Anxiety Plus Depression

anxious depressionPeople sometimes think that feeling anxious and feeling depressed are separate emotional states. While this is sometimes true, anxiety and depression often come together and can feel like components of an overall state. The idea that you seek psychotherapy for depression vs. psychotherapy for anxiety may be the result of using overly simplistic categories.

When describing depression, people often include emotions such as hopelessness, emptiness, and despair. Although depression may be described on a continuum from mild to severe, there are experiential themes that tend to exist across the spectrum. There is often a loss of interest in daily activities, and a loss of enthusiasm for things that brought pleasure or were fun in the past. There may be a pervasive feeling of sadness and/or a sense of emptiness, and the experience of the world as a whole is darker and gloomy. It can be hard to concentrate.

People who are depressed frequently have low energy levels and feel overwhelmed by performing day-to-day tasks and maintaining their personal relationships. Life may seem simply overwhelming and black, and there may be suicidal thoughts or behavior. Sleep is often disturbed: some depressed people feel like sleeping all the time, while others have trouble sleeping at all. Many people describe a day-night reversal, sleeping all day and being awake all night. There can be a constant sense of fatigue, at the same time one is unable to sleep. Depression is a dark and lonely struggle.

When describing anxiety, experiences of fear or panic come to the foreground, along with a general feeling in the body of agitation and restlessness. Even in normal social situations, this state leads to feeling anxious or threatened, and brings the anticipation of some misfortune. The experience of panic or anxiety may come in waves, without any obvious trigger in the moment. With panic or anxiety attacks, it’s common to get into an endless circle that builds on itself. There is something wrong, my heart is beating fast, and since my heart is beating fast there must really be something wrong, leading to your heart beating faster.  I am sweating and I feel flushed. I must be falling apart or going crazy. I’m hyperventilating and can’t even get my breath, Oh my god I’m dying! The anxiety escalates still more. Even without an anxious crisis like this, there may be a constant undertow of nagging worry or fear.

In fact, depression and anxiety frequently co-occur. In many cases, they may be seen as part of a single overall state of anxious depression or agitated depression. Though depression is often seen as a low energy state, this may not be true with agitated depression. A depressed person with low levels of energy may also experience considerable fear and agitation, or even terror. They may be having circular thoughts: I’m so depressed, I can’t function, I can’t sleep, I can’t take care of myself, I can barely move. I’m so paralyzed I will lose my job, lose my friends, have no money and wind up on the street. Without support from others or control of the things happening to me, my life will go downhill and I will wind up dead. These horrible thoughts alone are overwhelming, and the cycle starts again and can deepen.

There is considerable research documenting the relationship between depression and anxiety. For example, researchers found that anxiety began before or at the same time as depression in 37% of people, while depression began before or concurrently in 32% of people (Arch Gen Psychiatry 2007;64:651-660).  In other words, for approximately 1 in 3 people, anxiety and depression exist together and begin at the same time.

Treatment. Most forms of anxiety and depression improve with psychotherapy and counseling. In some cases, adding antidepressant medication therapy to psychotherapy is helpful in relieving the acute symptoms, while underlying problems that trigger or contribute to a person’s anxiety and depression are addressed in psychotherapy. (It’s notable that antidepressants are used for both anxiety therapy and depression therapy.) Antidepressant medication therapy is not always necessary; for some people whose ideas about or reactions to taking medication are negative, psychotherapy alone may be the best option. In cases where the symptoms are not life-threatening, a person’s feelings about the use of medication should be respected.

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Anxiety + Depression
Anxiety and depression often occur simultaneously, and most forms improve with psychotherapy or counseling. In some situations medication can be helpful, but it is not always necessary.

About Marc Handelman, PhD

I am a licensed clinical psychologist practicing in New York City. My office is located on the Upper West Side of Manhattan, near Columbia University. I work with adults from college age and up who want help addressing problems ranging from depression, anxiety, and relationship issues to addiction, co-dependency, and the effects of early trauma. I believe psychotherapy should provide a sense of comfort and support as the starting point for addressing emotional problems. I have more than 30 years' experience as a psychotherapist, and have been affiliated with The Hazelden Foundation since 1997. Please see my professional website for more information:
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