A conversation with Dr. Kavosh Rouhani of Psychiatry Connection
Anxiety and depression are not always easy to recognize, especially when the symptoms have been around for a long time.
Some people know they feel down, worried, overwhelmed, or exhausted. Others only know that something feels off. Sleep is harder. Eating seems different. Their patience is shorter. Their body hurts more. They are not enjoying the things they used to enjoy, but they may not think of it as depression or anxiety because it has started to feel normal.
Dr. Kavosh Rouhani, a board-certified psychiatrist and internal medicine physician with Psychiatry Connection, said that is one reason an evaluation can be helpful.
“Some people have had it for so long that it may feel like the new normal,” Rouhani said.
If what you are feeling has become your baseline, it may be hard to tell whether it is something you have to keep living with or something that can be treated.
Depression Does Not Always Feel Like Sadness
Many people associate depression with feeling sad, hopeless, or unable to get out of bed. Those can be signs of depression, but they are not the only signs.
For some people, depression shows up more quietly as a loss of interest or enjoyment. A person may still go to work, take care of family responsibilities, and move through daily life, but things that used to feel meaningful no longer do.
Rouhani described this as a “creeping feeling” that you are not enjoying what you used to enjoy. In psychiatry, this is often called anhedonia.
That might look like:
- No longer wanting to see friends
- Losing interest in hobbies, movies, games, reading, exercise, or other activities
- Going through the motions without feeling much pleasure
- Feeling like nothing sounds fun anymore
- Not replacing old interests with anything new
This can be easy to dismiss as boredom, burnout, aging, or a busy season. Sometimes those factors are part of the story. But when loss of interest is persistent and begins affecting how someone lives, it may be worth talking with a mental health provider.
Anxiety Can Feel Like Fight-or-Flight With Nowhere to Go
Anxiety is not always obvious worry. It can also feel physical.
Rouhani described anxiety as stress “turned up several notches” and not going away. The body is built for fight-or-flight responses. In a real emergency, your heart rate rises, your breathing changes, your body becomes alert, and your brain starts scanning for danger.
The problem, he explained, is when the body reacts that way even when there is no immediate threat.
“What anxiety is, is when there is no bear in the room and those things are still happening,” Rouhani said.
That kind of anxiety may affect:
- Sleep
- Appetite
- Concentration
- Muscle tension
- Irritability
- Restlessness
- Digestive symptoms
- Jaw, neck, or back pain
Someone may not say, “I feel anxious.” They may say they cannot sleep, cannot relax, feel keyed up, grind their teeth at night, or wake up with jaw pain. They may notice stomach pain, constipation, diarrhea, or other digestive changes that seem to flare during stress.
These symptoms can have many possible causes, including medical ones. That is why a good evaluation looks at both mental and physical health.
Symptoms Can Look Different at Different Ages
Anxiety and depression may also look different depending on age, development, culture, and life circumstances.
In children, teens, and young adults, symptoms may show up as irritability, conflict, snapping quickly, sleeping too much, or difficulty getting out of bed. Younger people may not have the language to describe sadness, worry, or emotional overwhelm, so the symptoms can show up behaviorally.
In older adults, depression can sometimes be mistaken for normal aging. Rouhani noted that memory issues can appear when an older adult is very depressed, and those symptoms may be written off too quickly.
That does not mean every memory concern is depression. It means memory changes, mood changes, and functioning changes deserve attention instead of being automatically dismissed as “just aging.”
Physical Symptoms Can Be Part of the Picture
Mental health symptoms and physical symptoms often overlap. A person may see a doctor several times for unexplained aches, stomach problems, jaw pain, fatigue, or sleep changes without realizing anxiety or depression may be part of the pattern.
Rouhani emphasized that untreated anxiety and untreated depression can sometimes present through the body.
Examples may include:
- Unexplained muscle aches or cramps
- Jaw pain from clenching or grinding teeth
- Neck or back pain
- Stomach pain
- Constipation or diarrhea
- Appetite changes
- Fatigue
- Sleep disruption
None of these symptoms automatically means someone has anxiety or depression. They can have many causes, and medical evaluation may be important. But if physical symptoms keep showing up alongside mood changes, stress, loss of interest, or worry, it may be worth discussing mental health as part of the bigger picture.
When Should You Talk to Someone?
If you are concerned, the first step does not have to be perfect. Rouhani said people can start by talking with a primary care provider, therapist, psychiatrist, or another qualified mental health professional.
The important part is starting the conversation.
“Everyone should see a mental health provider or someone that has some training in it at some point in their lives,” Rouhani said.
He compared mental health skills to a first-aid kit. Ideally, people would have tools for stress, grief, conflict, anxiety, depression, and crisis before life becomes unmanageable, not only after something has already gone wrong.
You may want to reach out if:
- Symptoms feel outside your usual baseline
- You no longer enjoy things that used to matter to you
- Sleep, appetite, energy, or concentration have changed
- Worry or physical tension feels hard to turn off
- Irritability is affecting relationships
- Physical symptoms keep appearing without a clear explanation
- You are avoiding responsibilities, people, or activities
- Others have noticed changes in your mood or behavior
If you are having thoughts of harming yourself or not wanting to be alive, seek urgent help right away. Call or text 988 in the U.S. to reach the Suicide and Crisis Lifeline, call 911, or go to the nearest emergency room.
Why Diagnosis Takes a Conversation
People often want a quick answer: Is this anxiety? Is this depression? Is this stress? Is it medical? Is it just life?
In real care, the answer often takes a conversation. Your psychiatrist may ask about symptoms, timing, sleep, appetite, medical history, medications, family history, substance use, stressors, relationships, work, school, and daily functioning. The goal is not to label someone quickly. The goal is to understand what is happening and what kind of support may help.
That is especially important because anxiety and depression can overlap with other conditions. They can also be affected by medical issues, medications, grief, trauma, substance use, sleep problems, major life changes, or chronic stress.
At Psychiatry Connection, the first appointment is designed to help your provider understand the bigger story, not only the symptom list. Our guide to what to expect at your first psychiatry appointment explains what that process can look like.
Getting Help Is Not a Sign of Weakness
Stigma keeps many people from asking for help, especially men and people from communities where mental health care may be misunderstood, minimized, or judged.
Rouhani said stigma remains deeply rooted, but getting help can be part of taking responsibility for yourself and the people around you.
As he put it, we cannot be good partners, parents, siblings, providers, or friends if we are not in a healthy place ourselves.
That does not mean everyone needs the same kind of care. Some people may benefit from therapy. Some may need psychiatric evaluation. Some may need medication, lifestyle changes, medical workup, or a combination of supports. The right starting point depends on the person.
You Do Not Have to Wait Until Things Are Severe
Many people wait until they are in crisis before they ask for help. But anxiety and depression are often easier to address when someone reaches out earlier.
If something feels different, if your baseline has shifted, or if your body keeps telling you something is wrong, it is reasonable to ask questions. You do not have to diagnose yourself first.
Psychiatry Connection provides online psychiatric care for patients across the Western U.S. If you are dealing with symptoms of anxiety, depression, or uncertainty about what you are experiencing, a psychiatric evaluation can help clarify what may be going on and what next steps make sense.
