Depression, anxiety not synonymous

U. IOWA (US) — Anxiety and depression are often lumped together, but the way they manifest themselves is quite different, a significant finding for diagnosis and treatment purposes.

People who report feeling depressed, express their emotions in terms of events that happened in the past while those who say they feel anxious, talk about things happening in the moment.

Understanding how factors such as mood influence symptom reporting is important because physicians make decisions based on the symptoms patients report, how intense they are, and how frequently they occur, says Jerry Suls, professor of psychology at the University of Iowa.

Previous studies have linked inflated symptom reports to “negative affect,” a disposition also known as neuroticism. One-fifth of the population is believed to have this general tendency, which involves frequent feelings of anger, anxiety, fear, irritation, or sadness.

For the new study, researchers examined the influence of temperament on symptom recall by isolating each emotion.

Details are published in the Journal of Personality and Social Psychology.

“Our data suggest that a person who walks into a physician’s office feeling sad will tend to recall experiencing more symptoms than they probably really did,” Suls says.

“If a person comes into the physician’s office feeling fearful, they’re more likely to scan their body and read any sensations they’re experiencing at that moment as something wrong.

“We believe this is because depression is associated with rumination and exaggerated recall of negative experiences, while anxiety is associated with vigilance for potentially negative things in the present time.”

In the first part of the study, 144 undergraduate students completed questionnaires to assess their level of “depressive affect,” and indicated which of 15 common physical symptoms they had experienced in the past three weeks.

Even after factoring out physical signs of depression, like appetite changes or sleep loss, people who felt more depressed believed they had experienced more symptoms.

“Is it possible they actually did experience more symptoms? Sure,” Suls says. “But all of these folks were nominally healthy. It’s likely that each one experienced roughly the same number in terms of actual symptoms, but those who happened to be feeling blue thought they had experienced more.”

Another phase of the study examined current symptom reporting. A sample of 125 undergraduates were assigned to groups. To induce a specific mood, each group wrote in detail for 15 minutes about an experience that made them feel angry, anxious, depressed, happy, or neutral.

They then completed a checklist to indicate which of 24 symptoms (weakness/fatigue, cardiorespiratory, musculoskeletal, and gastrointestinal) they currently felt. Participants in the anxious mood category reported higher numbers of physical symptoms.

“People could say, ‘Well, you made them anxious—isn’t that going to produce a physiologic reaction, like a pounding heart or sweaty palms?’” Suls says.

“But we observed a general increase in all current physical symptoms—fatigue, for example, which isn’t typically a consequence of feeling fearful or nervous.”

Researchers repeated the writing exercise with another group of 120 students—only this time they asked participants to report both current and retrospective symptoms.

On average, people in the anxious group reported five current symptoms, while those in the depressed and neutral groups only reported one or two. Reflecting on the past three weeks, the sad participants reported experiencing seven symptoms on average, while the other groups only recalled about three.

“Making people feel sad didn’t influence what they reported feeling at the moment, but it was associated with reporting having had more symptoms in the recent past,” Suls says.

“With anxiety, we saw exactly the opposite. They didn’t report more symptoms over the past three weeks, but at the moment they reported more.”

Health care providers should not discount symptoms by virtue of the patient’s mood, but should be aware that different emotions appear to play into how patients perceive their current and past symptoms.

“Ideally, a doctor would engage with the patient briefly to get a sense whether they’re experiencing anxiety or sadness at the time of the visit,” Suls says.

“In some cases, it may be worthwhile to ask a significant other what they’ve observed in terms of symptoms, or to ask the patient to keep a symptom diary to ensure accuracy.”

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