Feeling anxious and blue about the future all at the same time? It's not surprising, given the established relationship between depression and anxiety. When it comes to social anxiety disorder (SAD) in particular, feelings of anxiety and worry about being around others can eventually translate into feeling down in general. To get a better handle on how these disorders relate, it helps to learn a bit about the relationship between the two.
Social Anxiety and Depression Go Hand-in-Hand
Research shows that there is a strong relationship between having social anxiety disorder (SAD) and developing depression later in life. If you have been diagnosed with SAD, you are up to six times more likely to develop depression, dysthymia or bipolar disorder. The risk of developing these secondary disorders also increases in relation to the number of social fears that you have.
Risks Associated With Comorbidity
Comorbidity of SAD and depression is associated with an increased risk of problems with alcohol, impairments in social and occupational functioning, poorer response to treatment, and risk of suicide. In addition, if you have been diagnosed with SAD and also suffer with a depressive disorder, you are more likely to have more severe and chronic depressive symptoms.
What Comes First -- Anxiety or Depression?
Although developing SAD at an early age is known to predispose you to later depression, not everyone who has SAD becomes depressed. We do know, however, that when SAD appears at a young age, appropriate treatment may reduce the risk of developing depression at a later age.
Social Withdrawal Differs Between SAD and Depression
Imagine a young college student who wants to make friends and go to parties but fears that she will embarrass herself in front of others. As a result, she stays in her dorm room night after night, wishing she could be a part of the group. Contrast this with the student who avoids social contact because it's just not any fun to her -- the thought of going to parties or getting together with a friend holds no promise of enjoyment.
Although both SAD and depression may involve social withdrawal, the cause of the withdrawal is different. People with SAD withdraw out of fear of negative evaluation by others, while people with depression withdraw due to a lack of enjoyment. People with SAD expect that they could enjoy themselves if they could somehow interact appropriately with others, whereas those with depression don't ever expect to enjoy themselves.
Treatment of SAD and Depression
Depression is often what leads people to seek help, even though SAD may be the underlying problem. Usually people who have SAD will not speak to anyone about the problems that they face and often do not realize that they have a diagnosable illness. As a result, most people with SAD do not usually receive treatment unless the disorder occurs alongside another condition. Unless a medical professional is trained to look for secondary disorders, SAD may continue to go undiagnosed. Unfortunately, treating depression without addressing underlying SAD can be ineffective. Although many of the treatments recommended for depression are also effective in treating SAD, such as selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT), treatment must still be tailored to the specific disorder. If you suffer with both SAD and depression, your doctor or mental health professional will devise a treatment plan designed to address symptoms of both disorders.
Douglas S. Comorbid major depression and social phobia. Primary Care Companion Journal of Clinical Psychiatry: Psychotherapy Casebook. 2001; 3(4): 179-180.
Hales RE, Yudofsky SC. (Eds.). (2003). The American psychiatry publishing textbook of clinical psychiatry. Washington, DC: American Psychiatric.
Stein MB, Fuetsch M, Müller N, Höfler M, Lieb R, Wittchen H-U. Social anxiety disorder and the risk of depression: A prospective community study of adolescents and young adults. Archives of General Psychiatry. 2001; 58: 251-256.