Not surprisingly many people who come to us have both anxiety and depression, and it’s important to distinguish between the two for a better outcome. It’s not always easy to understand where one ends and the other begins: am I in bed at noon because I’m avoiding anxiety provoking situations, or because I’m so sad and tired it’s hard for me to get up? Often one can cause the other (I’m so unhappy that it’s hard for me to get to work on time, which causes me anxiety about being fired, vs. I’m so anxious about my work performance I’m depressed at the idea that I may lose my job).
Chicken or egg: Why does it matter which comes first?
In a nutshell, knowing which diagnosis is primary helps the person recover more quickly. It gives a focus for treatment. More often we see the anxiety fueling the low mood, and less often the mood causing the anxiety. On occasion individuals have both but they are unrelated. Very often if someone has significant anxiety (e.g., panic attacks that disallows them to go to work or school), it can cause low mood. Once the anxiety is addressed and a person is able to get back to their lives, the depression often lifts on its own. If the depression is primary, the focus is then on behavioral activation first, and later helping the person walk through their anxieties.
Knowing which is primary gives us our first issue to target and address, and if we are even the right provider to help an individual.