At first glance, one may think there’s no link between panic disorder and depression. One condition implies a person may be animated and visibly upset after being triggered, while the other may bring to mind an image of a person who mopes around while feeling “down in the dumps.”

Neither assumption presents the whole story, as the connection is more complex than what meets the eye. To understand how these two mental health conditions are connected, we must first understand what they are.

Depression and anxiety disorders may seem like opposites. Depression comes with mood disorders and involves a very low mood, while panic disorders involve an elevated level of vigilance and worry. However, these mental health issues are complex, and they can occur at the same time. They may have similar risk factors that lead to the development of both disorders. In some cases, one issue may lead to the other.

What Is Panic Disorder?

People with panic disorder experience repeated episodes of intense fear known as panic attacks and usually are caught off guard because these episodes seemingly come out of nowhere.

Panic disorder is common, as it affects 6 million adults, or 2.7 percent of the U.S. population, according to the Anxiety and Depression Association of America (ADAA). Women are twice as likely to be affected as men, and about 2 to 3 percent of Americans experience panic disorder in a year.

In some cases, panic attacks happen after a person has experienced an external stressor, such as a phobia. However, they can happen unexpectedly with no clear cause or reason.

Physical symptoms often mark these episodes, which can be helpful in recognizing them when they happen. Among these symptoms are:

  • Dizziness
  • Heart palpitations
  • Shortness of breath
  • Sweating
  • Nausea

Symptoms usually peak within 10 minutes, and the panic attacks eventually subside. However, the fear that they will return usually lingers long after the attacks are over. People who have them can become preoccupied with the possibility of the episodes happening again, and some may feel helpless in controlling them. The American Academy of Family Physicians explains that panic disorder is diagnosed when a person experiences recurring, unexpected panic attacks and exhibits at least one of the following:

  1. Having persistent concern about having another attack
  2. Worrying about the implications of an attack or its consequences
  3. Experiencing a major change in behavior related to the attacks (such as avoiding daily activities like going to work)

The ADAA writes that panic disorder is real and that treatment can be effective. People who experience it are encouraged to seek professional help.

What Is Depression?

Depression goes beyond “feeling the blues,” and it is often more significant than most realize. The condition, also known as major depressive disorder, is a serious medical illness that negatively affects how a person feels, thinks, and acts, according to the American Psychiatric Association (APA).

In addition to changing one’s mood, depression can cause a person to lose interest in activities they once found enjoyable and disengage from life in such a way that they can’t function in any environment, such as at home or at work. They also may experience changes in their appetite or sleep schedule and find it hard to stay on task or feel motivated to take on tasks.

Symptoms of depression range from mild to severe, but the APA advises that symptoms must last at least two weeks before a diagnosis of depression can be given. It also writes that depression is treatable and that between 80 percent and 90 percent of people with the condition eventually respond to treatment. “Almost all patients gain some relief from their symptoms,” the association says.

Treatment may involve antidepressant medications and therapies, such as cognitive behavioral therapy (CBT), to help the person focus on positive solutions for changing their thoughts and behaviors.

Are Depression and Anxiety Related?

Anxiety involves worry, alertness, insomnia, and hypervigilance. Panic disorders are intense forms of anxiety that involve periods of terror and the feeling of impending doom. Depression involves low energy, loss of interest in most activities, and feelings of sadness or worthlessness. However, these two problems aren’t opposites, and they may be more closely related than you think. In fact, as much as 60% of people with anxiety disorders also experience depression symptoms. 

Anxiety and depression have significant overlap, and it’s possible to experience both disorders at the same time. Both can be caused by stress, trauma, and genetic factors. If you go through a period of high stress or a sudden traumatic event, it’s possible to develop anxiety and depression problems. Mental health issues can be progressive, which means they can get worse over time if they are left untreated. In many cases, severe depression and anxiety can lead to one another. Panic disorders can be overwhelming, making your life seem more difficult. As anxiety starts to affect multiple areas of your life, you may start to experience depression symptoms. 

Panic Disorders and Isolation

Panic attacks are intense moments of fear and anxiety, but they are often brief. Still, the relationship between anxiety and depression could have to do with the panic attack aftermath. Panic attacks are so intense that people who experience them often worry about the next time they might have one. This can lead to anxiety symptoms in between panic attacks. It can also lead to something called avoidance, which is a psychological phenomenon when you start to avoid people, places, and situations that you associate with negative emotions. People with panic disorders often avoid the places and situations in which they experienced panic episodes, even if their environment wasn’t directly related to the attack. 

Avoidance can make your life more complicated, especially as you avoid more and more scenarios. This can lead to more stress, but it could also cause social isolation. Isolation is mental health kryptonite. Staying away from friends and family limits your support system and worsens your overall mental health, which can lead to depressive disorders.  

Biological Mechanisms of Anxiety and Depression

Anxiety disorders and depression may be related through similar biological mechanisms in the brain. A 2010 study found that stress, anxiety, and depression may be linked by neurological pathways that have to do with a specific serotonin receptor called 5-HTRs. Serotonin is an important brain neurotransmitter that is responsible for balancing your mood. It also plays a role in sleep, digestion, blood clotting, wound healing, bone health, and sexual desire.

Serotonin levels could be a common link between panic and depressive disorders. Fortunately, treatment options can address these disorders by addressing serotonin levels. Selective serotonin reuptake inhibitors (SSRI) are first-line treatment options for both anxiety and depression. These drugs can increase serotonin levels to improve your mood and relieve anxiety. Though they aren’t magic pills, it’s important to work with your doctor to find the best treatment option for your needs. 

How Panic Disorder And Depression Are Linked

Panic disorders can be brought on by overwhelming anxiety, and anxiety disorders are usually found in people who are also dealing with depression. It is also common for both conditions to co-occur when they appear.

“It’s not uncommon for someone with an anxiety disorder to also suffer from depression or vice versa,” the ADAA says. “Nearly one-half of those diagnosed with depression are also diagnosed with an anxiety disorder.” It also highlights that generalized anxiety disorder (GAD) often co-occurs with major depression.

According to VeryWell Mind, people with panic disorder have a greater chance of developing clinical depression, which is the more-severe form of depression, as the Mayo Clinic explains.

“Research has indicated that approximately half of those diagnosed with panic disorder will have at least one incidence of major depression in their lifetime,” the web publication writes.

The Mayo Clinic, which also confirms it is possible to have both conditions at the same time, advises people to seek treatment for them. That treatment is similar to the methods used to address each condition individually.

“Symptoms of both conditions usually improve with psychological counseling (psychotherapy), medications, such as antidepressants, or both,” it says. “Lifestyle changes, such as improving sleep habits, increasing social support, using stress-reduction techniques, or getting regular exercise, also may help.”

People who have panic disorder and/or depression are advised to stay away from alcohol, smoking, and recreational drugs. “They can make both conditions worse and interfere with treatment,” the Mayo Clinic says.

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