Season 1, Episode 11: The Connection Between Anxiety and Depression
Depression and anxiety are different, but it’s quite common to experience the feelings of anxiety and depression at the same time.
On this episode of Living Fully, Katherine Hurtig talks with registered psychologist, Wardah Elahi, about the differences between these two mental health concerns and why they often show up together. Learn tips and strategies to manage the symptoms of anxiety and depression.
During October 2–8, Calgary Counselling Centre and Counselling Alberta encourage you to check in with your mental health through a short, anonymous, and free online quiz at areyoufeelingok.com. Check in with how you’re feeling and get help if you need it. The quiz takes about three minutes and is available in English, French, Spanish, Punjabi, Chinese, and Ukrainian.
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Katherine Hurtig
Welcome to Living Fully, a Calgary Counselling Centre podcast. Each episode, we'll bring you insights from our expert counsellors and tips and strategies to improve your mental well-being.
I'm your host, Katherine Hurtig.
Calgary Counselling Centre and Counselling Alberta provide effective counselling for anyone in Alberta with no waitlist and no financial barriers. Find us online at calgarycounselling.com or counsellingalberta.com.
Depression and anxiety are different, but it's quite common to experience the feelings of anxiety and depression at the same time. In this episode, I talk with Wardah Elahi about anxiety and depression, how these mental health concerns are different and why they often show up together. She'll also give tips and strategies to manage the symptoms of anxiety and depression.
Katherine Hurtig
So, to start out, can you tell us about the relationship between anxiety and depression and how they can kind of coexist?
Wardah Elahi
Yeah, they're actually both internalized disorders. They're highly comorbid, so they do occur. Like, if you have one, then the chance of acquiring the other is there. So, the chance of acquiring depression is much higher when you have an existing anxiety disorder. And a lot of research indicates that generally anxiety does come before depression, and anxiety generally tends to happen in preadolescence or when you're in early adolescence, and then depression occurs during adolescent years to mid adulthood. And the same way anxiety can be a symptom of depression, and it's also common to have depression that is triggered by anxiety. Yeah, they're very highly related.
Katherine Hurtig
So, what kind of differentiates between the two? What does anxiety look and feel like? What does depression look and feel like?
Wardah Elahi
A lot of the traits sometimes overlap. Some of the common symptoms that are present are things like irrational worries or fears that won't go away, physical symptoms such as fatigue, headaches, rapid heartbeat, labored breathing or abdominal pain. Things like difficulty going to sleep or staying asleep, changes in eating habits, either you're eating too much or too little. Yeah, things like trouble remembering, making decisions or concentrating. That's just kind of some of the things that are similar.
But the difference with anxiety disorders is you experience excessive fear that interferes with your functioning. And with depressive disorders, you experience this sadness, emptiness, irritable mood, and along with that, cognitive changes that significantly affect your capacity to function. Depression is more like ruminative, and then anxiety could be about the future.
Katherine Hurtig
As a counsellor, what have you seen in your clients when there is that overlap of anxiety and depression?
Wardah Elahi
Some really common observations are that people mistake one for the other. A lot of my clients will sometimes come in and say, I'm experiencing one or the other. And then when they do describe some of the symptoms, I'm kind of like, okay, it does lead more towards the other. Or sometimes I do notice that people will be in a different state at different points in their life, so sometimes they feel more anxiety and in other stages they feel more depressive symptoms. But it's very common in my work for people to have experienced both at the same time or at different times.
Katherine Hurtig
Is that fairly common for clients to almost diagnose themselves?
Wardah Elahi
At times, yes, it can be like either they read up on it or they know family members who've been diagnosed and then they kind of compare and contrast that way. But usually when that happens, my main recommendation is to go get a diagnosis and talk to their healthcare provider or psychiatrist or a psychologist that could diagnose.
Katherine Hurtig
Is that official diagnosis -Is that necessary to get help?
Wardah Elahi
No, I don't believe so. It can be very obvious if something is not functioning the way it's meant to. And if you're struggling, then of course reach out whether you have a diagnosis or not. I don't think that's a necessary prerequisite, but I think it's just good to know about yourself because it's just a thing that you could use to explain to your supports and loved ones. This is something that has come about and a lot of times, let's say you're a student in school. It can maybe help you get accommodations for tests and quizzes and assignments. So, there's benefits to it, but no, you can reach out to counselling anytime.
Katherine Hurtig
Right. I like what you mentioned about students. I didn't even think of that. I guess that's a lot more common now is a great thing that we are kind of making those accommodations and helping people out when they're struggling. Personally, I've dealt with both of these things for sure in my past, and for me I did kind of like getting that kind of official this is an explanation for what you're going through. But yeah, I think it's important for people to know that a medical professional or whatever, they don't need to tell you that you're depressed or anxious for you to reach out and figure out what's going on and get help.
Wardah Elahi
Exactly 100% agreed. It is very important to just know and be self-aware. You know yourself best, and if you notice that you're struggling at different points in your life, then reaching out is the best thing to do for sure.
Katherine Hurtig
How do anxiety and depression affect different age groups? Like, are there any noticeable differences?
Wardah Elahi
Yeah, so for children, depression isn't common in children under twelve, but it does occur. So along with feeling sad or hopeless, common signs include problems at school, loss of interest in fun activities, changed eating habits, weight gain or loss, clinginess, anxiety, difficulties with family members, and avoiding school and social activities. And then in teens, there's wide mood swings, which are normal in the ages twelve to 18. But to be on the lookout for depression, watching for mood changes that last longer than a few weeks.
Katherine Hurtig
Okay.
Wardah Elahi
Problems at school, home or with friends. Unusual levels of irritability and lashing out, feelings of worthlessness anger and extreme sensitivity, sleeping or eating too much, avoiding friends and others, a loss of interest in activities, or self-harm behaviors such as cutting and alcohol or drug use.
So many of the same life issues that affect young children can lead to depression in teenagers. And in addition, in teens may come from a pressure to fit in, to succeed and mature. Hormonal issues, sexuality concerns, lack of sleep and being rejected by peers.
Katherine Hurtig
Yeah, there's a lot going on in those teenage years, for sure.
Wardah Elahi
Definitely very volatile, for sure. And then in young adults, ages 19 to 29, sometimes they develop depression due to major life transitions. So, university, lack of support in their environments, lack of coping skills, relationship issues, poverty, trauma, work issues, and more.
Katherine Hurtig
Yeah
Wardah Elahi
And then in adults ages 30 to 60 tend to have a lot going on that can trigger depression.
So, caring for children as well as aging parents, financial stress, isolation, work and relationship issues, menopause and perimenopause, dealing with any major illnesses, and just a lot of responsibilities with no relief in sight. And then for senior adults’ depression is not a normal part of growing older, but it is common, and it’s frequently overlooked and left untreated. So, symptoms in seniors can include trouble sleeping, fatigue, sadness and anxiety making decisions, mood changes that don't let up, physical aches and pains are often signs of that as well. And just dealing with common late life issues such as major losses, such as a death of a spouse, social isolation, financial stress and health problems, and illnesses and medication can also set some of those symptoms off.
Katherine Hurtig
Yeah, it can definitely look a little different with each generation, for sure.
Wardah Elahi
Yeah. So, it's helpful to know these things.
So, if you are wanting to support somebody, these are things you should be looking out for.
Katherine Hurtig
And how else can anxiety and depression occur? How can it develop? Whether that's events that we've experienced or people in our lives.
Wardah Elahi
There’s no specific gene that points out to this will cause depression. But depression and anxiety do play a genetic role as well as things like stress and trauma. Any adverse events when you're younger: abuse, assault - anything like that can increase somebody's risk of developing depression.
There are also certain personality traits that are associated with increased risk of these disorders.
Katherine Hurtig
Really?
Wardah Elahi
Yeah. Stress can make anyone upset.
But people who are prone to catastrophizing or becoming extremely upset when they're under stress are at higher risk of becoming depressed. And people who are prone to things like perfectionism, self-criticism, and negativity are likely to develop depression and anxiety more so than others. One of the main symptoms of depression is like, pervasive, uncontrollable thoughts of low self-worth and guilt, a sense of hopelessness. And people who are naturally inclined to view themselves critically or have trouble with optimism can also risk becoming depressed. So, there's a lot of different factors that could contribute to an increased risk of both of these disorders.
Katherine Hurtig
So, these personality traits I mean, correct me if I'm wrong, but I don't know how it's not super easy to just change our personality if we have these personality traits. Are there ways to kind of prevent anxiety and depression?
Wardah Elahi
I would say that if you are prone to these things and if they're causing an issue in your life because sometimes you could have these things and they don't really cause an issue and you're functioning, but other times if you do notice that it's harming your work or relationships or anything like that, then I think the self-awareness of it that like I tend to be perfectionistic or self-critical. Right. Knowing those things about yourself and what the effects of them are can really benefit you. And noticing, like, okay, if I do think this way, what can I do about it? Right. What are things that I can think about differently? What are actions that I could do differently so that it doesn't harm my relationships or my functioning?
Katherine Hurtig
In your work with clients, how do you help them overcome or manage anxiety and depression? What things do you get them to work on? What strategies do you suggest?
Wardah Elahi
So, typically when someone does come in with anxiety or depression, the first thing I do focus on is sleep, exercise, diet, things like that.
Katherine Hurtig
Okay. Really back to basics.
Wardah Elahi
Yeah, really, because those things are key, and it's really just worth investing into those. And we can talk more about that later on as well, about specifically why that's important. But other things I would suggest is really keeping a record of your thoughts and knowing how your thoughts affect you. Kind of writing them down and looking at them from a distance, right. Once the emotions relating to that pass and thinking about what could you have thought differently? How could you have challenged that thought?
Is that thought based in reality or just based on emotions? Just critically thinking about those things.
And the other thing I really teach my clients is how to regulate their emotions. So grounding techniques, meditation, deep breathing, things like that. But those are pretty much the areas that I would start off with to kind of support somebody going through this.
Katherine Hurtig
Excellent. Yeah.
In my own counseling experience, that practice of challenging thoughts and stepping back and looking at it with a bit of distance was actually really helpful. And just coming up with alternatives. Because I think when you're going through anxiety or depression, I think your mind really plays tricks on you, and you think and feel things, and it feels very real and true, but that's not necessarily the case.
So, I think that practice of coming up with alternatives can be really beneficial.
Wardah Elahi
Agreed. And I also think our brain can kind of convince us of anything, so it's important to keep it in check.
Katherine Hurtig
So yeah, you touched on going back to basics and the physical aspects of our health like sleep and exercise and diet. Can you talk about how those things impact our mood and can have a relationship between anxiety and depression?
Wardah Elahi
For sure. Diet, sleep, and exercise can really impact how you feel about yourself, and it plays a huge role in how we regulate our mood. The mind and body are very connected. So often people who are stressed or fatigued or mentally just down are usually under exercised, undernourished, and under rested. And a lot of times, people think it takes too much time to tend to their body or it's too difficult. But you can't ignore your body and expect to feel good.
Katherine Hurtig
Of course.
Wardah Elahi
Time invested in your physical health is a wise investment. And yeah, I always ask my clients in their first session what their sleeping and eating habits and exercising habits look like because it's so vital.
Exercise affects our self-esteem, and it can also be a way to cope with both depression and anxiety. And it also helps us to sleep better. Diet can affect mood swings, so someone who is skipping meals or with a poor appetite can increase the severity and duration of depression. Additionally, people who follow extremely low carbohydrate diets also run the risk of feeling depressed. There are certain brain chemicals that promote feelings of well-being, such as serotonin. And serotonin is triggered by healthy carbohydrate rich foods. So, if you're not eating them, then those brain chemicals are likely lower.
Katherine Hurtig
It's beyond the scope of this podcast, but yeah, it's sad how the diet industry is. You're always hearing that a certain macronutrient or whatever is the enemy, but we need all of them to function properly.
Wardah Elahi
Exactly. So having a balanced diet is key and essential to mental health. Yeah, they're just kind of picking what is healthy for you and your body and then going back to the sleep part is finally like lack of sleep can also lead to mood swings and fatigue, impaired memory and concentration and it affects the way we live.
So, to summarize, just please take care of and honor your physical health because it's so important.
Katherine Hurtig
Now, you had said some people don't feel they have the time to address these things. If the idea of overhauling your physical health is overwhelming, you know, like why can't eat super healthy and exercise and sleep 8 hours a night? If you could recommend prioritizing just one of those things to our
audience, what do you think would make the biggest difference starting out?
Wardah Elahi
I think I personally would say sleep because that definitely affects mood, which also affects our appetite. So usually if you're not sleeping, then you're not feeling that hungry anyway, and then that turns into that cycle. And then if you're tired, then you're too tired to exercise.
Katherine Hurtig
Yeah, that makes a lot of sense because I find that if I'm really tired, I have a greater appetite and not necessarily for salads or anything like that. And I wouldn't have the energy to exercise. So, it sets you up for failure right away if you're not getting the right amount of sleep.
Wardah Elahi
Yeah, exactly, that's. What I would recommend is if it's too overwhelming, just slow yourself down and take a good nap.
Katherine Hurtig
Yes, I will always follow that recommendation. For sure. Love a good nap. Let's talk about socialization, what role it plays in depression, anxiety, and how to use it to help manage those.
Wardah Elahi
So, what do you mean by socialization?
Katherine Hurtig
Like social support, whether that's friends, family, a community, that kind of thing.
Wardah Elahi
Social support is so key because we're humans and we're social by nature. We do need alone time, but most people really enjoy spending time with loved ones and people they trust, and pretty much I would define social support as any individual who can provide some type of care advice or be a sounding board for the person in need. Based on that definition, please reach out to your social support. And it can include family, friends, religious clergy, therapists, support groups, anything like that could be social support.
Katherine Hurtig
I mean, I've definitely been in this spot, and I'm sure others have too, where if you're in that depressive state, sometimes you really just don't feel like being around anyone. So, what advice would you give to someone in that scenario to motivate them to put themselves out there and seek out that support?
Wardah Elahi
I'd say when that happens, that's definitely the depression talking and being loud. Right. Because we rationally know that we feel better after we see friends or family.
Katherine Hurtig
That's true.
Wardah Elahi
We know that we feel better when we talk with people. So, I would say feeling better is not a prerequisite to doing an action. I would say do the action and then see how you feel and reflect on it. Do things apart from how you feel about it and how your depression is kind of taking that wheel and do things, what the depression is not telling you to do, essentially. So, yeah, do what you know is best for you. Wait to see afterwards how that impacts you and reflect on it, and maybe that'll motivate you for future situations.
Katherine Hurtig
I can totally relate to that. There are so many times, and as an introvert as well, sometimes I'm just like, no, I'm just going to enjoy my own company. But I'll think of that like, no, it's important for me to go to this event or go to that friend's place because I know that I'll feel better afterwards. Same with like a workout. It's like I do not want to go for a run, but I know I'll feel great after.
Wardah Elahi
Exactly. Sometimes you just got to drag yourself to the gym or go for a run or even a walk. And then you notice, like, wow, I feel significantly better for sure. So, yeah, don't give in to the thoughts and just kind of do what you already know will help.
Katherine Hurtig
So, on the flip side, how can family members and friends best support someone who's struggling with anxiety and depression?
Wardah Elahi
I actually get this question asked by a lot of clients. Like, a lot of clients ask me this question because everyone knows somebody who is struggling with something. And so, what I usually recommend is the best way to start is to learn more about depression and anxiety and how it affects people, how it can be treated, learning what symptoms are common to both depression and anxiety. So, these disorders can vary from person to person, but they do include some of the symptoms that I've mentioned earlier. And yeah, urge your loved ones to seek support and help. Sometimes people may think their feelings are normal, or at times people can also feel ashamed or they think they can overcome these things with just willpower alone. I think talking to your loved one when you are noticing some of those symptoms and explaining that depression and anxiety or health conditions, I think that would encourage them to kind of seek help from a professional. And a great place to start is talking with your doctor. And if your loved one is planning to do that, then maybe you can offer to help prepare a list of questions with them. Just kind of support their journey in any way that you can by just being present, right. And checking.
Katherine Hurtig
I like that idea of helping to prepare questions. I've definitely been in that spot where I go to my doctor, and you feel rushed, and you don't leave with the answer that you wanted. So, taking a few minutes to write down your questions, I think you'll leave with a lot more knowledge, insight into how to move forward. Warda, how does Calgary Counselling Center support clients with anxiety and depression?
Wardah Elahi
Our goal here at the agency is to ensure that the skills that we're talking about in therapy with our clients are applicable to their life outside of essentially, we work ourselves out of a job, right. Like, we don't want to keep people in therapy, so we're going to set them up with skills, a very practical skills that they could easily apply outside, which that's where their problems reside. So, we do this by monitoring our clients and their stress levels and obtaining that constant feedback so that we are able to align with our clients' goals. And usually in the last few sessions, I always discuss with my clients what their plans are to maintain the positive changes that they have made through the course of therapy and really kind of reinforcing those changes.
And another great option that Calgary Counselling Centre offers is group therapy, which, again, increases people's social support and as well as teach important skills that clients can apply after they have done therapy.
Katherine Hurtig
So that group program is something that’s done after individual counselling?
Wardah Elahi
So, it's kind of like a transition. You do individually, you get what you need from it, and then group therapy is a different kind of learning and combined, I think both of those are so beneficial. So, it's kind of a way to wean off therapy, like doing group and learning what you can and then reflecting on all those changes and seeing what you take from it.
Katherine Hurtig
So, in your experience and understanding that every client is different, about how many sessions would someone typically attend if they're working through anxiety and depression?
Wardah Elahi
It just varies from person to person and what their situation is like. I wouldn't say there's any specific amount of sessions, but in general, what research has kind of said it's about six to twelve sessions. If you're not seeing changes, then that means you need something different.
So, being in touch with therapist about that and really monitoring the changes, and if they’ve been positive and how therapy is contributing to that is really important to reflect on after each session.
Katherine Hurtig
So, to just kind of wrap up, what advice would you have for our listeners who might be experiencing symptoms of anxiety and depression but either feel overwhelmed or are just hesitant to seek help?
Wardah Elahi
I would say you deserve to be healthy both physically and mentally, and you deserve to have a life full of meaning and fulfillment. You deserve to feel good about yourself. So please reach out. You're not alone and this is not something that you have to go through and overcome alone. There are so many different treatment options out there, so please use them. Talk to anyone that you trust and let them know that you're struggling and that you need help. And if you're feeling overwhelmed, slow yourself down. Take things one step at a time and go and talk with your doctors to see if they can give you any resources.
Katherine Hurtig
Thank you so much, Wardah. I think it's a really important topic because these are common things that a lot of people experience, and they just might not know how to tackle them. So, thank you so much for all of your advice.
Wardah Elahi
Thank you so much for having me. It was great to talk about this.
Katherine Hurtig
We all feel down or not ourselves from time to time, and the longer these feelings last, the harder it may seem to overcome them. But feeling better is within everyone's reach. Anyone can learn the skills to overcome these feelings, and taking even one simple step can help move us in the direction of feeling better. From October 2nd to 8th, check in with how you’re feeling at areyoufeelingokay.com. It's a free confidential quiz that's the first step towards feeling better and finding support if you need it. Brought to you by Calgary Counselling Center and Counselling Alberta.
You've been listening to Living Fully, a Calgary Counselling Centre podcast. Thank you for tuning in.
This episode was produced by Luiza Campos, Jenna Forbes, and by me, Katherine Hurtig. A special thanks to Wardah Elahi.
To stay up to date on our latest episodes, be sure to subscribe. We're available in your favorite podcast app. Living Fully is a production of Calgary Counselling Centre and recorded in Calgary on Treaty Seven territory.
Living Fully podcast is not a substitute or alternative for professional care or treatment. If you're in Alberta and need help, please go to calgarycounselling.com or counsellingalberta.com. For help across Canada and the United States, call 211. If you are outside of Canada and the US, seek help from your general medical practitioner.