How to distinguish everyday emotions from mental health conditions, recognize early warning signs, and know when to seek support
Everyone experiences periods of stress, worry, and sadness, but persistent or overwhelming emotions may signal something more. Left unrecognized and untreated, the symptoms of anxiety and depression can begin to interfere with daily life. We spoke with Dr. Oshra Cohen, founding director of Cognitive Behavioral Health Psychology, about how to identify the signs of anxiety and depression, protect our mental health, and why seeking help is a sign of strength.*
How can someone tell the difference between everyday emotions and anxiety or depression?
While anxiety and depression are two distinct mental health conditions, they frequently overlap. So when clinicians evaluate someone for anxiety or depression, we typically screen for the other as well.
Everyone experiences some anxiety or depressive feelings at some point, and that is completely normal, because we have the capacity to experience a very wide range of emotions.
Generally speaking, depression is characterized by feeling sad, empty, worthless, or hopeless; lacking pleasure or interest in activities; weight gain or loss; insomnia or hypersomnia (sleeping too much); fatigue, loss of energy, and diminished ability to think and concentrate.
Many of these symptoms also occur with anxiety. People who are highly anxious may eventually develop depression because the anxiety is overwhelming, and people who are depressed often also experience anxiety, which may feed their depression.
What distinguishes the normal range from what we consider to be clinical is that the anxiety and the worry are excessive —above and beyond what the circumstances or the environment would warrant; they occur more days than not, for at least six months, and are pervasive, which means they interfere with functioning across many areas of life.
The worry is difficult to control, and it’s associated with multiple physical symptoms: feeling restless, being on edge, being easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbances — either having a hard time falling asleep or staying asleep.
What are some of the early warning signs of anxiety and depression that people often overlook in themselves or in loved ones?
In terms of depression, the things to look out for are changes in energy level, changes in a person’s outlook on the future, or losing hope. Depression tends to come with lower energy, a loss of interest and motivation to go out, engage in activities, and spend time with others.
The key is to pay attention to behavioral changes. In the case of an introvert, not wanting to spend time with others may be typical behavior. But if someone generally goes out and suddenly prefers to stay home and is not returning phone calls, those are signs we would want to note.
With anxiety, signs include someone becoming much more high-strung, worrying a lot more than they used to, experiencing racing thoughts, preoccupation with, and rumination about, what has happened or what is going to happen, and whether those worries are excessive, appropriate or productive relative to their current environment and the state of the world.
What can people do to protect their mental health and prevent mild symptoms from becoming more serious or debilitating?
Protective measures for both anxiety and depression are very similar. Regular exercise has been shown to reduce stress as it stimulates the release of endorphins, the body’s natural feel-good chemicals. Additionally, maintaining a healthy diet, getting enough sleep, and having supportive social relationships — people whom you can turn to — are highly beneficial on both a physical and social level.
Psychologically, being able to self-regulate — to recognize how you are feeling, and what action you can take towards accepting or modifying the feeling — is valuable. Another key protective factor is having cognitive flexibility: the ability to reframe negative life events and experiences, and therefore manage stress as it comes.
Equally important is the ability to recognize when things become too much, and you can’t do it alone. Knowing when you need to turn to someone else for assistance is very, very important.
If someone recognizes these warning signs, when is it time to seek professional help?
If you recognize that your functioning is being impaired because of excessive worry or depressive symptoms — or if the people around you are noticing it — that’s the time to seek help.
Conversely, you may be functioning well, but only on the surface. You may be doing everything you need to do — you may be going out, working, and socializing, but living in a constant state of anxiety. There’s no good reason to suffer unnecessarily.
We know that both cognitive behavioral therapy and medication are effective in treating anxiety and depression. Sometimes what we advise is a combination of the two, because when people initially start therapy, they may benefit from medication in order to be able to do the therapeutic work. That’s a discussion and an evaluation that can be had with your psychiatrist or therapist.
Taking that first step can be difficult. What advice would you give someone who is hesitant to seek help?
The first step is to be honest with yourself and acknowledge that, yes, you are suffering and you are struggling, and that it’s okay to get help. This is not something you’re supposed to do alone. Certainly, once depression or anxiety settles in, it becomes really, really difficult to manage on your own. It is not a failure; it simply means something isn’t working right now. The most powerful thing a person can do is find the people who can help them.
Finding the right therapist is kind of like a shidduch. You want a competent therapist whom you feel is an expert in their field, but it also needs to click between you. Don’t be afraid to try someone and then say, “This isn’t right for me.”
But keep trying. Just because you haven’t found the right therapist doesn’t mean that person isn’t out there. It may take a number of sessions before you know whether this work can be done together, so don’t give up too quickly. Stay motivated.
Both therapy and medication can be very helpful. The goal is to stay the course, do the work, and ultimately change the way we think, the way we behave, and the way we feel.
*The information presented is provided for general informational purposes only. This information does not constitute and should not be relied upon as medical or other professional advice.
Dr. Oshra Cohen is a passionate advocate of mental health awareness and of increased psychological well-being in our communities. She is the founding director of Cognitive Behavioral Health Psychology, Prizmah’s director of Mental Health and Wellness, and a mentor for the OU Women’s Initiative. Dr. Cohen holds a Ph.D. in clinical psychology with a health emphasis from Ferkauf Graduate School of Psychology at Yeshiva University. She lectures nationwide on topics related to mental health and wellness, education and psychology.