Short answer: Yes, anxiety and depression are related in a variety of ways. Effective treatments are available for both, whether they occur separately or together.
Long version follows.
The Connection Between Anxiety and Depression
The first and most obvious way anxiety and depression are related is that they’re both mental health disorders that can develop and persist across the lifespan – from childhood to late adulthood – at varying levels of severity:
- Mild cases of anxiety and/or depression can cause disruption in daily life
- In mild cases, it’s often possible to manage negative symptoms with weekly or biweekly outpatient treatment.
- Moderate cases of anxiety and/or depression may or may not cause significant disruption in daily life, depending on individual factors, including level of support, family circumstances, and treatment engagement.
- In moderate cases, a more immersive outpatient experience, such as intensive outpatient programs (IOP), or partial hospitalization programs (PHP) may be necessary.
- Severe cases of anxiety and/or depression often cause significant disruption in daily life.
- In severe cases, symptoms often cause significant disruption in daily life, and rarely resolve without some form of immersive treatment, such as IOP, PHP, or residential treatment programs.
The second way they’re related is that they often appear in the same person. When this happens, they’re called co-occurring disorders or comorbid disorders. In adults, evidence shows the following rates of comorbid anxiety and depression:
- Among people with an anxiety disorder:
- 30% – 63% meet criteria for major depressive disorder
- Among people with a depressive disorder:
- 45% – 67% meet criteria for an anxiety disorder
In adolescents, evidence shows the following rates of comorbid anxiety and depression:
- Among adolescents with an anxiety disorder:
- Around 25% meet criteria for a depressive disorder
- Among adolescents diagnosed with a depressive disorder:
- Around 50% meet criteria for an anxiety disorder
Here’s an important fact: when depression and anxiety co-occur, treating both at the same time yields the most favorable outcomes.
The Consequences of Co-Occurring Anxiety and Depression
The study “Comorbid Anxiety and Depressive Symptoms in Children and Adolescents: A Systematic Review and Analysis” provides an in-depth analysis of the phenomenon of co-occurring anxiety and depression in young people.
In general, when a person has more than one mental health disorder, they experience:
- Elevated levels of distress
- Elevated levels of disability
- Decreased treatment response
- Impaired overall physical health
- Impaired educational achievement
- Decreased interpersonal functioning
Overall, people with co-occurring disorders receive a less favorable long-term prognosis than those with one disorder. When anxiety and depression co-occur in children and adolescents, the following symptoms either appear for the first time, or increase in severity:
- Physical problems, including gastrointestinal symptoms and aches and pains that don’t respond to common treatments
- Low energy
- Sleep problems
- Agitation/irritability/anger
- Impaired concentration
- Impaired decision making
- Obsessive thoughts/compulsive behaviors
- Suspicion/distrustfulness
- Decreased appetite
eparately, anxiety and depression can be difficult for children, adolescents, and families to manage. When they co-occur, and the consequences we share above appear, the difficulties increase. Experts indicate that children and adolescents who experience elevated symptoms caused by co-occurrence show an increase in life disruption.
In other words, the consequences of co-occurrence have consequences.
A child or teen with both anxiety and depression is more likely to have somatic symptoms, such as headache, stomachache, and other issues that lead to an increase in school avoidance – i.e. not wanting to go to school – and decreased academic performance. When children and teens with co-occurring anxiety and depression attend school less often, and their grades fall, the following negative consequences – the consequences of the consequences – may occur:
- Withdrawal from peers
- Isolation from family
- Decreased social activity
- Decreased involvement in extracurricular activities
- Increased likelihood of risky behavior
If untreated, these compounding problems can lead to long-term distress, disability, and impairment that may last into young adulthood, adulthood, middle age, and late adulthood. There’s something else to address here, too: the co-occurrence of anxiety and depression that don’t meet clinical criteria for diagnosis, i.e. sub-threshold anxiety and depression.
However, alongside the problem of co-occurrence and the serious long-term consequences, it’s important for parents of children and teens to understand that evidence-based treatment can work.
How to Identify Co-Occurring Anxiety and Depression: Find Professional Support
We’ll talk about treatment in a moment.
First, parents should be aware of the symptoms of anxiety and depression.
If children or teens show symptoms of one, the other, or both – even if they’re sub-threshold, and not too serious/disruptive – it’s important to consider arranging a full psychiatric evaluation administered by a qualified mental health professional. We encourage assessment and/or evaluation because of the serious consequences of anxiety, depression, and the potential of cumulative problems caused by subthreshold symptoms.
Symptoms of anxiety to watch for:
- Fear of typical daily situations
- Restlessness
- Agitation/irritability
- Elevated heart rate
- Excess/unusual sweating
- Headaches/stomachaches
- Sleep problems
- Tremors/shakiness
Symptoms of depression to watch for:
- Constant/persistent sadness
- Frequent crying
- Hopelessness
- Frequent anger/irritability
- Feelings of worthlessness and guilt
- Fatigue
- Withdrawal from friends and family
- Boredom/restlessness
- Problems with memory, concentration, decision-making
- Sleep problems
- Headaches, stomachaches, common ailments that don’t respond to common treatment
- Suicidal behavior/suicidal ideation: talking about suicide, thinking about suicide, making plans for suicide.
NEVER IGNORE SUICIDAL BEHAVIOR: IF A CHILD OR TEEN IS AT IMMINENT RISK OF DANGER, CALL 911. IF THEY’RE NOT, CALL 988, THE NATIONAL SUICIDE/MENTAL HEALTH HOTLINE/HELPLINE
We’ll be clear: everyone, children and teens included, may show the symptoms above sometimes. When they occur every day for two weeks or more, that’s a serious red flag that there may be an underlying mental health disorder, and seeking a professional assessment is the best path forward. When they appear more than sometimes, but less than every day, there’s a gray area, and a professional assessment can help parents determine if the symptoms are typical child/teen ups and downs, or symptoms of one or more mental health disorders.
Treatment for Co-Occurring Anxiety and Depression
The most effective treatment for either anxiety or depression – when they occur separately – includes an integrated combination of therapy, medication (if needed), family therapy, peer support, and lifestyle changes.
The same is true for co-occurring anxiety and depression. However, in some cases, therapeutic approaches that are effective for anxiety are not effective for depression, and vice-versa. That means a treatment plan for co-occurring anxiety and depression requires the input of a skilled, experienced mental health professional with an extensive history treating both conditions – separately and together – in the child and adolescent population.
Evidences shows the following approaches – read the research here and here – are effective for co-occurring anxiety and depressive disorders in children and adolescents:
- Cognitive behavioral therapy (CBT)
- Interpersonal psychotherapy for adolescents (IPT-A)
- Psychodynamic psychotherapy
- Medication: Selective serotonin uptake inhibitors (SSRIs), including:
- Fluoxetine
- Sertraline
- Family therapy
- Group therapy
Although studies don’t mention lifestyle changes, we know that things like a healthy diet, plenty of exercise and activity help almost all people with mental health disorders. In addition, stress management skills such as mindfulness, when modified for children and adolescents, can help improve overall health and wellness, which creates a solid foundation for treatment progress and overall wellbeing.
How to Find Support: Resources for Families
Click here to contact us via our online contact form or reach us directly at (844) 763-5532.
Parents can also use these helpful online resources for families, children, and teens:
- The American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Their treatment finder is convenient and easy to use.
- The National Institute of Mental Health (NIMH) maintains a page for youth, adolescent, and family mental health
- The National Alliance on Mental Illness maintains excellent resources for families
