Anxious or Depressed? Or Both?

Depression and anxiety commonly occur simultaneously

/ Author:  / Reviewed by: Robert Carlson, M.D

When it rains it pours, they say. The old adage may hold more truth than expected when it comes to mental health diagnosis.

Commonly, those who are diagnosed with depression are also suffering from anxiety as well.

This seems to hold true for both unipolar and bipolar depressive disorders, and it presents unique challenges for both patient and clinician.

Difficulties in Diagnosis

Proper diagnosis of depression and anxiety disorders is difficult. For starters, patients commonly report physical symptoms, like back or chest pain, shortness of breath, fatigue and loss of appetite, but rarely report psychological symptoms.

Since both depression and anxiety share many of these physical symptoms, it is often difficult to discern if anxiety is present in addition to depression.

Additionally, patients often assume that once they have been diagnosed with one mental health disorder, their diagnosis is complete and it is time to move on to the treatment phase. However, they may have only solved half of the puzzle.

An incomplete diagnosis can cause the treatment to not work well, or at all. It may also increase treatment time and cause confusion and frustration for the patient and clinician alike.

How Common Is It?

A recent survey of multiple studies found that approximately 11 percent of those with major depressive disorder (MDD) are also suffering from general anxiety disorder (GAD). Almost 45 percent of those with MDD show symptoms for any anxiety diagnosis, like panic disorder or obsessive compulsive disorder.

Those suffering from bipolar depression are at risk of anxiety disorders as well. Those with bipolar disorder 1 or 2 (BPD1, BPD2) were found to suffer from GAD at 17 percent and 8 percent, respectively. Almost 55 percent of those with BPD1 suffer from any anxiety disorder and 59 percent of those with BPD2.

These numbers are believed to underestimate the real rates of comorbidity because of the longer time period required for symptoms in anxiety-related diagnoses. According to the Diagnostic and Statistical Manual of Mental Disorders, which is used to diagnose all mental health issues, a patient needs to show symptoms of depression for only two weeks. For an anxiety diagnosis, they need to experience symptoms for six months.

This time discrepancy is believed to leave out those patients whose depression and anxiety symptoms develop simultaneously. If they have been suffering from anxiety symptoms for only a few months, the diagnosis may be missed.


A diagnosis of depression and anxiety is a worse prognosis than depression alone.

A variety of studies have shown that those diagnosed with both need a longer time to recover from the disorders. They also show higher severity of illness, greater impairment in ability to work, lower social functioning and lower quality of life. Additionally, comorbid diagnosis result in hospitalization more often.

Patients who have been diagnosed with both a depressive disorder and an anxiety disorder are also more likely to have suicidal thoughts, attempt suicide, or in the worst case, completed suicide.

For these reasons it is imperative that patients receive a correct diagnosis. If you or someone you love has been diagnosed with either depression or anxiety, be on the lookout for additional symptoms.

Understanding Symptoms and Recovery

Dr. Nicole Meise, psychotherapist and mental health expert, spoke with dailyRX to provide advice for those who are dealing with depression and anxiety.

“Remember that avoidant coping styles don’t really resolve the problem,” said Dr. Meise. “People who suffer from anxiety and/or depression often try to avoid what they fear instead of developing the skills to manage what it is that’s making them feel uncomfortable.”

“Avoidant coping often results in increased levels of stress, depression, anxiety, low self esteem and even relationship problems. The key to a successful recovery is understanding more about your symptoms and how to effectively manage them,” she said.

It is important to be able to recognize the symptoms of anxiety and depression and be able to differentiate between them. Of course, only a professional can tell you the best course of action, but recognizing how you are feeling and accurately reporting it is an important step.

“Are you anxious? Are you depressed? Or are you both?” questions Dr. Meise. “Does your anxiety result in your feeling hopelessness and/or helplessness? Are your symptoms of depression so overwhelming that they leave you feeling anxious or overly concerned?”

If symptoms are coupled with, caused by or related to substance abuse of any kind, it is very important to be honest with the clinician - they are there to help you and can guide you to the best course of action.

“Individuals who are anxious and/or depressed often resort to alcohol or illegal drug use to help mask symptoms,” Dr. Meise added. “However, doing so can increase risks of harmful drug interactions (with prescribed medications) and actually make symptoms worse.”

Review Date: 
June 7, 2012