Do you sometimes worry so much that it interferes with your everyday activities? Or feel so blue that it completely clouds your outlook? Do you often experience these or similar feelings together? You’re not the only one.
Anxiety disorders — which include generalized anxiety disorder, panic disorder, phobias, and social anxiety disorder — are the most common mental health problem among U.S. adults, affecting 19.1 percent of the population each year, according to the Anxiety and Depression Association of America (ADAA).
And mood disorders — which include major depressive disorder, bipolar disorder, and seasonal affective disorder — are the leading cause of disability, research shows.
Moreover, the incidence of developing depression in addition to an anxiety disorder or vice versa is high. Many people with major depression also have severe and persistent anxiety, notes Sally R. Connolly, a licensed marriage and family therapist in Louisville, Kentucky. And some experts estimate that 60 percent of people with anxiety will also have symptoms of depression, according to the National Alliance on Mental Illness (NAMI).
“Anxiety and depression co-occurring results in more negative outcomes in life quality than if each illness was separately experienced,” says Deborah Serani, PsyD, a psychologist and senior adjunct professor at Adelphi University in Garden City, New York.
“When you have two distinct sets of symptoms pressing on you, there’s a doubling-down intensity that makes it hard to cope well on a daily basis,” she explains.
That’s why it’s so important to get properly diagnosed and treated if you have both conditions (or suspect you do). Here’s what to know.
Anxiety and Depression: What Are the Possible Links?
Although clearly not identical emotional states, mental health research suggests that depression and anxiety often coexist because they can be caused by the same or similar factors. According to an article published May 2020 in the American Journal of Psychiatry, those overlapping causes can include:
- Genetic Factors Genetic differences between people account for 40 percent of the variability in depressive and anxious symptoms, with 60 percent being attributed to environmental, noninherited factors. “Especially with anxiety, more so than depression, there often is some family history, and so therefore we think that there may be some genetic predisposition to this,” Connolly explains.
- Environmental Factors Also referred to as social factors, these include experiences like trauma or neglect in early childhood, and current stressors such as relationship difficulties, unemployment, social isolation, and physical illness. People who have post-traumatic stress disorder (PTSD), which often includes anxiety, are particularly likely to also develop depression, according to the National Institute of Mental Health (NIMH).
- Pain Chronic pain, and particularly disabling pain syndromes such as fibromyalgia, irritable bowel syndrome (IBS), low back pain, headaches, and nerve pain, are closely linked to psychological distress, including both anxiety and depression, notes Harvard Health. In fact, they say, research suggests that “pain shares some biological mechanisms with anxiety and depression.”
Symptoms of Anxiety and Depression
According to the American Psychiatric Association’s current Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the standard classification of mental disorders used by mental health professionals in the United States, anxiety and depression can share several common symptoms, including, but not limited to:
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Sleep disturbance (difficulty falling or staying asleep; restless, unsatisfying sleep)
Other potential signs and symptoms of an anxiety disorder include:
- Constant, irrational fear and worry
- Physical symptoms like rapid heartbeat, headaches, hot flashes, sweating, abdominal pain, or difficulty breathing
- Inability to relax
- Panic attacks
Other potential signs and symptoms of depression include:
- Persistent feelings of sadness or worthlessness
- Loss of interest or pleasure in hobbies and activities
- Changes in eating, either too much or too little
- Thoughts of suicide
Can Anxiety and Depression Be Treated Together?
Yes. There are well-established treatments for both anxiety and depression that can help a person find relief.
If you suspect you have both anxiety and depression, Connolly recommends getting a thorough evaluation from a psychiatrist as a first step. “It’s really crucial for people with both [anxiety and depression] to have a good assessment to rule out bipolar disorder,” she says.
If you do have both conditions, it’s important to get treatment for both together rather than separately, notes Serani.
“Taking care of one set of issues (anxiety) without the consideration of how the other illness (depression) interlaces with the former would be a slower and more ineffective approach,” she explains. “Instead, an integrated treatment would address both disorders at once,” she says.
Effective treatment strategies often involve a combination of talk therapy (psychotherapy), medication, and certain lifestyle changes, according to research published December 2015 in the World Journal of Psychiatry. These may include:
- Cognitive Behavioral Therapy (CBT) CBT focuses on teaching people to challenge their negative thoughts, to use coping skills and relaxation techniques to reduce stress, and to plan strategic behaviors that reduce anxiety and boost mood. CBT is not only an established treatment for anxiety and depression, it is also the best studied psychotherapy for treating pain, per Harvard Health.
- Interpersonal Psychotherapy (IPT) IPT focuses on the connection between onset of symptoms and current interpersonal problems, such as unresolved grief, relationship disputes, and social isolation or withdrawal.
- Antidepressant Medication Antidepressants include selective serotonin reuptake inhibitors (SSRIs), such as citalopram (Celexa), fluoxetine (Prozac), escitalopram (Lexapro), paroxetine (Paxil), and sertraline (Zoloft). SSRIs are often used in conjunction with CBT and other forms of psychotherapy for more severe anxiety and depression. Serotonin and norepinephrine reuptake inhibitors (SNRIs), which include duloxetine (Cymbalta), venlafaxine (Effexor), and desvenlafaxine (Pristiq), are other options.
- Exercise Getting exercise can also help ease symptoms of both depression and anxiety, although why isn’t entirely clear, per the Mayo Clinic. One reason may be that exercise releases feel-good chemicals in the brain that enhance your sense of well-being. Another may be that it distracts you from your worries, fears, and other negative thoughts. Whatever the reason, walking for as little as 10 minutes may alleviate symptoms, the ADAA notes.
- Relaxation Techniques Mindfulness meditation — a way of training your mind to be in the present, release judgments, and calm both your mind and body by sitting quietly and practicing meditation such as focusing on your breathing — can ease symptoms of both anxiety and depression and improve quality of life, according to a large research review published in JAMA Internal Medicine.
Additional reporting by Shelby House.