Anxiety or depression: how to tell them apart and what to do if you have both
They get confused because they share tiredness, insomnia and poor concentration. But they work in opposite ways: one speeds you up, the other shuts you down.
"I don't know if I have anxiety or depression" is one of the sentences heard most often in a first appointment. It makes sense: both steal your sleep, both leave people unable to concentrate, and both make the body ache. Inside, though, they work in opposite directions. One speeds you up, the other shuts you down. Telling them apart matters, because what helps in one case can be the exact opposite of what helps in the other.
Anxiety and depression: two different responses from the same brain
Anxiety is an alarm system. The brain anticipates a threat that has not happened yet and prepares the body to respond: heart rate rises, muscles tense, attention narrows. It looks forward and asks "what if…?".
Depression is the opposite: a system pulling the shutters down. The brain reduces available energy, switches off the capacity to anticipate pleasure and slows thinking. It looks backwards, or at a flat present, and the typical sentence is not "what if…?" but "what's the point".
They are also the two most common mental health problems in the world. The World Health Organization estimates that around 301 million people live with an anxiety disorder and roughly 280 million with depression. Being common does not make them something to put up with.
Six differences that help you tell them apart
Where your head is pointing
With anxiety, thoughts run to the future: the email still unanswered, what your boss will say on Monday, what could go wrong on the trip. With depression, the mind stays in the present or the past, with the tone of a negative balance sheet: what you did wrong, what you are no longer, what was lost.
What the body does
This is the most visible contrast. Anxiety activates: racing heart, tension in the neck and jaw, a knotted stomach, the sense of not being able to sit still. Depression deactivates: heaviness, slowness in moving and speaking, the feeling that the body costs twice what it should.
How sleep breaks
With anxiety the problem is usually at the start of the night: falling asleep is hard because the head will not switch off. With depression comes early waking, opening your eyes at four or five in the morning unable to get back to sleep, or the opposite pattern, sleeping many hours and getting up just as tired.
What happens with pleasure
This is the difference clinicians find most useful. With anxiety, if you manage to switch off for a while, you still enjoy things: a series, dinner with friends, a walk. In depression comes anhedonia: you do exactly what you always did and nothing reaches you. The plan goes well, and it makes no difference.
How the future looks
Anxiety sees the future as a threat: full of things that could go wrong. Depression sees it as empty: it is not that it will go badly, it is that it will not go at all. That nuance, threat versus emptiness, is often a good guide.
Why you stop doing things
Both lead to avoidance, but for different reasons. With anxiety you avoid out of fear: you skip the meeting because speaking terrifies you. With depression you do not go because you cannot face it: there is no fear, there is no fuel.
The symptoms they share, which is why they get mixed up
If you only look at this list, telling them apart is impossible:
- Concentration problems and a sense that your memory has got worse.
- Irritability: little patience with anyone, especially at home.
- Tiredness that sleep does not fix.
- Physical complaints with no clear medical cause: headaches, odd digestion, muscle tension.
- Appetite changes, in either direction.
- The urge to withdraw, even if the underlying reason differs.
That is why differential diagnosis is not made from a single symptom but from the whole picture: what predominates, how it started, what keeps it going.
When they come together: the mixed picture
What shows up most often in practice is not one or the other but both. Epidemiological studies find that around half of people with depression also meet criteria for an anxiety disorder, and the relationship runs in both directions.
There is usually a recognisable sequence. Someone spends months with high anxiety, sleeps badly, burns out, starts performing worse, withdraws from what they enjoyed to "save energy" and, through that withdrawal, low mood eventually appears. Or the reverse: a depression that generates constant worry about everything being left undone.
Having both does not complicate treatment as much as it sounds. Cognitive behavioural therapy works well with both, and many of its tools serve either one.
How to find out which weighs more in your case
This is where a couple of screening questionnaires save weeks of doubt. The point is not to diagnose yourself but to have two numbers to compare.
Take both, even if you think you only have one. The Anxiety Test is built on the structure of the GAD-7 and measures worry, physical symptoms and avoidance over the last two weeks. The Depression Test draws on the PHQ-9 and measures mood, motivation, sleep, energy and thoughts. Each takes about four minutes, both are anonymous and both are scored on your own device.
Then compare. If one comes out clearly higher, you have a direction. If both come out moderate or high, a mixed picture is the likely answer, and it is worth saying exactly that in the appointment. And if both come out low but you still feel unwell, try the Stress Test or the Insomnia Test: sometimes the main problem is another one. They are all in the psychological tests catalogue, and the guide on the Mental health test: what it measures, which ones exist and how to read your result explains how these questionnaires are built and how to read the score without over-reading it.
Other things that look like both
Before assuming it is anxiety or depression, it is worth ruling out a few conditions that mimic them:
- Thyroid problems. An overactive thyroid produces nervousness, palpitations and insomnia; an underactive one, tiredness, slowness and low mood. A blood test settles it.
- Anaemia and deficiencies of iron or vitamin B12, which cause fatigue and brain fog.
- Chronic insomnia. Sustained poor sleep on its own produces irritability, sadness and concentration problems.
- Grief. Sadness after a loss is not depression, although it can turn into it. Grief comes in waves and keeps moments of relief.
- Undiagnosed ADHD, especially in adults who have spent years compensating and arrive exhausted and anxious.
- Alcohol or cannabis use, which disrupts sleep and mood more than people tend to admit.
That is why, when there are physical symptoms, the first step is usually a visit to your GP. MedlinePlus has straightforward information about when to seek help.
What to do with each one
If anxiety weighs more, the treatment with the strongest evidence is cognitive behavioural therapy with graded exposure: approaching what you avoid step by step, instead of waiting to stop being afraid. Alongside it come work on anticipatory thoughts and techniques for bringing the body's activation down.
If depression weighs more, the central tool is different: behavioural activation. It means recovering activity and contact before you feel like it, because in depression motivation does not come first, it comes after. It is combined with work on thoughts of worthlessness and hopelessness.
If both are present, you start with whichever is more disabling, and often progress happens in parallel. In moderate or severe cases, combining psychotherapy with medication prescribed by a psychiatrist usually gives better results than either alone.
And one situation cannot wait: if thoughts of harming yourself appear, or thoughts that it would be better not to carry on, call the 024 line in Spain (free, confidential, around the clock), 112, or your local emergency number. If what you need is to take the step of booking an appointment and you do not know where to start, the guide on When to see a psychologist: signs, common doubts and what happens in the first session explains what happens in a first session.
If your result worries you or you want a professional assessment, you can talk to Xènia Capel Salcedo, a licensed psychologist (COPC reg. 14982), who offers a free first consultation call and online therapy from anywhere.
MyPsicoTest team · Updated:
FAQ
Frequently asked questions
How do I know whether I have anxiety or depression?
Look at two things: whether your body is wound up or shut down, and whether you still enjoy anything when you manage to switch off. Anxiety usually means an activated body with pleasure intact; depression, a slow body and pleasure that does not arrive. Taking both screening tests and comparing the scores is the quick way to orient yourself.
Can you have both at the same time?
Yes, and it is the most common scenario. Around half of people with depression also show anxiety symptoms. Having both does not mean you are worse off or that treatment is harder: cognitive behavioural therapy addresses both.
Which one is more serious?
Neither is by definition. What determines severity is how much it interferes with your life and for how long. Anxiety that stops you leaving the house is more disabling than mild depression, and the other way round.
Can anxiety turn into depression?
One does not transform into the other, but anxiety sustained for months is a clear risk factor for a depressive episode appearing. Exhaustion, poor sleep quality and the gradual abandonment of activities that used to bring pleasure explain much of that shift.
Can online tests tell me which one I have?
No. A test is a screening tool: it estimates whether your symptoms resemble those of a condition and how intense they are. The diagnosis is made by a licensed professional after an interview, reviewing your history and ruling out medical causes. What the test does give you is a concrete starting point for that conversation.
How long does it take to feel better?
With appropriate treatment, most people notice changes within the first six to eight weeks, for both anxiety and depression. Full courses usually run eight to twenty sessions, with periodic reviews to check that progress is happening.
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