Anxiety disorders and risk for suicide: why such controversy?.” Depression and anxiety 28.11 (2011): 941-945. http://onlinelibrary.wiley.com/doi/10.1002/da.20906/full

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