Medically reviewed by Michael MacIntyre, MD
Having depression and anxiety at the same time is somewhat common. Research shows that 60% of people with anxiety will also have symptoms of depression. The rate is the same for those who have depression with symptoms of anxiety.
Anxiety and depression are two distinct conditions that can occur at the same time. This can make symptoms more complex. However, the same treatments can address both problems. They can often improve with psychotherapy (talk therapy), drugs, or both.
This article describes the link between anxiety and depression. It also explains their symptoms, diagnosis, and treatment when they occur at the same time.
Anxiety and Depression: An Indirect or Direct Link?
The relationship between anxiety and depression is complex. While depression is typically regarded as a low-energy condition and anxiety a high-energy condition, these disorders and their symptoms commonly occur together. The reason they are often linked is well understood, though several potential factors exist.
Many of the same factors that predispose you to anxiety also make you vulnerable to depression. Both are considered internalizing disorders, problems that are developed and maintained to a great extent within the affected person.
Like other internalizing disorders, anxiety and depression are linked to similar factors that include genetic risk and neuroticism (the tendency toward negative thoughts). They are also associated with several shared nongenetic risk factors such as early trauma and current stress.
Anxiety and depression have many overlapping symptoms because they both involve changes in the function of neurotransmitters like serotonin in your brain. Your symptoms may meet the criteria of both disorders.
The relationship between anxiety and depression may not be a situation in which one causes the other, but the fact that they may be two sides of the same coin. Being depressed can often make you feel worried or anxious. Similarly, having an anxiety attack can make you feel hopeless with depression.
Related Causes/Risk Factors
While the exact causes of comorbid depression and anxiety are not known, the following risk factors increase your chances of having these disorders together:
- Lifetime history of anxiety or depression
- Adversity during childhood
- Poor parenting
- Recent major life events
- Current exposure to stress
- High neuroticism
- Substance use disorders
- Family history
How Anxiety and Depression Symptoms Feel
Symptoms of anxiety and depression can vary by individual. However, both disorders can cause symptoms that can interfere with daily life and interpersonal relationships.
Similarities
Symptoms common in both anxiety and depression include:
- Problems with digestion
- Unintended changes in appetite or weight
- Inability to concentrate or make decisions
- Problems sleeping, either too much or too little
- Feeling constantly restless or irritable
Differences
Worrying is normal in some situations. Anxiety differs from normal worrying because it involves excessive fear that can be debilitating. Symptoms that may be characteristic of anxiety include:
- Constantly feeling wound up or restless
- Ongoing excessive worry about the immediate or long-term future
- Focusing on negative outcomes when decision-making
- Uncontrollable, racing thoughts about something going wrong
- Avoiding situations that could cause worry and anxiety
- Feeling a lack of certainty
The key characteristics of depression involve a persistent feeling of extremely low mood and/or loss of interest in activities you once enjoyed. Symptoms that may be characteristic of depression include:
- Feelings of sadness and persistent low mood
- Lack of interest or enjoyment in life experiences
- Loss of energy or extreme fatigue
- Increase in purposeless physical activities such as hand-wringing that is noticeable to others
- Increase in slowed movements or speech that occur often enough to be noticed by others
- Feelings of worthlessness or guilt
- Emphasis on loss or deprivation
- Thoughts of death or suicide
Help Is Available
If you or someone you know is having suicidal thoughts, call or text 988 to contact the 988 Suicide & Crisis Lifeline and connect with a trained counselor. If you or they are in immediate danger, dial 911.
For more mental health resources, see our National Helpline Database.
Anxiety, Depression, or Both: How to Diagnose Symptoms
Many symptoms of anxiety and depression overlap, making it harder to determine which disorder is causing the problem. When anxiety and depression occur together, symptoms tend to be more intense and persistent because they work together. This can make your condition harder to diagnose and more complex to treat.
Diagnosing symptoms of a mental health disorder requires a comprehensive evaluation by a mental health provider. This can help ensure you get an accurate diagnosis and treatment.
Symptoms that might indicate that both anxiety and depression exist include:
- Persistent irrational fears or worries
- Physical symptoms like fatigue, headaches, labored breathing, abdominal pain, or rapid heartbeat
- Persistent feelings of worthlessness or sadness
- Problems going to sleep or staying asleep
- Difficulty remembering or concentrating
- Inability to make decisions
- Loss of interest in hobbies or activities
- Constantly feeling tired and cranky
- Panic attacks or a sense of losing inner control
- Inability to live in the moment and relax
Role of Gut Microbiome
Gut microbiome includes all the microorganisms living in your digestive system. It affects your digestive health as well as your overall health.
Research indicates that there is evidence of a link between gut microbes and depression. It is attributed to the gut and brain connection, called the gut-brain axis. Evidence shows that inflammation caused by gut microbes can influence mood in depression.
How to Cope With Comorbid Anxiety and Depression
There is no single treatment appropriate for every case of comorbid (co-occurring) anxiety and depression. Therapies typically include antidepressant drugs and/or a form of psychotherapy. Self-care can help you maintain your progress.
While research indicates that a combination of medication and therapy can provide the best results, your treatment plan may differ. Depending on your symptoms, you may be advised to start your treatment with either one of these therapies.
Self-Care
Self-care includes behaviors that support your physical and mental well-being. It involves actions that can help manage symptoms of anxiety and/or depression and complement therapy and/or medications.
The following strategies are ways to prioritize self-care:
- Establish and maintain a regular exercise routine with a target of 30 minutes daily. Exercising for smaller amounts of time can also make a difference.
- Follow a diet of nutritious meals and adequate hydration. Limit caffeinated beverages, alcohol, and added sugar.
- Maintain proper sleep hygiene, which involves following a daily sleep schedule and other behaviors supporting a good night’s sleep.
- Try activities that involve relaxation, meditation, and breathing exercises to relieve stress and reduce feelings linked with anxiety and depression.
- Remain connected with friends or family members you can count on to provide practical help and emotional support if needed.
- Practice gratitude by journaling to remind yourself of the positive things in your life.
- Establish goals and priorities to avoid taking on new tasks and responsibilities that can overwhelm you.
In Therapy
Therapy is regarded as a key part of treatment for symptoms that involve anxiety and/or depression. Your results and the time it takes to achieve them depend on your symptoms and your unique situation.
The following types of therapy are used to treat anxiety and depression:
- Cognitive behavioral therapy (CBT): This type of psychotherapy is considered the gold standard for treating anxiety and depression, among other mental health conditions.
- CBT is a time-limited and goal-oriented therapy. It focuses on changing negative thought patterns by altering negative behaviors and emotions.
- Interpersonal therapy (IPT): This type of time-limited psychotherapy helps you see emotions as social signals so you can use them to improve interpersonal challenges. Rather than focusing on your past, IPT focuses on communication and current interpersonal relationships and issues you’re having related to them.
- Dialectical behavioral therapy (DBT): DBT is a modified version of CBT that focuses on healthy ways to live in the moment, regulate emotions, and improve interpersonal relationships. It integrates mindfulness skills, interpersonal effectiveness, distress tolerance, and emotion regulation into treatment.
- Acceptance and commitment therapy (ACT): ACT is a type of psychotherapy that focuses on mindfulness, remaining in the present, and strategies for behavioral changes. It focuses on helping you become psychologically flexible so you can accept difficult thoughts and emotions while committing to meaningful life activities consistent with your goals and values.
With Medication
Medication for anxiety and/or depression works by increasing the activity of neurotransmitters, like serotonin, dopamine, norepinephrine, and gamma-aminobutyric acid (GABA). These are the chemical messengers in your brain that affect mood regulation.
The type of medication you receive depends on your symptoms and other factors regarding your overall condition. The following classes of medications are commonly used:
Selective serotonin reuptake inhibitors (SSRIs): SSRIs are the first-line treatments preferred for treating depression and many comorbid anxiety disorders. They work by increasing serotonin levels.
SSRIs include:
Serotonin-norepinephrine reuptake inhibitors (SNRIs): SNRIs increase levels of serotonin and norepinephrine. These drugs are also acceptable first-line treatments for comorbid anxiety and depression.
SNRIs include:
- Effexor (venlafaxine)
- Pristiq (desvenlafaxine)
- Cymbalta (duloxetine)
- Savella (milnacipran):
- Fetzima (levomilnacipran):
Tricyclic antidepressants (TCAs): TCAs boost levels of serotonin and norepinephrine. TCAs include:
- Elavil (amitriptyline)
- Pamelor (nortriptyline)
- Tofranil (imipramine)
- Norpramin (desipramine)
- Anafranil (clomipramine)
Monoamine oxidase inhibitors (MAOIs): MAOIs were the first class of antidepressants. They are generally regarded as outdated because of their side effects, though they may be appropriate for treatment-resistant depression in its later stages.
MAOIs include:
- Marplan (isocarboxazid)
- Nardil (phenelzine)
- Emsam (selegiline patch)
Learn More: Antidepressants Alone Don’t Lead to Higher Quality of Life, Study Finds
Treatment-Resistant Depression (With Anxiety)
Treatment-resistant depression (with anxiety) describes depression that hasn’t responded to an adequate trial of at least two different antidepressants. Research indicates that the situation is not uncommon. Between 29% and 46% of people with depression show partial or no response to treatments.
Therapies for treatment-resistant depression (with anxiety) involve the following:
- Transcranial magnetic stimulation (TMS): TMS is a noninvasive treatment that involves placing electromagnets on your head. The magnets send hundreds of thousands of targeted magnetic pulses to stimulate and reset the neurological processes regulating mood.
- Electroconvulsive therapy (ECT): ECT, previously known as electroshock therapy, is a procedure in which controlled electric currents are passed through your brain while you are under anesthesia. Treatment is usually given two or three times a week for six to 12 weeks, depending on your symptoms and response.
- Ketamine: Ketamine has been used as an anesthetic in surgeries for many years. It is also used off-label for treatment-resistant depression. It works by targeting subsets of neurotransmitters that are different from those affected by traditional antidepressants. Ketamine is delivered by intravenous infusion (directly into your vein) in a procedure that takes up to an hour.
- Spravato (esketamine): Esketamine is a ketamine formulation approved by the Food and Drug Administration (FDA) for depression. Esketamine is more potent than ketamine, so it may produce results with lower doses than ketamine. It is administered as an intranasal spray in monitored treatment sessions over a few weeks.
Summary
Feelings of sadness and worry are normal. However, when these types of feelings intrude on your daily life, they may be signs of mental health problems.
Anxiety and depression are two of the most commonly diagnosed mental health problems. While they are two distinct conditions, they often occur at the same time.
When these disorders occur together, treatments are more complex. Symptoms can overlap and often worsen when more than one mental health problem exists. The good news is that treating these comorbid disorders is most effective when they are handled at the same time.
Read the original article on Verywell Health.
