Anxiety and depression

By Nancy Kupka, PhD, RN Oct 09, 2019 • 12 min


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.1 In fact, depression and anxiety are two mental health conditions that commonly occur together.1 

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.2 Many of the symptoms for both conditions are similar or may overlap, which is why it’s important for you to discuss all of your symptoms with your healthcare provider.2

Why do many people suffer from both depression and anxiety?

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 your brain, so they are likely to appear together.1  Another theory is that people tend to meet the diagnostic criteria for both conditions because their symptoms overlap.1  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.

Differences between depression and anxiety

Depression, also called clinical depression or major depressive disorder, is a common, serious mood disorder in which you may feel intense, lasting sadness that affects your thoughts and your ability to function in day-to-day life.3 Anxiety, on the other hand, is characterized by excessive worry and stress in anticipation of a real or perceived threat.4

Symptoms of depression and anxiety

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 you about your symptoms and how they affect your daily life.It’s also a useful tool to keep track of how well you respond 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.3

Depressive disorders are further classified into specific subgroups, including reactive and endogenous depression, melancholia, atypical depression, depression with a seasonal pattern/seasonal affective disorder and dysthymia. Depression diagnostic criteria states a person must have five or more symptoms of depression, lasting for at least two weeks.6

Some signs of depression may include3:

  • Lasting feelings of sadness, unhappiness or hopelessness

  • Loss of interest in things or activities that were once enjoyed

  • Feeling tired, sleeping all of the time or sleeping poorly

  • Aches and pains 

  • Loss of appetite or overeating

  • Loss of sex drive

  • Trouble concentrating, restlessness or irritability

  • Memory lapses or trouble making decisions 

  • Thoughts of death or suicide, or attempts at suicide

**If you or a loved one is struggling with suicidal thoughts, free and confidential help is available 24/7 by calling 800-273-8255 to speak with a trained counselor from the Suicide Prevention Lifeline.7

People with chronic depression may also experience persistent physical symptoms, such as headaches, stomach problems or pain, that do not respond to treatment or do not have another 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 following8,9:

  • 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.8Panic 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.9 During a panic attack, people may experience8,9

  • 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.8 People with a phobia tend to8

  • 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

Treatment for anxiety and depression

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 anxiety10,11,12,13:

 

 

Therapeutic group 

 

 

 

 

How they work/when they're used 

 

 

 

 

Medication names

 

 

 

 

Selective serotonin reuptake inhibitors (SSRIs) 

 

 

 

 

Increase levels of serotonin, a brain chemical 

 

 

 

 

  • Citalopram (Celexa) 

  • Escitalopram (Lexapro) 

  • Fluoxetine (Prozac) 

  • Paroxetine (Paxil, Pexeva, Brisdelle) 

  • Sertraline (Zoloft) 

 

 

 

 

Serotonin and norepinephrine reuptake inhibitors (SNRIs) 

 

 

 

 

Increase levels of the brain chemicals serotonin and norepinephrine 

 

 

 

 

  • Desvenlafaxine (Pristiq) 

  • Duloxetine (Cymbalta, Drizalma Sprinkle) 

  • Venlafaxine (Effexor XR) 

  • Levomilnacipran (Fetzima) 

 

 

 

 

Tricyclic antidepressants 

 

 

 

 

Older medications that are used when other antidepressants have not worked 

 

 

 

 

  • Amitriptyline  

  • Desipramine (Norpramin) 

  • Doxepin (Silenor) 

  • Imipramine (Tofranil) 

  • Nortriptyline (Pamelor) 

  • Protriptyline (Vivactil) 

 

 

 

 

Monoamine oxidase inhibitors (MAOIs) 

 

 

 

 

Older medications that can be effective when other antidepressants haven't worked 

 

 

 

 

  • Isocarboxazid (Marplan) 

  • Phenelzine (Nardil) 

  • Selegiline patch (Emsam, Zelapar) 

  • Tranylcypromine Sulfate (Parnate) 

 

 

 

 

 

Norepinephrine-dopamine reuptake inhibitors (NDRIs) 

 

 

 

 

Increase brain levels of dopamine and norepinephrine 

 

 

 

 

  • Bupropion (Wellbutrin, Aplenzin, Forfivo XL) 

  • Mirtazapine (Remeron, Remeron SolTab) 

 

 

 

 

Second-generation antipsychotics or atypical antipsychotics 

 

 

 

 

Used for treatment-resistant depression 

 

 

 

 

  • Aripiprazole (Abilify, Abilify Mycite) 

  • Quetiapine (Seroquel XR) 

 

 

 

 

Miscellaneous (SSRI combinations, NMDA receptor agonist, etc.) 

 

 

 

 

 

 

 

Antipsychotics, anti-anxiety and antidepressant medications used to treat depression and/or anxiety conditions, yet have complex, sometimes unknown mechanism of action   

 

 

 

 

 

 

 

  • Vortioxetine (Trintellix) 

  • Esketamine (Spravato) 

  • Vilazodone (Viibryd)  

  • Buspirone12  

 

 

 

 

 

 

 

 

 

Benzodiazepines11

 

 

 

 

Promotes relaxation and reduces muscular tension 

 

 

 

 

Alprazolam, clonazepam, diazepam, lorazepam 

 

 

 

 

Miscellaneous11,14

 

 

 

 

Multiple medications that are approved for other uses but prescribed for the treatment of anxiety
 

 

 

 

 

  • Hydroxyzine (Vistaril) 

  • Quetiapine (Seroquel) 

 

 

Natural supplements for anxiety, depression, and depression coupled with anxiety

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.17 Folate, also called folic acid or vitamin B9, is a vitamin available in certain foods and required by your 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.16,17 Melatonin may be helpful with circadian rhythm and improving sleep.18 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.19

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 should not be taken without the supervision of a knowledgeable healthcare provider.20

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.23 Be sure to consult a healthcare provider before taking SAMe if you are pregnant or nursing, if you take medicine or other dietary supplements, if you have bipolar disorder or Parkinson's disease, if you're HIV-positive, or if you're considering giving SAMe to a child.21,22

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.23

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

Clinically reviewed and updated October 2019.

Sources:

1.  https://www.nami.org/Blogs/NAMI-Blog/January-2018/The-Comorbidity-of-Anxiety-and-Depression

2.  https://adaa.org/understanding-anxiety/depression.  

3.  https://www.ncbi.nlm.nih.gov/books/NBK63740/.

4. Renna M, OToole M, Spaeth P, Lekander M, Mennin D.  (2018). The association between anxiety, traumatic stress, and obsessive-compulsive disorders and chronic inflammation: A systematic review and meta-analysis. (35)11: 1081-1094.

5. https://www.apa.org/pi/about/publications/caregivers/practice-settings/assessment/tools/patient-health.  

6. Tolentino JC, Schmidt SL. DSM-5. Criteria and Depression Severity: Implications for Clinical Practice. Front Psychiatry. 2018;9:450. Published October 2, 2018.  doi:10.3389/fpsyt.2018.00450.

7. https://suicidepreventionlifeline.org/.   

8. https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml.

9. https://adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad/symptoms.

10. https://www.uptodate.com/contents/

11. https://adaa.org/learn-from-us/from-the-experts/blog-posts/what-medications-are-used-treat-anxiety-disorders

12. https://www.uptodate.com/contents/

13.  https://www.uptodate.com/contents

14.  https://nccih.nih.gov/health/providers/digest/anxiety-science.  

15. National Alliance of Mental Health. Complementary Health Approaches.  Complementary Health Approaches | NAMI: National Alliance on Mental Illness. Accessed January 27, 2022.

16. https://www.nccih.nih.gov/health/chamomile.

17. https://www.nccih.nih.gov/health/lavender#what-do-we-know-about-safety

18. https://files.nccih.nih.gov/s3fs-public/Melatonin_11-18-2015.pdf

19. https://www.nccih.nih.gov/health/kava

20. https://files.nccih.nih.gov/s3fs-public/SJW_and_Depression_11-30-2015.pdf

21. Galizia I, Oldani L, Macritchie K, et al. S-adenosyl methionine (SAMe) for depression in adults. Cochrane Database Syst Rev. 2016;10(10):CD011286. Published October 10, 2016. doi:10.1002/14651858.CD011286.pub2.

22. https://nccih.nih.gov/health/supplements/SAMe

23. https://www.nccih.nih.gov/health/valerian

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