Causes of Anxiety and Depression: Symptoms and Signs
Some people suffer from severe anxiety or depression symptoms, while others have subtle signs that are commonly brushed aside. For millions of children, adolescents and adults, anxiety can be paralyzing, and its constant presence can wreak havoc on health, sleep and other aspects of daily functioning. Major depressive disorder is the leading cause of disability in the U.S. for people ages 15 to 44.2 It can become so severe that it is refractive to treatment and is a significant cause of suicide.
Anxiety Disorder Facts and Stats
- An estimated 18% of adults in the U.S. have an anxiety disorder in any given 12-month period, and of those, 22.8% are classified as severe.3
- People with an anxiety disorder are three to five times more likely to go to the doctor and six times more likely to be hospitalized for psychiatric disorders than those who do not suffer from one.2
- Anxiety disorders are the most common type of mental health disorder in the general population, affecting women more often than men. The estimated lifetime prevalence of any anxiety disorder is 15%.4
- Epidemiological studies have shown that social anxiety disorder is the third-leading psychological disorder in the U.S.5
Below are the estimated numbers of people in the U.S. with disorders that fall within the anxiety disorder spectrum. The last two are not anxiety disorders in the strictest definition, but most organizations list them as such because they are closely related.3
- Generalized Anxiety Disorder (GAD): 6.8 million adults
- Panic Disorder: 6 million
- Social Anxiety Disorder: 15 million
- Specific Phobias: 19 million
- Obsessive-Compulsive Disorder (OCD): 2.2 million
- Post-Traumatic Stress Disorder (PTSD): 7.7 million
Causes and Symptoms of Anxiety
Experts believe the two primary underlying causes of anxiety are genetics and stress. Studies have shown that some families have a higher than average number of members with anxiety-related issues, which suggests a familial link. Anxiety disorders can also be the result of stressful or traumatic events, such as abuse, the death of a loved one or chronic physical illness.4
While not all of the following behaviors imply the presence of a full-blown anxiety disorder, they may be a red flag and warrant an evaluation by a mental health professional. The symptoms vary based on the type of anxiety disorder.
Generalized anxiety disorder: This is characterized by persistent, excessive and unrealistic worrying about everyday things.6
Panic disorders: The most obvious symptom is a spontaneous seemingly out-of-the-blue panic attack and a preoccupation and fear of a recurring attack. A panic attack is characterized by the abrupt onset of intense fear or discomfort that reaches a peak within minutes, including at least four of the following symptoms.7
- Palpitations, pounding heart or accelerated heart rate
- Trembling or shaking
- Sensations of shortness of breath or smothering
- Feelings of choking
- Chest pain or discomfort
- Nausea or abdominal distress
- Feeling dizzy, unsteady, light-headed or faint
- Chills or heat sensations
- Paresthesia (numbness or tingling sensations)
- Feelings of unreality or being detached from oneself
- Fear of losing control or “going crazy”
- Fear of dying
Social anxiety disorder: Symptoms vary from person to person, but the following are some of the most common experienced by people with social anxiety disorder:5,8
- Excessive sweating
- Dry throat and mouth
- Muscle twitching
- Nausea or other abdominal distress
- Rapid heartbeat
- Shortness of breath
- Dizziness or lightheadedness
- Feeling detached
- Loss of self-control
Phobias: Irrational fears can involve a variety of things, including the fear that people are watching or following you, an extreme fear of objects (e.g. dogs or spiders), or situations (e.g. flying, elevators or social situations). Irrational fears can become obsessive in nature, leading to persistent and intrusive thoughts that create significant anxiety and detrimental behaviors.9
Obsessive compulsive disorder (OCD): Repetitive, irrational thoughts may be accompanied by compulsive actions, routines and rituals performed over and over again. The thoughts and rituals associated with OCD can cause terrible inner turmoil and interfere with optimal daily functioning.10
Post-traumatic stress disorder (PTSD): While both men and women can experience the cardinal symptoms of PTSD (hyperarousal, re-experiencing, avoidance and numbing), some behaviors are more prevalent in women than men, including:
- Feeling jumpy
- Trouble feeling emotions
- Avoiding trauma reminders
Depression Facts and Stats
- Major depressive disorder affects more than 15 million American adults, or about 6.7% of the U.S. population ages 18 and older in any given year, with a median age of onset of 32.5.2
- Persistent depressive disorder (PDD), formerly called dysthymia, is a form of depression that typically continues for a minimum of two years. It affects an estimated 3.3 million American adults or about 1.5% of the U.S. population ages 18 and older in any given year. The median age of onset is 31.1.2
- Combined data from 2010 to 2012 indicated one in 10 older adolescents ages 16 to 17 experienced a major depressive episode in the past year. In that same time period, an estimated 3.1% of older adolescents had co-occurring major depressive episode and a substance use disorder in the past year.12
Causes and Symptoms of Depression
The exact cause of depression is unknown, although experts believe it is related to chemical changes in the brain and a likely genetic link since depression tends to be more prevalent in some families. Depression can also be triggered by certain stressful events such as abuse, the death of a loved one, physical illness, chronic pain, substance abuse, medication side effects and sleeping problems.13
Symptoms vary depending on severity of the depression, the person’s age, co-occurring mental health disorders and a number of other mitigating factors, but may include:
- Agitation, restlessness, irritability and anger
- Becoming withdrawn or isolated
- Fatigue and lack of energy
- Feeling hopeless, helpless, worthless, guilty and self-hatred
- Loss of interest or pleasure in activities that were once enjoyable
- Sudden change in appetite, often with weight gain or loss
- Thoughts of death or suicide
- Trouble concentrating
- Insomnia or sleeping too much13
The Role of Chronic Pain in Anxiety and Depression
Scientists have long believed there was a connection between chronic pain and anxiety, but the underlying correlations were not well understood. Research published in August 2016 showed expression of PACAP (pituitary adenylate cyclase activating polypeptide), a peptide neurotransmitter the body releases in response to stress, increased in response to neuropathic pain and contributed to anxiety symptoms. While there was a notable increase in anxiety-related behaviors in models of chronic pain, the anxious behaviors and pain hypersensitivity were significantly reduced when a PACAP receptor antagonist (designed to block the response) was applied.14
Chronic pain and major depressive disorder (MDD) are highly prevalent and frequently co-occur. While the causes of chronic pain and depression are poorly understood, evidence indicates genetic factors play a role. Recent research showed that genetic factors, along with chronic pain in a partner or spouse, contributed substantially to the risk of chronic pain for an individual. Furthermore, the findings suggest that the presence of pain in one spouse/partner increased the likelihood of MDD in the other spouse/partner. Interestingly, the analysis showed chronic pain was associated with an increased genomic risk for MDD. However, the reverse was not true.15
Treatment for Depression, Anxiety and Pain
Cognitive behavioral therapy (CBT): Emotional and mental problems can cause normal information-processing abilities to break down due to a consistently negative bias introduced into thinking, thereby perpetuating an ongoing cycle of negativity. CBT helps people learn to identify, challenge and transform distorted beliefs and negative, irrational thoughts into ones that are empowering, realistic and positive. It also teaches people healthy coping skills and behaviors. When people change the way they perceive themselves, this changes the way they react to and view the world around them. As a result, depression, anxiety and even physical pain are no longer debilitating.
Medications: Antidepressants are used to alleviate feelings of depression, but some may be prescribed for anxiety disorders and in smaller dosages for people with chronic pain. There are several different types of drugs used for the treatment of depression including selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants, tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs).
Alternative therapies: Mindfulness approaches may include relaxation therapy, meditation or guided meditation walks. Biofeedback is an alternative therapy that teaches people to consciously control automatic body functions, such as reactions to stress or anxiety. Some treatment programs incorporate yoga or tai chi. Acupuncture may help relieve pain because it is believed to release endorphins that block feelings of pain. Always talk with your doctor to ensure alternative therapies do not interfere with conventional depression, anxiety or chronic pain treatments.
- Mental Health by the Numbers. National Alliance on Mental Illness website. https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers Accessed November 14, 2016.
- Facts & Statistics. Anxiety and Depression Association of America website http://www.adaa.org/about-adaa/press-room/facts-statistics Updated August 2016. Accessed November 14, 2016.
- Any Anxiety Disorder Among Adults. National Institute of Mental Health website. http://www.nimh.nih.gov/health/statistics/prevalence/any-anxiety-disorder-among-adults.shtml Accessed November 14, 2016.
- Anxiety Disorders: 15 Facts About The Most Common Mental Disorder, From Symptoms To Efforts To Reduce Stigma. Medical News Daily website. http://www.medicaldaily.com/anxiety-disorders-15-facts-about-most-common-mental-disorder-symptoms-efforts-reduce-369110 Published January 13, 2016. Accessed November 14, 2016.
- Social Anxiety: Symptoms and Treatment. Social Anxiety Association website. http://socialphobia.org/social-anxiety-symptoms-and-treatment Accessed November 14 2016.
- Generalized Anxiety Disorder (GAD). Anxiety and Depression Association of America website. https://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad Updated July 2016. Accessed November 14 2016.
- Panic Disorder & Agoraphobia. Anxiety and Depression Association of America website. https://www.adaa.org/understanding-anxiety/panic-disorder-agoraphobia Accessed November 14, 2016.
- Social Anxiety Disorder. Anxiety and Depression Association of America website. http://www.adaa.org/understanding-anxiety/social-anxiety-disorder Updated June 2016. Accessed November 14, 2016.
- Specific Phobias. Anxiety and Depression Association of America website. https://www.adaa.org/understanding-anxiety/specific-phobias Updated December 2015. Accessed November 14, 2016.
- Obsessive-Compulsive Disorder: When Unwanted Thoughts Take Over. National Institute of Mental Health website. http://www.nimh.nih.gov/health/publications/obsessive-compulsive-disorder-when-unwanted-thoughts-take-over/index.shtml Accessed November 14, 2016.
- Women, Trauma, and PTSD. U.S. Department of Veteran Affairs National Center for PTSD website. http://www.ptsd.va.gov/public/PTSD-overview/women/women-trauma-and-ptsd.asp Updated August 13, 2015. Accessed November 14, 2016.
- Lipari RN, Hedden SL. Serious Mental Health Challenges among Older Adolescents and Young Adults. The CBHSQ Report. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2013-2014 May 6.
- Major depression. MedlinePlus website. https://medlineplus.gov/ency/article/000945.htm Updated February 2, 2016. Accessed November 14, 2016.
- Connection between chronic pain, anxiety disorders found by researchers. Science Daily website. https://www.sciencedaily.com/releases/2016/08/160831133421.htm Published August 31, 2016. Accessed November 14, 2016.
- McIntosh AM, Hall LS, et al. Genetic and Environmental Risk for Chronic Pain and the Contribution of Risk Variants for Major Depressive Disorder: A Family-Based Mixed-Model Analysis. PLoS Med. 2016 Aug 16;13(8):e1002090. doi: 10.1371/journal.pmed.1002090. eCollection 2016