It’s pretty common for people to experience depression and anxiety together, and when they do, it can feel like a double whammy.
Imagine battling intense sadness, lack of motivation, and feelings of worthlessness (thanks, depression) while also feeling on edge, restless, and plagued with constant worry (thanks, anxiety).
It’s a lot to deal with, but understanding why they co-occur can shed some light on what’s happening beneath the surface. We can use that knowledge to create a better action plan for both disorders.
It’s like they’re uninvited guests at the same party. But why do they pair up so often? Let’s break it down:
- Shared biological factors
One of the reasons is that they share some of the same biological pathways in the brain.
Both conditions involve neurotransmitters like serotonin, dopamine, and norepinephrine. As you might already know from reading my other articles, these chemicals regulate our mood, feelings of pleasure, and stress responses. An imbalance in these neurotransmitters can lead to anxiety and depression.
On top of that, the amygdala, which is the part of your brain responsible for processing emotions (especially fear and threat), leans toward being overactive in people with anxiety and underactive in those with depression.
So, your amygdala acting up can manifest itself as either heightened anxiety or a dampened mood.
- The vicious cycle of negative thinking
On the other hand, depression can make you feel like everything is hopeless and nothing will ever get better. When these two thought patterns combine, it’s like a mental storm.
For example, let’s say you’re anxious about something like a work presentation. You start worrying obsessively (classic anxiety move) and then, when you feel drained by all that worry, depression kicks in and makes you feel like, “What’s the point? I’m going to fail anyway.”
It becomes this exhausting feedback loop where anxiety drives you to worry about everything, and depression convinces you that nothing will ever change, which only deepens the anxiety.
- Stress and life events as common triggers
Both depression and anxiety can be triggered by stressful life events, like losing a job, going through a breakup, or even positive changes like starting a new job or moving to a new city.
Stress increases levels of cortisol, the body’s primary stress hormone, which can lead to heightened anxiety. And if that stress drags on for too long (chronic stress), it can deplete your emotional resources and cause feelings of hopelessness and depression.
So, it’s easy to see how a stressful situation can first cause anxiety by making you feel nervous and on edge, and then snowball into depression when it feels like there’s no way out of the mental strain.
In essence, prolonged anxiety can burn you out and pave the way for depression to settle in.
- Personality traits and coping styles
Certain personality traits and coping styles can make someone more vulnerable to both anxiety and depression. Think of characteristics such as:
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- Perfectionists often struggle with anxiety because they’re always worried about not being good enough or making mistakes.
But depression can sneak in when perfectionism turns into feeling like you’re never going to measure up, no matter what you do. - People-pleasers might experience anxiety from trying to keep everyone around them happy.
The exhaustion of constantly putting others first can lead to feelings of emptiness or depression over time. - Ruminators (people who overthink everything) are especially at risk.
That’s because the tendency to dwell on problems and negative thoughts is common in both anxiety and depression. It’s like replaying the worst scenes of your life over and over.
- Perfectionists often struggle with anxiety because they’re always worried about not being good enough or making mistakes.
- Genetics
There’s also a genetic component at play. If you have a family history of depression or anxiety, your chances of developing these conditions increase. Research has found that if you inherit a genetic predisposition to anxiety, you’re more likely to experience depression too.
It’s not just about inheriting one “anxiety gene” or one “depression gene” either, since there’s a lot of overlap in the genes that can trigger both.
- Impact on the nervous system
Both disorders can also affect your nervous system in different but overlapping ways.
Anxiety keeps your sympathetic nervous system on high alert, which is why you might feel that constant sense of fight-or-flight.
On the other hand, depression favors activating the parasympathetic nervous system, which can leave you feeling fatigued, unmotivated, and withdrawn.
Switching back and forth between these two states can completely exhaust your system eventually and leave you restless and drained, an awful combo that makes it hard to find peace.
- The influence of trauma
This shock may leave your brain stuck in a heightened state of alertness (anxiety) or feeling overwhelmed and numb (depression).
The scars of trauma often blur the lines between these issues, making it difficult to tell them apart.
- Social isolation and loneliness
Another factor that can cause anxiety and depression to co-occur is loneliness.
Anxiety can make socializing feel terrifying, while depression can sap your motivation to even try. The result? You end up isolated, which only worsens the sadness and worry.
It’s a cycle where anxiety makes you withdraw, and depression makes you feel like no one cares, which further feeds doubt and nervousness.
- Shared cognitive patterns: “Cognitive distortions“
Both depression and anxiety are regularly fueled by cognitive distortions. These are faulty ways of thinking that warp how you perceive yourself, others, and the world. For example:
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- Catastrophizing: Thinking that the worst will happen (linked to anxiety).
- Overgeneralization: Believing that one negative event means a pattern of failure (linked to depression).
These types of thoughts can easily blend. For instance, anxiety might cause someone to think, “I’m going to fail this exam,” which can spiral into depressive thoughts like, “I always mess things up, so why bother trying?”
Unfortunately, this overlap in negative thinking patterns makes it easier for one condition to trigger the other.
- Emotional dysregulation
People who experience both disorders frequently struggle with emotional dysregulation.
This means having difficulty managing intense emotions like fear and frustration, for instance. Emotions can quickly spiral out of control and leave you overwhelmed when you’re anxious. Depression may leave you feeling emotionally numb.
This push-pull effect between feeling too much and feeling nothing at all can make it easy for anxiety and depression to feed each other. Your brain might go into overdrive with anxious thoughts, then burn out and make you feel emotionally drained and depressed.
When you’re anxious, your body is often stuck in “fight or flight” mode while constantly scanning for threats.
But there’s also a third response to stress, the freeze response. This is where depression can come into play.
If anxiety is the “fight or flight” response in overdrive, depression can be seen as the “freeze” response, where your system shuts down because it’s overwhelmed.
For instance, you might feel anxious about your responsibilities, but then freeze up and feel paralyzed when it becomes too much, while consequently sinking into depressive feelings.
- Overlapping impact on sleep and energy levels
Both these issues can make each condition worse by disrupting your sleep patterns.
Anxiety might cause racing thoughts that keep you up at night, while depression can make you want to sleep all day, or not sleep at all. The resulting fatigue can amplify both anxious and depressive symptoms due to low energy and poor concentration.
Lack of restful sleep also throws off your body’s ability to regulate mood and stress. Sleep deprivation (especially when chronic) can increase the risk of both anxiety and depression and create a cycle where each disorder fuels the other.
- Perceived lack of control
Both anxiety and depression are often rooted in a sense of powerlessness.
Anxiety tends to focus on worrying about future events you can’t control, while depression is linked to feelings of hopelessness about your current situation. Anxiety and depression can develop simultaneously as two sides of the same coin when someone feels like they have no control over their life.
For example, if you’re in a situation where you feel trapped, like a toxic job, financial stress, or a difficult relationship, this sense of helplessness can breed anxious thoughts (“What if I never get out of this?”) and depressive feelings (“There’s no point in trying because nothing will change”) as well.
- The role of inflammation and physical health
There’s increasing evidence that inflammation in the body can contribute to both anxiety and depression.
Chronic stress and other lifestyle factors can lead to inflammation and affect the brain’s functioning. High levels of cytokines (proteins involved in inflammation) in particular have been linked to both conditions.
This physical component helps explain why anxiety and depression often occur together. If your body is under chronic stress, your brain can experience inflammation, which disrupts the balance of neurotransmitters and increases the likelihood of developing both anxiety and depression.
- Social and cultural factors
There’s also a social dimension to why these conditions regularly happen together.
Living in an environment that constantly emphasizes productivity, competition, or perfectionism can breed both anxiety (fear of not measuring up) and depression (feelings of inadequacy).
Additionally, social stigma around mental health can make it harder to reach out for help, which can worsen both conditions. Someone who is already anxious about being judged may avoid seeking support, leading to isolation and stronger depressive feelings.
- Existential concerns
Both disorders can be linked to deeper, existential concerns.
Anxiety can stem from a fear of the unknown or worries about the future, while depression may arise from a sense of meaninglessness or feeling disconnected from life’s purpose. These existential worries often overlap, especially in people who feel stuck, lost, or uncertain about their direction in life.
For example, if someone is constantly anxious about whether they’re living the “right” kind of life or making the “right” decisions, that anxiety can morph into depression if they feel like they’ve failed or that there’s no point in trying anymore.
- Neuroplasticity
Anxiety and depression occurring together can change the structure of your brain over time.
Neuroplasticity is the brain’s ability to rewire itself based on your experiences, thoughts, and behaviors. However, chronic anxiety and depression can reinforce negative pathways and make it harder to break free from these conditions.
This “rewiring” effect means that the more your brain gets stuck in the loop of anxiety and depression, the harder it is to escape, as your brain essentially becomes trained to operate in that mode.
How common is it?
Studies suggest that up to 50-60% of people with depression also experience symptoms of anxiety and vice versa.
This means there’s a good chance the other might show up too if you’re struggling with one of these issues.
Final note
The fact that anxiety and depression often show up together can make the struggle feel even heavier.
But knowing that they’re interconnected means that working on one often helps the other as well. It’s not easy, but the good news is that treatments such as therapy, medication, lifestyle changes, and support from loved ones can make a real difference, even when both anxiety and depression are in the mix.
And while it can feel like they’re tag-teaming against you, remember that it’s possible to break the cycle. By tackling one, you’ll typically end up helping the other too. So even small steps like reaching out for help and simply being kinder to yourself can already go a long way in healing both sides.
