Depression is characterized by persistent sadness, whereas social anxiety presents as an intense fear of social interactions.

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

While these are separate conditions, they can occur at the same time, creating a unique challenge. In fact, according to a 2014 review of studies, for nearly 70 percent of people diagnosed with both disorders, social anxiety comes first, then depression.

In many instances, social anxiety causes depression.

If you have social anxiety, you may have trouble making friends and maintaining close relationships. Fear of social interaction can even result in missed opportunities.

Without treatment, the symptoms of social anxiety often lead to:

  • frustration
  • feelings of hopelessness
  • isolation
  • depression

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

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

To be diagnosed with social anxiety and depression, you must show 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 in public
  • low self-esteem
  • avoiding eye contract
  • avoiding social settings
  • constantly worrying about everyday social situations

Symptoms of social anxiety in children can differ from adults. A child may show some of the above symptoms. Additionally, a child may fear:

  • going to school
  • using a public bathroom
  • reading out loud

They may also have tantrums or cry when uncomfortable in social settings.

There’s often a cycle when social anxiety and depression occur together. It starts with feeling intense anxiety or fear in social settings. To avoid the physical, emotional, and psychological effects of this anxiety, an individual may withdraw from others.

Living with social anxiety is often tricky. On one hand, you may want to make friends and share yourself with the world. On the other hand, you may feel as though you can’t overcome the overwhelming anxiety, so you avoid interactions with others whenever possible.

While avoidance is one way to deal with anxiety, it can lead to other feelings like:

  • loneliness
  • guilt
  • shame
  • depression
Symptoms of depression

In children, signs of depression can also include:

  • having a hard time paying attention
  • changes in eating patterns (eating too little or too much)
  • changes in energy levels (from higher energy to low or no energy)
  • anger
  • self-destructive behaviors

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. How you handle and cope with these interactions can determine whether you’re dealing with mental health challenges.

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

For someone living with social anxiety, however, the fear of embarrassment and genuine anxiety may feel too intense to even deal with a social situation. If you do find yourself in a social setting, you may feel like you’re being watched and judged the whole time.

If you suspect you’re dealing with symptoms of social anxiety, depression, or both, try to talk with a doctor or mental health expert. They can help you understand your symptoms and point you toward the best type of treatment.

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


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 things that trigger sadness. Social anxiety is a common underlying cause. Therefore, your therapist may focus treatment on developing your social skills and building your confidence in social settings.

Changing your thought patterns 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 behaviors.

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

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 focused on 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 therapy.

Group therapy is an opportunity to practice social interactions in a safe, controlled environment. You can receive feedback from people who understand what you’re going through, and you’re able to talk openly without judgment.

With exposure therapy, 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.

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


There are medications out there that may help with the symptoms of social anxiety and depression.

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.

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 often short-term solutions. Some of these medications can be habit-forming and have a sedative effect on some people. They may also have dangerous side effects when taken with alcohol.

Benzodiazepines carry a boxed warning because of the risk of dependence. Life threatening symptoms can occur if a person stops using them suddenly.

Lifestyle remedies

Along with talk therapy and medication, lifestyle changes can help your recovery, including:

  • avoiding alcohol and drug use, which can worsen symptoms of anxiety and depression
  • exercising regularly
  • getting plenty of sleep
  • eating a balanced diet

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

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

Finding a therapist in your area

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

Here are some questions you can ask a mental health professional when deciding if they’re a good fit:

  • 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 it’s important to know you are not alone. These two mental health conditions can often present together.

If you feel you’re living with the symptoms of social anxiety disorder, depression, or a combination of both, reach out to a doctor or mental health professional. They can help diagnose your condition and point you toward lifestyle changes, therapy, or medication.