People who are depressed usually feel anxious as well. In agitated depression, their anxiety is extreme and may be displayed as an inability to sit still, constant pacing, hand wringing, picking at clothing or fingers and nails, lip biting, and anguished facial expressions that convey their inner turmoil. Depression may accentuate anxiety and worry about everyday problems that individuals previously took in stride.
Difficulty making up one’s mind and other indications of anxiety may also emerge with depression.
On the other hand, anxiety itself is depressing, and it is normal to get somewhat depressed if anxiety persists too long. Usually, however, sad feelings in anxious people are less intense than those found in people in whom depression is the primary problem. Relieving primary anxiety often helps mild associated depression as well.
Some people can have both a primary depression and a primary Anxiety Disorder. For doctors, it is current practice to distinguish the various types of depression and anxiety based on information obtained from the patient: the medical history of the individual and his or her family, the specific symptoms that are present, and sometimes the sequence of symptoms (that is, whether depression or anxiety occurs first). The doctor’s professional decision on whether anxiety or depression or another disorder is the primary cause of a patient’s difficulty is called the differential diagnosis. At times, however, arriving at this differential diagnosis is complicated and may require repeated evaluations through interviews, laboratory tests, and—sometimes—trials of various treatments appropriate for depression and Anxiety Disorders.