When a person suffers from two or more mental health conditions, they are referred to as “comorbid” or co-occurring disorders. Anxiety and depression are the two diagnoses most closely related, and for adolescents and teenagers, the two mental health disorders most commonly assigned together. Anxiety and depression can be difficult to cope with and manage at any age. Yet for young people dealing with both mental health disorders (at the same time) the symptoms can be overwhelming, cause significant distress, and impact all areas of life.
What Is Anxiety?
Anxiety is a general term for the many disorders that cause worry, nervousness, apprehension, and fear. The various types of anxiety disorders not only cause emotional and cognitive symptoms, but can also manifest in physical ways, such as increased blood pressure, tension headaches, and/or gastrointestinal upset. Anxiety disorders are typically classified into six main types including:
- Generalized anxiety disorder (GAD) – the most common type of anxiety is generalized anxiety disorder, which is characterized by ongoing and long-lasting worry. Those with generalized anxiety disorder are often unable to identify a cause for the anxiety.
- Social anxiety disorder – social anxiety disorder is marked by fear of social situations, including fear of public embarrassment and/or fear of being judged negatively by others.
- Obsessive-compulsive disorder (OCD) – one of the more unique anxiety disorders, OCD sufferers have repetitive and intrusive thoughts or behaviors.
- Post-traumatic stress disorder (PTSD) – this type of anxiety is usually the result of experiencing trauma (i.e. – emotional/physical/sexual abuse, combat, serious accident, etc.).
- Separation anxiety disorder – marked by high levels of anxiety when separated from a particular person/place to which an individual is attached to, separation anxiety disorder can often result in panic symptoms.
- Panic Disorder – sudden attacks of intense fear or terror are inherent for those who suffer from panic disorder. These attacks tend to come on quickly (often without a clear trigger) and can last anywhere from a few minutes to a few hours.
It is estimated approximately 15-20% of adolescents and teenagers meet criteria for at least one anxiety disorder.
General Symptoms of Anxiety in Adolescents and Teenagers
- Restlessness or nervousness
- Increased heart rate and/or breathing
- Rapid breathing patterns or hyperventilation
- Gastrointestinal issues
- Avoidance (of things that trigger anxiety)
- Changes in eating and/or sleeping patterns
What Is Depression?
Depression refers to a serious mental illness and mood disorder that can cause persistent feelings of sadness, hopelessness, and/or loss of interest. Depression is more than just the “blues” or occasional sadness that all people feel at some point throughout life. Depression can take on many forms in teens, with the four most common being:
- Major Depression – also called clinical depression, major depression manifests in adolescents and teenagers as feelings of sadness (lasting longer than 2 weeks). Other typical signs of major depression in teens are difficulty concentrating, changes in sleep and/or eating habits, lack of interest in previously enjoyed activities, and social isolation.
- Dysthymia – dysthymia, also called persistent depressive disorder, is a long-term, chronic form of depression. Dysthymia often presents many of the same symptoms as major depression, but they tend to be less severe. To be diagnosed with dysthymia, an adolescent or teen must experience ongoing “low mood” for at least two years.
- Adjustment Disorder with Depressed Mood – this form of depression occurs much more frequently in adolescents/teens than in adults. Adjustment disorder usually develops within three months following a life change or event. These life events or life changes can vary in intensity – anything from a breakup with a boyfriend/girlfriend to the death of a family member.
- Bipolar Disorder – bipolar disorder in adolescents and teens is often described as a sort of teeter-tooter in that they experience periods of elevated mood (sometimes very extreme) followed by periods of low mood.
General Symptoms of Depression in Adolescents and Teenagers
- Irritable mood
- Changes in sleep and/or eating habits (including weight loss or weight gain)
- Low self-esteem
- Slowed speech and/or thinking
- Difficulty concentrating
- Loss of energy
- Frequent crying episodes
- Drastic mood swings
- Low self-esteem
- Physical aches and pains (unexplained by other health issues)
- Thoughts of self-harm, death, and/or suicide
Link Between Anxiety and Depression
For teens and adolescents, anxiety disorders and depression frequently manifest together. The symptoms of both tend to overlap to some extent, and end up presenting similarly, especially in adolescents and teens (insomnia, agitation, trouble focusing, ongoing worry). This overlap in symptomology can make the diagnostic process difficult in terms of deciphering if the person is suffering from anxiety, depression, or both.
The connection between the symptoms of anxiety and depression is so strong that some antidepressants (typically prescribed for those with some form of depression) are often given to individuals diagnosed with anxiety (that do not suffer from depression at all). In the same respect, coping skills and tools taught for individuals with anxiety are frequently recommended for those with depression (even when that person does not have an anxiety disorder). Additionally, many studies evidence several of the same neurotransmitters lead to both depression and anxiety.
Of course, comorbid anxiety and depression tend to have strong effects on one another, in that the presence of depressive symptoms may lead to an increase in anxiety symptoms, and vice versa. Teenagers who struggle with anxiety are at an increased risk of developing depression. In fact, having an anxiety disorder is the most significant predictor that a young person will develop depression. There have been many studies on the comorbidity of anxiety and depression in adolescents and teenagers that show anxiety is almost always the “predictor,” with depression as the “outcome.” This means that typically, teens and adolescents who struggle with both depression and anxiety, most likely suffered with anxiety first, and the depression developed sometime later. Some studies show this to be particularly true when it comes to females. Interestingly, there is far less evidence of depression preceding anxiety.
The likelihood of depression developing after anxiety could be due to the impact ongoing anxious thoughts can have on one’s general mental health and overall outlook on life. This seems to be particularly true for those with panic disorder, as panic attacks tend to trigger feelings of fear, helplessness, and catastrophe.
Treatment for Anxiety and Depression in Teens
The prognosis of comorbid anxiety and depression is worse than either condition alone, with an increased risk of recurrence, higher risk of suicide, greater impairment, and longer duration.
Thankfully, comorbid anxiety and depression in adolescents and teenagers is treatable, especially if caught early. The most commonly used approach for treating both anxiety and depression is cognitive-behavioral therapy (CBT). Cognitive-behavioral therapy teaches individuals to catch and challenge negative thoughts, recognize unhealthy patterns of behavior, and identify helpful ways to cope with the difficult symptoms of depression and anxiety.
If the depression, anxiety, or both are on the more severe side, medication may also be incorporated into the treatment plan.