Depressed man struggles with day to day life and anxiety

How Depression and Anxiety Go Hand in Hand


shutterstock_546242254“Do I have both?! And if so, which do we treat first? Which came first?”

These are common questions we hear from patients and would-be patients here in Ottawa.

A common misperception is that depression and anxiety are completely independent disorders that operate as an either/or type of proposition. ‘Either you have depression, or you have anxiety. How could you have both?’

Well, let’s address that head on.

Are Depression and Anxiety Mutually Exclusive?

shutterstock_623913050If we were only looking at the stereotypes of depression, for example, someone who “is depressed” (as oppose to “struggles with clinical depression”) is said to be “sad” and “mopey,” in a “low-energy” state where they are “feeling down.”

Someone who is “anxious” (as opposed to “dealing with anxiety”) would be said to experience “a lot of stress” and be “constantly worried,” in a state of extremely heightened awareness (sometimes to the point of “paranoia” or “delusion”), and feeling quite “agitated” and “jumpy.”

Could we make the case that these two examples appear to be polar opposites, or something thereabouts? Quite possibly, yes.

Yet even in looking at the individual symptoms of each, we see some overlap. One can be “worried” in either a state of depression or anxiety. Same goes for “distressed,” “disturbed,” “concerned,” or even “fearful.”

How we respond to these emotions, what state we fall more into, depends on our individual nature.

In reality, we can experience both depression and anxiety in conjunction with those and other emotions.

Two Sides of the Same Coin

One might go so far as to say, even, that depression and anxiety are often two sides of the same coin.

Yes, depression is a distinct and widely recognized disorder. So is anxiety. But the two are certainly not mutually exclusive.

In fact, somewhere between 60-85% of people with depression are also dealing with anxiety. And around half of those who suffer from anxiety also have depression.

“They’re probably two sides of the same coin,” says David Barlow, Ph.D., director of the Center for Anxiety and Related Disorders at Boston University. “The genetics seem to be the same. The neurobiology seems to overlap. The psychological and biological nature of the vulnerability are the same.

Barlow calls depression a kind of “shutdown,” where a person shuts off a lot of the world around them – and a lot of their own emotions and functions – as a defense mechanism. Anxiety, he says, is more of a “looking to the future” and seeing what could go wrong.

While the reactions are different, the core issues can be quite similar.shutterstock_530558311

Something is taking place within the brain that sends emotion centres into overdrive. This includes the amygdala or “lizard brain,” which is responsible for the “fight or flight” mechanism that’s been with us for the duration of humankind, and even before that.

Fight or Flight

If you think about what fight or flight means in the context of depression and anxiety, the connection becomes clearer.

“Fight” is the brain going into a heightened state, fighting the inputs with anxiety, worry, and an overly elevated sense of distress.

“Flight” is depression taking over and turning the worry inward, shutting down and shutting off, in an effort to flee from the same issue as what anxiety fights.

But the two can coexist, unfortunately. And the reasons vary.

The first is a causal effect that one could have on the other.

“Being depressed often makes us anxious, and anxiety often makes us depressed,” says therapist Nancy B. Irwin, PsyD.

If we realize that we’re depressed, in other words, we could become anxious about that depression in and of itself. The anxiety could be heightened if we realize what the depression is doing to us, what it’s costing us (lost time, productivity, finances, relationships, etc.). And the same is true in reverse. If we have anxiety and become cognizant of what it’s costing us, we could become depressed as a result.

But cause-and-effect isn’t the only scenario.

Anxiety tends to precede depression.

Adults over 40 who develop an anxiety disorder, however, likely already have depression.

In other words, we can’t say with certainty that depression causes or comes before anxiety, or vice versa. But we do know that they can coexist.

shutterstock_94195759Downsides and Costs

“The shared cornerstone of anxiety and depression is the perceptual process of overestimating the risk in a situation and underestimating personal resources for coping,” says psychologist Michael Yapko. “Those vulnerable see lots of risk in everyday things-applying for a job, asking for a favor, asking for a date.”

Anxiety and depression share something else: an inability to cope effectively. Those afflicted will avoid what they fear instead of developing the skills to handle the kinds of situations that make them uncomfortable.

Delayed development of social skills happens in youth and early adulthood when anxiety and/or depression are present. That has a lot of ramifications down the line.

The cost can be tremendous when avoiding situations that cause stress, anxiety, worry, depression, etc. School and work can suffer, and the long term effects of that can be measured by finances in particular, but also in mental and emotional well-being later on.

Specifically, the costs include:

  • Struggles or failure in school
  • Job difficulty or loss
  • Deteriorating relationships
  • Lack of desire or drive
  • Financial losses
  • Physical health suffering (weight gain or loss, other conditions)
  • Suicide *


* In one study, 92% of patients with depression who attempted suicide also had anxiety issues

By now, the need to treat depression and anxiety should be clear.

So how do we go about that?shutterstock_563555992


Cognitive Behavioral Therapy (CBT) has been found to be an effective therapy treatment for the combination of anxiety and depression.

Medication is also an option.

CBT is better at preventing relapse, and it creates greater patient satisfaction. “It’s more empowering,” says Yapko. “Patients like feeling responsible for their own success.”

When it comes to medication, there are some pitfalls to be wary of.

“We know from our treatments that medications that are approved for depression also treat anxiety,” says Dr. Neil Liebowitz, medical director of the Anxiety and Depression Treatment Center in Farmington, Connecticut. But that doesn’t necessarily work the other way around. “Meds that treat anxiety alone may make some of the depression worse,” he adds. “So that is a problem.”

We can’t stress this enough:

It is highly important to speak at length with a qualified therapist before and while taking medications for the combination of depression and anxiety.

Having the two conditions together means that a medication could help one condition and exacerbate the other. It could also improve one, which then leads to the lessening of the other. Only through careful supervision and monitoring will the patient truly know how the meds are working.

Capital Choice Counselling Can Help With Your Depression and Anxiety

At Capital Choice Counselling of Ottawa, our trained counsellors have years of experience treating depression and anxiety, and a trained to and skilled at recognizing when the two conditions are present at the same time.

We have counsellors specializing in cognitive behavioral therapy (CBT), a process that doesn’t involve years and years of work (more like 12-15 initial sessions on average), but does entail a process of intensive work on the part of the patient.

While nobody expects this journey to be easy for you, you have a far higher chance of sticking to it by reaching out to Capital Choice Counselling for Cognitive Therapy in Ottawa.