Depression, anxiety, and low self-esteem: how are they related?

Why do depression, anxiety, and low self-esteem often go together? Is low self-esteem a mental health problem? Can they be treated in the same way? We asked leading clinical psychologist Dr Julia Heller:

Depression and anxiety are the most prevalent of all the mental health conditions: depression is experienced by about one in ten people and anxiety in about one in twelve people. The World Health Organisation estimates that by 2020 depression will be the second leading cause of world disability.

Of course, everyone experiences low mood and anxiety from time to time, but these clinical conditions are persistent over months, cause marked distress and impact on work, relationships and general life.

What is depression?

If you are clinically depressed it is likely that you will experience:

• ongoing low mood and sadness
• little or no interest in activities
• fatigue and reduced energy
• poor concentration and indecisiveness
• changes in appetite and sleep patterns, which can cause significant distress.

There are associated negative thoughts such as ‘what is the point in anything’ and thoughts of death in some cases.

Read more about the signs of depression

What is anxiety?

Anxiety disorders can be equally disturbing and disabling and are characterized by:

• constant worry
• overthinking
• over-checking things with a negative prediction
• restlessness.

There are likely to be physical symptoms associated with a fear response - such as heart racing or breathing difficulties. Sometimes, people get headaches and back or neck pain from the associated stress.

Read more about the signs of anxiety

How does low self-esteem fit in?

Low self-esteem isn’t a mental health condition in itself, but it is a major component of depression – often they are very close neighbours. Low self-esteem can be a feature of anxiety as well, but is mostly associated with depression.

The other complicating thing is that depression and anxiety often go together, so that many of the symptoms overlap. However, it is usual for one condition to take the lead.

Self-esteem is not a single concept. You can feel confident in some situations (e.g. at work) but not in others (e.g. socially). People are usually more resilient in situations they are highly familiar with but resist new situations unless they are confident.

Can you treat them in the same way?

Depressive and anxiety conditions can be managed and improved with a range of treatment approaches, including medication and therapy.

Medication is not prescribed for low self-esteem, but a type of therapy called cognitive behavioural therapy (CBT) can be useful. This type of therapy aims to determine a person’s thinking and behaviour patterns and, where appropriate, to replace these with more adaptive and helpful patterns. We can provide someone with advice and strategies to take on particular difficulties, setting achievable goals and taking a tiny dip in a deep sea with helping hands.

Depression, anxiety, and self-esteem can all be improved with cognitive behavioural therapy.

The keys to treatment are motivation and finding the right approach to help – there is no one size that fits all.