Clinical Depression (aka, “Major Depressive Disorder”): a mood disorder that causes severe symptoms affecting how a person feels, thinks, and manages daily activities (sleeping, eating, working, etc.). To be diagnosed with depression, symptoms must be present for at least two weeks.
Anxiety Disorders: a group of mental disturbances with anxiety as a central symptom. Although anxiety is common, not everyone who experiences it has an anxiety disorder. Anxiety is associated with a wide range of physical illnesses, medication side effects, and conditions.
This article was medically reviewed by Dr. Troy Noonan, MD Psychiatry. Dr. Noonan received his M.D. from Finch University at the Chicago Medical School, Psychiatry Residency and fellowship at the University of South Florida (USF) College of Medicine. He is Certified by the American Board of Psychiatry & Neurology.
Can Stress Cause Depression and Anxiety?
How can stress cause depression and anxiety? If you found this article by asking that question, you’re not alone. The short answer is that chronic stress, when untreated, can lead to multiple health problems including, high blood pressure, muscular pain, insomnia, immune system problems, obesity, and heart problems.
Chronic untreated stress can also play a role in someone developing major depressive disorder (I.E., clinical depression). That’s the short answer to the “can stress cause depression and anxiety” question.
The more important question is how this happens and what it means if you’re concerned about the impact of stress on your long-term mental health.
This article explains the complex connections between everyday stress (I.E., acute stress) and chronic stress, and the longer-term mental and physical health problems caused by chronic stress. We’ll also discuss treatment options for anxiety and how modern doctors treat depression without medication. We’ll start by clarifying the difference between ordinary stress and chronic stress.
NOTE: Throughout this article, you will find the terms “clinical depression” and “major depression disorder” used interchangeably. You’ll also find the terms “depression,” “reactive depression,” “low-grade depression,” and “situational depression” used to describe non-clinical depression.
Acute Stress vs. Chronic Stress – The Differences That Matter
Acute stress is normal and even healthy. It is your body’s natural response to unpredictable, novel, high-risk, or high-pressure events. Acute stress causes your body to release specialized hormones (including, glucocorticoids, catecholamines, growth hormone, and prolactin) to help you deal with the stressful situation.
A hormone is a specialized chemical that carries “messages” through your bloodstream. Hormones and neurotransmitters are alike in that they are both chemical messengers. The difference is that hormones work through your bloodstream and therefore have a longer-term effect on your body. Hormones control everything from muscle movement, gland activation, mood, and more.
Like neurotransmitters, hormones come in two basic types: excitatory and inhibitory. In layman’s terms, excitatory hormones are your “fight or flight” hormones, while inhibitory hormones are your “rest and digest” hormones.
Excitatory hormones promote functions that increase certain physiological activities, while inhibitory hormones cause decreased physiological activities.
The negotiation between excitatory and inhibitory hormones regulates and stabilizes fluctuations between your “fight or flight” and “rest and digest” states and their corresponding functions. Too much, or too little, of any hormone, can upset this balance, leading to prolonged states of stress, known as chronic stress.
For example, cortisol is your body’s primary stress hormone. When a sudden stressful situation causes an elevated heartbeat, fast breathing, muscle tension, and hypervigilance, you feel cortisol’s effect on your nervous system. Think of cortisol as your body pulling a fire alarm to alert the other systems in your body. It is produced in your adrenal glands (triangle-shaped glands that sit on top of your kidneys). Cortisol controls how your body uses fats, proteins, and carbohydrates.
In healthy doses, it also regulates your blood pressure and helps your body reduce inflammation, and to control your sleep/wake cycles. Acute stress (temporary stress) causes your body to release cortisol, sending your body into a hypervigilant state. For instance, when your body is in fight or flight mode, cortisol can change or even shut down functions that interfere with your goal to deal with the stressful situation. These shutdowns can include your digestive system, reproductive systems, immune system, and (in younger people) even growth processes.
Under normal circumstances, the effects of cortisol wear off, and your state returns to normal. However, prolonged exposure to stressful circumstances (or perceived stressful circumstances) can cause abnormally elevated levels of cortisol in your bloodstream. Over time, this can lead to several health problems, including anxiety, headaches, digestion trouble, memory and concentration problems, insomnia, and even depression and heart disease.
Simply put, if acute stress is your body pulling the fire alarm, chronic stress is when your body acts as if the fire never stopped burning. Now that you have a basic understanding of acute stress vs. chronic stress, let’s talk about how regular stress can lead to severe mental and physical health problems.
Stress, Anxiety, and Anxiety Disorders
Let’s start by clarifying the commonly misstated difference between stress and anxiety. Simply put, stress is the set of exterior stimuli that trigger anxiety, which is the corresponding response within your body.
For example, imagine that your boss emails you with an unexpected and urgent project that’s on a tight deadline. That is stress. When your body responds to this stressful situation by putting you into the fight or flight state described above, that’s anxiety.
As you can see, this control helps answer the question of whether stress can cause anxiety. When the state of anxiety persists over a longer period (days, weeks, months), that is chronic anxiety.
Chronic anxiety can lead to chronic anxiety disorders, some of which, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR), include:
- Generalized anxiety disorder (GAD) – when anxiety symptoms occur in a variety of environments and in response to multiple situations or objections. Generalized anxiety symptoms are usually not attributed to a specific and known cause.
- Obsessive-Compulsive Disorder (OCD) – when anxiety symptoms take the form of obsessive and intrusive thoughts or compulsive behaviors (or mentally rehearsed behaviors).
- Posttraumatic Stress Disorder (PTSD) – when long-term anxiety symptoms occur after a trauma or in response to stimulants which trigger memories of that trauma.
- Panic Disorder –when immediate and severe anxiety symptoms (aka “panic attack”) arise in response to a variety of causes. These panic attacks can also occur in response to the worry of having a panic attack.
- Medically Induced Anxiety – when anxiety is caused by a short or long-term medical condition. Medically induced anxiety often develops in response to illnesses like heart conditions.
- Agoraphobia – a fear or anxiety of being in a public place where getting away might be impossible or embarrassing. Agoraphobia is often associated with the fear of having a panic attack.
- Social Anxiety Disorder – when anxiety symptoms occur in response to social situations or social performances. Social Anxiety is typically based on the fear of being embarrassed or humiliated.
- Specific Phobias – when anxiety symptoms occur in response to a specific object or situation. People with specific phobias will usually avoid the external triggers.
A Common Link Between Anxiety and Depression
Depression and anxiety can cause or magnify one another. For example, people suffering from the anxiety disorders listed above often withdraw from social situations and other life activities to avoid triggering anxiety symptoms. This withdrawal can trigger depression symptoms or intensify them in people who already have them. Likewise, people with depression symptoms can magnify those symptoms by pulling away from social interactions.
"When we're clinically depressed, there's a very strong urge to pull away from others and to shut down, It turns out to be the exact opposite of what we need. In depression, social isolation typically serves to worsen the illness and how we feel …Social withdrawal amplifies the brain's stress response. Social contact helps put the brakes on it."
According to the Centers for Disease Control (CDC), the exact causes of depression are unknown. However, our current research suggests that a combination of genetic, biological, environmental, and psychological factors may be responsible:
- Having blood relatives who have had depression
- Experiencing traumatic or stressful events, such as physical or sexual abuse, the death of a loved one, or financial problems
- Going through a major life change‚ even if it was planned
- Having a medical problem, such as cancer, stroke, or chronic pain
- Taking certain medications
- Using alcohol or drugs
You’ll notice that numbers two, three, and four all involve stress and anxiety. This gives us our first clue for answering the “can stress cause depression and anxiety” question.
How Can Stress Cause Depression and Anxiety? The Long Answer
Understanding the link between anxiety and depression starts with understanding a system called your hypothalamic-pituitary-adrenal axis (aka “HPA axis). The HPA axis is a group of three hormone-secreting glands:
- Hypothalamus
- Pituitary Gland
- Adrenal Gland
The hypothalamus sits just above your brainstem and influences the release of hormones from your pituitary gland. Your pituitary gland is located below your hypothalamus and secretes hormones into your bloodstream to influence targets (glands or muscles) in your nervous system and endocrine system. When activated by an external stressor, your hypothalamus releases corticotropin-releasing hormone (CRH), which signals your pituitary gland to secrete adrenocorticotropic hormone (ACTH) into your bloodstream.
ACTH travels to your adrenal glands, where it causes the release of the stress hormone cortisol. When your blood cortisol levels get too high, receptors in your hypothalamus and hippocampus (both in your brain) shut off the stress response through a negative feedback mechanism. This is a description of your body’s natural and normal response to stress, which—as said earlier—is called anxiety.
However, hyperactivity or dysregulation in the HPA axis has been implicated in multiple disorders, including PTSD, chronic fatigue syndrome, anxiety disorders, cognitive problems, and even major depressive disorder and manic depression. The question which is still being researched and debated is exactly how anxiety might cause major depressive disorder, or vice versa. But the two conditions commonly occur at the same time. They also share common symptoms, including:
- Weight Changes (increased or decreased)
- Sleep Problems (insomnia or hypersomnia)
- Fatigue or being frequently tired
- Trouble concentrating or remembering
More importantly, chronic anxiety disorders and major depressive disorders are both associated with low levels of serotonin and high levels of cortisol. Serotonin is a neurotransmitter (a chemical messenger similar to a hormone but with shorter lasting effects) that can function as an inhibitory or excitatory agent. Serotonin is important in mood regulation, and deficiencies in serotonin are associated with multiple psychiatric disorders, depression being the most common.
This is why anxiety disorders and clinical depression are often treated with the same medications. For example, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are both used to treat anxiety disorders and to treat major depressive disorder.
In many cases, antidepressants like SNRIs and SSRIs can relieve the symptoms of major depressive disorder. However, about 33% of people who use antidepressants will continue to experience symptoms. This is called “treatment-resistant depression” (TRD) or “refractory depression.”
Thankfully, safe and effective ways exist for treating treatment-resistant depression without medication, which we’ll discuss in a moment. The most important thing to understand about the relationship between anxiety and depression is that neither one of them is “all in your head.” The human brain is an extremely complex biological machine, and it’s not the only organ involved in depression and anxiety.
Anxiety, Depression, and Your Gut Health
About 95% of your serotonin is found in your gut, making gut health a likely factor in preventing or managing symptoms of depressions of anxiety and depression. It’s also true that your brain is likely to “remember” episodes of either disorder, and that the likelihood of recurrence increases with every recurrence of both anxiety and depression.
For example, according to data from the American Psychiatric Association, about 50% of people who recover from their first bout with depression will have recurrences, and 80% of those who have already had two episodes of depression will have a third recurrence. While studies have shown recurrence rates for anxiety disorders to be lower (23.5% to 32.7% depending on the number of past episodes), the point is that those who have already suffered one episode of anxiety or depression are more likely to suffer a second.
This tells us that even if you beat depression or anxiety once, it might be harder to overcome the second or third time. This recurrence is called a relapse and is a key consideration when choosing a treatment for anxiety or depression. If you’ve had a long bout with anxiety or depression, or if you’re having recurrences or experiencing both at the same time, it’ll take more than a self-help book or yoga classes to get your life back on track.
In about one-third of clinical depression cases, even antidepressants don’t provide relief. Thankfully, antidepressant medications aren’t your only option.
Major depressive disorder is a very real biological illness and should be treated with the same seriousness as physical illnesses like diabetes. What many people don’t know is that antidepressants aren’t the only option for treating clinical depression. In 2008, the FDA approved Transcranial Magnetic Stimulation (TMS) as a valid option for treating depression without medication.
Today, TMS remains the safest and most effective method for treating clinical depression. TMS was also FDA approved in 2018 for treating obsessive-compulsive disorder (OCD). TMS is not to be confused with ECT, which we discuss in our TMS vs. ECT analysis article. TMS uses magnetic fields, similar to those used in MRIs, to stimulate blood flow in the prefrontal cortex and promote neurotransmitters that play a role in symptoms of depression.
According to controlled clinical studies, 83% of Neurostar TMS patients see a positive response using TMS therapy. The clinical trials also showed TMS to have a 11% relapse rate across all patients, which is a lower rate than any other depression treatment.
Only 37% of TMS patients needed additional TMS, and 85% of these patients re-achieved clinical benefits. Unlike antidepressant medications, TMS doesn’t subject patients to a long list of negative side-effects.
How effective is TMS as a long-term treatment for clinical depression? Controlled clinical studies with Neurostar TMS machines show that 83% of patients experience positive outcomes from undergoing TMS therapy.
These controlled clinical trials also demonstrated an impressive relapse rate of only 11% for all patients tested. This relapse rate is lower than any other depression treatment available. In addition to the low relapse rate, only 37% of TMS patients required more TMS treatments. Moreover, 85% of those treated re-achieved positive clinical benefits.
“Transcranial magnetic stimulation has shown its potential to help patients suffering from depression and headaches. With today’s marketing authorization, patients with OCD who have not responded to traditional treatments now have another option.”
TMS also comes with a less intimidating list of potential side-effects, including:
Common TMS Therapy Side Effects
- Headaches (non-migraine): sometimes reported after TMS treatment sessions. This is particularly common early during the treatment and typically decreases as the treatment progresses.
- Facial Twitching: slight movement of the eyelid or jaw during stimulation. This happens because of superficial nerve branches and muscle groups being stimulated.
- Scalp Discomfort: fleeting discomfort in the head or scalp where the TMS pulses are applied.
Rare Side-Effects of TMS Therapy
- Manic or Hypomanic Symptoms: induction of manic/hypomanic symptoms (e.g., irritability, agitation). Medical professionals typically pause TMS therapy until these symptoms are gone.
- Decreased Auditory Acuity: this side-effect is easily prevented by wearing ear protection (foam earplugs, etc), which most TMS doctors require patients to wear during treatment.
- Syncope Vasovagal Response: this is a medical term that simply means fainting or passing out. This is usually the result of a fleeting drop in blood flow to the brain. Other potential causes include heightened dehydration, anxiety, hypoglycemia, or hyperventilation.
- Seizure Induction: this is extremely rare for TMS patients (estimated 0.001%, or approximately 1 in 89,000 TMS treatments). It is related to the direct stimulation of the motor cortex or adjacent brain area, thus causing excitation to spread to the motor cortex.
TMS is a non-invasive treatment. It does not require sedatives or other medications. Rather, it is a twenty-minute (on average) outpatient procedure that you can undergo during your lunch break, after which you can drive back to work and have a normal day. The TMS full treatment cycle lasts an average of six to eight weeks, with an average of five treatment sessions per week. No other medication-free depression treatment comes close to the safety and effectiveness of TMS therapy.
If you, or someone you know, are looking for a safe and effective way to get free from depression without medication, Mental Health Management Group can help. Mental Health Management Group’s doctors have practiced medicine since 1996 and have assisted hundreds of patients in overcoming clinical depression, anxiety, OCD, PTSD, and other mental illnesses.
The experts at Mental Health Management Group can also help get your insurance company to fund your TMS treatment sessions. To see if you or a family member qualify for TMS treatment, please fill out the patient referral form and one of our practitioners will call you. Don’t let depression and anxiety run your life. We can help, so contact us right now.
This concludes our answer to the question, “can stress cause depression and anxiety.”
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