Depression and anxiety often travel together. Studies put the overlap at more than half of the people who seek care for either one. Recognizing both is part of getting the plan right.
Quick view
- Roughly 60 percent of patients with major depressive disorder also meet criteria for at least one anxiety disorder during their lifetime (Kessler et al., NCS-R, Arch Gen Psychiatry, 2005).
- The DSM-5-TR includes an "anxious distress" specifier for major depressive disorder that flags higher symptom severity, suicide risk, and treatment resistance.
- SSRIs, SNRIs, and CBT have first-line evidence for both conditions.
- Benzodiazepines can provide short-term relief but do not treat the underlying depression and carry tolerance, dependence, and overdose risks.
DSM-5-TR diagnostic criteria
"Depression with anxiety" is not a single DSM-5-TR diagnosis but typically reflects either a major depressive episode with the "with anxious distress" specifier, or co-occurring major depressive disorder and a separate anxiety disorder (generalized anxiety disorder, panic disorder, social anxiety disorder, or others). The anxious distress specifier requires at least two of: feeling keyed up or tense, feeling unusually restless, difficulty concentrating because of worry, fear that something awful may happen, and feeling that the person might lose control of themselves. As with all major depressive episodes, the criteria require that there has never been a manic or hypomanic episode; otherwise the diagnosis is on the bipolar spectrum and the treatment plan is different.
Epidemiology
About 60 percent of adults with major depressive disorder also meet lifetime criteria for at least one anxiety disorder, and approximately 75 percent of patients with generalized anxiety disorder will experience a major depressive episode at some point (Kessler et al., NCS-R, Arch Gen Psychiatry, 2005). Co-occurring depression and anxiety carry higher symptom severity, longer episodes, greater functional impairment, and higher suicide risk than either condition alone (Fava et al., Am J Psychiatry, 2008).
What it can look like
Low mood paired with constant worry. Loss of interest paired with restlessness. Fatigue paired with a body that will not settle. Sleep that is difficult to fall into and difficult to maintain. Concentration problems that come from both directions at once. A pattern of waking at three in the morning to a racing mind and a flat sense of dread.
How it shows up in different people
- In adults, the combined picture frequently leads to higher use of urgent care visits and more days off work than depression alone.
- In adolescents, anxiety often precedes depression by months to years, and combined screening at every visit is appropriate.
- In older adults, anxiety symptoms can be misattributed to a medical illness; depression is often the underlying driver.
- In women, the combined picture is more common, particularly during perimenopause and after pregnancy.
- In men, anxiety symptoms are often underreported and may surface as irritability, sleep loss, or alcohol use.
Why it matters
When anxiety is missed, treatment for depression may help only part of the picture. When depression is missed, treatment for anxiety may not address the heaviness underneath. The combined picture is associated with higher suicide risk than either condition alone, and untreated co-occurring anxiety is one of the strongest predictors of slower response to antidepressants. Treating both conditions together is the standard.
Screening
The PHQ-9 measures depressive symptoms; the GAD-7 measures generalized anxiety symptoms. Both are brief, validated, and routinely used in primary care. A combined PHQ-9 plus GAD-7 (sometimes available as the PHQ-ADS) gives a clearer picture than either alone. The MDQ should be considered before starting an antidepressant if there is any prior history of mood elevation.
When to seek same-day care
Suicidal thoughts with intent or a plan, panic with chest pain that has not been evaluated, inability to keep yourself safe, or new psychotic symptoms are reasons for same-day care. Call 988, call 911, or go to the nearest emergency department.
What helps
Therapy. Cognitive behavioral therapy has the strongest evidence for both depression and anxiety; transdiagnostic protocols (such as the Unified Protocol) treat both at once. Acceptance and commitment therapy is another evidence-based option.
Medication. SSRIs and SNRIs treat both conditions and are first-line. Onset of effect is typically two to six weeks, and some patients experience an early increase in anxiety in the first one to two weeks that resolves with continued treatment. Buspirone is an option as augmentation for residual anxiety. Benzodiazepines can provide short-term relief but do not treat depression and are generally avoided as a first-line approach because of tolerance, dependence, and overdose risk, especially with alcohol or opioids.
Daily anchors. Sleep regularity, daily movement, reduction or elimination of alcohol and caffeine, and structured worry time are all useful. Education on the patterns of both conditions, often through reading or through therapy, helps the person recognize and respond to symptoms earlier.
Sources
- American Psychiatric Association. DSM-5-TR. 2022.
- Kessler RC, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005.
- Fava M, et al. Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D. Am J Psychiatry. 2008.
- National Institute of Mental Health. Anxiety disorders. Accessed 2026.
- National Institute of Mental Health. Depression overview. Accessed 2026.
Related
Major depressive disorder. Treatment. AnxietyResource.org for more depth on anxiety.
For anxiety-specific information beyond what this page covers, see our sister publication AnxietyResource.org, edited by the same physician reviewer
