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. Around 10% of Americans experience major depression (sometimes called major depressive disorder), 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)
- Posttraumatic 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 this 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 can be a symptom of depression, but depression is not a symptom of anxiety.
Depression and anxiety have the following symptoms in common: feelings of despair like nothing good will ever happen, physical symptoms (including headache and stomach pain), 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, become avoidant of situations, and experience heightened anxious thoughts and feelings.
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 marijuna 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
- Breathing exercises
- Connection with supportive family members and friends
- Regular exercise
- Eating a healthy diet
- Supplements (like omega-3 fatty acids)
Research even shows that yoga may help to combat depression for some.
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Medication for anxiety and depression
There are many medications for anxiety and depression that are available for patients experiencing both disorders.
Danielle Plummer, Pharm.D., says that antidepressants can treat panic disorder, social anxiety disorder, generalized anxiety disorder, and phobias. Dr. Shelton adds that “the medications are also somewhat effective for OCD, and less so for PTSD, which are technically not anxiety disorders.”
Dr. Plummer says that the treatment depends on which anxiety disorder a patient has. “For generalized anxiety disorder (GAD), both SSRIs and SNRIs are first in line,” she says. She added that the most commonly prescribed medications to treat both depression and anxiety are SSRIs and SNRIs.
Selective serotonin reuptake inhibitors (SSRIs) are a class of medications that have a broad therapeutic range. They can be used to treat some 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.
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.
Dr. Shelton says benzodiazepines, including brand-name drugs like Xanax and Valium, are considered poor choices for someone being treated for anxiety disorders and depression because of their temporary effectiveness and the risks associated with dependency.
If a patient has both anxiety and depression, and is noticing that symptoms of anxiety are decreasing but their depression isn’t, then a medical professional will likely increase their dosage. “To dose up through the typical dosing range for the medication is a great way to treat both anxiety and depression,” he says.
|Common medications that treat both anxiety and depression|
|Drug name||Drug class||Administration route||Standard dosage||Common side effects|
|SSRI||Oral||50 to 200 mg per day||Nausea, diarrhea, decreased appetite|
|Paxil||SSRI||Oral||20 to 50 mg per day||Drowsiness, nausea, headache|
|Prozac||SSRI||Oral||20 to 80 mg in the morning||Insomnia, nausea, nervousness|
|Celexa||SSRI||Oral||20 to 40 mg daily in the morning or evening||Nausea, insomnia, dizziness|
|Lexapro||SSRI||Oral||10 to 20 mg daily in the morning or evening||Insomnia, nausea, decreased libido|
|SSRI||Oral||50 to 300 mg daily, taken before bed||Drowsiness, drowsiness, insomnia|
|Cymbalta||SNRI||Oral||40 to 60 mg per day||Nausea, dry mouth, drowsiness|
|Pristiq||SNRI||Oral||50 mg once daily at approximately the same time each day||Nausea, dizziness, insomnia|
|Effexor XR (Capsule)||SNRI||Oral||37.5 to 225 mg per day
|Nausea, somnolence, dry mouth|
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?
Sometimes an SSRI will work to reduce anxiety, but it won’t be effective for a patient who has low energy or low mood, says Dr. Shelton. If increasing the dosage of that medication doesn’t work, another medication to tackle the low energy will likely be introduced. “SSRIs actually seem to work best for clusters of anxiety symptoms, but there are other antidepressants that have the opposite profile,” Dr. Shelton explains.
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.
As always, make sure you talk with a mental health professional about which medication or treatment plan is right for you. 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.