As a psychotherapist, people often ask me about the difference between anxiety and depression; often they lump the two together, saying things like, “My doctor gave me pills for anxiety and depression”. I also hear anxiety thrown together with panic attacks and “being“ bi-polar.

I like to demystify psychobabble. Insurance companies are obsessed with “The Diagnostic and Statistical Manual of Mental Disorders”. This book is full of psychological terms they use to diagnose you.  But what do these diagnoses mean?

With a diagnosis of depression, you typically experience sadness, irritability and have less interest in the usual pleasures of life.  Other signs of depression include: low energy, a change in appetite or sleep and problems concentrating.  Depression may be caused by an imbalance of brain chemicals or it may be a reaction to a death, breakup, or losing your job/partner/home. At its most severe, depression can result in feeling hopeless and suicidal. If you have suicidal thoughts or feelings, don’t ignore them: get professional help. Call your doctor, therapist or the San Diego County’s 24-hour crisis line at 800-479-3339.

Anxiety is harder to quantify. We all experience “normal” anxiety; it’s part of life: it might appear as worry, obsessive negative thoughts, poor sleep and/or concentration. See how these symptoms overlap with those of depression? That’s why there is often confusion about the two.

There are many different “types” of anxiety. Let me give you the basics for each:

  • Social anxiety – an intense fear and/or embarrassment in social situations.
  • Panic disorder – sudden feelings of intense fear accompanied by physical symptoms that can seem like a heart attack, e.g., dizziness, nausea, rapid heart rate.
  • Generalized Anxiety Disorder – daily feelings of worry and anxiety that never go away and aren’t related to any specific event. You feel (mildly) worried all the time.
  • Obsessive Compulsive Disorder (OCD) – there are two ways that OCD plays out:
    1. as thoughts that you can’t stop thinking (“obsessions”) and
    2. actions you can’t stop doing (“compulsions”).
  • Post Traumatic Stress Disorder (PTSD) – a specific, intense kind of anxiety. It’s a reaction to trauma, like wartime combat, being raped or robbed at gunpoint.  Symptoms include flashbacks, nightmares or unwanted memories of the event.

Most of us experience periods of anxiety and depression throughout our lives. However, if anxiety or depression interferes with your ability to get through the day, your doctor may consider you “clinically depressed” or find that you meet the criteria for “generalized anxiety disorder”.  This is usually when doctors recommend anti-depressants or anti-anxiety medications.

If your depression or anxiety comes and goes relatively quickly, it probably wouldn’t be considered a psychological diagnosis.  For example, I like to organize my closet by color and type of garment (e.g., t-shirts together, jeans together), but I don’t spend much time worrying about it. It’s a bit obsessive, but I don’t have OCD. On the other hand, if I am so depressed that it’s hard for me to get out of bed or I stop seeing most of my friends, that’s probably “clinical” depression.

And what about that universally misunderstood phenomenon: bipolar disorder? Bipolar disorder used to be called “manic depression”. To meet the diagnostic criteria, you must experience both: (1) mania, intense/extreme moods and sleeplessness, and (2) depression. It’s not about dancing drunkenly at your favorite bar or occasionally buying something expensive at Nordstrom. True mania is an ongoing experience of staying up for days with racing thoughts, extreme (delusional) self-confidence, and repeatedly engaging in behavior that endangers you or others.

If you wonder if you’re “clinically” anxious or depressed, talk with a psychiatrist you trust.  I encourage you to be a mildly cynical patient (it’s good for your health) and to switch doctors if your doctor talks down to you.

It’s always wise to question whether “pills” are right for you or not.  For some people, medication is a real lifesaver, while for others, it’s not so helpful.

I hope I’ve demystified some psychobabble for you. If your doctor uses any of these words, ask her/him to explain them: not everyone uses these terms the same way. And please be wary about information you find on Internet sites: you can find anything out there, from one extreme to the other. Instead, quiz your doctor and trust yourself.