Panic Disorder & Depression

People who suffer from anxiety disorders frequently have a history of major depression as well. This connection holds for all types of anxiety disorder, but the association is strongest among those who’ve been diagnosed with panic disorder, or who’ve suffered symptoms consistent with such a diagnosis.

About half of all panic disorder sufferers will be diagnosed with depression either before, during, or after the onset of their panic attacks, and depression does not co-occur with any of the other anxiety disorders at such a high rate.

The relationship between panic disorder and depression is undeniable. But the explanation for the association cannot be reduced to a simple case of cause-and-effect. People who are prone to one condition tend to be prone to the other, and that is why depression has such a high predictive value for panic disorder.

Panic disorder and depression are serious mental health conditions that can each cause major life disruption. But when they occur simultaneously the symptoms of each may become even more intense and disabling, overwhelming the capacity of sufferers to cope.

There is a varying temporal pattern in the development of depression and panic disorder. Some people who suffer from both experience depression symptoms first, while others have panic attacks first and only experience the depression later.

Nevertheless, studies have revealed some tendencies. While any sequence of development is possible, a majority of sufferers will experience their initial panic symptoms before the onset of depression. These symptoms are sudden, random, and a complete surprise, and they leave the men and women who experience them mystified about what has happened.

But early panic symptoms are distinct from actual panic attacks, which must occur repeatedly before panic disorder can be diagnosed—and most people with both conditions suffer their first depressive episode before the onset of full-blown panic disorder. Initial panic symptoms may take weeks, months, or even years to blossom into disabling panic attacks, and by that time depression will usually have made its presence known.

It must be emphasized that this pattern of development is not universal. But its prevalence reveals that panic disorder and depression are closely aligned and intertwined, and the factors that predispose a person to one condition may also put them at risk for the other.

The symptoms of panic disorder and depression are distinct, but when both are experienced simultaneously they reinforce and amplify each other to produce more intense and troubling effects.

In comparison to those who suffer from only one of these mental health disorders, people who experience panic disorder and depression together are:

• More likely to seek treatment from physicians or mental health care providers, based on the debilitating capacity of their symptoms
• More likely to require hospitalization or other forms of intensive medical care
• More likely to lose or quit their jobs (or drop out of school) because of their impaired capacity to perform
• More likely to suffer from stress-related health issues (heart problems, respiratory conditions, high blood pressure, nervous breakdown, chronic headaches or muscle pain, etc.)
• Far more likely to contemplate or attempt suicide

The primary symptoms of depression (loss of energy, motivation, and emotional connection to the world) and panic disorder (multiple panic attacks, usually provoked by specific types of exposures) are likely to be more devastating and overwhelming when the two conditions manifest concurrently. For recovery to occur, both disorders must be treated with equal focus and vigor.

There is some variance in the risk factors for panic disorder and major depression. But there are broad commonalities that help explain the frequent co-existence of the two conditions.

The risk factors shared by these disorders include:

Exposure to childhood abuse. Physical, emotional, and sexual abuse are significant risk factors for all types of all mental health disorders. One 2012 Harvard University study found a strong correlation between childhood abuse and future incidence of depression and PTSD, which happen to be the two co-occurring disorders most frequently experienced by panic disorder sufferers.

Neuroticism. A 2016 joint study sponsored by UCLA and Northwestern University found a strong correlation between neurotic personality and mood and anxiety disorders. People who demonstrate the traits of neuroticism are highly sensitive to negative emotional experiences, which in their case are generated by stressful outside experiences they are unable to cope with or handle.

Negative biases that distort information processing. These biases create unhelpful and unproductive thinking patterns. Information processing biases for depression are revealed through an obsessive focus on negative feedback, a tendency to interprete ambiguous data negatively, and especially vivid memories of traumatic or self-esteem-damaging events.Information processing biases connected to anxiety make panic disorder sufferers highly sensitive and reactive to even the slightest hint of panic symptoms, cause them to interpret relatively benign situations as threatening, and leave them feeling as if they have no control over their anxiety symptoms (or, ultimately, over their lives).

Excessive activity in areas of the brain related to fear and memory. People suffering from depression and/or panic disorder demonstrate hyperactive patterns of response in two interrelated areas of the brain: the hippocampus and the amygdala. The latter is associated with emotional responses, including the intense and paralyzing fear associated with anxiety, while the former is responsible for the processing and formation of memory. Excessive activity in both areas makes anxious responses common and assures their triggers will be vividly remembered.

Suffering from other anxiety disorders besides panic disorder. Panic disorder and agoraphobia have a high rate of co-occurrence, and somewhere between 30 and 50 percent of all panic disorder sufferers will be diagnosed with co-occurring agoraphobia. There is a strong link between social anxiety disorder and panic disorder as well, which is not surprising since social anxiety is a common complicating factor in the development of agoraphobia.

Major depression is also strongly associated with social anxiety disorder. It also develops in many people who suffer from generalized anxiety disorder, which is frequently diagnosed among those who experience recurrent panic attacks.

These mutually relevant risk factors demonstrate the common roots of panic disorder and depression, which can easily manifest in the same individual without any type of cause-and-effect relationship.

Diagnosing co-occurring mental or behavioral health conditions can be a significant challenge, since comorbid conditions often exhibit similar symptoms.

But this is usually not a problem when the comorbid disorders are major depression and panic disorder. Both produce distinctive symptoms that are not difficult to identify, if patients report those symptoms thoroughly and accurately. Also, mental health professionals are well aware of how common depression is among panic disorder sufferers, and vice versa, and they are certain to screen for both conditions when one or the other is suspected.

Panic disorder and depression must be diagnosed separately, based on the appearance of multiple symptoms over an extended period of time (two weeks for major depression and one month for panic disorder).

After a dual diagnosis for panic disorder and depression has been made, patients should be referred to integrated treatment programs that will address all the symptoms of both conditions at once. Neither condition should be given priority over the other, since each is a serious condition that can have significant long-term effects if left untreated.

When multiple mental health conditions are diagnosed, treatment should begin in a residential treatment facility, where inpatient programs can be customized to meet the unique needs of every individual in recovery.

A dual diagnosis treatment program for panic disorder and depression will include daily psychotherapy sessions offered in a mixture of individual, group, and family therapy formats. Cognitive-behavioral therapy (CBT) is highly effective against the symptoms of panic disorder and is quite useful for depressed patients as well, and is likely to play a key role in any therapy regimen.

Anti-depressant medications are the preferred choice for panic disorders, which blends perfectly with the needs of those suffering from clinical depression. Other additions to a dual diagnosis recovery program may include life skills/coping skills classes designed to help sufferers deal more effectively with their symptoms when they do arise, and training in holistic healing practices that can be potent remedies for stress and anxiety management.

Separately, panic disorder and depression are both treatable and respond well to intensive interventions, and when they must be treated together the results can be just as favorable. The symptoms of panic disorder and depression can be powerful and intimidating if left unaddressed, but when sufferers get the help they need their odds of long-term recovery are excellent.