Anxiety and depression are probably the oldest forms of psychopathology identified by man, sometimes considered separated interconnected vault.
The question is very interesting because regarding this relationship they remain completely discordant versions between lorOE Each with a good amount of data to its support.
From the times of ancient Greece until the nineteenth century the two forms were considered unitary, a single disorder that compromised affectivity.
Freud conceptualized anxiety and depression as two separate and distinct entities. So much so that later he further dismissed anxiety by distinguishing realistic anxiety (in situations of real danger) from neurotic anxiety (due to a subjective perception of danger). Thus he created a further taking of these symptoms from the depressive side.
In the 70s of the last century Aubrey Lewis conceived a model in which Anxiety and depressionalbeit distinct as disorders in extreme forms, could still return to a continuum. He considered the integral part of the depression, in particular in a form of depressive maniac disorder in which he observed a “agitated depression” in the most serious forms while in the milder forms a neurotic anxiety.
Simultaneously having anxiety and depression And più serious that only one
However, the relationship between the two psychopathological forms is conceptual, some data are confirmed. When there is co-president of anxiety and depression We witness:
- early debut age
- worst general operation
- worst life quality
- worse or absent response to treatments
- Trend of chronicization with worse outcome
- greater probability of graft of other psychopathological paintings
- probability of having a greater number of relapses
The Anderson group (Anderson et al, clinical psychology review 28 (2008) 275-287) observed that about 66% of the teenagers who was diagnosed with one anxious form will develop in the years to come a depressive disorder. While only 6.5 % of teenagers who were first diagnosed with a depressive disorder will develop an anxiety disorder.
In other words, the appearance of anxiety disorders precede the appearance of depressive disorders but not vice versa.
Models regarding the anxiety-depression report
There are several models that evaluate the anxiety report depression (Levine et al, Depression and Anxiety 14: 94-104, 2001).
According to some, anxiety and depression are one same phenomenonas if to say that they are different parts of the same elephant. According to this orientation, a picture is the reflection of the other, one of the two components induces changes that bring out the other part.
Other models consider depression and anxiety distinct entities But who share common factors. For example, these could concern the type of stress, negative affectivity or a certain type of vulnerability that interacting with other parameters determines the emergence of the pathology.
Other models still consider depression and anxiety two distinct and separate entities that share absolutely nothing. So in the same subject we accidentally observe two paintings that only share temporality. As if to say that a subject suffers on the same day of teeth and knee pain without any link between the two phenomena.
A critical examination
Let’s try to examine some of the points mentioned above.
A factor that actually seems united anxiety and depression It is the presence, in both situations, of a negative effectiveness. In particular, feeling irritable and not very sensitive to activities usually considered pleasant.
In negative affectivity we find feelings such as anger, fault, shame, sadness, disgust, concern, feeling squeezing.
A topic that leads to differentiating the two paintings distinguishes two constructs: positive affectivity and neurovegetative hyper-activation (AROUSAL). Starting from this distinction, low levels of positive affectivity and high levels of negative affectivity are noted in the depressed subject. On the contrary, the anxious subjects would manifest high levels of arousal and negative affectivity but not necessarily a reduction in positive affectivity.
In the clinical field, the absence of positive affectivity is detected by the use of terms such as fatigue, tiredness, slowdown. The increased Arousal is expressed instead with references to the sense of Somatic tension, short breath, sweating, dizziness or flagings, dryness of the jaws.
The weakness point of this construct is the observation that in anxious subjects The appreciable neurovegetative symptoms are mostly present in panic attack disorder not necessarily in all forms of anxiety.
Role of genetics
The data from genetics studies seem to support all theories. Most studies agree that family history is the most correlated factor to co-president of anxiety and depression.
In other studies, relatives of subjects who had anxiety and depression were more likely to suffer from unipolar depression, alcoholism but not anxious spectrum disorders.
The subjects with the presence of depression and generalized anxiety disorder (Gad) had double the relatives suffering of depression compared to those who suffered from depression or only gad only.
Some studies have detected genetic elements that unite the two disorders: i children of subjects with depression or anxiety They were more likely to develop both a depressive and anxious disorder.
Neurobiology of anxiety and depression
Alterations were found in the central nervous system that they unite anxiety and depressionin particular in the circuits with serotonergic component, dopaminergic, noreernergic and Gabergic.
The prolonged activation of the centers that generate ARUSAL could over time lead to depletion of neurotransmitters which would cause depressive disorders.
It seems that anomalies concerning the estradiol unites the two ailments, as well as amendments to the corticotrophin releasing Hormone (GrH). The latter that seems to unite the two disorders, however, is in contrast with other results. CRH production is detected in both disorders. However, while the depressed subjects show an anomaly of the parameters of the hypothalamous-pituitary axis at the baseline, this is not observed in patients with gad.
Pharmacological and psychological therapies
We have long known that drug treatment with antidepressants improves both depressive disorders and anxiety disorders. In fact, many of these molecules show the indication for both disorders in the technical data sheet.
This would confirm the hypothesis of a biological factor that unites the two ailments. But in theclinical experience We know that it is not so: there are situations in which the treatment of depression with antidepressants leads to the onset of anxious symptoms or the exacerbation of these.
The anxiolytic therapies On the other hand, the depressive symptoms do not often improve them by worsening them by accentuating asthenia, cognitive difficulties or emotional flattening.
Cognitive behavioral psychotherapy has shown itself to be an excellent therapeutic tool both alone and as a support for pharmacological treatment. On the other hand, these patients are difficult to treat pharmacologically due to hypervigilance and hypersensitivity to even minimal side effects.
There Cognitive and behavioral psychotherapy It is able to have both the depressive symptoms and anxious symptoms as therapeutic objectives through motivation interventions, revaluation of cognitive distortions, interventions on cognitive patterns, improvements in self -regulation and training of social skills.
Conclusions
I think they will not soon arrive convincing clarifications on the anxiety-depression report For many reasons. The main one, in my opinion, is that terms as anxiety and depression do not mean absolutely anything; Personally I consider these terms as a doctor considers the word “fever”.
There are many forms of anxiety and as many of depression: if we imagine approaching the many components, such a large number of combinations would be made to make any sensible evaluation impossible.
To this we must add many other components that characterize the complexity of man: temperamental factors, the intellectual level, the history of development and the life history, the environmental factors and much more.
This does not mean that it is always of great use to focus on reflecting on the state of the art of research, keeping our mental elasticity active, excellent antidote to dogmatism sometimes also present among the insiders.
