Experiencing both depression and anxiety simultaneously is relatively common. Studies indicate that 60% of individuals living with anxiety also experience depressive symptoms. This percentage holds true for people with depression who also show signs of anxiety.

While anxiety and depression are separate conditions, they frequently co-occur. This combination can complicate symptoms. Fortunately, both conditions often respond to similar treatment approaches. Many people find relief through psychotherapy (talk therapy), medication, or a combination of the two.

Exploring the Relationship: Anxiety and Depression

The connection between these two conditions is multifaceted. Though depression is generally viewed as a low-energy state and anxiety as a high-energy one, these disorders and their associated symptoms regularly appear together. While the reasons behind their frequent pairing are fairly well understood, multiple potential explanations exist.

Several factors that increase vulnerability to anxiety also heighten susceptibility to depression. Both are classified as internalizing disorders—conditions that largely develop and persist within the individual experiencing them.

Similar to other internalizing disorders, anxiety and depression share connections to comparable factors, including genetic predisposition and neuroticism (a propensity toward negative thinking). They’re also tied to various shared environmental risk factors like early-life trauma and ongoing stress.

Because both involve alterations in neurotransmitter function—such as serotonin—in the brain, anxiety and depression display numerous overlapping symptoms. Your symptoms might fulfill diagnostic criteria for both conditions.

Rather than one condition causing the other, the relationship between anxiety and depression may represent two manifestations of the same underlying issue. Depression often triggers feelings of worry or anxiety. Likewise, experiencing an anxiety attack can leave you feeling hopeless and depressed.

Shared Causes and Risk Factors

Though the precise origins of comorbid depression and anxiety remain unclear, certain risk factors elevate your likelihood of developing both disorders simultaneously:

• Previous history of anxiety or depression
• Childhood adversity
• Inadequate parenting
• Significant recent life changes
• Ongoing stress exposure
• Elevated neuroticism levels
• Substance use disorders
• Family history of mental health conditions

Recognizing Anxiety and Depression Symptoms

Individual experiences with anxiety and depression symptoms vary considerably. Both disorders, however, can produce symptoms that disrupt everyday activities and personal relationships.

Similarities

Common symptoms present in both conditions include:

• Digestive difficulties
• Unexpected appetite or weight fluctuations
• Difficulty concentrating or making decisions
• Sleep disturbances (excessive or insufficient sleep)
• Persistent restlessness or irritability
  

Differences

While worrying is natural in certain circumstances, anxiety becomes problematic when it involves overwhelming fear that impairs functioning. Symptoms particularly associated with anxiety include:

• Persistent feelings of tension or restlessness
• Continuous excessive worry regarding immediate or future concerns
• Fixating on negative possibilities during decision-making
• Racing, uncontrollable thoughts about potential problems
• Steering clear of situations that might trigger worry
• Struggling with uncertainty

The defining features of depression center on enduring extremely low mood and/or diminished interest in previously enjoyable activities. Depression-specific symptoms may include:

• Persistent sadness and low mood
• Diminished interest or pleasure in life experiences
• Energy depletion or severe fatigue
• Noticeable increases in aimless physical activity like hand-wringing
• Observable slowing of movements or speech
• Overwhelming feelings of worthlessness or guilt
• Preoccupation with loss or deprivation
• Suicidal ideation or thoughts of death

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.

Determining Your Diagnosis: Anxiety, Depression, or Both

Because many symptoms overlap between anxiety and depression, identifying which disorder is responsible can be challenging. When both conditions coexist, symptoms typically intensify and linger longer as they reinforce each other. This interaction can complicate both diagnosis and treatment.

Proper diagnosis of mental health disorders requires thorough assessment by a mental health professional. This ensures accurate identification and appropriate treatment planning.

Indicators suggesting both conditions may be present include:

• Ongoing irrational fears or concerns
• Physical manifestations like fatigue, headaches, breathing difficulties, stomach pain, or accelerated heartbeat
• Continuous feelings of worthlessness or sadness
• Trouble falling or remaining asleep
• Memory or concentration difficulties
• Decision-making challenges
• Decreased interest in hobbies or activities
• Chronic tiredness and irritability
• Panic episodes or feelings of losing control
• Difficulty staying present and relaxing

The Gut Microbiome Connection

Your gut microbiome encompasses all microorganisms inhabiting your digestive tract. It influences both digestive and overall health.

Studies suggest evidence linking gut microbes to depression. This connection operates through the gut-brain axis—the communication pathway between your gut and brain. Research demonstrates that gut microbe-induced inflammation can affect mood in depression.

Managing Co-Occurring Anxiety and Depression

No universal treatment exists for comorbid anxiety and depression. Treatment typically combines antidepressant medications and/or psychotherapy. Self-care practices help maintain therapeutic gains.

Though research suggests combining medication and therapy yields optimal outcomes, your treatment plan may vary. Based on your specific symptoms, you might begin with either approach.

Self-Care

Self-care encompasses behaviors supporting physical and mental wellness. It includes practices that help manage anxiety and/or depression symptoms while complementing professional treatment.

Consider these self-care priorities:

National Institute of Mental Health. Caring for your mental health.

• Create and follow a regular exercise schedule targeting 30 minutes daily. Even shorter exercise sessions provide benefits.
• Consume nutritious meals and stay properly hydrated. Minimize caffeinated drinks, alcohol, and added sugars.
• Practice good sleep hygiene through consistent sleep schedules and behaviors promoting quality rest.
• Engage in relaxation activities, meditation, and breathing exercises to manage stress and reduce anxiety and depression symptoms.
• Stay connected with reliable friends or family who can offer practical assistance and emotional support when necessary.
• Keep a gratitude journal to acknowledge positive aspects of your life.
• Set realistic goals and priorities to prevent overwhelming yourself with excessive commitments.

In Therapy

Therapy represents a fundamental treatment component for anxiety and/or depression symptoms. Your progress and timeline depend on your specific symptoms and circumstances.

These therapeutic approaches address anxiety and depression:

Cognitive behavioral therapy (CBT): This psychotherapy approach is considered the premier treatment for anxiety, depression, and other mental health conditions.

CBT is goal-focused and time-bound therapy. It aims to transform negative thinking patterns by modifying negative behaviors and emotions.

Interpersonal therapy (IPT): This time-limited psychotherapy helps you interpret emotions as social cues, enabling you to address interpersonal difficulties. Rather than examining your history, IPT emphasizes current communication patterns and relationship challenges.

Dialectical behavioral therapy (DBT): DBT represents a CBT adaptation emphasizing healthy present-moment awareness, emotion regulation, and relationship enhancement. It incorporates mindfulness techniques, interpersonal effectiveness, distress tolerance, and emotion regulation.

Acceptance and commitment therapy (ACT): ACT is a psychotherapy form emphasizing mindfulness, present-moment awareness, and behavioral change strategies. It helps develop psychological flexibility, enabling you to accept challenging thoughts and emotions while pursuing meaningful activities aligned with your values and goals.

With Medication

Medications for anxiety and/or depression function by enhancing neurotransmitter activity—including serotonin, dopamine, norepinephrine, and gamma-aminobutyric acid (GABA). These brain chemical messengers influence mood regulation.

Your medication choice depends on symptoms and overall health factors. These medication classes are frequently prescribed:

Selective serotonin reuptake inhibitors (SSRIs): SSRIs serve as first-choice treatments for depression and numerous comorbid anxiety disorders. They function by elevating serotonin levels.

SSRIs include:

• Celexa (citalopram)
• Lexapro (escitalopram)
• Paxil (paroxetine)
• Prozac (fluoxetine)
• Zoloft (sertraline)

Serotonin-norepinephrine reuptake inhibitors (SNRIs): SNRIs elevate both serotonin and norepinephrine levels. These medications also qualify as first-line treatments for comorbid anxiety and depression.

SNRIs include:

• Effexor (venlafaxine)
• Pristiq (desvenlafaxine)
• Cymbalta (duloxetine)
• Savella (milnacipran)
• Fetzima (levomilnacipran)

Tricyclic antidepressants (TCAs): TCAs increase serotonin and norepinephrine levels. TCAs include:

• Amitriptyline
• Pamelor (nortriptyline)
• Imipramine
• Norpramin (desipramine)
• Anafranil (clomipramine)

Monoamine oxidase inhibitors (MAOIs): MAOIs represent the original antidepressant class. They’re typically considered outdated due to side effects, though they may suit treatment-resistant depression in advanced stages.

MAOIs include:

• Marplan (isocarboxazid)
• Nardil (phenelzine)
• Emsam (selegiline patch)

Addressing Treatment-Resistant Depression (With Anxiety)

Treatment-resistant depression (with anxiety) refers to depression unresponsive to adequate trials of at least two different antidepressants. Studies indicate this situation occurs frequently. Between 29% and 46% of individuals with depression demonstrate partial or no treatment response.

Treatment options for treatment-resistant depression (with anxiety) include:

Transcranial magnetic stimulation (TMS): TMS is a non-invasive treatment using electromagnets positioned on your head. These magnets deliver hundreds of thousands of targeted magnetic pulses to stimulate and recalibrate mood-regulating neurological processes.

Electroconvulsive therapy (ECT): ECT, formerly called electroshock therapy, involves passing controlled electrical currents through your brain under anesthesia. Treatment typically occurs two or three times weekly for six to 12 weeks, adjusted based on symptoms and response.

Ketamine: Long used as a surgical anesthetic, ketamine is also prescribed off-label for treatment-resistant depression. It targets different neurotransmitter subsets than traditional antidepressants. Ketamine administration occurs through intravenous infusion (directly into your vein) during procedures lasting up to one hour.

Spravato (esketamine): Esketamine is a ketamine formulation with Food and Drug Administration (FDA) approval for depression treatment. Being more potent than ketamine, esketamine may achieve results at lower doses. It’s administered via intranasal spray during supervised treatment sessions spanning several weeks.

Summary

Experiencing sadness and worry is part of normal human experience. However, when these emotions consistently interfere with daily functioning, they may signal mental health concerns.

Anxiety and depression rank among the most frequently diagnosed mental health conditions. Though distinct, they commonly appear simultaneously.

When these disorders coexist, treatment becomes more intricate. Symptoms overlap and frequently intensify when multiple mental health issues are present. Encouragingly, treating these comorbid disorders proves most successful when addressed concurrently.