Nobody around you has the right word for it. Stressed is what your sister calls it, and it misses half of what's happening. Anxiety is a body braced for something that hasn't happened yet, and depression is a body that has stopped expecting anything worth getting up for, and you've got both at once. Anxiety and depression together is one of the most common pairings in mental health. In large World Health Organization surveys, close to half of people who'd had depression had also had an anxiety disorder. Here's how the two differ, where they overlap, and which to work on first.
The one-line difference between anxiety and depression
Anxiety points forward, at what might go wrong. Depression points inward, at what's already lost.
Anxiety runs hot, with a racing mind, a tight chest and a need to do something. Depression runs cold, with a slow mind, a heavy body and no pull toward anything. The list below sets them side by side, and the sections after it explain the third column.
Direction of the thoughts
Anxiety: The future, what could go wrong
Depression: The past and the self, what's already gone
Both together: Worry about the future, then hopelessness about ever fixing it
Energy
Anxiety: Wired, restless
Depression: Flat, drained
Both together: Exhausted and unable to rest
Sleep
Anxiety: Trouble falling asleep, mind racing
Depression: Waking early or sleeping far too much
Both together: Falling asleep late, waking early, never refreshed
What you do
Anxiety: Avoid, check, seek reassurance
Depression: Withdraw, stop doing things
Both together: Withdraw, then worry about having withdrawn
The inner sentence
Anxiety: "Something bad is coming"
Depression: "Nothing is going to get better"
Both together: "Something bad is coming and I can't handle it"
Which column is yours is a fair first question, and a free 15-minute consultation is enough to start answering it.
Common signs of anxiety and depression
Everyone feels worried or low sometimes. These are signs that it may be more than a rough patch.
Anxiety often looks like:
worry that's hard to control, about many different things
feeling restless, keyed up or on edge
muscle tension, headaches or an upset stomach
trouble falling or staying asleep
avoiding things, or seeking reassurance again and again
Depression often looks like:
feeling sad, empty or irritable most of the day
losing interest in things you used to enjoy
feeling worthless or weighed down by guilt
trouble concentrating or making decisions
changes in sleep, appetite or energy
thoughts of death or suicide
If several signs from both lists fit, and they've been around for weeks rather than days, it's worth talking to someone.
Where they overlap
Can you have anxiety and depression at the same time? Yes, and it's common. Having one also raises the odds of developing the other later, in both directions. A review of 66 long-term studies found that anxiety predicted later depression about as strongly as depression predicted later anxiety.
The overlap makes sense from the inside. Both can bring poor sleep, tiredness, trouble concentrating and irritability. And each can feed the other. Months of anxiety can wear you down until you stop hoping, which can turn into depression. Months of depression can shrink your life until every remaining task feels dangerous, which can turn into anxiety.
Clinicians call it comorbid anxiety and depression when both are fully present. When you have symptoms of both but neither is strong enough on its own for a diagnosis, the World Health Organization's classification calls it mixed depressive and anxiety disorder.
Why do anxiety and depression happen together? Partly shared roots. Twin research suggests the two share much of their genetic risk, and hard life experiences can play a part in both. Partly the feeding loop above. And partly because the thinking styles are cousins. Anxiety says the future is dangerous. Depression says you can't cope with it.
Where they diverge
Energy is the clearest divider. Anxious people want to do something and can't settle. Depressed people can't find the reason to do anything.
Fear versus loss is the other. An anxious person dreads the party. A depressed person doesn't see the point of it.
Pleasure can be a useful clue. Anxiety spoils enjoyment because you're too braced to feel it. Depression removes it, so the things you used to love land flat. If you can still enjoy a meal once the worry lets go for an hour, that may point toward anxiety. If the worry lifts and there's still nothing there, depression may be in the room.
How each is treated, and how we treat both
How do you treat both? With approaches that reach both, and a plan that names which goes first.
For anxiety on its own, cognitive behavioural therapy (CBT) is the best-studied talk therapy. It often includes exposure, where you catch the catastrophic prediction and test it by doing the feared thing in small steps. Our page on anxiety counselling explains how we work with it.
For depression on its own, Canadian treatment guidelines list CBT, interpersonal therapy and behavioural activation among the first-choice talk therapies. Behavioural activation rebuilds the doing before the wanting returns, alongside work on the thoughts that insist nothing will help. Our page on depression counselling covers our approach.
When both are present, our clinicians don't usually run two separate programs. Catching a thought and checking it against the facts works on "this will go wrong" and on "nothing will ever change". Scheduling small activities lifts mood and tests the worry at the same time. Canadian guidelines support CBT for depression that comes with anxiety. Medication from a family doctor or psychiatrist is sometimes part of the picture, alongside therapy. In Ontario, the free Ontario Structured Psychotherapy program offers CBT-based help to adults with depression and anxiety-related concerns, and you can refer yourself.
Which one to act on first if you have both
Act on the depression first when it's keeping you in bed. It's hard to do exposure work if you can't leave the house, so the first weeks go on energy, sleep and one small activity a day.
Act on the anxiety first when it's shrinking your life. If you're functioning but avoiding more and more, the avoidance is feeding the low mood, and loosening it can lift both.
Act on safety first, always, if either one has brought thoughts of ending your life.
Waterloo Region's line is Here 24/7, on 1-844-437-3247, day or night.
Anywhere in Canada, call or text 9-8-8.
Ottawa's Mental Health Crisis Line is 613-722-6914, or 1-866-996-0991 from outside the city.
In immediate danger, call 911 or go to the closest emergency department.
We aren't a crisis service, and those lines are.
Anxiety and depression together, what a first session looks like
You'll be asked about both, not one. Which came first. What a bad day looks like now, waking to bed. Which parts feel like dread and which feel like nothing. From that, your counsellor sketches the loop running in your case and suggests where to cut into it. You'll leave with one thing to try, not necessarily a diagnosis. In Ontario, only some professionals, such as psychologists and physicians, can give a diagnosis. Our psychologists can assess and diagnose if that would help, but you don't need a label to start.
Kitchener, Waterloo, Cambridge and Ottawa all have a room for you, and there's a video option anywhere in Ontario if none of them is close. You don't need a referral, and evening and weekend appointments are available. Therapy is offered in French, and some of our therapists speak Punjabi, Hindi, Urdu or Gujarati. In many cases we can bill your insurance directly, depending on your plan and your therapist.
Frequently asked questions
Is it normal to have anxiety and depression at the same time?
Yes. They often travel together, and having both doesn't mean something is especially wrong with you.
Can anxiety turn into depression?
It can. Long-running anxiety raises the risk of depression later, and the reverse is true too. That's one more reason not to wait.
Do I need a diagnosis to start counselling?
No. You can start working on what's happening without a label. If a diagnosis would help, for work or for your own peace of mind, our psychologists can assess for one.
Taking the first step
When both have been running for a while, the hardest part is the first message. Send it as a free 15-minute consultation request and let us take it from there.
If you are in crisis, call or text 9-8-8, or call Here 24/7 at 1-844-437-3247. In an emergency, call 911.