How common is it?
Studies suggest that 50–60% of people with a depressive disorder also have an anxiety disorder, and many people with anxiety develop depression over time. Mixed anxiety and depression, with symptoms of both that do not fully meet criteria for either, is also common in primary care. When both are present, symptoms tend to be more severe, last longer and cause more disability, which is why identifying both is important.
Typical features of anxiety
- Excessive worry, feeling on edge, restlessness and tension.
- Physical symptoms: racing heart, sweating, trembling, nausea, breathlessness.
- Fear of specific situations, panic attacks or avoidance.
- Difficulty concentrating and irritability.
- Sleep problems, with trouble falling asleep.
- See anxiety symptoms.
Typical features of depression
- Persistent low mood or emptiness for most of the day, most days.
- Loss of interest or pleasure in activities.
- Changes in appetite and weight, sleeping too little or too much.
- Fatigue, slowed thinking or restlessness.
- Feelings of worthlessness or excessive guilt.
- Difficulty concentrating or making decisions.
- Thoughts of death or suicide.
- Symptoms last at least two weeks and affect functioning.
Overlapping symptoms and why they coexist
Fatigue, insomnia, poor concentration, irritability and physical complaints (headaches, stomach upset, muscle tension) appear in both. They share risk factors: genetics, early adversity, chronic stress, personality traits such as high sensitivity to threat, and medical illness. Anxiety can lead to depression through demoralisation, avoidance and exhaustion; depression can lead to anxiety through rumination and worry about the future. Both involve overlapping brain circuits and neurotransmitters, including serotonin and noradrenaline.
How it is assessed
A doctor or psychologist asks about symptoms, duration, triggers, impact on daily life, medical history, medicines, alcohol and drug use, previous episodes and family history. Questionnaires such as the PHQ-9 (depression) and GAD-7 (anxiety) are commonly used, and blood tests can exclude thyroid problems, anaemia, vitamin deficiencies and other causes. A key part of the assessment is risk: asking about suicidal thoughts and self-harm directly. Asking does not make them more likely; it makes it easier to get help.
Psychological treatment
- Cognitive behavioural therapy (CBT): targets negative thinking, avoidance, worry and inactivity; effective for both conditions, in individual, group or online formats.
- Behavioural activation: planning rewarding and meaningful activities to reverse withdrawal and inactivity.
- Interpersonal therapy and acceptance and commitment therapy are alternatives.
- Transdiagnostic approaches (such as the Unified Protocol) treat common processes in several emotional disorders at once.
- Mindfulness-based therapies help reduce rumination and relapse.
- Therapy usually runs for 12–20 sessions, with booster sessions if needed.
Medication
SSRIs (such as sertraline, escitalopram) and SNRIs (such as venlafaxine, duloxetine) are first-line treatments for both anxiety and depression, usually taking 2–6 weeks to begin working, with the full effect over 8–12 weeks. Side effects are usually mild and settle in a few weeks. Benzodiazepines should be used only briefly, if at all, because of dependence and because they can worsen depression. Never stop an antidepressant suddenly: ask about tapering. Combined treatment of therapy and medication may be most effective for moderate to severe symptoms.
Self-help and lifestyle
- Exercise: regular aerobic and strength activity reduces both anxiety and depression.
- Sleep: keep a regular schedule; see insomnia.
- Social connection: stay in contact with supportive people even when you do not feel like it.
- Limit alcohol, cannabis and caffeine, which worsen mood and anxiety.
- Structure the day with small, achievable goals.
- Practise relaxation and breathing. See deep breathing for anxiety.
- Nutrition: regular meals and a varied diet.
- Avoid isolation and talk about how you feel.
When to seek help
- Low mood or anxiety most days for more than two weeks.
- Trouble functioning at work, school, or in relationships.
- Panic attacks, constant worry or avoidance.
- Hopelessness, thoughts of death or self-harm (urgent).
- Use of alcohol or drugs to cope.
- Previous episodes, or a family history of mood or anxiety disorders.
Three common situations
Constant worry, poor sleep and loss of interest for two months: may be both anxiety and depression; arrange an assessment.
Panic attacks that led to avoiding going out, now feeling hopeless: seek treatment for both.
Low mood with irritability and constant tension after a bereavement: grief can trigger both; support and, if persistent, therapy help.
Supporting someone with anxiety and depression
Listen without judging, avoid telling them to “cheer up” or “stop worrying”, and offer practical help such as accompanying them to an appointment. Encourage professional treatment and gentle activity, keep in touch even when they withdraw and learn the warning signs of crisis. Ask directly about suicidal thoughts if you are worried; this does not plant the idea. Look after your own wellbeing too.
Key points to remember
Anxiety and depression often occur together but are both highly treatable. A thorough assessment, CBT and, when needed, medication provide effective care. Self-care, exercise, sleep and support help recovery. Our psychology team can offer evidence-based treatment.
This guide is for general information and does not replace an assessment by a qualified health professional.
Questions about anxiety and depression
These answers are general information and do not replace an examination or individual medical advice.
Can you have anxiety and depression at the same time?
Yes, they commonly coexist, in roughly half of people with either condition.
Which is treated first?
Treatment plans usually address both together; the main or most severe problem and any risk come first.
What is the best treatment for both?
CBT and SSRI or SNRI antidepressants are effective for both.
Does exercise help?
Yes, regular exercise reduces symptoms of both anxiety and depression.
How long does treatment take?
Many people improve within 6–12 weeks, and continuing treatment for several months reduces relapse.
When should I seek urgent help?
If you have thoughts of harming yourself or feel you cannot go on.
Sources
- NHS · Stress, anxiety and depression
- NIMH · Anxiety disorders
- NIMH · Depression
- NICE · Generalised anxiety disorder and panic disorder in adults: management (CG113)
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.