Anxiety and depression

Depression and anxiety disorders are not the same thing. But as many as 60% of people with depression also frequently experience anxiety, and likewise, people with anxiety can experience depressive symptoms. In fact, depression and anxiety are two mental health conditions that commonly occur together.

There is no evidence that anxiety causes depression or vice versa, but each condition has its own causes or contributing factors. People may experience depression and anxiety as separate or combined conditions. Many of the symptoms for both conditions are similar or may overlap, which is why it’s important to discuss all symptoms with a healthcare provider.

There are several thoughts about why people often experience depression and anxiety together. One theory is that both conditions affect similar areas and chemicals in the brain, so they are likely to appear together.  Another theory is that people tend to meet the diagnostic criteria for both conditions because their symptoms overlap.  However, no one really knows for sure, and research about people experiencing both conditions is ongoing. What we do know is that people experiencing both anxiety and depression can and should seek help from a professional who understands how to treat both conditions at the same time.

Depression, also called clinical depression or major depressive disorder, is a common, serious mood disorder in which a person may feel intense, lasting sadness that affects thoughts and the ability to function in day-to-day life. Anxiety, on the other hand, is characterized by excessive worry and stress in anticipation of a real or perceived threat.

Signs and symptoms of depression and anxiety vary from person to person, depending on the type of depression or anxiety disorder that they experience.

Severity of depressive episodes are often monitored and measured by healthcare providers using a PHQ-9 questionnaire, which asks about symptoms and how they affect daily life. It’s also a useful tool for keeping track of response to any treatments. Severity is determined by the number of symptoms the person experiences and how much the symptoms affect their ability to function daily. Depression may be classified as either mild, moderate or severe.

Depressive disorders are further classified into specific subgroups, including reactive and endogenous depression (depression with no apparent outside cause), melancholia, atypical depression, depression with a seasonal pattern, also known as seasonal affective disorder, and dysthymia (persistent, mild depression). Depression diagnostic criteria states a person must have five or more symptoms of depression lasting for at least two weeks.

Some signs of depression may include:

• Persistent feelings of sadness, unhappiness or hopelessness
• Loss of interest in things or activities that were once enjoyed
• Feeling tired, sleeping in excess or sleeping poorly
• Aches and pains 
• Loss of appetite or eating too much
• Loss of sex drive
• Difficulty concentrating, restlessness or irritability
• Memory lapses or difficulty making decisions 
• Suicidal thoughts or thoughts of death, or attempted suicide

People who experience chronic depression may also have trouble with persistent physical symptoms, such as headaches, stomach problems or pain, that don’t improve with treatment or don’t have another identifiable cause.

Just as there are different types of depression, people also experience different types of anxiety. People with generalized anxiety disorder (GAD) have excessive anxiety or worry most days for at least six months. Worries can include anything, and even minor worries can cause significant problems in their lives. Generalized anxiety disorder symptoms include some of the following:

• Restlessness, worrying, nervousness, fear or being on edge
• Fatigue
• Difficulty concentrating
• Irritability 
• Muscle tension
• Difficulty falling or staying asleep
• Gastrointestinal symptoms such as nausea or upset stomach

People with panic disorder have recurrent, unexpected periods of intense fear that come on quickly and reach their peak within minutes. Panic attacks are a defining symptom of panic disorder, but they can be experienced by anyone during a stressful event, regardless of whether the person has a panic disorder. During a panic attack, people may experience: 

• A pounding heartbeat that can be accompanied by chest pain or discomfort
• Sweating
• Feeling faint, dizziness or numbness
• Shaking 
• Shortness of breath to the point of a choking sensation or feeling smothered
• Feeling of impending doom or that something bad is going to happen soon
• Fear of losing control or fear of dying

Phobias are fears of specific objects (like needles) or situations (like flying) that are excessive in comparison to the actual danger caused by the situation or object. People with a phobia tend to: 

• Have excessive or irrational worry about encountering a feared object or situation
• Take extra precautions or steps to avoid something they fear
• Experience instant, overwhelming anxiety when confronting the feared object or situation

The same or similar medications are often prescribed for anxiety and depression. Additional anxiety and depression medicine may be recommended by a healthcare professional, depending on a person’s circumstances. It is important to note that any of these medications may take up to four weeks to begin having an effect and up to 12 weeks to reach their full effect. It is also common for people to try different medications or doses as recommended by their healthcare provider until they determine which therapy works best.

Medications used to treat depression, anxiety and depression coupled with anxiety include:

• Selective serotonin reuptake inhibitors (SSRIs). These medications increase levels of serotonin, a brain chemical which impacts both an individual’s mood and their emotions.
• Serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs increase levels of serotonin and norepinephrine, the brain chemicals that play a role in happiness and satisfaction.
• Norepinephrine-dopamine reuptake inhibitors (NDRIs). This class of medications increases dopamine and norepinephrine concentrations in the brain.
• Second-generation antipsychotics or atypical antipsychotics. These are used for treatment-resistant depression to enhance the impact of antidepressants.
• Benzodiazepines. Also known as “Benzos,” benzodiazepines promote relaxation and reduce muscular tension and depression symptoms.
• Tricyclic antidepressants. These older medications are used when other antidepressants have not worked. Unfortunately, they have severe side effects and a low threshold for overdose.
• Monoamine oxidase inhibitors (MAOIs). MAOIs are older medications that can be used when other antidepressants haven't worked, but they require dietary restrictions, and there have been some safety concerns. 
• Miscellaneous (combination therapies, antipsychotics, etc.). There are additional medications that may be considered in order to treat depression and anxiety, but these may have complex, sometimes unknown mechanisms of action.  

Some people find that taking vitamins and supplements may help lessen the symptoms of their anxiety or depression, especially if a deficiency is a contributing factor. People who have depression and have low folate levels may benefit from treatment with additional folate. Folate, also called folic acid or vitamin B9, is a vitamin available in certain foods and required by the body to perform many essential processes. 

Other popular natural remedies for anxiety and depression include the use of chamomile and lavender, but findings so far are inconclusive. Melatonin may be helpful with circadian rhythm and improving sleep. Kava, derived from a pepper, may have an effect on anxiety, but it is linked to severe liver disease and should be used only with the monitoring of a healthcare provider.

There has been extensive research on St. John's wort, especially on its use for depression. While the results on its effectiveness are mixed, it has been clearly shown that St. John's wort can interact in dangerous, sometimes life-threatening ways with a variety of medicines, and it should not be taken without the supervision of a knowledgeable healthcare provider.

S-adenosyl-L-methionine (SAMe) is a chemical that is found naturally in the body and sold as a dietary supplement. SAMe has been studied primarily for depression, osteoarthritis and liver diseases. Although there is some indication that it might be helpful for depression, the evidence is not conclusive. Be sure to consult a healthcare provider if you’re considering giving SAMe to a child. If you are pregnant or nursing, taking medicine or other dietary supplements, have bipolar disorder or Parkinson's disease, or you are HIV-positive, talk to your healthcare provider before taking SAMe.

Valerian is used as a dietary supplement for anxiety and depression, among other conditions. Studies suggest that valerian is generally safe for use by most healthy adults for short periods of time, but there is not enough evidence to conclude whether valerian can relieve anxiety or depression.

Anxiety and depression are serious and common, yet complex conditions that can occur together. If you’re experiencing anxiety, depression or both, it is important to seek help from a mental health professional to find the right treatment and plan.

**If you or a loved one is struggling with suicidal thoughts, free and confidential help is available 24/7 by calling 988 to speak with a trained counselor from the Suicide Prevention Lifeline, sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). They have options for Spanish speakers and Deaf and Hard of Hearing as well. 

Clinically reviewed and updated July 2022.