How To Spot Anxious Depression In Teens And Adults 2024

where you start off with something like obsessive compulsive disorder, where you have these overwhelming thoughts that you can't get out of your head or rituals that you can't stop doing or you may have generalized anxiety disorder where you're gripped with worry and fear. Some people's anxiety can be so bad that they wake up every morning and throw up or they can feel like there's this heavy weight pressing on them all day. Some people feel like their throat is closing all day long and this is a horrible way to feel especially when there's not a clear reason to feel anxious. You can start to think what's wrong with me, why can't I feel normal, feeling like this for weeks or months on end can make some people sink into a depression. 

In this case, you would have two disorders, the original anxiety disorder and then a depression that's one scenario. Another scenario is when your primary problem is depression having no joy, feeling hopeless, and hardly having the energy to do anything. Instead of feeling a heavy weight on your chest all day, you feel tears just behind your eyes all day, ready to stream at the slightest provocation. In fact, you'd probably need to go off and cry occasionally, but it's not one of those nice cleansing cries

where you feel like you purged pent-up emotions. It's crying on top of pain and the tears don't release anything. You still hurt even after you've cried. This is what your depression might look like if you had pure depression but many times people have anxiety symptoms mixed in with their depression. The anxiety doesn't really rise to the level of a full disorder like panic disorder or generalized anxiety disorder. But its presence is enough to make the quality of the depression different. The term for this is depression with anxious distress. Anxious distress is what we call a core specifier. It gives more specific information about how your depression looks and behaves.

Here's The Criteria For The Core Specifier

This is from the Diagnostic and Statistical Manual of Mental Disorders 5th edition. Anxious distress is defined as the presence of at least two of the following symptoms during the majority of days of a major depressive episode or persistent depressive disorder, dysthymia. Let me jump in here. This is saying that this specifier applies to either depression or this re-imagined entity called persistent depressive disorder, formerly called dysthymic disorder which is a chronic lower level of depression that hangs around for at least two years. So you need to have these. Feeling keyed up or tense, feeling unusually restless, difficulty concentrating because of worry, fear that something awful may happen, feeling that you may lose control of yourself. Every time I hear it reference to losing control, I think of the Android and the original Alien movie when it was discovered that he wasn't real
and he started malfunctioning. This is not what it looks like to lose control. You may fear that this is what you'll be doing but that fear is part of the anxiety, imagining extreme behaviors but losing control can be as subtle as not being able to stop yourself from doing something destructive like quitting your job. Two of these symptoms put you in a mild level of anxious distress. Three symptoms are moderate four to five are moderate to severe and four to five with motor agitation are considered severe.

What is motor agitation?

Motor just refers to your body movements and agitation is increased physical activity. It could take the form of pacing or leg shaking, it's usually movement that doesn't have any real purpose. So it could be incessant throat clearing or pin clicking. Scientists have seen differences in the brains and blood work of people with anxious depression compared to non-anxious depression. The brain imaging shows thinning of the gray matter in parts of the brain. The gray matter represents densely packed nerve cells and looks great on a scan. This is also called cortical thickness. One of the references in the description uses this term.

Why does all of this matter?

Because anxious depression tends to be harder to treat than depression without the anxiety mixed in.  In my experience, this is where people fall into the treatment resistant category. Treatment resistance is usually used when someone fails to get better from one or two antidepressants, also people with anxious depression are more likely to have a negative experience with antidepressants like having your anxiety ramp up when you first start medication or even feeling more depressed when you first start the antidepressant. And when this happens, it could be very discouraging. So should we just all pack up and go home? No, all is not lost and if you know ahead of time that starting medication can make you feel worse first, then you can be prepared for the long haul by trying different agents. Also, this means that you will probably require more than one antidepressant to get and stay better. 

 Uncomplicated depression responds well to one antidepressant and often this can be treated by your primary care doctor. And you may not need to see a psychiatrist but anxious depression that does not respond to a single medication usually requires a psychiatrist to look at other options. Some of these are off-label meaning that they're used for the drugs that we use outside of their approved purposes. For anxious depression in addition to the antidepressant, we will use anti-psychotic medications like aripiprazol or brexpiprazole. Sometimes we add on an anticonvulsant like Lamotrigine or Gabapentin. Of course, psychotherapy in combination with medication is more helpful than medication alone. So the moral of this story is if you have depression with anxious distress, be prepared that you may need more than one medication to treat your condition and you may have to try a few before you get one that works well with the least amount of side effects.