Most people who come to me with depression and anxiety don’t even realize they have both. They describe feeling exhausted and unmotivated, then mention in the same breath that they can’t stop worrying, that they lie awake running disaster scenarios, that dread follows them from room to room. They think it’s all one thing. Often, it is, in the sense that the two conditions are so frequently tangled together that treating one without acknowledging the other tends to backfire.

Here’s something I tell people right away: having depression and anxiety simultaneously is genuinely common. A 2015 review published in Dialogues in Clinical Neuroscience found that roughly 60% of people with depression also meet criteria for an anxiety disorder. That number should probably be more reassuring than it is, because when you’re in it, you still feel like you’re uniquely broken.

You’re not broken. But you do need a slightly different approach than someone dealing with just one or the other.

Why Treating Both Together Changes Everything

A lot of people, including some therapists, make the mistake of picking whichever condition looks worse and assuming the other will resolve on its own. Sometimes that works. Usually it doesn’t, and the reason is straightforward: depression and anxiety feed each other through different but overlapping mechanisms. Depression pulls you inward, toward withdrawal and inactivity. Anxiety pushes you outward, toward hypervigilance and avoidance. When they run together, you end up simultaneously paralyzed and wired. It’s genuinely one of the most exhausting states a person can inhabit.

A therapist working only on depression might use behavioral activation, encouraging you to do more, get out, build momentum. Theoretically sound. But if anxiety is driving your avoidance, being told to “just do it” feels impossible. When it doesn’t work, your depression deepens and you blame yourself for failing at something that was never going to succeed without addressing both pieces.

The reverse problem is equally real. Pure anxiety work through relaxation and exposure might calm you down, but it won’t touch the anhedonia, the flattened emotional landscape, the inability to feel anything about things you used to love. You end up calmer but hollow.

What actually works is a therapist who holds both conditions in mind simultaneously and builds a treatment plan that addresses how they interact.

The Therapy Approaches With Real Evidence Behind Them

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There’s endless noise online about therapy types. I’ll be direct about what has the strongest research base for this specific combination.

Cognitive Behavioral Therapy (CBT) is the most well-studied treatment for depression and anxiety together. It works by identifying the thought patterns that sustain both conditions, catastrophizing, black-and-white thinking, relentless self-blame, and then systematically testing whether those thoughts hold up. The 2013 edition of David Burns’s Feeling Good remains one of the best-written explanations of CBT for a general reader, and his follow-up When Panic Attacks handles the anxiety piece specifically. I often recommend both to people who want to understand what they’re walking into before their first appointment.

Acceptance and Commitment Therapy (ACT) has gained serious traction over the past decade, and for people whose depression and anxiety both root in relentless self-criticism and psychological rigidity, I think ACT sometimes outperforms traditional CBT. It doesn’t ask you to challenge your thoughts so much as change your relationship with them. Notice the thought. Don’t let it drive. The Happiness Trap by Russ Harris is a solid self-help workbook for this, available on Amazon, and gives you foundation before or alongside working with a therapist.

Behavioral Activation, used within CBT or standalone, specifically targets the withdrawal and inertia of depression. Recent meta-analyses suggest it also reduces anxiety, particularly social anxiety. It’s less about “doing more” in some vague sense and more about strategically reintroducing meaningful activity in small, graded steps.

Mindfulness-Based Cognitive Therapy (MBCT) is worth knowing about if you’ve experienced multiple depressive episodes. Oxford developed it in the 1990s specifically for preventing recurrence, and there’s solid evidence it reduces anxiety symptoms alongside depressive relapse. Jon Kabat-Zinn’s Full Catastrophe Living is the foundational text, though it’s a genuine time commitment.

The research across these approaches is solid. But here’s what actually matters more: no therapy works for everyone, and the specific modality matters less than the therapist. A mediocre CBT practitioner will underperform a skilled ACT therapist, and vice versa.

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What to Actually Look For in a Therapist

Most advice here fails people. Everyone says “find someone you connect with,” which is true but useless when you don’t know what you’re walking into.

When you’re dealing with depression and anxiety together, you want a therapist who explicitly says they work with comorbid conditions. That word just means two or more conditions present simultaneously. Ask directly in your initial consultation: “Do you have experience treating depression and anxiety together, and how do you approach it when one is making the other worse?” A therapist who gives you a clear, specific answer is worth pursuing. One who gives you vague reassurance is a yellow flag.

You also want someone trained in at least one evidence-based modality mentioned above, not someone describing their approach as “eclectic” without being able to explain what that means in practice. Eclectic can work, but it can also mean they’ll improvise.

Start with Psychology Today’s therapist directory, which lets you filter by specialty, insurance, and location. Most listings include a statement from the therapist that tells you quickly how they work. If cost or access is an issue, SAMHSA’s treatment locator can help you find sliding-scale and community options.

On cost: therapy for depression and anxiety typically runs $100 to $250 per session out of pocket depending on your city and the therapist’s background. With insurance, your copay might be $20 to $60. Telehealth has genuinely expanded access. Platforms like Alma or Headway specialize in connecting people with insurance-paneled therapists. I’m not affiliated with any of these, but I’ve seen them work well for people who assumed they couldn’t afford care.

What the First Few Months Actually Look Like

Most evidence-based treatments for comorbid depression and anxiety involve somewhere between 12 and 20 structured sessions, though some people do shorter or longer work depending on severity and history.

The first two or three sessions are assessment. Your therapist is building a picture of how your symptoms developed, what makes them worse, what helps even slightly. This phase feels slow when you’re in pain. Tolerate it anyway, because a solid assessment leads to a better treatment plan, and a better plan means fewer wasted months.

Around sessions four through eight, you start the actual work: identifying thought patterns, building skills, making behavioral changes in increments. This phase often feels harder before it feels better. That’s not failure. That’s what exposure to avoided things feels like initially.

By session ten or twelve, most people notice something shift. Not a dramatic turnaround. More like: “I had a bad week but didn’t spiral for as long.” Or: “I went to that thing I’d been avoiding and it was fine.” Small data points that accumulate.

Some people are also working with a psychiatrist on medication during this time. Therapy and medication aren’t in competition. For moderate to severe presentations of both conditions, the research consistently shows better outcomes with both than either alone. That’s not a knock on therapy. It’s what the data says.

You Don’t Have to Have It All Figured Out Before You Start

A lot of people delay starting therapy because they want to articulate exactly what’s wrong. They want to show up prepared, to not waste the therapist’s time.

You don’t.

You can show up and say, “I feel anxious and depressed and I don’t know which is which or why, and I’ve been putting this off for a year.” That’s a complete and valid starting point. The therapist’s job is to help you make sense of it, not receive a well-organized report.

The harder obstacle is what depression itself creates: the belief that it won’t work, that you’re too far gone, that you tried before and it failed. I’ve heard this from countless people, and I never dismiss it. Sometimes previous therapy genuinely wasn’t the right fit. But giving up after one mismatch is like deciding restaurants aren’t for you because one gave you food poisoning.

If you’ve had therapy before and it didn’t help, tell your new therapist that. Tell them specifically what felt unhelpful. That’s useful information, not a complaint.

FAQ

Can therapy alone treat depression and anxiety, or do I need medication too?

Therapy alone can be very effective, especially for mild to moderate presentations. For more severe symptoms, or when depression and anxiety are making it hard to engage with therapy at all, medication may help enough to make the therapeutic work possible. Talk to both a therapist and a psychiatrist or your primary care doctor before deciding.

How do I know if my anxiety is separate from my depression or just part of it?

The distinction matters less than you might think when it comes to treatment. Some anxiety is a feature of depression itself, some is a separate anxiety disorder, and a competent therapist will assess this over time. You don’t need to know before you start.

What if I can’t afford regular therapy right now?

Sliding-scale clinics, community mental health centers, and training clinics at universities (where supervised graduate students provide therapy at reduced cost) are real options. Open Path Collective offers sessions from $30 to $80. Online tools like CBT-based apps can supplement care, though they shouldn’t replace it for significant symptoms.

How long before I start feeling better in therapy?

Most people notice some improvement within six to eight weeks, though this varies widely by severity and how well the approach fits. If you’ve had several sessions and feel no movement at all, discuss a shift in approach with your therapist rather than assuming therapy itself isn’t working.

Is it normal to feel worse when I first start therapy?

Yes, and more often than people expect. Early sessions can stir up things you’ve been avoiding, and the work of changing thought patterns and behaviors is uncomfortable at first. Feeling worse in the first few weeks isn’t a sign to stop. It’s usually a sign something is actually being addressed.

Sources & References

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This article is for general informational purposes only and does not constitute mental health, medical, or clinical advice. If you are in crisis or experiencing a mental health emergency, please contact the 988 Suicide and Crisis Lifeline (call or text 988) or go to your nearest emergency room. Always consult a licensed mental health professional for care specific to your needs.

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