What is the relationship between Stress, Anxiety, and Depression?

What is the relationship between Stress, Anxiety, and Depression?
Written By: Counselling Psychologist
Reviewed By: Counselling Psychologist
MA Psychology Pennsylvania State University, USA
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Stress: A word affecting all of us in some form or the other on a regular basis. But what exactly is stress? Is it the same as Depression and Anxiety?

Stress is the body’s natural response to any kind of threat, pressure or anything that requires attention or action. It can be defined as any type of change that causes physical, emotional, or psychological strain. For eg: Juggling multiple responsibilities, such as work, family, and personal commitments or living in a chaotic environment, such as a noisy neighborhood or a crowded home, can be a major source of stress. 

Then what are Anxiety and Depression?

Anxiety is our body’s natural response to stress. It’s a feeling of fear or apprehension about what will happen in the future (anticipation of perceived threat). For example, giving a speech in public may make some people feel fearful or nervous, experience sweating, shortness of breath, dizziness, rapid heart rate, etc. In some cases, the occurrence of anxiety helps alert us from potential danger and helps us prepare and take action. 

Depression on the other hand is a state in which we have a "low mood" and are generally upset, along with a loss of interest in activities we used to enjoy, changes in sleep, hunger, guilt, lack of motivation, and general social withdrawal.

We frequently refer to anxiety, stress, and depression interchangeably or as the same thing when we speak with friends or family on a daily basis. This is not correct. While Depression and Anxiety can be the consequences of prolonged stress or vice versa, they are not exactly the same, however related. Symptoms might overlap but the intensity differs.

What is Stress? How does stress affect us?

Stress is a person s reaction to a hazardous event or a change in circumstances. It can be seen as a person s response to an internal mental condition, such as worrying about an exam, or to an external event or demand, such as writing an exam. It s interesting to note that tension tends to rise when one fears they won t be able to handle the current circumstance.

The majority of people see stress as something bad. Stress can motivate us to perform at our highest level, though. For instance, under the stress and strain of the Olympics, athletes frequently set world records. In this instance, a healthy and required level of stress is helpful in motivating us to write a term paper or study for a test. Thus, while some stress is good for you, too much of it can be harmful.

Negative effects of chronic stress on physical and mental health

Physical:

An individual s physical health is impacted by stress. Stress can be linked to a variety of conditions, including hypertension, diabetes, ulcers, aches and pains, asthma, hyperthyroidism, and even cancer.  An individual s immune system may be impacted by stress, which could make them more susceptible to a variety of diseases and disorders.

Additionally, stress might hasten aging. Stress causes the body to redirect its resources and energy from the immune system to other systems that are more crucial to stress reactivity (as was also covered under the fight-or-flight response and GAS). As a result, people who experience stress over an extended length of time are more likely to become infected because their immune systems are weakened.

Signs and Symptoms: 

  • Changes in Appetite
  • Tension in the neck
  • Upset stomach, pounding heart
  • Tendency to accidents, chilly hands and feet
  • Headaches and Early Aging
  • Eating too much etc.

Psychological:

An individual s ability to perform executive functions, which include planning, reasoning, managing their life, solving problems, and other duties, is negatively impacted by stress. And this can be linked to the overload that stress causes, when a person s resources are redirected to deal with the stress. As a result, a person experiencing stress may find it difficult to focus, remember details, or solve problems effectively.

An individual s capacity to make judgments and perform cognitively might both suffer when they are under stress. When under stress, people tend to filter out external stimuli and make heuristic-based decisions. People who are under stress can also exhibit restricted thinking patterns and rigidity in their performance. People may also find it difficult to manipulate information or analyze complex circumstances when they are under stress (Kavanagh, 2005). 

Signs & Symptoms:

  • Difficulty solving problems
  • Difficulty making decisions
  • Difficulty concentrating
  • Negative self-talk
  • Denial: Believe nothing is wrong 
  • Withdrawal: Avoid situations, Catastrophize, Overly suspicious.

Prolonged or persistent stress can have negative impacts on the immunological, cardiovascular, neuroendocrine, and central neurological systems of the body. Untreated chronic stress can lead to major impairments such as Anxiety, Depression, sleeplessness, elevated blood pressure, and muscular aches. 

What is Anxiety? How does Anxiety affect us?

According to the American Psychological Association, “Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.”

For instance, when we re anxious, we frequently worry for extended periods of time—to the point where it can feel uncontrollable. These anxieties frequently involve a wide range of topics, and our minds frequently switch rapidly between them. Anxiety affects our behavior as well. For example, when we experience anxiety, we frequently put off doing things we want to accomplish because we are concerned about the outcome. While brief episodes of worry are common in everyday life, it becomes problematic when fear starts to haunt a person s every move and becomes a recurring theme in their existence.

Anxiety is not the same as fear, but they are often used interchangeably. Anxiety is considered a future-oriented, long-acting response broadly focused on a diffuse threat, whereas fear is an appropriate, present-oriented, and short-lived response to a clearly identifiable and specific threat.

Signs and Symptoms

  • Feeling nervous, restless or tense
  • Having a sense of impending danger
  • Having an increased heart rate
  • Feeling weak or tired
  • Having trouble sleeping
  • Sweating
  • Trembling
  • Having difficulty controlling worry

Types of Anxiety Disorders

Generalized Anxiety Disorder: Worry that interferes with everyday tasks and is excessive and persistent is indicative of generalized anxiety disorder. Physical symptoms like restlessness, feeling tense or easily fatigued, difficulty concentrating, tense muscles, or trouble sleeping may be present along with this continuous worry and tension. Worries tend to center around routine issues like work obligations, family health, or smaller concerns like housework, auto maintenance, or appointments.

Panic Disorder: Recurrent panic attacks, a severe mix of psychological and physical discomfort, are the main symptoms of panic disorder. Several of these signs and symptoms coexist during an attack:

  • Heart palpitations, thumping, or accelerated heart rate
  • Perspiration
  • Shaky or trembling
  • Breathing difficulties or suffocating feelings, chest ache
  • Feeling lightheaded, faint, or dizzy, a sensation of choking
  • Sensitivity or tingling
  • Flashes of heat or chills, nausea or discomfort in the abdomen
  • Feeling disengaged
  • Fear of becoming out of control

Phobia: Phobia is an extreme and enduring fear of a particular thing, circumstance, or action that is usually not dangerous. People who are phobic are unable to get over their overwhelming dread despite knowing it. Some people go to great lengths to escape their worries because they are so distressed. Examples include the fear of spiders, flying, and public speaking.

Social Anxiety Disorder: A primary source of worry and suffering for a person with social anxiety disorder is the fear of being rejected, humiliated, embarrassed, or looked down upon in social situations. With this disease, people would either try to escape the situation or deal with it very anxiously. Seen in public eating and drinking, meeting new people, and public speaking are common examples of great fear. The worry or anxiety lasts for at least six months and interferes with day-to-day functioning.

Separation Anxiety Disorder: An individual suffering from separation anxiety disorder has overwhelming worry or anxiety when they are separated from the people they are attached to. The emotion is excessive for the person s age, lasts longer than normal (at least four weeks for children and six months for adults), and interferes with daily functioning. A person suffering from separation anxiety disorder could have nightmares about being apart from the person they love the most, be reluctant to leave the house or go out at night, or be extremely concerned about losing the person they care about the most. Although physical signs of distress might last into maturity, they typically first appear in childhood.

Post Traumatic Stress Disorder: People who have witnessed or experienced a traumatic incident, sequence of events, or combination of circumstances may develop post traumatic stress disorder (PTSD). People with PTSD continue to have intense, unsettling thoughts and sensations about the traumatic experience. They might experience nightmares or flashbacks where they relive the incident; they might experience despair, dread, or rage; and they might feel distant or alienated from other people. They might also respond negatively to seemingly insignificant things like loud noises or unintentional touches.

What is Depression? How does Depression Affect us?

Depression refers to a state of overall loss of interest or enjoyment in life, as well as feelings of sadness, discouragement, hopelessness, and unmotivation. When these emotions persist for a little duration, they could be referred to as a transient episode of "the blues." However, if they persist for longer than two weeks and cause disruption to your usual daily routine, you probably have depression. 

Signs & Symptoms:

  • A persistently sad, or "empty" mood
  • Feelings of hopelessness or pessimism 
  • Feelings of guilt, worthlessness, or helplessness 
  • A loss of interest in or enjoyment from hobbies and activities 
  • Decreased energy, fatigue, or a feeling of "slowed down" 
  • Insomnia, early morning awakenings, or excessive sleeping

Depressive disorders, also known as mood disorders, include three main types: major depression, dysthymia, and bipolar disorder, and they can occur with any anxiety disorder.

Major Depression: A range of incapacitating symptoms that impair your capacity to work, learn, eat, and sleep are indicative of major depression. It could happen to you once, twice, or more often during your lifetime. Alternatively, it could be connected to a loved one s passing, a breakdown in your romantic life, a health issue, or another life event. 

Dysthymia: A persistent form of depression called dysthymia, sometimes known as dysthymic disorder, often lasts for at least two years. The symptoms are similar to those of major depression, however milder; these include low energy, poor appetite or overeating, and insomnia or oversleeping. Stress, impatience, and mild anhedonia—the inability to enjoy most activities—can be symptoms of it.

Bipolar Disorder: Bipolar disorder is typified by mood swings from extreme lows (depression) to extreme highs (mania) or mild highs (hypomania). A person may have unusual or excessive happiness, agitation, a diminished need for sleep, grandiose ideas, increased talking, racing thoughts, increased sexual desire, noticeably increased energy, poor judgment, and improper social behavior during the manic phase. A person suffers the symptoms of major depression during the depressive phase. 

What is the relationship between chronic Stress, Anxiety and Depression?

Stress, Anxiety and Depression are closely associated, with depression frequently resulting from and preceded by chronic stress & anxiety. Long-term exposure to stressors that exceeds a person s capacity for coping results in chronic stress, which is defined as a sustained activation of the body s stress response mechanisms.

Scientists at The University of Western Ontario have discovered the biological link between stress, anxiety and depression. By identifying the connecting mechanism in the brain, this high impact research led by Stephen Ferguson of Robarts Research Institute shows a link between stress, anxiety and depression. 

A good understanding of the physiology of stress can help us better understand the relationship between stress and mental disease. The hypothalamic-pituitary-adrenocortical (HPA) axis and the sympathetic adreno-medullary (SAM) system are two interrelated systems that are activated during stressful events. The cerebral cortex in SAM activation classifies a stimulus as a stressor when it causes a person to lose his/her balance/homeostasis. The hypothalamus receives this information and starts the fight-or-flight response. This causes the adrenal medulla to release catecholamines, such as norepinephrine and adrenaline. When two things happen together, the body becomes aroused, resulting in symptoms like palpitations, perspiration, elevated blood pressure, constriction of blood vessels, etc. If the stress is prolonged for a long time, it converts into anxiety or depression.

Another study by Ardayfio and colleagues showed how chronic stress could lead to anxiety and depression. It presented that prolonged exposure to the stress hormone, cortisol, contributed to symptoms of depression. According to this study, stress hormones help a person in responding to an immediate threat. However, if stress remains heightened, it could boost anxiety and lead to mood disorder or most commonly major depressive disorder. Repeated or recurrent stress is known to quicken or worsen mood disorders.

Depression, Anxiety, Stress Treatment: Tips to Manage

Stress, anxiety, depression are highly treatable issues. They can be effectively treated with medication and therapy, sometimes in conjunction with one another.

  1. Therapies like Cognitive Behavioral Therapy (CBT), Acceptance & Commitment Therapy (ACT) are highly beneficial.
  2. Relaxation and Mindfulness Exercises can help feel better and release tension. It helps the individual to focus on the here and now instead of past or future.
  3. If the condition is persistent, medications can also help in overcoming Anxiety and Depression counselling online,

Reference

Khan, S., & Khan, R. A. Chronic Stress Leads to Anxiety and Depression An. Psych. and Mental Health. 2017.5 (1): 1–4.

American Psychiatric Association. Anxiety Disorders. In: Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Text Revision. American Psychiatric Association; 2022: pp. 215-231.

American Psychiatric Association. (2022). Trauma- and Stressor-Related Disorders. In Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).

Ana C Magalhaes, Kevin D Holmes, Lianne B Dale, Laetitia Comps-Agrar, Dennis Lee, Prem N Yadav, Linsay Drysdale, Michael O Poulter, Bryan L Roth, Jean-Philippe Pin, Hymie Anisman, Stephen S G Ferguson. CRF receptor 1 regulates anxiety behavior via sensitization of 5-HT2 receptor signaling. Nature Neuroscience, 2010; DOI: 10.1038/nn.2529

Baum A. Stress, intrusive imagery, and chronic distress. Health Psychol. 1990; 9: 653-675.

Cohen S, Kessler RC, Gordon LU. Strategies for measuring stress in studies of psychiatric and physical disorders. In: Cohen S, Kessler RC, Gordon LU, editors. Measuring stress: A guide for Health and Social Scientists. Oxford: Oxford University Press. 1995.

Salleh MR. Life event, stress and illness. Malays J Med Sci. 2008; 15: 9-18.

Anderson NB. Levels of Analysis in Health Science: A Framework for Integrating Socio behavioral and Biomedical Research. Annals of the New York Academy of Sciences. 1998; 840: 563-576.

 

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