Many people who feel anxious also feel low, and many people who feel low also feel keyed up. It can be hard to say which came first, or which one is the real problem. Often the honest answer is both.
This article sets out what the two have in common, what tends to belong to one and not the other, and how often they occur together. It cannot tell you which you have. That takes a conversation with a clinician. If you are still working out what anxiety itself is like, start with what anxiety feels like.
Why are anxiety and depression so easy to confuse?
They share a good part of their symptom lists. The National Institute of Mental Health (NIMH) publishes plain-language descriptions of depression and of generalized anxiety disorder (GAD), the anxiety disorder built around persistent worry. Read side by side, the two pages have several things in common: restlessness, irritability, fatigue, trouble concentrating, sleep problems, and aches and pains. That comparison is this guide's reading of the two NIMH pages. It is not a table NIMH publishes.
The overlap goes further. NIMH's description of depression begins with a persistent sad, anxious or "empty" mood, and it includes feeling restless or on edge. So anxiety can be part of depression itself. Someone who is exhausted, sleeping badly and unable to concentrate could be describing either condition, or both.
What tends to set them apart?
The center of each is different. For depression, NIMH says one of the symptoms must be a depressed mood or a loss of interest or pleasure in most activities, with symptoms present most of the day, nearly every day, for at least 2 weeks. For GAD, the center is worry that a person finds difficult to control on most days for at least 6 months.
Beyond that, a few items appear on one NIMH page and not the other:
- On the depression page only: feelings of hopelessness or pessimism, feelings of guilt or worthlessness, loss of interest or pleasure in hobbies and activities, changes in appetite or unplanned weight changes, and thoughts of death or suicide.
- On the GAD page only: worrying excessively about everyday things, trouble controlling the worry, and muscle tension.
- Time frame: at least 2 weeks for depression, at least 6 months for GAD.
These are descriptions of what clinicians look for. They are not a checklist to score yourself against, and real people do not sort neatly into two columns. Only a clinician can assess which applies. If you are feeling hopeless or having thoughts of death or suicide, do not wait for an appointment. Call or text 988, or call 911 in an emergency.
GAD is one anxiety disorder among several. Panic disorder, social anxiety disorder and the others have their own patterns, described in types of anxiety disorders in plain words.
How often do they occur together?
Often. One large source is the World Health Organization's World Mental Health Surveys. In an analysis published in 2015, covering 74,045 adults in 27 surveys across 24 countries, 45.7% of people who had ever had major depressive disorder had also had one or more anxiety disorders in their lifetime. The figure varied by survey. The middle half of the surveys fell between 32.0% and 46.5%.
A 2017 analysis from the same survey program looked from the anxiety side. Among 147,261 adults in 26 countries, 81.9% of people with lifetime GAD had also had another mental disorder, and 63.0% had had a mood disorder. Mood disorders are a wider group than major depression, so that second figure is not a depression rate.
Which comes first? In the 2015 analysis, 68% of people with both reported that their first anxiety disorder began before their depression, and 13.5% reported that depression began first. Those ages were recalled by the people surveyed, so treat the order as approximate. These are figures about large groups. They do not predict what will happen to any one person.
What is anxious distress?
It is a label a clinician can add to a diagnosis of depression. DSM-5, the manual American clinicians use to diagnose mental health conditions, introduced the anxious distress specifier, in the words of one research group, "in recognition of the clinical significance of anxiety in depressed patients." It is attached to a depression diagnosis. It is not a separate anxiety disorder.
In a 2019 study from a Rhode Island research project, 260 patients with a principal diagnosis of major depressive disorder were interviewed, and approximately three-quarters met the criteria for the specifier. Those were people already in clinical care, so the result is not a figure for everyone with depression. The authors concluded that anxious distress is common in depressed patients.
Are anxiety and depression treated together?
Often they can be, because several of the same treatments are used for both. NIMH says commonly prescribed antidepressants, a group that includes SSRIs and SNRIs, "improve the symptoms of a broad group of depressive and anxiety disorders." Whether medication makes sense for you is a decision to make with a prescriber, and so is any change to a medication you already take.
Talk therapy is used for both as well. A 2014 meta-analysis pooled 52 randomized trials with 3,623 patients: 32 on depressive disorders and 21 on anxiety and related disorders, with one trial counted in both groups. Each trial compared an antidepressant alone with an antidepressant plus psychotherapy. The overall difference favored the combination (Hedges' g = 0.43), which the authors called a moderately large effect. They found sufficient evidence that the combination was superior for major depression, panic disorder and obsessive-compulsive disorder. Only one of the trials concerned GAD, and the trials tested adding therapy to medication, not the reverse.
The practical point is that you do not have to work out which problem is the real one before asking for help. For how therapy and medication compare, see therapy, medication or both for anxiety. For the kinds of talk therapy, see types of anxiety therapy and what the research says.
When is it worth getting assessed?
You do not need to know which it is before you ask. NIMH's guidance on anxiety is that if it does not go away and begins to interfere with your daily activities, you may have an anxiety disorder, and that when it causes problems at school, at work, or with friends and family, it is time to seek professional help. Its page on depression gives similar advice: if signs or symptoms of depression persist or do not go away, talk to a health care provider.
A licensed mental health clinician can assess what is happening and talk through options with you. Dr. Rabin is a licensed clinical psychologist who offers anxiety therapy and therapy for depression and mood difficulties, in person in Brookline and by secure telehealth to clients in Massachusetts. She offers a free consultation of about 15 minutes, which you can request through the contact page.
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Last reviewed October 2026. This guide is general information, not medical advice or a diagnosis. If you are in crisis, call or text 988, or call 911 in an emergency.
