By We Level Up FL Treatment Center | Editor Yamilla Francese | Clinically Reviewed By Lauren Barry, LMFT, MCAP, QS, Director of Quality Assurance | Editorial Policy | Research Policy | Last Updated: December 19, 2022
Difference Between Anxiety and Depression – Mixed Anxiety and Depressive Disorder
The fact that one term denotes a single sickness while the other denotes a collection of ailments is a significant distinction between anxiety and depression.
In reality, depression is one illness. There are numerous distinct symptoms (see below). And different people may experience it very differently. However, the term “depression” only refers to one illness.
The word “anxiety” can indicate a number of different things. We all experience anxiety occasionally, and the word “anxiety” can be used to describe that feeling simply. However, when we use the word anxiety in a medical context, it actually refers to anxiety disorder.
Some less frequent conditions are included under anxiety. These include panic disorders and phobias. However, generalized anxiety disorder is the most prevalent (GAD). In the US, a generalized anxiety disorder may affect four to five out of every 100 persons. In this post, we’ll concentrate on generalized anxiety.
What is Anxiety Disorder?
According to The National Institute on Mental Health, periodic anxiety is a standard component of life. When faced with a challenge at work, before a test, or before making a crucial decision, you could experience anxiety. However, anxiety disorders involve more than just passing apprehension or terror.
Anxiety and depression difference: It’s critical to get anxiety treatment as soon as possible since, for someone with an anxiety condition, the anxiety does not go away and can worsen over time. The symptoms might affect daily tasks like work performance, academic progress, and interpersonal connections. Generalized anxiety disorder, panic disorder, and various phobia-related disorders are only a few of the several types of anxiety disorders.

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- Difference Between Anxiety and Depression – Mixed Anxiety and Depressive Disorder
- Depression Fact Sheet
- Depression and Anxiety Statistics
- Mixed Anxiety Depressive Disorder
- Adjustment Disorder With Mixed Anxiety and Depressed Mood Criteria
- Adjustment Disorder With Mixed Anxiety And Depression: Different Types
- Adjustment Disorder With Mixed Anxiety And Depressed Mood Treatment Plan
- We Level Up Dual Diagnosis Treatment
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Anxiety and depression difference: People with a generalized Anxiety disorder (GAD) display excessive Anxiety or worry, most days for at least 6 months, about many things such as personal health, work, social interactions, and everyday routine life circumstances. Fear and Anxiety can cause significant problems in areas of their life, such as social interactions, school, and work.
What is Depression?
Depression (also known as Major Depressive Illness or Clinical Depression) is a common but significant mood disorder, according to the National Institute of Mental Health. It produces severe symptoms that interfere with your ability to function on a daily basis, including sleeping, eating, and working. The signs of depression must last for at least two weeks before a diagnosis may be made.
Depression treatment is required when depressive symptoms are chronic and do not go away since some types of depression are slightly different or may arise in unusual situations.
Types of Depression
- Persistent depressive disorder (also called dysthymia): is a depressed mood that lasts for at least two years. A person diagnosed with persistent depressive disorder may have episodes of major Depression along with periods of less severe symptoms, but symptoms must last for two years to be considered a persistent depressive disorder.
- Psychotic Depression: occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive “theme,” such as delusions of guilt, poverty, or illness.

- Bipolar disorder: is different from Depression, but it is included in this list because someone with bipolar disorder experiences episodes of extremely low moods that meet the criteria for major Depression (called “Bipolar Depression”). But a person with bipolar disorder also experiences extreme high – euphoric or irritable – moods called “mania” or a less severe form called “hypomania.”
- Postpartum Depression: is much more serious than the “baby blues” (relatively mild depressive and anxiety symptoms that typically clear within two weeks after delivery) that many women experience after giving birth. Women with postpartum Depression experience full-blown major Depression during pregnancy or after delivery (postpartum depression). The feelings of extreme sadness, anxiety, and exhaustion that accompany postpartum depression may make it difficult for these new mothers to complete daily care activities for themselves and/or their babies.
- Seasonal affective disorder: is characterized by the onset of Depression during the winter months, when there is less natural sunlight. This Depression generally lifts during spring and summer. Winter Depression, typically accompanied by social withdrawal, increased sleep, and weight gain, predictably returns every year in seasonal affective disorder.
- SAD Seasonal Depression (Depressed SAD): A form of depression known as seasonal affective disorder (SAD) is triggered by the changing of the seasons; it starts and ends about at the same periods each year. If you have SAD like the majority of people do, your symptoms begin in the fall and last through the winter, draining your energy and making you cranky. Typically, these symptoms go away in the spring and summer. SAD less frequently results in depression in the spring or early summer and clears up in the fall or winter. SAD treatment options include medications, psychotherapy, and light therapy (phototherapy).
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FREE 24/7 Dual Diagnosis Mental Health Services HotlineDepression Fact Sheet
Depression Overview
Depression is a group of illnesses like depression or bipolar disorder that are connected to mood elevation or depression
Types of Depression
- Clinical Depression: A mental health disorder characterized by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.
- Persistent depressive disorder: A mild but long-term form of depression.
- Bipolar disorder: A disorder associated with episodes of mood swings ranging from depressive lows to manic highs.
- Bipolar II disorder: A type of bipolar disorder characterized by depressive and hypomanic episodes.
- Postpartum depression: Depression that occurs after childbirth.
Depression Treatments
- Support group: A place where those pursuing the same disease or objective, such as weight loss or depression, can receive counseling and exchange experiences.
- Cognitive behavioral therapy: A conversation treatment that aimed to change the negative attitudes, actions, and feelings connected to psychiatric discomfort.
- Counseling psychology: A subfield of psychology that handles issues with the self that are connected to work, school, family, and social life.
- Anger management: To reduce destructive emotional outbursts, practice mindfulness, coping skills, and trigger avoidance.
- Psychoeducation: Mental health education that also helps individuals feel supported, validated, and empowered
- Family therapy: psychological counseling that improves family communication and conflict resolution.
Depression and Anxiety Statistics
It’s critical to understand the distinction between anxiety and depression. Anxiety, in its most basic form, is an excessive feeling of worry, whereas depression, in its most basic form, is an excessive feeling of worthlessness and hopelessness. It is conceivable for someone to experience depression and anxiety simultaneously.
6.8 million
GAD affects 6.8 million adults or 3.1% of the U.S. population, yet only 43.2% are receiving treatment.
Source: National Institute on Mental Health
19 million
19 million adults experience specific phobias, making it the most common anxiety disorder in America.
Source: ADAA, 2020
17.3 million
Major depressive disorder affects approximately 17.3 million American adults or about 7.1% of the U.S. population aged 18 and older.
Source: National Institute of Mental Health

What is Mixed Anxiety and Depressive Disorder? Mixed Anxiety Depressive Disorder
For the most part, depression and anxiety may appear to be quite different.
The primary sign of depression is often a persistent low, depressed, or hopeless mood, whereas the major sign of anxiety is an abundance of worry, uneasiness, and fear.
But certain crucial symptoms are indeed common to these ailments. Some people with depression may experience more irritability than sadness, as anxiety, for instance, frequently entails irritability.
You might not always understand what your symptoms signify because these disorders might manifest themselves in different ways depending on the individual.
Additionally, it is conceivable to experience both depression and anxiety simultaneously: According to a global poll conducted in 2015, 41.6% of respondents said they experienced both serious depression and an anxiety condition over a 12-month period.
What is a crucial similarity between anxiety and depression? With assistance from a mental health professional, both can get better.
We’ll break down the primary symptoms and warning signs of each condition below, as well as provide some coping mechanisms and advice on where to get support.
Mixed Depression and Anxiety Disorder: Overlapping Symptoms
Although it’s crucial to keep in mind that not everyone who has depression, anxiety, or both disorders will have the same symptoms, the two conditions frequently share a number of them.
You might have the following mixed anxiety and depressive disorder symptoms:
- Changes in sleep patterns
- Changes in energy level
- Increased irritability
- The trouble with concentration, focus, and memory
- Aches and pains or stomach issues that have no clear cause
Rumination can also happen with both conditions. In basic terms, rumination refers to a persistent loop of dark, sad, or other negative thoughts. You may not want these thoughts, but you still can’t seem to stop thinking about them.
With anxiety, you might find yourself:
- Stuck in a cycle where you explore, over and over, all the possible ways a situation could go wrong
- Unable to stop thinking about all the things worrying you, even when you know you can’t do anything about them
With depression, you might find yourself:
- Fixating on guilt about not having the energy to spend time with friends
- Going over and over past events and blaming yourself for things you have no control over, including feelings of depression
Get tips on breaking a cycle of rumination.

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Hotline (855) 940-6125Adjustment Disorder With Mixed Anxiety and Depressed Mood Criteria
Adjustment disorder is a transient illness. An individual who exhibits an excessive response to a stressful or distressing situation is diagnosed with it.
Stressors might consist of a single incident (such as a painful breakup) or a series of occurrences (like work problems, struggles at school, or financial issues). Stressors can affect a single person, a family, or an entire community (such as disaster survivors). Additionally, stressors may be recurring (such elements linked to seasonal business) or tied to certain “milestone” occasions (like going to school, getting married, or retiring).
Situational depression is another name for adjustment disorder.
Adjustment Disorder With Mixed Anxiety And Depressed Mood DSM-5
The DSM-5 defines adjustment disorder as “the presence of emotional or behavioral symptoms in response to an identifiable stressor(s) occurring within 3 months of the onset of the stressor(s)” (American Psychiatric Association, 2013).
In addition to exposure to one or more stressors, other DSM-5 criteria for adjustment disorder must be present. One or both of these criteria exist:
- Distress that is out of proportion with expected reactions to the stressor
- Symptoms must be clinically significant—they cause marked distress and impairment in functioning
Further, these criteria must be present:
- Distress and impairment are related to the stressor and are not an escalation of existing mental health disorders
- The reaction isn’t part of normal bereavement
- Once the stressor is removed or the person has begun to adjust and cope, the symptoms must subside within six months.
Adjustment Disorder Mixed Anxiety and Depression: How Common is Adjustment Disorder?
Adjustment disorder is thought to affect 2 to 8% of the general population. It can affect anyone at any age. It affects twice as many females as males.
Adjustment Disorder With Mixed Anxiety And Depressed Mood: Causes
There are many possible causes of adjustment disorders. Generally, it’s any situation you perceive as stressful and that causes significant problems in your work, social, or home life. They can be both positive and negative events.
Some examples include:
- Death of a family member or friend.
- Relationship issues, including breakups, marital problems, and divorce.
- Getting married; having a baby.
- Serious health issues.
- School issues.
- Financial difficulties.
- Work issues (job loss, failing to meet goals).
- Living in a crime-ridden neighborhood.
- Retiring.
- Disaster or unexpected tragedy.
Your personality, temperament, well-being, life experiences and family history are all also thought to play a role in the possible development of adjustment disorder.
Adjustment Disorder With Mixed Anxiety And Depressed Mood Symptoms
Varied people will have different experiences with adjustment disorders. Depending on the severity of the triggering event and its personal relevance for you, symptoms can range from moderate to severe.
Typical physical signs:
- Being tired, but can’t sleep (insomnia).
- Body aches and soreness; thinking that you’re sick.
- Headaches or stomachaches.
- Heart palpitations.
- Sweating hands.
Common behavioral or emotional symptoms:
- Acting rebellious, destructive, reckless, or impulsive.
- Being anxious or agitated, feeling trapped, hopeless.
- Crying easily.
- Trouble concentrating.
- Being withdrawn or isolated; feeling sad; lacking energy or enthusiasm; loss of self-esteem.
- Loss of interest in everyday activities.
- Changes in eating habits.
- Feeling overwhelmed and stressed.
- Abusing alcohol or drugs.
- Having suicidal thoughts or behaviors.
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Adjustment Disorder With Mixed Anxiety And Depression: Different Types
The DSM-5 lists six types of adjustment disorders:
- Adjustment disorder with depressed mood: Symptoms include feelings of sadness, hopelessness, crying, and lack of joy from previous pleasurable things.
- Adjustment disorder with anxiety: Symptoms include feeling worried, anxious, and overwhelmed. You also have trouble concentrating. Separation anxiety is a dominant symptom in children.
- Adjustment disorder with mixed anxiety and depressed mood: Symptoms include feeling both anxious and depressed.

- Adjustment disorder with disturbance of conduct: Symptoms include behavioral issues such as acting rebellious, destructive, reckless, or impulsive.
- Adjustment disorder with mixed disturbance of emotions and conduct: Symptoms include anxiety, depression, and behavioral issues.
- Adjustment disorder unspecified: Symptoms include physical symptoms such as headaches, body aches, stomach aches, heart palpitations, or insomnia.
Adjustment Disorder Mixed With Anxiety And Depressed Mood: Complications
People with adjustment disorders are more likely to attempt suicide or have suicidal thoughts if they are not addressed. Call your healthcare professional if your symptoms get so severe that you find it difficult to get through the day. Get treatment right now if you’re having suicidal thoughts. Dial 800.273.TALK to reach the National Suicide Prevention Lifeline (800.273.8255).
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Anxiety And Anger: Can Anxiety Cause Anger?
Anxiety causing anger: In the wide range of human emotions, two are particularly connected to one another and to surviving. The worry or fear you experience in response to a perceived threat is called anxiety. Although it is accompanied by a strong sense of displeasure, anger is also a danger response.
Anger anxiety and irritability are signs of physical and mental health conditions, including depression, bipolar disorder, anxiety, and post-traumatic stress disorder (PTSD). These two emotions, according to researchers, may be crucial in influencing how we perceive and respond to risk. But do rage and anxiety share any additional connections?
Anger And Anxiety: How are these two emotions connected?
There are several areas where rage and anxiety coexist. Both emotions send powerful hormones into your system, which then result in physical discomfort. Both can be set off by typical events. Your mental habits can help or hurt both of these things. Here is what we know about the relationship between rage and anxiety.
Anxiety Anger: Part of the human condition
Everyone becomes irate. Everybody has occasional anxiety. In truth, there are instances when worry makes sense and rage is a healthy reaction that can spark significant change.
Anxiety and fury may even seem to be the new normal during times of increased stress and tension when issues in your personal life are compounded by happenings in the outside world.
Anger Anxiety: Same physiological symptoms
When you’re angry or anxious, your body secretes hormones, including cortisol and adrenaline, that prepare you to fight or flee. During anxious or angry moments, you’re likely to experience:
- Rapid heart rate
- Chest tightness
- Clenched or tight muscles
- Rushes of heat
- Gastrointestinal symptoms like diarrhea
- Tension headaches
These symptoms will dissipate quickly under normal circumstances. But if you have long-term issues with anger or anxiety, the release of these hormones over and over may lead to health problems.
Anger Anxiety Attack
The symptoms of a panic attack and an angry outburst are very similar. Researchers have noted that both cause many of the same abrupt, powerful, and emotional feelings. However, they also point out certain variations.
Researchers contend that rather than the fear and anxiety that are frequently linked to panic attacks, fury episodes typically take place in circumstances when a person feels emotionally trapped.
Additionally, there are characteristics specific to anger attacks, such as:
- Angry overreaction to small irritations
- Inappropriate anger directed toward others
- Irritable feelings in the past 6 months
- One or more anger attacks experienced in the past month
Anger attacks can also be a symptom of numerous health conditions, including:
- Alcohol misuse: Misusing alcohol makes it more difficult to control your emotions.
- Attention-deficit/hyperactivity disorder (ADHD): People with ADHD often experience greater emotional intensity.
- Bipolar disorder: Mania in bipolar disorder can cause extreme anger over a mild irritant.
- Depression: Many people with depression experience anger attacks as a result of common annoyances.
- Grief: It is common for people to experience anger attacks after the loss of a loved one.
Stress, problems with money, work or relationships, lack of sleep, and even being frustrated with having panic disorder, agoraphobia, or another sort of anxiety illness are just a few of the many causes that can cause anger attacks.
On the other hand, panic episodes can be sudden, unprovoked, or triggered by thinking about or being around something you fear. For instance, panic attacks are frequently experienced by those who have phobias, such as a fear of flying, a fear of small spaces, or a dread of public speaking. Additionally, anger can exacerbate and worsen panic attack symptoms.
Does Anxiety Cause Anger? Same psychological roots
Anxiety and rage have been linked by psychologists to a loss of control. In other words, you might feel apprehensive when you encounter a stressor that you feel unprepared to handle.
Anger can emerge quite quickly from worry if you feel even more threatened. Both times, an external stimulation puts your sense of security and environmental control in jeopardy. Anger can just be worry with more chemical energy.
Angry people who haven’t learned how to vent their anger in a healthy way could have protracted anxiety, according to some psychologists.
Anger From Anxiety: Effect on health
It can be a good idea to get treatment if your anger and anxiety feel out of control or if others have expressed concern about how you handle them. Your emotional and physical health may be negatively impacted by excessive anger and worry.
For instance, researchers have discovered that depression and anxiety disorders are both associated with higher levels of rage. According to additional research, excessive fear and rage might cause:
- Lung problems, including worsened asthma
- Headaches
- Heart diseaseTrusted Source
- Fatigue
- High blood pressure
- Insomnia
Anger Anxiety And Depression (Anger Depression Anxiety)
The two most prevalent mental health issues in the nation are anxiety and depressive disorders. In the United States, 16.2 million adults experience depression each year, and 40 million adults suffer from anxiety disorders. Each year, many children and teenagers also experience similar diseases.
There are many misconceptions about how persons with depression and anxiety behave, despite the fact that both conditions are rather common. For instance, it’s a common misconception that people with depression only feel depressed or hopeless and that persons with anxiety disorders only have panic attacks. However, both of these illnesses can lead to irrational wrath.
Since anger is seen as a secondary emotion, it is a response to other emotions. For instance, when someone experiences fear and panic repeatedly over an extended length of time, that person may begin to feel annoyed by the emotion.
The person could become angry and react violently to seemingly unimportant occurrences as a result. Others may assume that the sufferer only has anger problems. However, the actual offender is anxiety.
How To Deal With Anger And Anxiety? Anxiety And Anger Outbursts
How To Control Anger And Anxiety? Cognitive behavioral therapy
The foundation of cognitive behavioral therapy (CBT) is the idea that your anxiety and anger may be exacerbated by unhelpful thought patterns.
You might be able to pinpoint the causes of your anxiety or anger by working with a CBT-trained therapist. You can develop your ability to recognize thoughts that are distorting the way you see the world.
Once you’ve identified them, you can learn to change the way you think to better control your anger and anxiety. Although there is no quick answer to these problems, evidence demonstrates that CBT is particularly beneficial in addressing long-term anxiety and anger problems.
Anxiety And Anger Medication (Medication For Anger And Anxiety)
Medication for anxiety and anger: certain antidepressants, such as selective serotonin reuptake inhibitors, can be used to treat rage (SSRIs). SSRIs are frequently given to treat mental health issues including anxiety and depression, but they have also been used to treat anger or irritability symptoms.
SSRIs including citalopram (Celexa), fluoxetine (Prozac), and sertraline (Zoloft), among others, have been demonstrated to reduce anger. Most evidence appears to be in favor of sertraline. Serotonin-norepinephrine reuptake inhibitors (SNRIs), a family of antidepressants, aren’t frequently used to alleviate rage.
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Anxiety And Anger Management – Anxiety Anger Issues (Anger Anxiety)
Consult a mental health professional if you feel that your anger is out of control and is negatively affecting your life and relationships. You can engage with a psychologist or other qualified mental health expert to better understand the root reasons for anger and to create strategies for altering your thinking and behavior.
You can get help from a professional to manage your anger in a healthy way. Make sure to choose a therapist carefully and go to someone who has received training in assertiveness and anger management if you need therapy.
How To Help Someone With Anger Anxiety? Anger Anxiety
- Stay calm
- Try to listen to them
- Give them space
- Set boundaries
- Help them identify their triggers
- Support them to seek professional help
- Look after your own well-being
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Adjustment Disorder With Mixed Anxiety And Depressed Mood Treatment Plan
It might occasionally be more difficult to treat co-occurring depression and anxiety than one disorder on its own. Even if you receive treatment for one ailment, several symptoms may continue or interact with one another.
For instance:
- You can’t stop thinking about how many things are going wrong in your life or how they might get worse. Your energy and motivation to keep trying eventually become depleted by these anxieties, leaving you feeling depressed and hopeless.
- You are unable to interact with people the way you would like to because of social anxiety. You want to meet new people, yet you usually end yourself avoiding social situations. You are left feeling alone, depressed, and guilty as a result, especially when you consider the squandered possibilities, yet you are powerless to change anything.
A mental health care provider might suggest combining different treatment modalities because what reduces anxiety and depression symptoms may not always reduce depression symptoms and vice versa.
Potential remedies for depression and anxiety include:
Mixed Anxiety-Depressive Disorder Therapy
Therapy comes in a variety of forms and can be used to treat depression or anxiety.
For instance, interpersonal therapy for depression teaches you how to communicate effectively to express yourself and meet your emotional needs. Phobias are a sort of anxiety that can be treated using exposure therapy, a method that helps you become more at ease in dreaded situations.
Other methods are available to address both conditions:
- Cognitive behavioral therapy (CBT) teaches techniques to identify, challenge, and reframe unwanted thoughts and behavior patterns.
- Mindfulness-based cognitive therapy teaches mindfulness techniques along with behavioral techniques to help you begin to manage unwanted feelings and stay present through them instead of becoming overwhelmed.
- Acceptance and commitment therapy teaches strategies to accept unwanted or distressing thoughts, stay present, and commit to positive activities that fulfill your personal values.
- Problem-solving therapy. This approach teaches using coping skills to manage mental health symptoms and life experiences that cause stress and other emotional turmoil.
Mixed Anxiety and Depressive Disorder Medications
Additionally, psychotropic drugs can lessen the signs and symptoms of anxiety and depression. But because it doesn’t help you deal with the root of those symptoms, your physician or psychiatrist will typically advise a therapy in addition to medication.
A therapist, such as a psychiatrist, might suggest:
- Antidepressants: include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). In some cases, these medications may also relieve anxiety symptoms.
- Anti-anxiety medications: including benzodiazepines, buspirone (Buspar), and beta-blockers. These medications can ease anxiety symptoms but may not improve depression symptoms. Benzodiazepines also carry a high risk of dependence, so your prescriber may try other medications first.
- Mood stabilizers: These medications may help treat depression symptoms that don’t respond to antidepressants alone.
We Level Up Dual Diagnosis Treatment
The exact definition of dual diagnosis (also referred to as co-occurring disorders) can differ between institutions. However, it is generally described as the specific treatment of someone who has been diagnosed with a substance use disorder and a mental health disorder at the same time.
Treating dual-diagnosis clients is a critical aspect of our inpatient treatment experience because co-occurring disorders are strongly correlated with instances of substance abuse. Creating a treatment plan that addresses the physical aspects of withdrawal, the psychological connection with drug use, and managing underlying mental health disorders is part of setting clients up for success.
A thorough mental health analysis identifies possibilities for treatment. Meeting with mental health counselors and medical care providers means access to behavioral therapy and medication treatment.
At our dual diagnosis treatment center, We Level Up can implement the highest quality of care. We recognize the fragile complexities of how mental and substance abuse disorders can influence others and sometimes result in a vicious cycle of addiction. That’s why we offer specialized treatment in dual-diagnosis cases to provide the most excellent chance of true healing and long-lasting recovery.
It can be challenging to accept that you may be living with a mental illness, but once it is properly diagnosed and treated, treating the presenting case of substance abuse can be magnitudes easier. Only a properly trained medical professional can diagnose these underlying conditions. If you believe you are suffering from a disorder alongside addiction, we urge you to seek a qualified treatment center to begin your journey to recovery. Call We Level Up today.
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Sources
[1] National Institute of Mental Health – ‘Depression’ (www.nimh.nih.gov)
[2] U.S. Food and Drug Administration (FDA) (www.fda.gov/)
[3] Depression Treatment » Drug Alcohol Addiction Rehab
[5] NIMH – https://www.nimh.nih.gov/health/publications/social-anxiety-disorder-more-than-just-shyness
[6] Selective Serotonin Reuptake Inhibitors – National Center for Biotechnology Information, U.S. National Library of Medicine
[7] ‘Anxiety Disorders’ – National Institute Of Mental Health (Nimh.nih.gov)
[8] Psychopharmacology of anxiety disorders – National Center for Biotechnology Information, U.S. National Library of Medicine
[9] Products – Data Briefs – Number 379 – September 2020 (cdc.gov) Depression – National Institute of Mental Health
[10] Coping with Stress – Centers for Disease Control and Prevention