Medications that treat anxiety and depression

Depression and anxiety are two of the most common mental health disorders in the United States. But did you know it’s common to have both depression and anxiety at the same time? Nearly 50% of people who are diagnosed with depression are also diagnosed with an anxiety disorder, according to the Anxiety and Depression Association of America (ADAA). 

If you or a loved one receive this dual diagnosis, you might wonder if that means double the treatment. Not necessarily—there are medications that treat both depression and anxiety. Your healthcare provider will work with you to determine the right treatment plan for your specific needs.

Can I have depression and anxiety at the same time? 

Depression and anxiety are two different mental health disorders that are often comorbid. Meaning, they occur at the same time. 

Depression is a mental disorder that is commonly identified with intense feelings of hopelessness, despair, worthlessness, and overwhelming sadness. More than 16% of Americans will experience depression (sometimes called major depressive disorder) at some point during their lifetime, according to the Cleveland Clinic. While most people will experience feelings of sadness at some point, with depression, these feelings are prolonged—lasting two weeks or more—and severe enough to impact daily life.

Anxiety disorders are characterized by excessive worry, nervousness, or fear that impacts everyday functioning. Without treatment, anxiety can get worse over time. There are a number of anxiety disorders, with their own set of unique symptoms.

About 2% of people in the U.S. have generalized anxiety disorder (GAD). According to Richard Shelton, MD, a psychiatrist and the vice chair of research at the University of Alabama at Birmingham, GAD symptoms include persistent fear and worry that is often difficult to control. Other anxiety disorders include:

• Panic disorder (PD)
• Social anxiety disorder (SAD)
• Phobias, such as vehophobia, or fear of driving
• Obsessive compulsive disorder (OCD)
• Post-traumatic stress disorder (PTSD)

Dr. Shelton says that diagnosing a patient with both depression and anxiety should be done carefully. “I would only give someone a comorbid anxiety disorder diagnosis if they had the anxiety problems before the start of the depression—or if they had a specific kind of anxiety, like anxiety attacks,” he says. He also added that, with these criteria in mind, around 40% of his patients receive both an anxiety disorder and depression diagnosis. 

There are similarities and differences between depression and anxiety disorders. “Both anxiety disorders and depression are characterized by feelings of distress,” says Dr. Shelton. However, anxiety itself is a broader concept that encompasses symptoms that are seen in a variety of mental illnesses, adds Dr. Shelton. Additionally, general feelings of anxiety may occur as a symptom of depression, but depression is not considered a symptom of anxiety. 

Depression and anxiety may share some of the same signs and symptoms, such as avoiding activities that were once previously enjoyed, headaches or changes in appetite, and exhaustion.

People that are depressed typically experience low energy, low motivation, guilt, and suicidal thoughts—these factors distinguish depression from anxiety, says Dr. Shelton. Additionally, a patient with an anxiety disorder will typically experience persistent fear and heightened thoughts or feelings of worry. 

Treatment options for depression and anxiety

If you’re hesitant to take antidepressants for anxiety, there are plenty of different non-medical treatments for depression and anxiety. “Most of the effective treatments for both depression and anxiety that don’t involve medications are variations of cognitive behavioral psychotherapy,” Dr. Shelton says. Cognitive behavioral therapy (CBT) is a treatment that involves changing your way of thinking as well as your behavioral patterns. Some CBT approaches include behavioral activation and mindfulness-based cognitive therapy

Dr. Plummer says that an alternative treatment that some patients with depression and anxiety find helpful is cannabidiol (CBD), a component of cannabis that doesn’t create the “high” of typical marijuana use. “Many state that CBD is shown to have positive effects for depression and anxiety, but too much cannabis may be associated with panic attacks,” she advises. She also warns that this is not an FDA-approved treatment.

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Some other non-medical treatments may include the following lifestyle changes:

• Support groups
• Talk therapy
• Meditation
• Breathing exercises
• Connection with supportive family members and friends
• Regular exercise, including yoga
• Eating a healthy diet
• Supplements (like omega-3 fatty acids

RELATED: Best diet for depression | Best diet for anxiety 

Medication for anxiety and depression

There are many medications for anxiety and depression that are available for patients experiencing both disorders. The antidepressants below can treat panic disorder, social anxiety disorder, generalized anxiety disorder, or phobias, in addition to depression. Antidepressants increase the activity of certain neurotransmitters, such as serotonin or norepinephrine, in the brain.  

The best treatment depends on which anxiety disorder a patient has. “For generalized anxiety disorder (GAD), both SSRIs and SNRIs are first in line,” says Danielle Plummer, Pharm.D. She adds that the most commonly prescribed medications to treat both depression and anxiety are SSRIs and SNRIs. 

1. Selective serotonin reuptake inhibitors (SSRIs) are a class of medications that have a broad therapeutic range. They can be used to treat anxiety disorders, depression, or, in some cases, both at the same time. SSRIs block the reuptake, or reabsorption, of serotonin. As a result, SSRIs increase serotonin in the brain.
2. Serotonin-norepinephrine reuptake inhibitors (SNRIs) are a class of medication that are similar to SSRIs because they too inhibit reuptake and increase the level of serotonin. Unlike SSRIs, they also increase norepinephrine, which is considered a component of our brain’s stress response. 
3. Tricyclic antidepressants (TCAs) increase serotonin and norepinephrine levels to improve mood. However, they also block the actions of acetylcholine. These drugs can cause more side effects (like low blood pressure, weight gain, and constipation) than other antidepressants. They’re not a first-line treatment for depression and anxiety disorders.
4. Monoamine oxidase inhibitors (MAOIs) are typically used for depression, but they can also be prescribed for panic disorder and social anxiety disorder. MAOIs work by blocking the breakdown of monoamine neurotransmitters and therefore increasing monoamine neurotransmitters in the brain. Monoamine neurotransmitters include serotonin, norepinephrine, and dopamine. Because they tend to cause more side effects than other antidepressants, MAOIs are usually reserved for people who have tried other antidepressants without improvements in their condition. 

Dr. Shelton says benzodiazepines, including brand-name drugs like Xanax (alprazolam) and Valium (diazepam), are considered poor choices for someone being treated for anxiety disorders and depression. They are effective temporarily, but have a risk of dependency with more than short-term use. 

If a patient has both anxiety and depression and is noticing that symptoms of anxiety are decreasing but their depression isn’t, then Increasing the dosage of a particular medication may help treat symptoms of anxiety or depression if a low dosage isn’t working. It is important that a patient discuss the type of medication that is right for them with a medical professional. 

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Can antidepressants cause anxiety?

Dr. Shelton says that SSRIs typically don’t cause anxiety symptoms. However, if a patient is very anxious it’s a good idea to start on a very low dose to allow the patient to adjust to the medication slowly.

Dr. Plummer says that a patient starting an SSRI may notice an initial increase in anxiety. “It takes a minimum of two to four weeks, sometimes longer, for SSRIs to reach the serotonin levels needed to relieve the depression or anxiety,” she says.

What if my anxiety gets better, but my depression doesn’t?

SSRIs can help treat anxiety and depression, but they don’t work the same for everyone. If increasing the dosage of that medication doesn’t work, another medication may be added or used to replace the current treatment. 

For example, Wellbutrin (bupropion) is a common antidepressant that tackles low mood and low energy, but it can increase feelings of anxiousness. “It’s one of the reasons why it’s often combined with an SSRI,” says Dr. Shelton, if depression isn’t alleviated completely.

RELATED: Depression treatment and medications | What is Wellbutrin?

What is the best anxiety medication with fewer side effects?

Side effects of antidepressants vary by drug class and medication, but some of the most common side effects across all antidepressants include:

• Nausea
• Constipation
• Insomnia 
• Fatigue
• Dizziness
• Drowsiness
• Anorexia 
• Weight gain
• Orthostatic hypotension 
• High blood pressure
• Excessive sweating
• Anxiety
• Tremor
• Dry mouth

RELATED: Going on antidepressants: A beginner’s guide to side effects

As always, make sure you talk with a mental health professional about which medication or treatment plan is right for you. Your healthcare provider will consider your medical history and existing health conditions. If you are experiencing suicidal thoughts, are thinking of harming yourself, or would like to talk to someone, contact the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). This hotline is available free, 24/7 for anyone experiencing emotional distress or suicidal thoughts.