As normal, pre-pandemic life became a distant memory, so did my anxiety. Sure, I was a little nervous about the dwindling toilet paper supply and the possibility of getting infected with a novel virus — who wouldn’t be? But my usual anxiety, which ordinarily caused feelings of breathlessness and impending doom, was nowhere to be found. Instead, I felt unmotivated and foggy. Getting off the couch had become a strenuous act. When I tried to go about my daily routine of writing and taking care of my kids, all I could think about was crawling back into bed.
This was all new to me. I’d been treated for generalized anxiety disorder for more than two decades. Every day, I took a pill to keep worries and panic attacks at bay, and I saw a therapist every other week to work through my sometimes-irrational fears. My go-to coping mechanisms, like mindfulness and deep breathing exercises, focused on calming myself down. I wasn’t sure how to help myself calm “up.”
I didn’t feel down and depleted every day, but it happened frequently enough to mention to my therapist. “I think I might be depressed,” I told her during a virtual session, my eyes glazed over in the tiny picture on my laptop screen. After I described my symptoms — struggling with motivation, uninterested in doing things, sleeping a lot, irritable — she agreed that depression seemed like the culprit.
What she said next surprised me: It’s not strange for an otherwise anxious person to sink into a depressed state. I’d always seen anxiety and depression as opposite issues. Apparently, they’re more closely related than I realized.
Natalie Dattillo, director of psychology at Brigham and Women’s Hospital in Boston, says she frequently sees patients with symptoms of both anxiety and depression. “Sometimes the symptoms overlap, or sometimes they take turns,” she says. “But it’s almost the exception for me to be working with someone who doesn’t have symptoms of both.”
How anxiety and depression coexist can vary from person to person. Sometimes anxiety masquerades as depression, says Washington, DC-based psychologist Alexis Moreno. The two disorders share a number of symptoms in common, including restlessness, fatigue, difficulty concentrating, sleep disturbances and irritability. It’s possible for someone with an anxiety disorder to develop new, anxiety-related symptoms that feel more like depression, but actually don’t indicate a separate diagnosis.
Constant worrying can also trigger feelings of depression. Dattillo says this is especially common if you’re experiencing relentless anxiety that interferes with your daily functioning, or if it’s affecting your self-esteem or causing isolation. “Dealing with chronic anxiety can be exhausting, and you can begin to feel like nothing you’re doing makes a difference,” she says. “So that layers in hopelessness, one of the key features of depression.”
When your mental health toolkit is fully stocked with self-soothing techniques, handling depression comes with a learning curve.
Anxiety can also cause people to burn out physically, which can feel a lot like depression. When your sympathetic nervous system goes into overdrive for a prolonged period of time (say, during a global pandemic), it’s your body’s job to restore balance. If you’ve ever had a panic attack, or even a long, stressful week, you know what it feels like to “hit a wall.” As you come down from your heightened emotional state, you might feel foggy, or just exhausted, almost like you have a hangover.
“If someone is hyperactivated for a long period, the body might go to an ‘underactivated’ state for a while so that person can rest and recover,” says Dattillo. “You can only function in fight-or-flight mode for so long, so your physical and mental health depend on taking a break.”
But there’s a difference between temporary sadness and clinical depression, often called major depressive disorder. A formal diagnosis of depression depends on the presence of certain symptoms. Dr. Michelle Durham, a psychiatrist at Boston Medical Center, says she typically looks for more than two weeks of feeling blue, more days than not, plus depressive symptoms such as loss of energy, motivation or interest in normal activities. Hopeless thoughts or suicidal ideation, which require immediate medical care, are also signs of clinical depression.
Sometimes anxiety disorders (including panic disorder, generalized anxiety, OCD, phobias and social anxiety) occur simultaneously with mood disorders like depression. That means someone could have two distinct diagnoses in their medical chart. For this to happen, a person would need to experience symptoms of both disorders, as opposed to only symptoms that could indicate either one. But that doesn’t mean all the symptoms come up at the same time; Durham says the severity of symptoms can change over time.
After telling my therapist about the anxiety-depression switcheroo, I talked to my psychiatrist. He never officially diagnosed me with depression, but he did suggest lifestyle modifications to help me manage my symptoms. I began walking a few miles a day and keeping a more consistent bedtime and wake-up schedule. My symptoms improved noticeably.
I also had to learn new coping mechanisms. When your mental health toolkit is fully stocked with self-soothing techniques, handling depression comes with a learning curve. For example, my therapist had taught me to take longer exhales when I’m feeling anxious, which can help the body end a fight-or-flight response. When you’re feeling depressed, Dattillo says, you’re supposed to do the opposite: “If you want to feel more alert or activated, concentrate on the inhale instead, whether you inhale longer or just concentrate on inhaling more.”
It’s also important, she says, to listen to the precise messages your body is sending you. If your depressed state feels more like “crashing” or burnout than sadness and hopelessness, then you probably need to get some rest. If your struggle to get off the couch is more of a mental challenge, a quick burst of exercise might give you the boost you need to get through the day.
Experiencing new emotional states and learning new coping mechanisms can be overwhelming, but keep in mind that you’re likely not the only one struggling. Pretty much no emotional response is off the table during something as stressful as COVID. “We all have a lot going on, and almost any reaction makes sense,” says Moreno. “It’s a survival tactic for our emotions to communicate to us that something is up.”
If you’re feeling out of sorts and it’s not letting up, consider talking to a professional. Your primary care provider can refer you to a therapist if you don’t already have one, as well as recommend next steps for managing your mental health. “This is a pandemic, and everyone has had to change in ways we never knew we’d have to adapt to,” says Durham. “But if you’re not feeling like yourself, or you’re experiencing new mental health symptoms beyond your normal baseline, definitely talk to someone.”
Dealing with depression for the first time can be daunting, especially if you only know yourself as an anxious person. While I’d spent years learning how to settle my nerves and quiet my racing mind, I had no practice climbing out from under the weight of ennui. By taking simple steps to seek support, however, I gained a better understanding of myself — and new ways to take care of my mental health.