Can you have depression and anxiety at the same time?
Yes, and it is very common. People often describe it as feeling both wired and exhausted: restless, worried and on edge, and at the same time flat, hopeless and without energy. Some days one is louder, some days the other.
The National Institute of Mental Health (NIMH) lists anxious mood among the signs of depression, and depression among the conditions that commonly co-occur with generalized anxiety disorder. Clinicians use the word comorbidity for two conditions present together. With depression and anxiety, it is the rule more than the exception.
How common is the overlap?
One of the clearest pictures comes from the Netherlands Study of Depression and Anxiety (NESDA), which assessed 1,783 adults. Published by Femke Lamers and colleagues in 2011, it found that of people with a depressive disorder, 67% had a current anxiety disorder and 75% had one at some point in their lives. Of people with a current anxiety disorder, 63% had a current depressive disorder.
The same study found that in 57% of people who had both, anxiety came first, while depression came first in 18%. The authors concluded that because the overlap is so high, both conditions should be assessed routinely, whatever the reason someone first seeks help.
NESDA recruited many people from mental health and primary care settings, so its rates are higher than you would find in the general population. The pattern, though, matches what NIMH and clinicians describe: the two are close companions.
Why do they go together?
Researchers have several overlapping explanations, none of them complete on its own.
- Shared ground. Both involve sleep problems, trouble concentrating, irritability and fatigue, and both can be triggered or deepened by stress, loss or trauma.
- Shared vulnerability. The NESDA team found that people with both conditions reported more childhood trauma and scored higher on neuroticism, a personality trait involving a tendency toward negative emotion.
- Repetitive negative thinking. Rumination about the past and worry about the future are closely related habits of mind, and research by Susan Nolen-Hoeksema and colleagues links rumination to both depression and anxiety.
- Exhaustion. Living on high alert for a long time is tiring, and that exhaustion can tip into hopelessness.
How each can feed the other
Anxiety often leads to avoidance: turning down invitations, putting off tasks, staying home. Avoidance shrinks life and cuts off sources of pleasure and connection, which feeds low mood. Low mood in turn saps the energy to face things, which makes avoidance easier and anxiety about what has been avoided worse. Depression and motivation looks at the low-energy side of that loop, and overthinking and worry at the thinking side.
Why it matters to have both recognized
The NESDA researchers found that people with both conditions tended to have more severe symptoms, an earlier start and a longer duration than people with one. The authors also note that earlier research had found having both to be a consistent predictor of a longer-lasting course. That is not a forecast for any one person, but it is a reason to say so if you notice signs of both.
If you only describe the part that bothers you most, a clinician may only treat that part. It helps to name everything: the worry and the flatness, the restlessness and the exhaustion. The pages on signs of depression and signs of anxiety can help you put words to each.
It also helps to notice the order and the triggers. Did a long stretch of worry come before the low mood, or did the anxiety start after a loss, a layoff or an illness? Did either change around a move, a new baby or a divorce? You do not need tidy answers. Rough notes on when things changed, what makes them better or worse, and how you are sleeping give a doctor or therapist a much clearer starting point than a single word like stressed.
What helps when you have both?
The good news is that the main treatments overlap too. NIMH says cognitive behavioral therapy helps people challenge and change unhelpful thoughts and behaviors to improve depressive and anxious feelings, and it describes the same broad options for both: psychotherapy, medication or both. Some antidepressants are used for both conditions, which is a conversation for a physician or psychiatric prescriber.
In counseling, work on one often helps the other. Reducing avoidance can lift mood; becoming more active can ease anxious rumination; learning to notice repetitive thinking helps with both. Day to day, NIMH's self-care advice applies: regular movement, regular meals, enough sleep, attention to caffeine and alcohol, and time with people.
For a broader view of the options, see therapy for depression and anxiety.
Counseling with Laura Bass
Laura Bass works with adults in Charlotte, North Carolina, and depression and anxiety are among the concerns she works with in individual counseling. You do not need to know which one you have, or whether you have both, before you call. Sorting that out is part of the work.
Laura does not diagnose by questionnaire or prescribe medication, and she can work alongside your doctor. Contact Laura to ask how she would approach it. If at any point you are thinking about ending your life, call or text 988 at any hour, and in an emergency call 911.
Common questions
Which usually comes first, anxiety or depression?
It varies. In the Netherlands Study of Depression and Anxiety, anxiety came first in 57% of people who had both and depression came first in 18%. Many people recognize the pattern of years of worry gradually giving way to exhaustion and low mood, but the order is not fixed.
Is it possible to feel anxious and numb at the same time?
Yes. People with both conditions often describe a restless, worried mind alongside a flat, empty mood, or swinging between the two in the same day. NIMH lists anxious mood and feeling empty among the signs of depression. It can be confusing, but it is a recognized combination, and describing both to a clinician helps them understand what you are dealing with.
Does having both mean it is more serious?
Not necessarily for you personally. Research such as the NESDA study has found that, on average, people with both conditions have more severe and longer-lasting symptoms than people with one. That is a reason to take it seriously and get both assessed, not a prediction. The same treatments are used for both, and many people improve.
Will one medication treat both?
Sometimes. NIMH notes that SSRI and SNRI antidepressants, commonly used for depression, can also help the symptoms of generalized anxiety disorder. Whether medication makes sense, and which one, is a decision for you and a physician or psychiatric prescriber. Laura Bass does not prescribe, and counseling can be used on its own or alongside medication.