Depression, Stress, and Anxiety: Understanding the Triad of Mental Health

We’ve all dealt with stress. It’s a normal part of life, whether it’s the subtle pressure of rushing to get to work on time or a traumatic event like losing a loved one. In a way, some stress can be a good thing. But you don’t want it to get out of hand. 

Three-quarters of American adults have experienced stress-related health issues.¹ Anxiety, depression, and other mental health issues are becoming increasingly common,² and these conditions can really get in the way of your daily life. 

Stress, anxiety, and depression are interrelated. They feed into one another, meaning when one gets worse, the others do too. Their symptoms are similar, and when you’re experiencing one, you may also experience the other. 

So, with how common chronic stress and mental health conditions are, it is incredibly important to understand the connection between them. 

This article covers everything you need to know about how anxiety, stress, and depression are interrelated and how to manage this triad so they don’t affect your daily life. 

Defining the Triad: Depression, Stress, and Anxiety Unveiled

To understand how these three conditions are closely related, you must first understand each condition and their similarities. 

Depression

Depression is a mental illness that causes irregular moods and persistent feelings of sadness. This mental health condition can be related to a variety of different circumstances, such as a genetic tendency and/or environmental factors.³ 

There are various depression disorders, including:

• major depressive disorder
• persistent depressive disorder
• seasonal affective disorder

Common symptoms of depression include:

• feelings of sadness
• lack of motivation
• feelings of hopelessness
• low energy

Anxiety

Anxiety is a feeling of worry or fear.⁴ 

Anxiety may be a short-term experience caused by a specific stressor, or if you have an anxiety disorder, you may experience it even in a normal situation. 

Sometimes anxiety is caused by other conditions such as panic disorders, phobias, and post-traumatic stress disorder (PTSD). 

Common symptoms of anxiety include: 

• feelings of restlessness or worry
• trouble concentrating or sleeping
• feelings of dizziness or heart palpitations

Stress

Stress is a state of worry.⁵ It prompts us to make certain adjustments for safety – think running away from a lion chasing you. 

Stress is typically triggered by an outside event, such as running late for work or feeling unsafe. For this reason, it is considered a healthy biological reaction. 

However, when stress goes unmanaged, it can lead to various health conditions and hinder quality of life. 

How are depression, stress, and anxiety connected?

Stress, anxiety, and depression have many similarities. All three can get in the way of everyday life when left untreated. Sometimes, poorly managed stress can lead to anxiety and depression or worsen these conditions. 

It can be hard to distinguish between anxiety and stress since both have similar symptoms. The main difference is that anxiety is a reaction to stress. 

Stress is more often a normal reaction to life events but chronic stress can definitely be hindering. Chronic stress can lead to anxiety and depression. 

What is the Depression Anxiety Stress Scale (DASS)? 

The Depression Anxiety Stress Scale (DASS) is an assessment tool⁶ used by doctors to measure a person’s severity of experiencing anxiety, depression, and stress. 

When this exam is administered, you will answer 42 questions on a 4-point scale. 

Higher scores mean a higher severity of depression, anxiety, or stress. The test usually takes about 10 to 20 minutes to complete. This test gives doctors an idea of how severely their patients are experiencing these emotions. 

Doctors use this test in combination with other tests and assessments to help diagnose and treat patients with mental health challenges. 

Depression and Stress: How Do They Influence Each Other?

The connection between stress and depression is “bidirectional,” meaning one causes the other and can worsen the other. 

Chronic stress can change your brain⁷ in ways that worsen symptoms of depression and make the condition worse. 

There are a few main ways that stress and depression fuel each other⁸:

• Chronic stress can dysregulate the HPA axis (a part of the brain involved in the stress response). Abnormalities with the HPA axis are commonly seen in people who have depression disorders.⁹ 
• Chronic stress affects the amygdala and prefrontal cortex,  two brain regions involved in emotional regulation, contributing to depression.   
• Depression may worsen stress since it can cause you to isolate yourself and avoid responsibilities. 
• Stressful events (such as traumatic events in childhood) can cause brain changes that lead to depression. 

The Link Between Stress and Anxiety: Exploring the Shared Mechanisms

It’s no surprise that stress and anxiety are linked, given that the two are so similar they are often mistaken for one another. Anxiety is usually a result of stress.¹⁰ 

For example, if you struggle with chronic stress, you may start to feel anxious even in situations that shouldn’t be anxiety-inducing because you’ve been holding on to unresolved stress. 

When you feel stressed, your body releases certain hormones to help increase your energy and biologically adapt your body to fend for itself. When stress is unmanaged, these hormones can be released inappropriately, causing you to live in a “fight-or-flight” state. 

You can become worried and preoccupied with your stress, increasing anxiety levels even further. Additionally, chronic stress often leads to unhealthy lifestyle habits like binge drinking, eating unhealthy foods, and self-isolation, which worsen mental health issues.

Some ways to manage stress-induced anxiety include:

• Pay attention to what areas of your life are causing anxiety, and set boundaries where needed. 
• Learn healthy coping mechanisms like deep breathing, exercise, and meditation
• Try to get onto a regular sleep schedule to help your brain process emotions and increase your ability to handle stress.

The Compounding Effect: When Depression and Stress Both Contribute to Anxiety

All three of these conditions play into each other. Many studies have pointed to the connection between chronic stress and depression and anxiety. 

There is also a subtype of depression called “anxious depression,” which is more severely influenced by chronic stress.⁷

Chronic stress has many effects on the brain, which can worsen and contribute to mental health issues like anxiety and depression. 

Managing the Triad: Strategies for Mitigating the Impact

It is important to find healthy coping strategies to manage stress, anxiety, and depression to prevent these issues from worsening so you can live a happy life. 

Some helpful coping strategies for the overlapping triad of anxiety, stress, and depression include:

• Professional support. Cognitive-behavioral therapy (CBT) is commonly used to help treat these conditions. CBT involves talking to a therapist about the issues you’re facing so that they can recommend methods to help you feel better. 
• Meditation. Meditation can help you clear your mind to reduce stress and anxiety.
• Exercise. Regular exercise positively impacts mood and helps with stress, anxiety, and depression. 
• Community support. Talk with your friends and family to feel like you have some support. It helps to lean on others and be open about your struggles. You may also be able to find a local support group where you can connect with other people who have similar challenges. 

Breaking the Cycle: Preventing the Triad’s Development With Lifestyle Changes

Quickly taking action can help prevent anxiety, depression, and stress from getting out of control. 

Some lifestyle practices to help prevent the triad of anxiety, depression, and stress include:

• Take steps to manage stress when it happens
• Set boundaries at work and in your personal life. If you feel like you have too much on your plate, this is likely contributing to your stress levels.
• Make healthy lifestyle choices like exercising regularly and eating healthy
• Avoid unhealthy coping mechanisms like substance abuse and binge drinking
• Maintain a healthy sleep schedule to help with stress management and emotional resilience 
• If you feel that a particularly stressful event is lingering in your mind and causing you anxiety, talk to a professional to help overcome this. 

Takeaway

Depression, stress, and anxiety all feed into each other. Chronic stress is incredibly common in our “go, go, go” society. It requires conscious effort to avoid chronic stress in your life, but these steps are essential to feeling your best. 

When stress levels get out of hand, it can lead to various health issues, including depression and anxiety. When you take steps to overcome and prevent these conditions, you will notice positive changes in your life and realize that it is entirely worth the effort. 

Sources

1. Stress in America 2022. Apa.org. Published 2023.
2. Depression and Anxiety Are on the Rise Globally | Psychology Today. www.psychologytoday.com.
3. National institute of Mental Health. Depression. National Institute of Mental Health. Published April 2023.
4. NHS. Overview – Generalised anxiety disorder in adults. nhs.uk. Published February 10, 2021.
5. Stress. www.who.int.
6. Overview of the DASS and its uses. www2.psy.unsw.edu.au. Accessed August 18, 2023.
7. Ross RA, Foster SL, Ionescu DF. The Role of Chronic Stress in Anxious Depression. Chronic Stress. 2017;1:247054701668947.
8. Tafet GE, Nemeroff CB. The Links Between Stress and Depression: Psychoneuroendocrinological, Genetic, and Environmental Interactions. The Journal of Neuropsychiatry and Clinical Neurosciences. 2015;28(2):77-88.
9. Varghese FP, Brown ES. The Hypothalamic-Pituitary-Adrenal Axis in Major Depressive Disorder: A Brief Primer for Primary Care Physicians. Primary Care Companion to The Journal of Clinical Psychiatry. 2001;3(4):151-155.
10. Daviu N, Bruchas MR, Moghaddam B, Sandi C, Beyeler A. Neurobiological links between stress and anxiety. Neurobiology of Stress. 2019;11(1):100191.