‘Comorbidity’ sounds like an intimidating term, but it is simply a word used to describe a situation where a person is living with two different medical or psychological conditions. Depression and anxiety frequently go hand-in-hand, and often people discuss experiencing both conditions at one time or another. They may either be present simultaneously or each present intermittently. Around 60% of people with anxiety also have depression and anxiety at some point in their lives, and there are a similar number of people with depression that will have anxiety at some point. Although it’s not clear why these two seemingly separate conditions are linked in this manner, there are two working theories. The first is that they have similar underlying biological processes in the brain, meaning that there is a lot of crossover between anxiety and depression at a neurological level. The other is that they have a lot of overlapping symptoms, and therefore both conditions may be part of a larger syndrome.
Although there isn’t a specific cause for depression and anxiety together that can be identified, it is known that people who are socioeconomically disadvantaged or have a chronic illness or disability are more susceptible to conditions like depression and anxiety. Women are also at greater risk for both conditions than men. In general, people with comorbid anxiety and depression describe experiencing anxiety for several years before depression became noticeable, although there are people who experience depression before anxiety.
Comorbid depression and anxiety can be very debilitating for a person, more so than either condition on its own. It is estimated that comorbid anxiety and depression account for around 2% to 4% of medical disabilities around the world. The symptoms associated with each condition tend to be more severe when depression and anxiety occur together.
When two or more conditions are present, diagnosis can become more difficult. Clinicians are of cautious of ‘overdiagnosing’, and the overlapping symptoms of depression and anxiety often mean only one of these conditions is diagnosed. To add to this, a lot of the symptoms observed in comorbid depression and anxiety can be confused with other mental health conditions, such as bipolar disorder. This can have some impacts on treatment, as these conditions are treated differently. Furthermore, when anxiety and depression are comorbid, they are much harder to treat than when they exist alone, often requiring a combination of therapies over a longer period of time. This is mostly due to the increased severity and duration of symptoms, not because this is something ‘more wrong’ with people who experience comorbidity. As with most mental health conditions, early intervention is important when combatting this condition.
Depression DSM-5 Diagnostic Criteria
The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual must be experiencing five or more symptoms during the same two-week period and at least one of the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
- Depressed mood most of the day, nearly every day.
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.
- Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day.
- A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down).
- Fatigue or loss of energy nearly every day.
- Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
- Diminished ability to think or concentrate, or indecisiveness, nearly every day.
- Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.
Anxiety DSM V Diagnostic Criteria
A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
B. The individual finds it difficult to control the worry.
C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
- Restlessness or feeling keyed up or on edge.
- Being easily fatigued.
- Difficulty concentrating or mind going blank.
- Muscle tension.
- Sleep disturbance
D. The symptoms cause significant distress and impact upon the person’s interactions with others and regular functioning.
There is real difficulty in managing depression and anxiety as they are interchangeable throughout the day and the struggle feels never ending on most days. Some people one condition is more present and more problematic than the other and this too can change throughout different stressors.