Can depression and anxiety occur together? Read about the differences between worry and low mood, what they share, and what helps when you live with both.
Imagine a thirty-three-year-old man renting a flat in İzmir. Ever since the landlord announced a rent increase, he has been lying in bed for hours at night doing sums: "What if we have to move, what if I get laid off, what if our child has to change schools?" His heart races, his stomach is in knots. When morning comes, however, a completely different feeling greets him: he cannot see a single reason to get up; everything feels heavy and meaningless. The man who cannot sleep at night because of anxiety turns into someone who does not want to do anything during the day. "Am I anxious, or am I depressed?" he asks himself. The answer may often be "both". Depression and anxiety together are two conditions that can occur side by side and feed each other. In this article I explain how the two are told apart, why they so often appear together, how they affect life when experienced at the same time, and what can help, both on your own and in therapy.
Can Depression and Anxiety Occur Together?
Yes, and quite often. In the clinic, a considerable proportion of people who come with depression also have marked anxiety symptoms; many of those who come with an anxiety complaint also develop a low mood over time. Research shows that the co-occurrence of these two conditions is not an exception but a fairly common pattern.
This co-occurrence can take two forms. Sometimes a person separately meets the criteria for both an anxiety disorder and depression. At other times the symptoms are spread across both sides, but neither forms a clear picture on its own; the person is a little anxious and a little low, and this mixture makes everyday life difficult.
Whatever the form, having both at once can make the picture heavier and longer-lasting. The person lives on alert against the threats of the future on the one hand, and having lost hope about the future on the other. This double load drains energy from both directions at once.
The Differences Between Anxiety and Low Mood
Telling the two conditions apart is not always easy, but their basic orientations differ. The comparison below shows general tendencies; they do not appear with such clear lines in everyone.
Direction in time: future or past?
- Anxiety mostly looks to the future: "What if something bad happens?" The mind scans for possible dangers and builds worst-case scenarios.
- Depression mostly looks to the past and the present: "I've ruined everything", "Nothing has any meaning." Themes of loss, failure and worthlessness come to the fore.
Energy level: on alert or exhausted?
- In anxiety, the body is on high alert: palpitations, muscle tension, restlessness, being unable to keep still, sweating, stomach complaints.
- In depression, the body has slowed down: heaviness, tiredness, reluctance, slowed movement.
Way of thinking: worry or rumination?
- Worry is the thinking style of anxiety; it chains forwards through "what if" questions.
- Rumination, that is, chewing things over, is the thinking style of depression; it circles backwards through "why did this happen" questions.
Enjoyment and interest
An anxious person often still wants the things they might enjoy, but cannot approach them because of anxiety. In a person with depression, the wanting itself has decreased; the things they loved no longer mean anything to them. This is an important distinguishing point.
If you would like to get to know the different faces of anxiety in more detail, the article on anxiety symptoms can give you a framework.
Common Ground: Why Are They So Often Confused?
Some symptoms of depression and anxiety are almost identical. This shared area is the main reason the two conditions are so often confused:
- Sleep problems
- Difficulty concentrating and making decisions
- Irritability and impatience
- Tiredness
- Changes in appetite
- Pulling away from social settings
- Physical complaints: headaches, stomach problems, muscle aches
There are also shared factors that feed both conditions. Genetic vulnerability, high sensitivity to negative emotions, difficult experiences in childhood, long-term stress and major life changes can all pave the way for both anxiety and depression. That is why some professionals think of these two conditions as two branches reaching in different directions from the same root.
Anxiety says "what if it happens", depression says "it already has"; when the two speak together, the person is caught between the future and the past.
How Do Depression and Anxiety Feed Each Other?
The two conditions do not just occur together; they also form a cycle that feeds itself.
From anxiety to depression
Someone who lives with anxiety for a long time begins to avoid the situations they fear. They do not go to crowded places, do not answer the phone, do not apply for new jobs. Avoidance brings relief in the short term, but in the long term it narrows the person's life. A narrower life means less enjoyment and less sense of achievement. Over time the thought "I can't do anything, I'm completely useless" appears, and depression develops. Being constantly on alert also exhausts the body and mind; this exhaustion paves the way for a low mood.
From depression to anxiety
A person with depression notices that their energy and concentration have decreased. Worries begin, such as "In this state I'll lose my job" or "I'll let my family down." The loss of functioning caused by depression also leads to real problems: unpaid bills, neglected tasks, strained relationships. These problems in turn increase anxiety.
The common denominator: avoidance
The strongest maintaining factor in both conditions is avoidance. In anxiety, the person avoids what they fear; in depression, what they find hard and cannot enjoy. In the end, both pull the person away from life. That is why noticing avoidance and reducing it step by step is of central importance in recovery.
When Depression and Anxiety Are Experienced Together: Daily Life
Having both conditions at once creates a particular kind of tiredness in everyday life. Let us say you have an important job interview one morning. Anxiety makes you think through every possible question and every failure scenario all night. When morning comes, depression whispers, "You won't get it anyway; it doesn't matter if you don't go." Even if you go to the interview, you are both tense and drained. If you do not go, the next day you are met with both regret and a new worry about the future.
The economic uncertainty Turkey has experienced in recent years, worries about rent and making ends meet, earthquake risk and the fear of unemployment are real and concrete sources of stress. While these sources understandably increase anxiety, when they last a long time they can also turn into hopelessness and helplessness. The feeling "Whatever I do, nothing will change" can slowly allow low mood to take the place of anxiety.
A two-sided picture is seen in relationships, too. On the one hand the person is afraid of being alone; on the other, they cannot find the energy to see people. Their loved ones may find it hard to understand why they are extremely worried one day and completely uninterested the next.
What Can You Do on Your Own?
Because depression and anxiety share mechanisms, some methods help with both at once.
Reduce avoidance in small steps
Write down the situations you have avoided over the past few weeks: calls you have not answered, tasks you have put off, places you have not gone. Then rank them from easiest to hardest and aim to do one of the easiest items on the list each week. This method targets both avoidance in anxiety and withdrawal in depression.
Split your thoughts into two columns
Draw a line down the middle of a sheet of paper. At the top of the left column write "Things I can do something about", and at the top of the right column "Things that are out of my hands right now". Then sort the worries and negative thoughts going round in your head into these two columns. For the question "What will I do if the rent goes up?", a concrete step such as "Review the budget, talk to the landlord" can go in the left column; for the question "What if there's an earthquake?", preparing an emergency bag goes in the left column, while when an earthquake will happen goes in the right. Choose a single step from the left column for this week; try leaving the items in the right column on the paper. This method loosens a little both anxiety's pressure of "I must control everything" and depression's helplessness of "I can't do anything".
Calm the body, then get it moving
In anxious moments, slow breathing exercises calm the body: for example, breathing in for four seconds and out for six. In depressive moments, however, the body needs movement; a short walk can revive your energy, even if only a little. Making room for both in your day supports balance.
Limit news and social media feeds
Bad news coming in all day can feed anxiety, while other people's seemingly bright lives can feed depression. Setting one or two fixed times a day for checking the news and spending the hour before bed without screens helps the mind rest.
Give your day some structure
Uncertainty increases anxiety, and a lack of plans increases the emptiness of depression. Building a simple structure for each day, made up of a waking time, mealtimes and one or two small activities, gives the mind safe ground.
Reconsider how you talk to yourself
When depression and anxiety occur together, the inner voice often becomes doubly harsh: on the one hand it warns, "Be careful, everything could go wrong", and on the other it accuses, "You can't do anything anyway." At a difficult moment, ask yourself what you would say to a close friend in the same situation. A sentence such as "Right now you're both frightened and tired; that's a very heavy load, but you can still take a small step today" denies neither the anxiety nor the low mood, but it offers a kinder stance towards them.
When Should You Seek Professional Support?
It is important to talk to a professional in the following situations:
- If anxiety and low mood have lasted several weeks and are clearly affecting your daily life
- If you are having panic attacks, intense physical anxiety symptoms or a constant sense of being on alert
- If the situations you avoid are steadily increasing and your life is narrowing
- If there are marked changes in your sleep, appetite and energy
- If you are trying to suppress anxiety or low mood with alcohol or other substances
- If thoughts of hopelessness, death or harming yourself cross your mind; in such a situation, if you do not feel safe, call 112 (emergency services) without delay
These signs on their own do not mean a diagnosis. An assessment by a professional can clarify to what extent anxiety and depression are present together, which is more dominant and which treatment approach is suitable. Where necessary, an assessment by a psychiatrist can also be part of the process.
How Does Therapy Work When Depression and Anxiety Occur Together?
Cognitive behavioural therapy is one of the approaches whose effectiveness is well established for both depression and anxiety. When the two occur together, therapy usually focuses on the shared mechanisms that feed both conditions: avoidance, negative thinking patterns, worry and rumination, and difficulties with emotion regulation.
The process often begins with an assessment and formulation: which symptoms are in the foreground, which one triggers the other, what are the sources of stress in the person's life? Then tools that work for both sides come into play. On the depression side, behavioural activation gradually adds meaningful activities back into the person's life. On the anxiety side, work is done on facing avoided situations step by step. Using thought records, both "what if" thoughts and "I've already ruined it" thoughts are examined.
Which side is focused on first varies from person to person. If the depression is very severe and the person struggles to get out of bed, regaining basic functioning may be prioritised. If anxiety, for example panic attacks, is locking up daily life, these symptoms may be worked on first. The schema therapy perspective can also help in understanding the deep beliefs that create a vulnerability to both anxiety and depression, such as "The world is dangerous" or "I'm not good enough."
If widespread and persistent worry is in the foreground, the article on generalised anxiety disorder may also feel familiar. You can find information about work on anxiety on the anxiety and panic page.
Frequently Asked Questions
Is my anxiety or my depression more dominant; how can I tell?
You can ask yourself these questions: Is my mind more occupied with future dangers, or with past losses and failures? Is my body more tense and on alert, or heavy and tired? Although the answers give clues, a professional assessment is needed for a definite distinction.
Does anxiety turn into depression over time?
Not all anxiety turns into depression. However, anxiety that goes untreated for a long time and narrows life can increase the risk of depression through avoidance and exhaustion. Addressing anxiety at an early stage can help prevent this development.
Someone close to me is both anxious and low; how can I support them?
Try not to judge them, neither by saying "Never mind, you're exaggerating" about their worries nor "Just snap out of it" about their lack of motivation. Listening and accompanying them in small, concrete steps, for example doing a task they have been putting off together or going for a short walk, works better than advice. If the symptoms continue, gently encourage them to get professional support.
Does recovery take longer when both are present?
Having depression and anxiety together can make the picture more complex, and recovery can sometimes take more time. Even so, when the two conditions are addressed together through their shared mechanisms, improvement on one side is often reflected on the other.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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