Dr. Hanscom's Blog Depression is Anxiety

Depression is anxiety. It is the constellation of symptoms caused by relentless anxiety. This is critical to understand because anxiety is simply the sensation you feel when your body is full of stress chemicals, such as cortisol, adrenaline and histamines. It is the essence of your body’s neurochemical unconscious survival response, which is approximately a million times stronger than your conscious brain. Anxiety basics

“I know better”

So, anxiety is not primarily psychological and not solvable by your rational brain. Have you ever wondered why so many people (maybe all of us) act badly when we know better? How successful are we at keeping our New Year’s resolutions? Why would you treat your loved ones worse than you would treat a stranger? What about the atrocities that are commonly committed at a societal level? This list is endless because you can’t outrun or overpower your mind and need to survive.

I have known for many years that anxiety is the driving force behind depression, and have seen smatterings of it being discussed in the literature and news. I suffered from a major depression for over 15 years with the last eight of them being extreme. In 2002, I was actively suicidal, and am still not quite sure why I didn’t go through with my plan. I got lucky and have been given a second chance. About 18 months later, I pulled out of my downward spiral of anxiety and major depression. Little did I know that they were the same entity.

I eventually was able to live a fuller and richer life than I dreamed was possible. It is also the experience of many of my patients who escaped from the grips of chronic pain in that their quality of life is even better than before they developed chronic pain.







Why is depression just the expression of sustained anxiety?

• All people with depression have anxiety (although it can be suppressed by anger), but not everyone with anxiety has depression.
• One of the earliest signs of depression is waking up in the morning and not being able to fall back asleep. This is usually from racing thoughts – connected to anxiety.
• Then you can’t fall asleep. Again, from disruptive thoughts, but also from your body being full of stress chemicals. You are on high alert, which isn’t conducive to falling asleep.
• You’re not sleeping – a cardinal symptom of depression.
• Eventually, you have trouble concentrating, which is a combination of your racing thoughts and not being able to sleep.

You have already defined a minor to moderate depression – and the relentless anxiety continues and becomes increasingly intolerable. It was by far and away the worst part of my ordeal. From a survival perspective, the intention is to create such an unpleasant feeling that you are compelled to take action that to escape the threat. But I couldn’t escape my thoughts and they progressed to vivid, obsessive thought patterns, which is the core of OCD (obsessive compulsive disorder). I was introduced to another realm of suffering I never would have imagined. It is beyond words, and that is why I use the term, “The Abyss.” I watched my patients try to describe how deep their suffering was, and all that kept coming up for me was the word, “dark”, and without any hope of light. The next word was, “despair.”







I also experienced the more advanced symptoms of a major depression (anxiety).

• Loss of appetite and weight loss – adrenaline decreases the blood supply to your GI tract.
• Lack of energy – being full of these chemicals keeps your body on high alert and it just wears you down. It is similar to attempting to sprint a mile.
• Multiple diffuse physical symptoms – direct effect of your body’s hormones on the different organ systems. I was experiencing over 17 of them at the worst phase of my ordeal.
• Social isolation – the one worst part of my journey, besides the anxiety, was loneliness. It was crushing and many self-deprecating thought patterns emerged. This occurred in spite of the fact that I am normally extremely social. It still took me down.
• Suicidal ideation – and action plan.

You get the point. What we are calling depression is a set of symptoms created by sustained levels of stress chemicals (anxiety).

Anger – stepping it up a notch

Then the story gets worse – a lot worse. One antidote to anxiety is control, and normally when a physical threat is solved, the anxiety drops, and you’ll live another day. However, when you can’t escape (your thoughts for example), your body will secrete more adrenaline, cortisol and histamines in an effort to regain control, and you’ll feel angry (trapped). So, anger is anxiety with a chemical kick and is the same entity. The problem is that anger is truly the last-ditch effort to survive and is destructive. An animal will do whatever it has to do to stay alive. Humans have the same need, but the destructive behavior doesn’t have an endpoint because we have consciousness. Additionally, it is self-destructive.

Sustained anger will drive you deep into the hole, cause more intense physical symptoms, and to me felt like a pile driver was driving my soul right into the center of the earth. Then, since you may be beyond caring, you might neglect your health. Complete disregard for your physical health is akin to a slow suicide. Talk about knowing better and then doing something different, is the classic illustration of the unconscious behavioral patterns winning out over willpower. Why else would you not want to feel physically great and live life to the fullest?

Medicine has missed it

I will get a lot of push back on this article from almost every corner of the medical world. But, they have missed this one – badly. Anxiety and depression are conceptualized, labeled and treated differently. They are not only the same entity, but neither are truly solvable with isolated psychological interventions. Although, psychological treatments are important aspects of care by providing support, wisdom, guidance and symptom control they must be combined with other strategies that teach you how to develop your own individualized way of regulating your body’s chemistry. Learning how to change your hormonal profile to “play”, which includes oxytocin (love drug), dopamine (rewards), GABA chemicals (anti-anxiety), and serotonin (antidepressant) is simple, effective, easily learned and will change your life.

Anxiety and depression are the same entity. The core driver is anxiety, which is not primarily a psychological problem. We can’t get rid of it or we wouldn’t survive. Understanding the nature of any problem will allow you to address the root issue. It is a solvable problem using strategies that stimulate your brain to rewire. (mod edit: dead link removed)



Related posts:

1. Societal Disintegration – Untreated Anxiety
2. Anxiety Basics
3. Anxiety, Anger, and Adrenaline

 

Thank you for this enlightening post. I'm experiencing a lot of depression, mixed with anxiety (the anxiety was definitely there first for me and has been ongoing for a while, mostly because of work). But I am also perimenopausal and I am told, all these mood swings are a part of this stage of life for women. I can't tell if it's TMS or natural hormonal fluctuations, but either way, it's really, really hard. Any thoughts on how to approach this in my particular case? Many thanks.

 

@honey badger, did you click through on any of the links? Such as https://backincontrol.com/anxiety-basics-2/ (Anxiety Basics)

We always recommend Help & Hope For Your Nerves by Claire Weekes, and when Dr. Hanscom talked about rewiring our brains (in the linked article) I also immediately thought about "Meditations To Change Your Brain" by Richard Mendius MD and Rick Hanson. This audio program is a combination of lecture and meditations about rewiring our primitive brains which were designed to be in a constant state of alertness and fear. This mechanism was meant to keep us safe, but does not work at all well in the modern world, resulting in the chronic cascade of symptoms that Dr. Sarno called TMS. I purchased the program at a good price as a download from soundstrue.com, but I recall that it was also available on CD from my public library (and AMZ, of course).

Combining this with Claire Weekes I was able to completely change my relationship with the fear mechanism that fed my lifelong anxiety - and which did indeed start to morph into depression as my lifelong TMS symptoms hit a crisis point in 2011 (age 60). Crippling anxiety and depression have not played a role in my life since then.

Also, don't discount the current state of world dysfunction, which is known to be feeding a world-wide mental health crisis. Give yourself a break where that is concerned.

 

I so appreciate your suggestions and kind words JanAttheCPA. I knew about Claire Weekes, but will have to look into "Meditations to Change Your Brain." I am inspired by the fact that you were able to change your relationship with fear/anxiety. That is really wonderful to hear and it gives me hope. Thank you!!

 

Anxiety and depression are the emotions we feel in response to the hormones in our bloodstream. And yes, during the menopause, hormones can rise and fall sharply, causing mood swings and anxiety/depression. Regardless of what causes them, it is still in our power to manage our response. Meditation, if done right, is the most powerful tool against anxiety because it de-sensitizes nervous system and calms down the brain. But have in mind that the best-known and most popular sit-down meditation may not be the best way of meditating for the highly anxious people, and there are other ways to meditate: walk, hike, swim, run, ride a bike. Sometimes physical activity gets our brains in the meditative state or "flow" as it is called. It often takes trying various kinds of meditation before it clicks with you.

 

Dr. Hanscom, it is a fantastic post, thank you so much!

 

I thank you for your reply TG957. I would have to add thoughts we're thinking (some of which can be faulty) as a trigger to anxiety and depression (instead of just emotions that we feel in response to hormones), and there are many other triggers. Anxiety has also been called a secondary fear because it is a reaction to our reactions (that is, we panic over the fact that we can't calm ourselves down, or at the severity of what we feel, etc). Being a woman, I've had my share of experiences with hormones in life, and have learned to understand them and treat myself more gently, which has worked well for me for decades. But believe me when I tell you that perimenopause and menopause is a time when hormones are really, REALLY tricky for many of us, and although my response to events is still under my responsibility, what I have trouble with is the dark thoughts that seem to come out of nowhere and that seem to have no bottom or end. I don't know that I would have appreciated the severity of this had I not experienced the AWESOME (not in a positive way) power of a woman's hormones as they flux and wane in mid-life. I'm finding it really hard and wondered how much of this I can sort out as being TMS and how much is simply biological and something I must learn to navigate through.

 

@honey badger , I have lived through perimenopause, along with anxiety and depression, and it was very hard. I found herbs like black cohosh very helpful, but exercise was a godsend. I wish I knew of TMS and this blog in particular back then. In any case, self-awareness (and the concept of TMS is nothing more than self-awareness on a deeper level) is what guides us through. Understanding that anxiety is emotion and being able to observe yourself from OUTSIDE of it helps to overcome the bout of it and not be led to actions by it. I hope it helps. Best of luck to you, and remember that it will get better one day .

 

Thank you for your great suggestions. I really appreciate it! Fingers crossed that it WILL one day get better!!