Many people around the world struggle with anxiety or depression, but what is anxious depression? It’s a condition that is more common than you might think, with research showing that 50-75% of individuals with major depressive disorder (MDD) meet the DSM-5 criteria for this subtype. Combining elements of both depression and anxiety, it can negatively affect one’s overall emotional, mental, and physical health.
Yes, it is possible and quite common to experience anxiety and depression simultaneously. In fact, comorbidity (the presence of two or more disorders at the same time) is the norm rather than the exception when it comes to psychiatric conditions. Anxiety and depressive disorders frequently overlap, with research showing that approximately 41.6% of individuals diagnosed with major depressive disorder (MDD) over a 12-month period also meet the criteria for at least one anxiety disorder during the same timeframe.
When these disorders occur together, the condition may be called anxious depression, mixed anxiety-depressive disorder (MADD), or mixed anxiety depression. This overlap can complicate diagnosis and treatment since both conditions often intensify each other’s symptoms.
Anxious depression can be understood in two ways:
The DSM-5 introduced many specifiers for MDD, including “anxious distress.” This specifier applies to those experiencing at least two of the following symptoms during most days of a depressive episode:
However, the symptoms of anxious depression aren’t limited to these. People with this condition may experience a mix of depressive and anxious symptoms, ranging from mild to severe.
Depression affects each person differently. Some describe it as being trapped in darkness, while others feel completely numb or disconnected. Common symptoms include:
Anxiety triggers the body’s natural “fight, flight, or freeze” response to prepare it to face perceived danger. While this response is helpful in life-threatening situations, chronic anxiety as seen in anxious depression can result in constant and distressing symptoms, such as:
There is no single cause for anxious depression; however, there are a combination of factors that could potentially play a role. These include genetics, personality traits, exposure to stress, and co-occurring conditions.
Your genes are instrumental in how your brain functions. They act as instructions for making proteins, which help regulate mood, emotions and brain chemistry. However, in people with genetic vulnerabilities to anxiety and depression, even mild stress can disrupt this system and cause mood instability.
Research shows that anxiety and depression are highly genetically correlated, with a 94% overlap in one study. This shared genetic structure may explain why some people develop anxious depression rather than one condition alone.
Certain personality traits can increase the risk of anxious depression, while others act as protectors against it. For example, neuroticism is the strongest risk factor for both anxiety and depression. People high in neuroticism tend to:
Protective personality traits that may decrease the risk of developing anxious depression include agreeableness, conscientiousness, openness, and extraversion.
Stress is unavoidable in life, but when it lasts for weeks or even months, it can disrupt the brain’s balance and trigger anxious depression. Chronic stress can cause changes at the genetic level by rewiring brain circuits and increasing sensitivity to future stressors. This can cause symptoms like increased anxiety, emotional instability, and hyperreactivity. Stressful events that can potentially contribute to anxious depression include:
Physical and mental health are closely connected. Nearly one in three people with a long-term physical health condition also struggles with a mental health disorder like anxiety or depression. Living with chronic illnesses such as cancer, heart disease, or chronic pain can add stress and fatigue that may trigger or worsen anxious depression. In some cases, conditions like strokes can change brain chemistry, which can directly affect mood and mental health.
Substance use can also exacerbate symptoms. Many people turn to alcohol or drugs to cope with emotional pain, but this can make things worse over time. Substances may provide temporary relief, but they create a cycle that’s hard to break.
If you or someone you know is struggling with anxious depression, the first step is to seek help from a mental health professional. A psychologist, psychiatrist, or licensed counselor can evaluate symptoms and provide a diagnosis, which can guide treatment. Treatment frequently includes one or a combination of the following: psychotherapy, medication, and transcranial magnetic stimulation (TMS).
Psychotherapy is a common treatment for anxious depression and can provide patients with strategies to help them manage symptoms. Therapy approaches that may be worth considering include:
Medications can be prescribed to regulate mood and relieve the symptoms of anxious depression. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are common antidepressants used to treat both anxiety and depression. In some cases, short-term use of anti-anxiety medications like benzodiazepines may be considered, but these are not a first-line treatment due to their potential for dependency.
Research shows that many patients with anxious depression respond well to antidepressants and see significant symptom improvements after seven weeks. However, some individuals may still experience lingering anxiety.
For those whose anxious depression is resistant to traditional treatments, TMS is another alternative. This non-invasive therapy uses magnetic pulses to target specific areas of the brain that are involved in mood regulation.
In a recent study, patients with anxious depression experienced significant improvements after TMS therapy, with reductions of 50% or more in both anxiety (GAD-7) and depression (PHQ-9) scores. TMS has the potential to help address the effects of chronic stress, inflammation, and altered brain circuits that can make anxious depression more difficult to treat.
Anxious depression can feel challenging as you’re juggling mixed symptoms of both anxiety and depression. However, from medication management to TMS therapy, treatment is available to help you get back to feeling like yourself again.
At Cura Behavioral Health, we’re committed to providing compassionate, evidence-based care that’s personalized just for you. We combine innovative therapies with a supportive and nurturing environment to help you regain control of your life. Contact us today to learn how we can support you on your journey toward mental wellness.
The Critical Relationship Between Anxiety and Depression – American Journal of Psychiatry
Panic: Understanding the Body’s Response to Stress – University of New Hampshire
The Role of Chronic Stress in Anxious Depression – Chronic Stress
Physical health and mental health – Mental Health Foundation
Substance Use and Co-Occurring Mental Disorders – National Institute of Mental Health
Determining if TMS therapy suits your mental health journey should involve consultation with a qualified professional. At Cura Behavioral Health, we provide comprehensive assessments to help you make informed treatment decisions.
Don’t let a mental health condition hold you back any longer. Schedule a consultation with Cura Behavioral Health today. Our experienced team is ready to answer your questions and create a personalized treatment plan tailored to your unique needs.
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Dr. Kevin Simonson, an esteemed Medical Director at Cura Behavioral Health, brings over 15 years of experience in psychiatry. A graduate from a top medical school, he specializes in the treatment of mood disorders and anxiety, employing a patient-centered approach. His dedication to evidence-based care and his commitment to advancing mental health practices have made him a respected figure in the field. Dr. Simonson’s leadership ensures the highest standard of care for the community at Cura Behavioral Health.
