Depression and social anxiety

The short answer

Social anxiety and depression often occur together. In most people, social anxiety comes first, often in the teenage years. Depression may follow years later.

It is easy to see why. Social anxiety can cut you off from friends, chances and the things that make life feel good. Over time, that loss and loneliness can turn into low mood and hopelessness.

The good news: both are treatable, and treating social anxiety early may lower the risk of depression.

What the research shows

• Social anxiety raises the risk of depression. In Munich, Germany, a study followed 2,548 young people aged 14 to 24. Those who had social anxiety at the start had 3.5 times the odds of developing depression later.
• Together, they are harder. The same study compared young people who had both with those who had depression alone. With both, the odds that the depression would last or come back were 2.3 times higher. They also had much higher odds of a suicide attempt (6.1 times). This is why low mood alongside social anxiety should always be taken seriously.
• Social anxiety usually comes first. It starts early, by age 11 in about half of cases, and is a known risk factor for later depression and substance problems.
• Depression slows recovery. In a 12-year US study, depression made recovery from anxiety less likely. In a trial of CBT and acceptance therapy, people who also had depression did less well.
• Having more than one condition is common. In a study of young people posting about diagnosed social anxiety, 61% mentioned at least one other condition.

How to tell if it is depression too

Social anxiety on its own can make you sad about what you are missing. Depression is more than that. Signs include, for most of the day, most days, for two weeks or more:

• feeling low, empty or hopeless;
• losing interest or pleasure in things you used to enjoy, even things you do alone;
• sleeping much more or much less;
• feeling tired with no energy;
• changes in appetite;
• feeling worthless or guilty;
• finding it hard to concentrate;
• thoughts of death or suicide.

A useful question: do you still enjoy things when you are alone and safe? If social anxiety is the main problem, solo activities often still bring pleasure. If depression has set in, enjoyment fades everywhere.

How the two feed each other

• Social anxiety → avoiding people → loneliness and fewer good moments → low mood.
• Low mood → less energy and more self-criticism → even less contact → more fear of being judged.

The loop runs both ways. Breaking it at any point helps.

What helps

• Tell your doctor about both. If you only mention low mood, the social anxiety underneath may be missed. See talking to your doctor.
• Medication. SSRIs are used for both social anxiety and depression. A doctor can tell you whether they suit you. Never start, stop or change a medicine without a doctor.
• Therapy. Cognitive therapy for social anxiety works on the fear. If depression is severe, a therapist may treat it first, or work on both together. Small steps back into contact with people often lift mood too.
• Watch the drinking. Alcohol can worsen both. See alcohol and social anxiety.

If you are struggling now

If you feel hopeless, or think the people around you would be better off without you, please reach out today. You can use text or chat services if phoning is too hard. See crisis lines.