Anxiety and depression are intricately linked, which is why the same types of therapy and the same classes of medications are often used to treat both disorders.
In my practice, I have noticed that many clients that have self-diagnosed as depressed are actually experiencing anxiety. Similarly, many clients who identify as anxious are often depressed. Here, I will explain the connections between anxiety and depression, and why one can lead to the other.
Shared Traits and Symptoms of Anxiety and Depression
Nervous Energy
When you are anxious, your predominant feeling is that of worry, and being wound too tightly. You feel like you can’t relax, and that danger is everywhere in some form or another. However, the irritability associated with depression gives you a similar wound up feeling. Often, the overlap between the two can be difficult to tease apart.
Avoidance or Retreat
Anxiety makes people retreat from situations, out of fear that they will be evaluated poorly, or that some danger will befall them. Depression also leads to retreat from the world, since you feel so negatively about yourself and others that you can’t imagine a reason to purposefully put yourself into contact with other people.
Negative Thinking
When you are depressed, you see the worst in every situation. The depressive cognitive triad includes negative thoughts about yourself, the world, and the future. For example, going to a party, you may think, “nobody will like me, I’m not going to make any friends.” There may in fact be a strong likelihood of this outcome coming to pass, since when you’re depressed, you don’t act as outgoing, engaged, or responsive.
However, if you focus on these negative thoughts about others, you may end up diagnosing yourself as socially anxious, and not recognizing the major impact that your depression has on your thinking.
Behavioral Changes
Additionally, both anxiety and depression can result in changes in your behavior.
Anxiety and depression can both prompt people to withdraw from social situations, for different reasons. However, let’s say you withdraw from parties due to fatigue and apathy. Eventually when you’re out of practice at socializing, you will in fact have raised your chances for developing social anxiety, as any anxiety deepens with avoidance of the feared situation.
It’s much the same when you stop engaging in world-expanding behaviors, like driving, flying, or even leaving the house, due to anxiety. Over time, your world will shrink and you may become depressed thinking about all of your missed opportunities.
No Matter the Challenge, Therapy Can Help
Whether you’re anxious, depressed, or (sometimes) both, therapy can help you get yourself back on track. A good therapist can help you identify what you’re feeling, and work to treat the exact issues you are struggling with.
There is no shame in getting help and support from a trained professional. Once you and your therapist figure out how your anxiety or depression, or both, is manifesting in your life, you can both figure out next steps to take to create a life that makes you feel happy and fulfilled.
You’ve noticed some changes lately. Maybe you feel sad, hopeless, or don’t get any joy out of activities that used to be fun. Sounds like depression, right?
Maybe that’s not all. Sometimes you’re worried, afraid, and just plain uneasy. Isn’t that a sign of anxiety?
Not so fast. It’s normal to have ups and downs or to have things you’re concerned about. You might be going through a difficult time. Your doctor can help you figure out if it’s actually a condition and what would help.
Depression and anxiety are like flip sides of the same coin, says therapist Nancy B. Irwin, PsyD. “Being depressed often makes us anxious, and anxiety often makes us depressed.”
If you have both conditions, there are lots of ways to get help.
What Is Depression?
Depression is more than just feeling down or having a bad day. When a sad mood lasts for a long time and interferes with normal, everyday functioning, you may be depressed. Symptoms of depression include:1
- Feeling sad or anxious often or all the time
- Not wanting to do activities that used to be fun
- Feeling irritable‚ easily frustrated‚ or restless
- Having trouble falling asleep or staying asleep
- Waking up too early or sleeping too much
- Eating more or less than usual or having no appetite
- Experiencing aches, pains, headaches, or stomach problems that do not improve with treatment
- Having trouble concentrating, remembering details, or making decisions
- Feeling tired‚ even after sleeping well
- Feeling guilty, worthless, or helpless
- Thinking about suicide or hurting yourself
The following information is not intended to provide a medical diagnosis of major depression and cannot take the place of seeing a mental health professional. If you think you are depressed‚ talk with your doctor or a mental health professional immediately. This is especially important if your symptoms are getting worse or affecting your daily activities.
Hi, I’m Dr. Craig Sawchuk, a clinical psychologist at Mayo Clinic. And I’m here to talk with you about depression. Whether you’re looking for answers for yourself, a friend, or loved one, understanding the basics of depression can help you take the next step.
What is depression?
Depression is a mood disorder that causes feelings of sadness that won’t go away. Unfortunately, there’s a lot of stigma around depression. Depression isn’t a weakness or a character flaw. It’s not about being in a bad mood, and people who experience depression can’t just snap out of it. Depression is a common, serious, and treatable condition. If you’re experiencing depression, you’re not alone. It honestly affects people of all ages and races and biological sexes, income levels and educational backgrounds. Approximately one in six people will experience a major depressive episode at some point in their lifetime, while up to 16 million adults each year suffer from clinical depression. There are many types of symptoms that make up depression. Emotionally, you may feel sad or down or irritable or even apathetic. Physically, the body really slows down. You feel tired. Your sleep is often disrupted. It’s really hard to get yourself motivated. Your thinking also changes. It can just be hard to concentrate. Your thoughts tend to be much more negative. You can be really hard on yourself, feel hopeless and helpless about things. And even in some cases, have thoughts of not wanting to live. Behaviorally, you just want to pull back and withdraw from others, activities, and day-to-day responsibilities. These symptoms all work together to keep you trapped in a cycle of depression. Symptoms of depression are different for everyone. Some symptoms may be a sign of another disorder or medical condition. That’s why it’s important to get an accurate diagnosis.
What causes depression?
While there’s no single cause of depression, most experts believe there’s a combination of biological, social, and psychological factors that contribute to depression risk. Biologically, we think about genetics or a family history of depression, health conditions such as diabetes, heart disease or thyroid disorders, and even hormonal changes that happen over the lifespan, such as pregnancy and menopause. Changes in brain chemistry, especially disruptions in neurotransmitters like serotonin, that play an important role in regulating many bodily functions, including mood, sleep, and appetite, are thought to play a particularly important role in depression. Socially stressful and traumatic life events, limited access to resources such as food, housing, and health care, and a lack of social support all contribute to depression risk. Psychologically, we think of how negative thoughts and problematic coping behaviors, such as avoidance and substance use, increase our vulnerability to depression.
The good news is that treatment helps. Effective treatments for depression exist and you do have options to see what works best for you. Lifestyle changes that improve sleep habits, exercise, and address underlying health conditions can be an important first step. Medications such as antidepressants can be helpful in alleviating depressive symptoms. Therapy, especially cognitive behavioral therapy, teaches skills to better manage negative thoughts and improve coping behaviors to help break you out of cycles of depression. Whatever the cause, remember that depression is not your fault and it can be treated.
To help diagnose depression, your health care provider may use a physical exam, lab tests, or a mental health evaluation. These results will help identify various treatment options that best fit your situation.
Help is available. You don’t have to deal with depression by yourself. Take the next step and reach out. If you’re hesitant to talk to a health care provider, talk to a friend or loved one about how to get help. Living with depression isn’t easy and you’re not alone in your struggles. Always remember that effective treatments and supports are available to help you start feeling better. Want to learn more about depression? Visit mayoclinic.org. Do take care.
Living with the effects of anxiety can cause depression as a result of avoidant behaviors, self-esteem changes, and hypervigilance.
If you live with an anxiety disorder, you may have experienced depression in tandem. It doesn’t always mean one caused the other but it’s possible.
Anxiety can be a temporary emotional response to a stressor but it can also be a chronic mental health condition like generalized anxiety disorder (GAD).
When you live with GAD or other anxiety disorders, you may be more likely to also experience symptoms of depression.
These overlapping symptoms can be managed and treatment may help you cope. Understanding why anxiety leads to depression symptoms in some cases can also help.
Does anxiety cause depression?
It depends. If your anxiety is a temporary emotional response, it’s not likely it may lead to symptoms of depression.
But if you notice that your signs of anxiety become a recurring experience, you may be living with an anxiety disorder. In this case, research suggests that it’s possible that anxiety leads to depression, or makes the existing symptoms of depression feel worse.
In that case, depression may be a side effect of anxiety.
3 ways anxiety causes depression
Here’s why and how the untreated effects of anxiety may cause depression symptoms to develop:
Avoidant behaviors
Anxiety is related to the stress response. When you live with anxiety, your brain is constantly or often alert.
As a natural response to fear, your brain starts asking you to avoid anything that causes significant nervous or anxious feelings, says Kathryn Ely, a licensed professional counselor in Birmingham, Alabama.
For example, if even the thought of public speaking activates your stress response, you may start avoiding giving presentations at work as much as possible.
“Anxiety shrinks lives by keeping us in our comfort zones, which is a misnomer because our comfort zones aren’t really comfortable,” she says.
We tend to feel anxious about things that are important to us, she adds. “If you avoid what is important to you long enough, your life becomes less enjoyable and you may not like who you are. That is where depression comes in.”
Avoidance may also lead you to isolate yourself from other people, particularly if you live with symptoms of social anxiety. In some cases, social anxiety and feelings of loneliness can lead to depression.
Changes in self-perception
If you find yourself unable to start or follow through with things you need to do due to anxiety, it can change the way you view yourself and your ability to handle tough moments, says Ely.
A sense of worthlessness is a formal symptom of depression. When you live with low self-esteem and self-confidence for long enough, you may be more likely to develop other symptoms of depression.
“Anxiety tells you, ‘I can’t do this. This is scary.’ So you don’t go to the dance, or you find a way to pass off the presentation at work. Now, self-criticism starts because you didn’t do the hard thing that was important to you, that you wish you had done,” Ely explains. “This is another way anxiety leads to depression.”
Depletion of resources
When you feel fear, adrenaline is released in your body to help you face the perceived threat, says Katie Luman, a licensed professional counselor in Marietta, Georgia.
“Hypervigilance — when fight or flight is triggered easily and often — can deplete and wear out our stress hormones,” she says. “It can also result in the disruption of sleep and appetite, which can result in a depressed mood.”
Causes of anxiety and depression
Each person experiences anxiety and depression differently, and the contributing factors to both conditions are going to be unique for each individual.
There are many possible causes of anxiety and causes of depression, and some may overlap.
These include:
- early experiences
- environmental factors
- family history of depression or anxiety
- neurobiology
- social experiences
- traumatic events
- personality traits
- emotional and physical neglect
How to know if you have depression
Research shows that 60% of people living with depression do not seek help for it.
Yet, major depressive disorder is a condition that often warrants support and treatment, especially when coupled with an anxiety disorder.
If you believe you may be living with depression, it’s highly advisable to seek the guidance of a mental health professional.
They’ll be able to assess whether or not you meet the diagnostic criteria for depression, as listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR).
In order to receive a diagnosis, at least five of nine formal symptoms must be present for longer than 2 weeks.
The formal symptoms of depression include:
- persistent low mood that may include sadness, hopelessness, and irritability
- disinterest in things you used to love
- trouble with concentration and memory
- changes in the way you talk and move, usually to a slower pace
- changes in sleep patterns
- appetite changes that may lead to weight fluctuation
- unexplained aches and pains and fatigue
- thoughts of self-harm or suicide
When to seek help
If you’re living with anxiety and you think it’s causing depression symptoms as well, you don’t have to go through this alone. You may find it useful to work with a therapist who is familiar with anxiety, depression, and the overlap between the two.
There are many types of treatment options available, but Ely recommends Acceptance Commitment Therapy (ACT) and cognitive behavioral therapy (CBT) as a great place to start.
Ely adds these modalities can help you:
- uncover negative core beliefs
- identify unhelpful or distorted thoughts
- widen your comfort zone
- increase your self-esteem
“In therapy, we focus on changing your negative narrative about yourself to one that is strength and value-focused,” she says. “By combining these methods, we see clients move from anxiety and depression, to self-confidence and more fulfilling lives.”
Let’s recap
In some cases, living with the effects of anxiety can cause depression symptoms to develop. It could also intensify these symptoms if you already live with both conditions.
Left untreated, anxiety disorders can have a negative impact on your overall quality of life in multiple areas, like your home life, relationships, work, or school.
Developing coping mechanisms and seeking the help of a professional can help and have been found effective in the relief of symptoms.
