Anxiety & Depression
It has become a common social practice to refer to “my anxiety” or to say “I’m feeling kind of depressed today.”
But what do these actually mean? What do we do about it?
We could reference the clinical definitions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR, 2022), but you’ve probably not read it. You aren’t checking boxes. You feel a particular way, “anxious” and/or “depressed” feel like the correct terms, and you want help.
So let’s start with some descriptions that might be more helpful. Let’s not lead with “diagnoses” but with “states of mind” you may be experiencing.
Anxious State of Mind
Feeling situationally or chronically:
Preoccupied with fear and/or safety
Aware of faults or dangers
Closeness with others is dangerous
In need of protection
A need to avoid risk
Worried without a clear cause
Inadequate
Indecisiveness
Depressive State of Mind
Feeling situationally or chronically:
Self-critical, not good enough
Like a failure
Afraid of rejection
Sad / despairing
Guilty / ashamed
Apathetic
Empty, isolated
That things are meaningless
Helpless and/or hopeless
Like you are stifling anger
Why Is This Happening to You
Anxiety and Depression are commonly co-occurring and significant research has posited them as two sides of the same coin or extensions of the same causes. The approaches I use in therapy see them in this way.
Anxiety can be viewed as a reaction to a perceived loss of value. What might we value? Safety, success, relationship, sense of identity, opportunity, and meaning to name a few. When we find ourselves wondering what we would do without these or if one has already been stripped away from us, we feel anxious. What happened? What else could happen? Is this all my fault? What can I do about it?
Some people stay in that space for quite a while. For others, these thoughts are so exhausting they give up thinking about it; they feel helpless and they become hopeless. The resulting despair describes Depression - something has been lost, and not knowing how to reclaim it, we become stagnant. The thoughts accompanying depression are seldom still questions. It’s all my fault. There’s nothing I can do. This will never improve.
The thoughts and feelings of Anxiety and Depression are actually signals telling you what’s wrong. I am afraid to take risks. I feel guilty I didn’t address this sooner.
What Can We Do About It?
The focus of therapy, in my view, should be to uncover what is missing in your life (i.e., what was lost) and resolve how it can be reclaimed. You may not know when the change began or the cause offhand, but you can feel the need to reroute - to find a direction that’s right for your personal values and goals. It not about doing the perfect or “right” thing; we all stumble as we go through life. However, by developing capacities, fostering resilience, and making active choices, we can overcome depression and tackle anxiety as it arises. Hopefully, the work of managing anxiety transforms into the work of seeking fulfillment.
Regarding Clinical Anxiety or Depression
Legally, a clinical diagnosis requires the above, plus some of the following: Chronic fatigue, Changes in appetite and/or weight, Restlessness, Difficulty concentrating, Irritability (for anxiety), and Contemplating suicide (for depression).
In addition, these must occur for a period of two weeks or more for depression or for a period of six months or more for anxiety…
…and “cause significant distress or problems in social, work, or other important areas of life.”
While these definitions have been vetted numerous times by research,
I find it ridiculous you are expected to struggle for that duration before seeking help.