Depression & Mood Disorders
Mood disorders are characterized by aberrant emotional states. Affected people usually experience elevated levels of sadness for a significant period of time, with some of them fluctuating between feeling overly excited and very depressed.
Social anxiety and depression often come together, which needs to be taken into consideration for treatment planning. The following mood disorders frequently occur along with SAD. Here, we will have a closer look at hem.
Major Depressive Disorder & Social Anxiety
Major depression accounts for one of the most common additional diagnoses of SAD (Szafranski, Talkovsky, Farris, & Norton, 2014). It is characterized by a persistent lack of interest and energy, loss of pleasure, difficulties engaging in everyday activities, and in most cases a predominant feeling of sadness.
People with major depressive disorder are between three to six times more likely to suffer from social anxiety than people without it (Mineka, Watson, & Clark, 1998).
Especially those with generalized SAD frequently show strong symptoms of depression (Szafranski, Talkovsky, Farris, & Norton, 2014). With the greater number of feared and avoided social situations, quality of life is usually heavily impacted. Therefore, depression is more likely to accompany this subtype of social anxiety compared to nongeneralized and specific SAD (Mineka et al., 1998).
As difficult as the co-occurrence of social anxiety and depression may be, affected individuals are more likely to seek help than individuals who “only” suffer from SAD alone (Ohayon, & Schatzberg, 2010).
It has been found that the older the person with SAD, less likely is an additional diagnosis of clinical depression. It is believed that due to the higher likelihood of seeking professional help in combination with the probable use of antidepressants at some point, odds of improvement are positive.
In most cases, social anxiety develops first and major depression follows at a later point (Väänänen et al., 2011). Generally speaking, people with both disorders start suffering earlier than those who exhibit only one of the two disorders (Erwin et al., 2002).
People with social anxiety and depression who start a therapeutic process are as likely as other SAD sufferers to benefit from treatment (Erwin et al., 2002).
Furthermore, it has been found that targeting social anxiety in treatment also significantly decreases depression (Moscovitch, Hofman, Suvak, & In-Albon, 2005). On the contrary, targeting only the depressive symptoms seems to have only a weak effect on the manifestations of social anxiety.
Persistent Depressive Disorder (Dysthymia) & Social Anxiety
Persistent Depressive Disorder (PDD; also: dysthymic disorder or dysthymia) is characterized by pretty much the same symptoms as major depressive disorder. The difference lies in the chronic course of dysthymia and its lower symptom severity (Sansone, & Sansone, 2009).
People diagnosed with SAD are about five times more likely to suffer from persistent depression at some point compared to those without it (Wittchen & Fehm, 2004).
Following this trend, people diagnosed with dysthymia often develop social anxiety at some later point (Wells, Tien, Garrison, & Eaton, 1994). This is especially relevant for patients who experience PDD at an early age (before 21 years; Barzega, Maina, Venturello, & Bogetto, 2001).
Just as with major depressive disorder, the generalized subtype of SAD is at higher risk of suffering from dysthymia (Wittchen & Fehm, 2004).
Bipolar Disorder / Manic-Depression & Social Anxiety
People suffering from bipolar disorder experience unusual and significant mood swings and strong shifts in energy levels, as well as in physiological and cognitive arousal (The National Institute of Mental Health, 2015). It is also referred to as manic-depressive illness.
Around 50% of people affected by bipolar disorder also receive a diagnosis of SAD at some point in their lives (Kessler, Stang, et al., 1999).
It has been found that people suffering from manic-depression display high levels of anxiety sensitivity (Simon et al., 2003). Being highly sensitive to experiencing anxiety and its related sensations in the body is a risk factor for SAD and other anxiety disorders (Szafranski, Talkovsky, Farris, & Norton, 2014).
Treatment for people suffering from both social anxiety and bipolar disorder may need to be highly individualized (Dilsaver & Chen, 2003).
Well planned, professionally guided pharmacotherapy and cognitive behavioral therapy have been suggested to be among the first recommendations (Szafranski, Talkovsky, Farris, & Norton, 2014; Freeman, Freeman, & McElroy, 2002).
Taken together, there is a significant overlap between social anxiety and depression. While a co-occurrence of the two disorders usually implicates more suffering for the individual, this often comes along with a higher likelihood of treatment-seeking.
Since anti-depressants often have a positive impact on both conditions, pharmacotherapy may accompany a psychotherapeutic process which is tailored to the individual’s needs.
Social anxiety is characterized by a high comorbidity, which means that depression is not the only psychological disorder which often comes along with it. The following three mental health conditions have been reported to frequently co-occur with SAD as well:
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