When you know the warning signs of clinical depression and anxiety, you can help yourself and help a friend or loved one seek the support and care necessary to heal, grow, and move past the disruptive cycles of behavior and emotion that mental health diagnoses like depression and anxiety can cause.
Mental Health in the U.S.: Where are We Now?
In the U.S. in 2023, our general outlook about mental health, mental illness, and mental health disgnoses is different than it was just five years ago. Back in 2018 – if you can think back that far – we were in the midst of two different crises related to mental health.
Among adults, the opioid addiction and overdose crisis had national attention. Policymakers, treatment providers, and advocates at the local, state, and federal level were working to implement harm reduction strategies to mitigate the ongoing harm cause by the crisis.
Among youth and teens, rates of suicide were increasing at alarming rates: trends rose from 2009-2015, fell from 2015-2017, then began increasing again. Now, according to the National Alliance on Mental Illness (NAMI), suicide is the second leading cause of death among people age 18-25.
Then the COVID-19 pandemic happened. This led in an increase in rates of depression and anxiety among all demographic groups in 2020 and 2021, which stabilized in 2022. However, those rates stabilized at their new levels, which means the residual effects of the pandemic remain, and rates of depression and anxiety among adults remain high.
Depression and Anxiety: Facts and Figures
The World Health Organization (WHO) reports the following statistics:
- 3.8% of people in the world report depression
- Among adults 18-59: 5.0%
- Among adults 60+: 5.7%
Now let’s look at the latest information for the U.S.:
- Age 18+: 8.4% report depression
- With major impairment: 6%
- Age 12-17: 17.0%
- With major impairment: 12%
Next, let’s look at the latest information on anxiety. Here’s the WHO data:
- 4.1% of people in the world report anxiety
- Rates are similar across age groups
- Rates are over 50% higher among women
And here’s the latest information for the U.S.:
- Age 18+: 31.1% report any anxiety diagnosis
- Past year diagnosis: 19.1%
- With major impairment: 22.8%
- Age 12-17: 31.9%
- With major impairment: 8.3%
We reported percentages above, but the numbers associated with these percentages might drive the data home more effectively. Around 280 people in the world report depression and around 300 million people in the world report anxiety. In the U.S., around 20 million people report depression, and close to 80 million people report anxiety: that’s an increase of close to 20 percent for each condition from pre-pandemic levels.
That’s why it’s important for all of us to keep an eye on our friends, family, and loved ones: the statistics show that among all demographics and age groups, rates of depression and anxiety are increasing. To keep any eye on them, we need to know what to watch or, i.e. the warning signs.
Depression: Warning Signs and Symptoms
Everyone experiences periods of sadness and worry in their lives. Most of us are familiar with depressive and anxious feelings that don’t meet the criteria for a clinical diagnosis of depression or anxiety. Sometimes those periods are difficult and take several days to pass. The feelings my recur, and then fade over a period of weeks or months, but the majority of the time, the symptoms are either absent or don’t cause significant problems.
That’s different than depression and anxiety that meet the criteria for a clinical mental health diagnosis. For both anxiety and depression, the threshold for a clinical diagnosis is relatively high. Symptoms must be present every day for at least two weeks and cause significant disruption in daily life. Significant disruption means the symptoms either impair or completely prevent full participation in activities related to work, school, or social life, and cause problems in family relationships, work relationships, and friendships.
That’s different than the temporary sadness caused by a disappointment at work or a romantic breakup, and different than the acute worry caused by an upcoming performance review at work or trepidation about a date or social event. With clinical depression or anxiety, the sadness or worry dominates daily life, prevents optimal functioning, and lasts every day for two weeks or more. Keep these important facts in mind while review the warning signs of depression and anxiety we list below.
Depression: Signs You Should Know
- Sadness that does not go away
- Excessive crying
- Irritability and anger
- Agitation and restlessness
- Persistent sense of worthlessness
- Detaching/disengaging from friends, family, and/or favorite hobbies or pastimes
- Difficulty concentrating, making decisions, and remembering things
- Sudden drop in work or school performance
- Sudden weight loss/gain
- Insomnia or oversleeping
- Recurring phantom aches and pains, i.e. headaches and stomachaches that have no apparent cause and don’t go away with typical remedies
- Suicidal thoughts/behaviors: thinking about, talking about, or attempting suicide*
*Note: NEVER IGNORE TALK OF SUICIDE. If you or someone you love is considering suicide, please call The National Suicide & Crisis Lifeline: dial 988 or use The Lifeline Chat for immediate help 24/7/365. If you or someone you love is in a medical crisis right now, call 911 or go the a hospital emergency room.*
Please listen to that advice and take any talk of suicide seriously. Those bullet points above include the major warning signs and symptoms of depression. Remember: symptom severity and duration are what distinguish typical sadness from depression. However, if you think you have depression but don’t meet the criteria we discuss above, we advise seeking an evaluation from a mental health professional: only a licensed provider can make an official diagnosis.
Anxiety: Warning Signs and Symptoms
Before reading the following lists, please remember the disclaimer above: to meet clinical criteria, symptoms must persist every day for two weeks or more and cause significant disruption in daily activities and responsibilities.
There are two types of symptoms associated with anxiety: symptoms related to emotions and symptoms related to physical sensations.
We’ll list the symptoms related to emotions first:
- Fear:
- People with anxiety display fear of many common situations, from work, to school, to social events
- Agitation:
- People with anxiety report feeling restless all the time
- Irritation:
- People with anxiety report getting annoyed easily and often
- Negative forecasting:
- People with anxiety often expect to experience the worst outcome in any given situation
- Tension/Stress:
- People with anxiety report feeling jumpy or on edge nearly all the time
Physical:
- Tachycardia:
- Defined as a heart rate of over 100 beats per minute, many people with anxiety report elevated heart rate and shortness of breath, with no physical cause
- Aches and pains:
- Headaches, muscle and joint pain, nausea, and stomachaches are common among people with anxiety
- Tics/other symptoms:
- People with anxiety often report uncharacteristic tremors, twitching, excessive sweating, and frequent trips to the restroom (diarrhea or constant need to urinate)
Those are the primary symptoms of anxiety to watch for in any friends or loved one who may have developed anxiety over past several years. If you or someone you love shows these signs, the first step is to arrange – or encourage them to arrange – a comprehensive mental health evaluation administered by a mental health professional. This article is meant as a guide: only a licensed professional can diagnose a clinical mental health condition.
Treatment for Depression and Anxiety: Traditional and New Modalities
The most common, traditional treatment approaches for both depression and anxiety include some combination of counseling/therapy, medication, lifestyle changes, and complementary therapies.
Counseling and Therapy
This may occur one-on-one, in groups of peers in treatment, or with family.
- Types of therapy for both depression and anxiety may include:
- Cognitive behavioral therapy (CBT)
- Dialectical behavior therapy (DBT)
- Acceptance and Commitment therapy (ACT)
- Types of therapy common for anxiety but not depression may include:
- Prolonged exposure therapy (PET)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Exposure and Response Prevention (ERP)
Medication
- Common medications for depression include:
- Antidepressants, such as selective serotonin uptake inhibitors (SSRIs), e.g. Prozac, Zoloft,
- Common medications for anxiety include:
- Anxiolytics, such as benzodiazepines, e.g. Xanax, Klonopin
- New medications for depression, treatment-resistant depression, and some types of anxiety (i.e. PTSD) include:
- Spravato®
- Ketamine
New Modalities
- The medications we list above are new: evidence shows Spravato® and Ketamine offer quick relief from depressive symptoms, and relief from some types of anxiety disorders
- In addition, a non-invasive form of treatment called transcranial magnetic stimulation (TMS) was recently approved by the FDA and offers quick relief from depressive symptoms
Lifestyle Changes/Complementary Therapies
- Healthy eating:
- Evidence shows a commonsense diet – low in sugar and processed foods, high in fresh fruits, vegetables, lean protein, and whole grains – can improve mental health and overall wellbeing
- Exercise/activity:
- Evidence shows a regular exercise routine helps improve mental health and overall wellbeing
- An active lifestyle has the same positive results, meaning you don’t have to go to the gym, lift weights, or run five miles a day to get the benefit of exercise: what you need to do is stay active, which can mean anything from projects around the house, to gardening, to daily walks, to playing recreational sports with friends
- Complementary therapies:
- Mindfulness and meditation can reduce stress and improve mental health
- Yoga and tai chi can improve physical, mental, and emotional health
- Acupuncture can help reduce symptoms of depression and anxiety
Of the treatments we share above, the most notable new therapies are TMS and the use of psychedelics, i.e. ketamine and Spravato®. While lifestyle changes, and mindfulness, meditation, yoga, and tai chi aren’t necessarily mainstream, they aren’t necessarily new, either. However, psychedelics and transcranial magnetic stimulation (TMS) are new, and evidence shows they offer fast-acting and long-lasting symptom relief for the symptoms of depression and anxiety.
Mental Health in 2023: Increasing Awareness and Access
It’s important to recognize the transformation around attitudes toward mental health conditions and treatment for mental health conditions that’s occurred over the past five years. And when we go back further and look at the past twenty years, we see even more progress: what was nearly taboo then is commonplace now. Although stigma still exists, it’s possible to hear people talk about treatment and therapy with pride rather than shame.
They’ll celebrate their treatment successes with friends, rather than hide them. They’ll talk openly about learning to manage they symptoms of depression and anxiety, and discuss warning signs with friends and family to they can get help and support if needed, too.
That’s very real and important progress. However, the real progress is within each of us: if we experience the symptoms of depression or anxiety, it’s important for us to seek professional support and care as soon as possible: mental health conditions rarely resolve on their own, but instead, often increase in severity when left untreated. We can extend this same awareness to our circle of friends and loved ones. If symptoms appear – in ourselves or people we care about – we need to seek support, and that starts with a professional evaluation.
Treatment works – and the sooner a person who needs treatment for depression or anxiety gets the treatment they need, the better the outcome.