Some people suffer from severe anxiety or depression symptoms, while others have subtle signs that are commonly brushed aside. For millions of children, adolescents and adults, anxiety can be paralyzing, and its constant presence can wreak havoc on health, sleep and other aspects of daily functioning. Major depressive disorder is the leading cause of disability in the U.S. for people ages 15 to 44.2 It can become so severe that it is refractive to treatment and is a significant cause of suicide.
Below are the estimated numbers of people in the U.S. with disorders that fall within the anxiety disorder spectrum. The last two are not anxiety disorders in the strictest definition, but most organizations list them as such because they are closely related.3
Experts believe the two primary underlying causes of anxiety are genetics and stress. Studies have shown that some families have a higher than average number of members with anxiety-related issues, which suggests a familial link. Anxiety disorders can also be the result of stressful or traumatic events, such as abuse, the death of a loved one or chronic physical illness.4
While not all of the following behaviors imply the presence of a full-blown anxiety disorder, they may be a red flag and warrant an evaluation by a mental health professional. The symptoms vary based on the type of anxiety disorder.
Generalized anxiety disorder: This is characterized by persistent, excessive and unrealistic worrying about everyday things.6
Panic disorders: The most obvious symptom is a spontaneous seemingly out-of-the-blue panic attack and a preoccupation and fear of a recurring attack. A panic attack is characterized by the abrupt onset of intense fear or discomfort that reaches a peak within minutes, including at least four of the following symptoms.7
Social anxiety disorder: Symptoms vary from person to person, but the following are some of the most common experienced by people with social anxiety disorder:5,8
Phobias: Irrational fears can involve a variety of things, including the fear that people are watching or following you, an extreme fear of objects (e.g. dogs or spiders), or situations (e.g. flying, elevators or social situations). Irrational fears can become obsessive in nature, leading to persistent and intrusive thoughts that create significant anxiety and detrimental behaviors.9
Obsessive compulsive disorder (OCD): Repetitive, irrational thoughts may be accompanied by compulsive actions, routines and rituals performed over and over again. The thoughts and rituals associated with OCD can cause terrible inner turmoil and interfere with optimal daily functioning.10
Post-traumatic stress disorder (PTSD): While both men and women can experience the cardinal symptoms of PTSD (hyperarousal, re-experiencing, avoidance and numbing), some behaviors are more prevalent in women than men, including:
The exact cause of depression is unknown, although experts believe it is related to chemical changes in the brain and a likely genetic link since depression tends to be more prevalent in some families. Depression can also be triggered by certain stressful events such as abuse, the death of a loved one, physical illness, chronic pain, substance abuse, medication side effects and sleeping problems.13
Symptoms vary depending on severity of the depression, the person’s age, co-occurring mental health disorders and a number of other mitigating factors, but may include:
Scientists have long believed there was a connection between chronic pain and anxiety, but the underlying correlations were not well understood. Research published in August 2016 showed expression of PACAP (pituitary adenylate cyclase activating polypeptide), a peptide neurotransmitter the body releases in response to stress, increased in response to neuropathic pain and contributed to anxiety symptoms. While there was a notable increase in anxiety-related behaviors in models of chronic pain, the anxious behaviors and pain hypersensitivity were significantly reduced when a PACAP receptor antagonist (designed to block the response) was applied.14
Chronic pain and major depressive disorder (MDD) are highly prevalent and frequently co-occur. While the causes of chronic pain and depression are poorly understood, evidence indicates genetic factors play a role. Recent research showed that genetic factors, along with chronic pain in a partner or spouse, contributed substantially to the risk of chronic pain for an individual. Furthermore, the findings suggest that the presence of pain in one spouse/partner increased the likelihood of MDD in the other spouse/partner. Interestingly, the analysis showed chronic pain was associated with an increased genomic risk for MDD. However, the reverse was not true.15
Cognitive behavioral therapy (CBT): Emotional and mental problems can cause normal information-processing abilities to break down due to a consistently negative bias introduced into thinking, thereby perpetuating an ongoing cycle of negativity. CBT helps people learn to identify, challenge and transform distorted beliefs and negative, irrational thoughts into ones that are empowering, realistic and positive. It also teaches people healthy coping skills and behaviors. When people change the way they perceive themselves, this changes the way they react to and view the world around them. As a result, depression, anxiety and even physical pain are no longer debilitating.
Medications: Antidepressants are used to alleviate feelings of depression, but some may be prescribed for anxiety disorders and in smaller dosages for people with chronic pain. There are several different types of drugs used for the treatment of depression including selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants, tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).
Alternative therapies: Mindfulness approaches may include relaxation therapy, meditation or guided meditation walks. Biofeedback is an alternative therapy that teaches people to consciously control automatic body functions, such as reactions to stress or anxiety. Some treatment programs incorporate yoga or tai chi. Acupuncture may help relieve pain because it is believed to release endorphins that block feelings of pain. Always talk with your doctor to ensure alternative therapies do not interfere with conventional depression, anxiety or chronic pain treatments.