Monday, June 18, 2012

Why anxiety and depression coexist?

We often see anxiety and depression coexist "hand and hand" in General Practice.  Why?  This is my opinion.

When I see someone with both anxiety and depression, I try to differentiate their problem into 2 types.
  1. The primary problem is the anxiety, and the depression is secondary.  What do I mean by this?  Well, the person is predominantly anxious, a worrier, and tends to "need" control of their external environment.  They tend not to be able to let things go easily, and tend to be a "fixer" of their environment in order to control their own anxiety.  They like routine, structure and predictability.  They tend to be a perfectionist, self critical, and if this is not managed properly, it can lead to a fear of failure, a fear of not being good enough and ultimately, fear of being judged and poor self esteem.  Of course, if the anxiety is managed well, and the anxiety is able to be "harnessed", then the outcome can be very good.  In actual fact, most high achievers are very anxious people.  However, like anything in life, a powerful tool is in essence a double edge sword.  If the anxiety is not managed well, then this can then lead to a lot of problems, a lot of drama, a lot of disappointments and conflict, and ultimately, this can then lead to depression.
  2. The second type is defined as "the primary problem is the depression and the anxiety is secondary".  This is probably less common in my clinical practice.
In summary, it is my belief that in most cases of depression and anxiety (at least in my clinical practice), it is actually the unresolved anxiety, or the poorly managed anxiety, that leads to the depression.  So understanding this may help us in some ways, prevent depression.

So here are my general tips:
  1. Be more self aware ie Are you an anxious person?  Are you a perfectionist? Are you self critical?  Do you have a fear of failure?  Do you know yourself well?
  2. Learn the skills to manage your anxiety better.  See anxiety as a strength rather than an absolute weakness. You can learn to manage it better.
  3. Learn to be more self aware and centred, learn life skills to fix the things that you can fix, and just as importantly, learn to let go of the things that you cannot.  "Letting things go for now" is often the hardest thing for an anxious person but that which can be learnt and cultivated.

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