Social anxiety and depression are two of the most commonly diagnosed mental health disorders in the United States.

Depression is characterized by persistent sadness, whereas social anxiety is an irrational fear of social interactions.

These are separate conditions, but they can co-occur, creating a unique challenge. In fact, for nearly 70 percent of individuals diagnosed with both disorders, social anxiety comes first, then depression.

In many instances, it’s the social anxiety that causes the depression.

A person with social anxiety may have trouble making friends and maintaining close relationships. Fear of social interaction may even result in missed opportunities. An inability to control the symptoms often leads to frustration, feelings of hopelessness, isolation, and ultimately depression.

Some people with social phobia also have a history of being bullied, rejected, or ignored. These experiences can affect their self-esteem and self-confidence, triggering depression later in life.

But although it appears that social anxiety is more likely to cause depression than the other way around, anxiety can also occur as a symptom of depression. So being depressed could potentially worsen an underlying social phobia.

To be diagnosed with social anxiety and depression, you must exhibit signs of both conditions at the same time. Social anxiety causes both physical and emotional symptoms before, during, or after social interactions.

symptoms of social anxiety

Physical symptoms include:

Emotional or psychological symptoms include:

  • fear of being embarrassed, rejected, or humiliated in public
  • low self-esteem
  • low self-confidence
  • avoidance of social settings
  • an inability to overcome social mistakes

Symptoms of social anxiety in children can differ from adults. A child may show some of the above symptoms.

Additionally, a child may also fear going to school, using a public bathroom, or reading out loud. They may also have tantrums or cry when uncomfortable in social settings.

There’s a cycle when social anxiety and depression co-occur. It starts with uncontrollable anxiety or an irrational fear in social settings. To avoid the physical, emotional, and psychological effects of this anxiety, you may withdraw from others.

Social anxiety is tricky. On one hand, you may want to make friends and share yourself with the world. But, on the other hand, you can’t overcome the overwhelming anxiety — so you avoid interactions with others whenever possible.

But while avoidance is one way to deal with anxiety, it can lead to other feelings like loneliness, guilt, shame, and ultimately depression.

symptoms of depression

In children, signs of depression can also include:

  • outbursts (tantrums and crying)
  • stomachaches
  • sensitivity to rejection
  • anger
  • poor academic performance

To answer this, think about how you feel after social interactions. Do you feel good about yourself or bad about yourself?

Keep in mind that everyone deals with awkward social interactions from time to time. It’s how you handle and cope with these interactions that can determine whether you have both.

A person who doesn’t have social anxiety can usually brush off an awkward social moment and move on.

For the socially anxious, however, the fear of embarrassment is too intense to brush off these types of incidents.

Often times, you can’t stop thinking about the mistake. You’ll replay it over and over in your head. You’ll convince yourself that you looked stupid or made a fool of yourself. The more you engage in this type of negative self-talk, the more socially inept and helpless you can feel.

If you can’t reign in these emotions, you may begin to experience depression as well.

Treatments are available to successfully improve social anxiety and depression when they occur together. If you’re diagnosed with both, your doctor may choose a therapy that works for both conditions.

Psychotherapy

Psychotherapy (talk therapy) can teach you how to replace negative thought patterns with positive ones. This is helpful for both social anxiety and depression.

With any type of treatment for depression, it helps to first identify issues that trigger sadness. In this case, the underlying problem is usually social anxiety. Therefore, your therapist may focus treatment on developing your social skills and building your confidence in social settings.

Changing your thought pattern helps put your fears in perspective

Cognitive behavioral therapy (CBT) is an effective type of psychotherapy. It helps you understand how your thoughts influence your feelings and behavior.

Since social anxiety is often fueled by irrational fears, one goal of therapy could be helping you develop a more realistic thought pattern. So, instead of always imagining worst-case scenarios with regard to social settings, you’ll learn how to focus on realistic outcomes.

An irrational fear would be thinking, “Everyone’s judging me,” or “I look stupid.”

A more realistic thought pattern would be: “Everyone’s nervous, and most people are too preoccupied with how they look and sound to be overly concerned about me.”

Other therapies

Your therapist may also recommend other therapies to address your fears, such as group therapy or exposure-based cognitive behavioral therapy.

Group therapy is an opportunity to practice social interactions in a safe, controlled environment. You can receive feedback from people who understand your struggles, and you’re able to talk openly without fear of judgement.

With exposure-based CBT, you’ll face your social fears under the guidance of a therapist. The exposure starts off simple, and then becomes more complex or intense over time.

This can include real-world exposure to fears, if possible. Or, your therapist may use vivid imagery with role-playing to help you develop the skills and confidence to handle different social situations.

Repeated exposure helps to gradually diminish social anxiety. Once you’re able to manage your anxiety, your depression and mood may improve.

Medication

Your therapist may use psychotherapy alone, or suggest that you speak with your provider about using an antidepressant.

Selective serotonin reuptake inhibitors (SSRIs) are often the first line of defense when treating social anxiety and depression. These include paroxetine (Paxil, Pexeva) and sertraline (Zoloft).

Your doctor can also prescribe a serotonin-norepinephrine reuptake inhibitor (SNRI) like venlafaxine (Effexor XR), as well as combine an anti-anxiety medication with an antidepressant.

Your doctor may begin by sending you for psychotherapy, before considering medication.

In addition to SSRIs and SNRIs, other medications used for anxiety include benzodiazepines like:

  • alprazolam (Xanax)
  • clonazepam (Klonopin)
  • diazepam (Valium, Diastat, Diazepam Intensol, and Diastat AcuDial)
  • lorazepam (Ativan and Lorazepam Intensol)

Anti-anxiety medications are short-term solutions. These can be habit-forming and they have a sedative effect on some people. They may also have dangerous interactions with alcohol.

Lifestyle remedies

Along with talk therapy and medication, lifestyle changes can assist your recovery.

For example:

  • avoiding alcohol and drug use, which can worsen symptoms of anxiety and depression
  • exercising for at least 30 minutes most days of the week
  • getting plenty of sleep
  • eating a balanced diet

It also helps to socialize with people you’re comfortable and familiar with in small settings. This can reduce loneliness and isolation, easing depression.

Use this as an opportunity to practice your new social skills.

Ask your doctor for a referral to a mental health professional if you have symptoms of social anxiety and depression.

finding a therapist in your area

These resources can help you find a mental health professional in your area:


Questions to ask a mental health professional:

  • How will you diagnose my condition?
  • Do you have experience treating people who have both anxiety and depression?
  • How soon can I expect to feel better?
  • What type of treatment or therapy do you think is right for me?
  • What are the risks and benefits of different treatments for social anxiety and depression?
  • What’s the success rate with treatment?

Living with symptoms of both social anxiety and depression can be challenging, but treatment is available. Between medication and therapy, you can learn practical skills to cope with both disorders and enjoy life.