Depression with Anxiety Disorder: What It Really Feels Like

Last updated: November 2025

If you’re experiencing both depression and anxiety at the same time, you’re far from alone. Depression with anxiety disorder affects millions of people, and the combination can feel overwhelming in ways that are hard to describe. Many people with major depressive disorder also meet criteria for anxiety disorders, with studies showing that 50% to 75% of individuals with major depression have comorbid anxiety. Approximately 40 million adults in the U.S. experience anxiety disorders each year, with similar prevalence for depressive disorders.

Understanding what these mental health conditions feel like—both separately and together—can help you recognize what you’re experiencing and know when to reach out for support.

What Does Anxiety and Depression Feel Like?

Depression and anxiety create distinctly different experiences, but when they happen together, the feelings blur and intensify each other. Clinical depression often shows up as persistent sadness, a sense of hopelessness, and losing interest in activities you once enjoyed. You might feel empty or numb, like you’re moving through life on autopilot. Energy drains away, making even small tasks feel exhausting.

Anxiety tends to show up as persistent worry, restlessness, and a sense of dread—even when there’s no clear threat. Your mind races with worst-case scenarios, and your body stays on high alert. Many people describe it as feeling like something bad is always about to happen.

When depression and anxiety occur together, you might experience both the heavy, exhausted feeling of depression and the jittery, worried energy of anxiety at the same time. This combination of mental health disorders can feel particularly confusing and distressing.

In our practice, we often see clients describe this experience as “tired but wired”—exhausted yet unable to rest, wanting to withdraw but feeling panicked about isolation. The two conditions create competing impulses that leave people feeling stuck. We’ve learned that validating both experiences simultaneously, rather than trying to address one at a time, helps clients feel understood and opens pathways for more effective treatment.

Physical Symptoms You Might Notice

Both anxiety disorders and depressive disorders cause physical symptoms that are very real, not “just in your head.” These physical signs are often what prompt people to first recognize something is wrong.

Common physical symptoms include:

Rapid heartbeat or pounding heart
Headaches or muscle tension
Stomachaches or digestive issues
Changes in appetite—eating much more or much less than usual
Difficulty concentrating or making decisions
Sleep problems—trouble falling asleep, staying asleep, or sleeping too much
Fatigue and low energy, even after rest
Restlessness or feeling on edge

These symptoms can make it harder to function at work, maintain relationships, or take care of daily life. Patients with comorbid anxiety and depression typically experience significantly worse psychosocial functioning compared to those with only one condition.

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What Is a Depressive Episode with Anxiety?

A major depressive episode with anxiety—sometimes called anxious depression or anxious major depressive disorder—refers to a period of depression where anxiety symptoms are prominent features. This isn’t just experiencing both conditions separately; the anxiety is woven into the depressive episode itself.

During an episode of anxious depression, you experience core symptoms of depression (sadness, hopelessness, loss of interest) alongside significant anxiety symptoms (excessive worry, tension, intense fear). The anxiety can make the depression feel more intense, and the depression can make anxiety symptoms harder to manage. Research shows that depressed patients with anxiety are more likely to experience severe depression and suicidal ideation compared to those with nonanxious depression.

Studies indicate that chronic stress may play a role in the development of anxious depression. In Washington, D.C., where over 40% of adults have reported symptoms of anxiety or depression, the city’s competitive work culture, long commutes, and high cost of living can contribute to this chronic stress.

Can Anxiety Cause Depression?

The relationship between anxiety disorders and depression is complex, and the connection can go both ways. Anxiety doesn’t necessarily cause depression in a simple, direct way, but the two mental disorders are deeply interconnected.

Research shows that anxiety typically emerges earlier in life, often during childhood or adolescence. When someone lives with untreated generalized anxiety disorder, panic disorder, social anxiety disorder, or other anxiety disorders for an extended period, the constant stress and difficulty functioning can create an increased risk of developing depression. The exhaustion from managing persistent anxiety can wear you down over time.

However, it’s also possible to experience depression first and then develop anxiety symptoms. Some people experience both anxiety and depression simultaneously without one clearly preceding the other. Environmental factors, genetics, brain chemistry, and life circumstances all play a role.

What matters most is recognizing that both conditions deserve attention and treatment, regardless of which came first.

Understanding Common Anxiety Disorders

Several types of anxiety disorders can occur alongside major depressive disorder. Understanding the most common anxiety disorders can help you recognize what you’re experiencing:

Generalized anxiety disorder is characterized by excessive and uncontrollable worry about everyday matters such as work, health, family, and finances, persisting for months. The worry feels disproportionate to the actual situation and interferes with daily life.

Panic disorder causes sudden feelings of intense fear accompanied by physical symptoms like rapid heartbeat, sweating, trembling, and shortness of breath. These panic attacks can happen unexpectedly and may lead to avoiding situations where attacks have occurred.

Social anxiety disorder, also known as social phobia, is characterized by an intense fear of social situations where you might be judged, embarrassed, or scrutinized by others. This goes beyond normal shyness and can significantly limit your ability to engage in work, school, or social activities.

Separation anxiety disorder involves excessive fear about being separated from attachment figures. While often associated with children, adults can experience separation anxiety too, particularly in the context of comorbid anxiety disorders.

Common Early Signs to Watch For

Recognizing depression anxiety early can help you get support sooner. According to behavioral health statistics, many people don’t receive needed care even when experiencing symptoms. Some early warning signs include:

Avoiding once-enjoyed activities. When you start turning down social invitations, skipping hobbies you used to love, or withdrawing from friends and family, it can signal both depression and anxiety disorders.

Difficulty concentrating. You might find yourself reading the same paragraph multiple times, forgetting what someone just said, or struggling to make simple decisions. This symptom appears in both anxiety and depressive disorders.

Changes in sleep patterns. This could mean trouble falling asleep due to racing thoughts, difficulty staying asleep throughout the night, or sleeping much more than usual and still feeling exhausted.

Intense fear or worry that feels out of proportion. You might experience sudden feelings of panic in stressful situations that didn’t used to bother you, or find yourself worrying excessively about everyday situations.

How These Conditions Affect Daily Life

Living with both anxiety and depressive disorders can severely impact quality of life. Studies show that comorbid anxiety and depression make quality of life worse than having either condition alone. The combination makes everyday tasks more challenging and can affect multiple areas of your life simultaneously.

At work, you might struggle with concentration, meeting deadlines, or interacting with colleagues. The anxiety might make you overthink emails or worry excessively about performance reviews, while depression saps your motivation and energy.

In relationships, you might withdraw from loved ones due to depression, or avoid social situations because of severe anxiety. You might cancel plans last minute, struggle to communicate how you’re feeling, or feel guilty about burdening others.

For self-care, both mental health conditions can make it harder to maintain healthy habits. Anxiety might make you feel too restless to relax, while depression makes it hard to find the energy for regular exercise or preparing nutritious meals.

From a treatment perspective, we see comorbid anxiety and depression create unique challenges. Clients with depression alone might respond well to behavioral activation—getting moving and doing things. But anxiety can make activity feel overwhelming rather than energizing. We approach this by helping clients build very gradual exposure hierarchies combined with depression interventions, recognizing that what works for “pure” depression often needs significant modification when anxiety is present.

How Do You Treat Severe Depression and Anxiety?

Treatment for depression with anxiety disorder typically involves effective treatments tailored to your specific symptoms and needs. According to the American Psychiatric Association and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), anxiety and depressive disorders are commonly diagnosed using established criteria, and medications and psychotherapy work for most people.

Therapy Options

Talk therapy—also called psychotherapy—is one of the most effective treatments for treating anxiety and depression together. Cognitive behavioral therapy and dialectical behavioral therapy help you identify and change unhelpful thought patterns and develop coping skills for managing both conditions. Mindfulness-based therapy uses meditation and grounding techniques to help manage overwhelming thoughts and feelings.

Many people benefit from outpatient psychotherapy, which allows you to receive support while maintaining your daily routine. A mental health professional or mental health provider can work with you to develop a treatment plan tailored to your needs.

Medication

A healthcare provider or psychiatrist can prescribe medications to relieve depression and anxiety symptoms. SSRIs (like sertraline, fluoxetine, or escitalopram) or SNRIs (like venlafaxine or duloxetine) are commonly prescribed because they can help with both depression and anxiety. Your healthcare provider can determine which medication might work best for your situation.

Intensive Care Options

For severe symptoms, intensive outpatient programs or partial hospitalization programs provide more comprehensive support. In the DC area, the Psychiatric Institute of Washington offers these options for individuals who need more structured care while still living at home.

Lifestyle Changes That Help

Lifestyle changes can support your treatment and help reduce stress:

Engage in outdoor activities for just two hours a week to improve mood
Establish a consistent routine with regular sleep and meal times for stability
Build social connections through a local support group to combat isolation
Maintain a balanced diet focusing on whole foods and omega-3 fatty acids
Limit substance abuse and recreational drugs, which can worsen other symptoms

Crisis support is available: If you’re experiencing severe symptoms or thoughts of self-harm, call or text 988 for the Suicide & Crisis Lifeline, or go to your nearest emergency room.

Why Gender and Other Factors Matter

Understanding the full picture of depression anxiety includes recognizing that these common mental health conditions don’t affect everyone equally. According to the World Health Organization and World Mental Health Surveys, women are more than twice as likely as men to experience anxiety disorders during their reproductive years. Globally, 4.4% of the population experiences depression and 3.6% experiences anxiety disorders, affecting hundreds of millions worldwide.

This doesn’t mean men don’t experience these health conditions—they absolutely do—but they may experience or express symptoms differently. Men might be more likely to show irritability or anger rather than sadness, or to engage in substance abuse as a way of coping with other mental health conditions.

Age also plays a role. Common anxiety disorders typically emerge earlier in life, often during childhood or adolescence, while major depression can develop at any age. Studies indicate that 45.7% of individuals with major depressive disorder have a history of anxiety disorders. Having generalized anxiety or other anxiety disorders increases the risk of developing depression later.

How Diagnosis and Treatment Work

Mental health professionals diagnose anxiety and depressive disorders using criteria from the Diagnostic and Statistical Manual (DSM-5) published by the American Psychiatric Association. The process typically involves:

Screening and Assessment. Your healthcare provider may use screening tools to assess the following symptoms and their severity. This helps distinguish anxious versus nonanxious depression and guides treatment planning.

Comprehensive Evaluation. A mental health professional will ask about your symptoms, how long you’ve been experiencing them, how they affect your daily life, and whether you have other mental health conditions or health conditions that might contribute.

Treatment Planning. Based on your evaluation, your mental health provider will work with you to develop a treatment plan. Findings support that combining talk therapy with lifestyle changes often produces the best results. People benefit most from individualized approaches that address their specific symptoms and circumstances.

Getting Help in DC

Living in Washington, D.C., comes with unique stressors that can amplify symptoms of anxiety and depression. According to the Substance Abuse and Mental Health Services Administration, many adults in DC experience mental health disorders but don’t receive needed care. The city’s highly competitive work culture, long commutes, and high cost of living create stressful situations that are constant for many residents.

If you’re looking for support with depression with anxiety disorder, the therapists at Therapy Group of DC understand the specific pressures of living and working in the District. We offer telehealth therapy options to increase accessibility for those facing challenges with in-person sessions, whether due to anxiety about leaving home, demanding work schedules, or transportation issues. Schedule an appointment to get started.