The Fuzzy Line Between Anxiety and Depression

People often experience both anxiety and depression. In fact, Psychology Today refers to them as “two sides of the same coin.” 

Susan Bernstein, a Connecticut-based licensed social worker and marriage and family therapist with expertise in domestic violence, agrees that the two conditions often go hand in hand. 

“Even though depression can have its own very distinctive symptoms and anxiety can have its own very distinctive symptoms, they tend to overlap in many ways,” Bernstein says. “The biggest is emotional dysregulation.”

With depression, typically you feel like everything slows down and becomes muted. You’re achy or in pain, you have diminished capacity to do things, and you’re uninterested in activities and experiences.

“You’re sad, you don’t want to get up, you don’t want to feed yourself, everything aches,” Bernstein says. “You think, ‘How will I go on? Will this pain ever stop?’”

Anxiety can send your emotions in the opposite direction. “You’re hyperaroused and hypervigilant. Your brain and body are in overdrive—your motor is on and can’t stop,” Bernstein says.

But some people with anxiety can also come to an abrupt stop and sleep. “Other people can’t sleep—they’re hyperaroused and can’t let go,” Bernstein says.

Problems with judgment and concentration overlap in both anxiety and depression. “Judgment gets impaired—people think, ‘I can’t think about that right now.’ And they can have trouble concentrating, following through, and staying on task,” Bernstein says.

And some people with depression can also have mania, which can mimic anxiety. 

Sorting out the two conditions can be tricky. “You have to understand what the symptoms of anxiety are in its purest form, and what the symptoms of depression are in its purest form, and see where they mingle,” Bernstein says.

Domestic Violence Can Trigger or Worsen Symptoms

Trauma can exacerbate anxiety and depression. Ideally, when someone endures trauma, they should seek treatment quickly so the effects don’t linger. That’s why with first responders, mental health specialists offer counseling right away. But with domestic violence, it’s not uncommon for survivors to minimize what they went through or keep it a secret all together, never seeking treatment. 

“With trauma, especially sexual trauma, those wounds are hidden,” says Bernstein. Survivors frequently find their own ways to cope and move forward, pretending they’re OK when they may not be.

“They come into a room as if nothing is wrong,” Bernstein says. “They don’t want to crack that façade that is holding them together. And that façade becomes who they are for years.” 

But that coping mechanism sometimes gets overpowered. That happened to a lot of people with the #MeToo movement, Bernstein says. Survivors coped by keeping their history of abuse private, but suddenly the topic was coming up in the news, in conversations with friends, and in the grocery line.

“The #MeToo movement has triggered so many people who have gone on quietly as survivors of trauma. Things had been dormant because their coping strategies worked, but they stopped working,” Bernstein says.

Therapy and Medication Can Help

Survivors are often diagnosed with anxiety, depression or both conditions—and the diagnosis is important for best practices in treatment and for insurance coverage. But what’s crucial is focusing on treating the symptoms that are getting in your way, Bernstein says. 

Counseling can help survivors find new ways of coping. “We retrain the brain to get back its healthier connections. We let the memory get filled in with new resources to take from and move forward with,” she says. 

Anxiety and depression are often linked with childhood trauma, which could include abuse, neglect or witnessing violence. “I have to tread respectfully and carefully,” she says.

She says sometimes it can take time for people to feel comfortable discussing their past. “As a therapist, I have to respect what brought them through my door,” she says. “Patients have a right to undergo the therapy they’re willing to talk about. That’s where I start, and I hope they will eventually allow further exploration or allow me to probe into an area I think is related.”

Bernstein says that certain medications can also address both anxiety and depression, but some aren’t appropriate for certain people. For example, if you have bipolar depression you need to avoid medication that could trigger a manic state.

Self-Compassion Is Crucial to Healing

Bernstein says when we think about what survivors should do during or after abuse, the focus should be on self-compassion. “That’s a term I have embraced in my work and I wish I heard more often. It’s so simple,” she says. “Self-compassion means understanding there’s a reason why we do what we do. We don’t have to judge ourselves or judge other people.” 

She also says it’s important to remind people that the condition they’re facing is temporary: “We can’t change the past or what was done to us, but we can evolve and find better ways to cope with it and continue to grow. We can surround ourselves with supportive people and do some reality checking, reassurance, and validation.”

Survivors need to expect they will have tough times, and focus on self-compassion. “There’s no one-and-done in treatment. You’re going to get triggered. It’s about how quickly you can recover and move through life. You trip, you fall, you get up and brush yourself off. You might have an exaggerated response, but you can think, ‘I’m safe now, I’m good, I’m moving on.’ That’s the recovery,” Bernstein says.

Watching for Anxiety and Depression in Children

In children, symptoms of anxiety and depression may look different, but you’ll likely spot some sort of emotional dysregulation. “They’re children. They lack the capacity in their own development to understand what’s going on, so they’re going to try to make sense of it in other ways,” Bernstein says.

Be alert for signs of regressive behavior—thumb-sucking, bedwetting, or outgrown coping strategies like sleeping with the light on, not wanting to be alone, or an extra level of neediness.

Children may also isolate themselves, be more agitated, shut down, or be angry, fearful or apathetic. Bernstein says to ask yourself, “What was the personality you’re used to? What is the new personality presentation? What behaviors seem to have changed? Who are the people they are gravitating to, and who are the people they are avoiding?”

Mental health counseling can help, but keep in mind that even if you know your child has witnessed or experienced trauma or abuse, a counselor might not address that right away. Some children aren’t ready to talk about what they’ve experienced. Bernstein says it’s important to first create a supportive, validating, safe place for them.