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Anxiety and Depression Go Together Like Peanut Butter and Jelly

It’s important to recognize the signs of Anxiety with Depression, as both disorders would need to be adequately addressed.

"How does she have depression? She's not crying all the time."

"How could he be depressed? He's always laughing."

These are the questions peers may ask about their classmates, parents about their kids, and teachers about their students. The truth is, depression isn't always what people perceive it to be.

How to Recognize Depression

Depression often goes undiagnosed for these exact reasons. However, it is vital to recognize the signs of depression early on, as it is one of the most prevalent disabilities in the world. According to Mayo Clinic, some symptoms of depression are indeed more typical: feelings of sadness for a prolonged period of time, hopelessness, helplessness, and feelings of being worthless. They may feel that they will never get better, and that there is no light at the end of the tunnel.

Other symptoms of depression may be harder to recognize. For example, somatic symptoms, or physical aches and pains, is a common way MDD (Major Depressive Disorder, also referred to as Unipolar Depression) expresses itself. 

The reason depression is not always recognized is because it hides within a diagnosis of GAD. In other words, depression may be a secondary diagnosis to Anxiety. Data shows that at least 59% of individuals with GAD also meet the criteria for a secondary diagnosis for depression (Carter el al.). The core reason depression is masked by anxiety is because of the similarities between some (but not all) symptoms. When GAD is the primary diagnosis, many people don't realize it could also come with depressive features.

Together like a PB&J Sandwich

Let’s pretend the peanut butter is Anxiety, and the Jelly is Depression. These two normally go hand-in-hand to create the classic PB&J sandwich. Hypothetically, you could have a sandwich with only peanut butter or with only jelly, but it’s not rare to see people enjoying one with both together. Anxiety and Depression are the same - it’s actually quite common to see both Anxiety and Depression in a single individual.

In the end, many psychiatric disorders are comorbid, which means they are present in individuals simultaneously. When this is the case, both the primary and secondary need to be adequately treated. The more people who are educated about the high prevalence of this comorbidity, the more people who get help and live a better life. 

Getting help takes courage, and it is a good idea to get an evaluation from a qualified professional, like Dr. Sambunaris. To set up an appointment and confidential evaluation, call 770-817-9200.


Carter R, Wittchen H, Pfister H, Kessler R. One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depression and Anxiety. 2001; 13: 78-88. 1:STN:280:DC%2BD3Mris1eksQ%3D%3D. 10.1002/da.1020

Fresán, A., Robles-García, R., González-Castro, T. B., Pool-García, S., Tovilla-Zárate, C. A., Hernández-Díaz, Y., Juárez-Rojop, I. E., & López-Narváez, M. L. (2019). Masked Depression: Profile and Severity of Symptoms and Impulsivity in Patients with Generalized Anxiety Disorder. International Journal of Mental Health and Addiction, 19(2), 429–437.

About the author

Amanda Leekley serves as an intern at Dr. Sambunaris and Associates, as well as the Institute for Advanced Medical Research. She is pursuing her undergraduate degree in Psychology University of Georgia with a minor in Sociology. Long-term she hopes to complete graduate studies in Psychology, allowing her to teach in a higher education setting and lead clinical research studies with students.


Angelo Sambunaris, M.D.

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