Anxious Depression

We know that each patient is unique and has a personal history that affects their mental health and any mental health diagnosis they may develop. While the criteria mental health professionals use to identify a mental health diagnosis are objective, each diagnosis manifests differently for each person, which means there’s a great deal of individual variation even among patients with the same or similar diagnoses.

Two mental health diagnoses for which there are several sub-types include anxiety and depression. That’s why our approach to mental health treatment, which combines the latest evidence-based treatments with personalized support, gives our patients the best chance of treatment success.

Treatment programs at Relief Mental Health include:

  • Skilled, experienced team of caring and compassionate mental health treatment professionals
  • Innovative approaches for the treatment of anxious depression including transcranial magnetic stimulation (TMS), SPRAVATO®, and IV ketamine infusions
  • Medication management directed by licensed providers
  • Therapy and support with our team of committed and compassionate therapists
  • Custom-tailored, personalized treatment plans

We combine traditional approaches to treatment such as psychiatry, medication management, and talk therapy with new treatments like transcranial magnetic stimulation (TMS), SPRAVATO®, and IV ketamine infusions. Our wide range of treatment options increases the likelihood that all patients at Relief Mental Health meet their treatment goals and learn to successfully manage the symptoms of their mental health condition.

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What is Anxious Depression?

According to the Diagnostic and Statistical Manual of Mental Disorders, Volume 5 (DSM-V), the industry standard reference tool for mental health providers, anxious depression is a subtype of major depressive disorder.

When a patient meets all criteria for both major depression and anxiety, they have what’s called co-morbid – i.e. simultaneous – depression and anxiety, which is not the same thing as anxious depression.

To meet the criteria for anxious depression, an individual must first meet the clinical criteria for major depressive disorder (MDD). Next, they must also display at least two of the following symptoms on a majority of days during a major depressive episode:

  • Unusual tension or feeling keyed up
  • Unusual restlessness
  • Difficulty concentrating as a result of worry
  • Sense or fear something terrible will happen
  • Feeling a loss of control

Viewed alone, a clinician would label these symptoms as sub-threshold for a diagnosis of anxiety, which means they don’t meet the full clinical criteria for an anxiety diagnosis. However, in the presence of an MDD diagnosis, these symptoms increase the severity of depression, which leads to the distinct diagnosis of MDD with anxious distress. 

In addition to MDD with anxious distress, mental health professionals also recognize another manifestation of combined anxiety and depression called an anxious-depressive attack (ADA), which may lead to “a wide range of coping behaviors for emotional distress, including self-harm and overdose.”

Symptoms of an anxious-depressive attack (ADA) include:

  • Sudden, intense discomfort consisting of mixed emotions associated with anxiety and depression that peaks within one minute
  • Intense rumination – looking back – that includes rehashing negative memories, which lasts from 20 minutes to several hours
  • Excess and disruptive agitation during rumination
  • Shortness of breath
  • Increased heart rate

To meet the criteria for ADA, clinicians must conclude that these symptoms are not the result of acute stress, intoxication, or another medical or psychiatric condition. Anxious-depressive attacks can be intense, disruptive, and disorienting – and most people who experience them require professional support to learn to manage them.

The Consequences of Untreated Anxious Depression

When mental health diagnoses go untreated, it often leads to significant complications. When a complex condition like MDD with anxious distress – i.e. anxious depression – goes undiagnosed and untreated, the consequences can be severe.

Experts identify the following potential outcomes associated with untreated anxious depression:

  • Increased impact on family members and loved ones, especially children
  • Elevated mental anguish, i.e., an increase in negative emotions
  • Reduced quality of life
  • Decreased psychosocial function
  • Decreased cognitive function
  • Impaired work performance
  • Insomnia/disrupted sleep
  • Increased risk of heart disease
  • Increased risk of suicidal behavior

While the consequences of untreated anxious depression are serious, a diagnosis of MDD with anxious distress does not mean an individual will experience those consequences. In fact, in most cases of anxiety and MDD with anxious distress, patients respond well to evidence-based treatment.

How Relief Mental Health Can Help: Treatment for Anxious Depression

At Relief Mental Health, comprehensive care for depressive diagnoses and anxiety diagnoses – including anxious depression – includes a combination of medication, psychiatry/therapy, and – if indicated by an initial assessment – treatment with transcranial magnetic stimulation (TMS), SPRAVATO®, or IV ketamine infusions.

Transcranial Magnetic Stimulation (TMS)

Transcranial magnetic stimulation (TMS) is designed to treat depression, OCD, and other common diagnoses safely and effectively. TMS works by emitting gentle magnetic pulses to the area of the brain that regulates mood. These pulses activate specific areas of the brain and decrease symptoms of depression. Patients will sit comfortably in a chair during their 20-minute session and can drive themselves home after treatment.

TMS does not require anesthesia, hospitalization, and has no systemic side effects.

BrainsWay Technology

Relief Mental Health uses BrainsWay technology which has been demonstrated to have exceptional efficacy due to its broad and deep prefrontal stimulation. Unlike medication, the benefits of TMS are durable. This means that patients experience lasting remission of symptoms long after treatment has been completed. Even in cases where medications have not proven effective, TMS can help our patients overcome their symptoms.

TMS does not require…

anesthesia, hospitalization, and has no systemic side effects. During the 20-minute treatment session, patients sit in a comfortable chair and engage with our staff. This extra engagement during treatment helps improve the efficacy of treatment and yield better results compared to other TMS clinics. Patients are awake and alert throughout treatment but typically don’t experience any pain.


SPRAVATO® is a prescription medicine used to treat:

  • Adults with treatment-resistant depression (TRD)
  • Depressive symptoms in adults with major depressive disorder (MDD) and suicidal thoughts or actions
  • Other complex mental health conditions

SPRAVATO® (esketamine) is the first and only NMDA receptor antagonist approved for adults. It’s administered under medical supervision in one of our carefully designed therapeutic rooms. Your physical and mental health are expertly monitored during care.

SPRAVATO® demonstrates consistent safety across indications and can only be administered in a certified healthcare setting. Relief Psychedelics is an REMS-certified provider of SPRAVATO® for people with treatment-resistant depression.

SPRAVATO® is fast acting and effective.

While some treatments take weeks or months to yield results, patients often feel the positive benefits of SPRAVATO® within hours. For patients with severe anxiety symptoms, this fast-acting treatment can propel patients into remission quickly.

IV Ketamine Infusions

Evidence shows that intravenous (IV) infusions with ketamine have positive therapeutic effects.

Research on ketamine shows the following:

  • Ketamine can reduce symptoms associated with mental health conditions quickly
  • Patients with mental health symptoms experience long-lasting improvement with ketamine treatment

When a patient chooses IV ketamine treatment, the first step is either a virtual or in-person consultation to determine whether IV ketamine is an appropriate candidate for their diagnosis. New patients to Relief Mental Health can expect their initial consultation to last about an hour, while current Relief Mental Health patients using IV ketamine as a new treatment modality can expect their initial consultation to last about half an hour. After an initial consultation and if the patient is deemed clinically appropriate, an appointment is scheduled for the patient to return at his or her earliest convenience.

Psychiatry & Medication Management

From initial evaluation to medication management to psychotherapy referrals, our psychiatric team puts you on the right path to optimal mental health. On your first visit, we will review symptoms, personal history, treatment options, and life goals to create a plan that keeps you moving forward. At returning visits, we monitor progress as well as respond to any new treatment modalities. We’re here to help you achieve your goals every step of the way.

We see patients with established diagnoses that need continued psychiatric care as well as patients seeking a diagnosis for the first time. Psychiatric medication is not the right fit for everyone but many find success by adding medication to their plan of care. Because many psychiatric medications are long term, having a provider that specializes in this type of prescribing is crucial.

Our team of Psychiatrists, Nurse Practitioners, and Physician Associates have unique treatment experience. Finding the right provider can be the catalyst to great results. For more information about an individual provider call our intake line and we will match you with the right fit. 

Relief Mental Health offers both in office and telehealth visits to be able to provide flexibility that fits into your life. Our team will develop a treatment plan tailored to your diagnosis and needs.


Discover the tremendous things you’re capable of achieving and create a more fulfilling life with the help of a Relief therapist. Our staff consists of therapists with varied expertise that we carefully match with patients to help them become the best version of themselves. We will do a short intake and match you with the most appropriate therapist based on your goals, geography, availability, and diagnosis.

Therapy is beneficial for a variety of challenging diagnoses including but not limited to depression, anxiety, mood instability, sexuality issues, trauma, self-injury, eating disorders, coping with loss, stress management, and more. Depending on your diagnosis, we use a variety of evidence-based modalities such as CBT, DBT, ERP, ACT.

We offer both telehealth and in person appointments. Schedules, geography, and provider will help determine how we see you.

Depression: Facts and Figures


Prevalence of anxiety and anxiety diagnoses in the US:

Data from the National Institute of Mental Health (NIMH) shows the following prevalence rates for anxiety and anxiety disgnoses in the U.S.

In 2020, 19.1% of U.S. adults reported diagnosis of anxiety:

  • 23.4% of females
  • 14.3% of males
  • 22.8% reported serious impairment
  • 33.7% reported moderate impairment
  • 43.5% reported mild impairment

Evidence also shows:

Evidence also shows the following:

  • 31.1% of U.S. adults report an anxiety diagnosis at some time during their lives
  • 31.9% of adolescents aged 12-17 report anxiety
  • 6.2% of children aged 6-11 report anxiety
  • 40-60% of patients with MDD also display symptoms of anxiety
  • The anxious distress subtype of MDD is associated with greater depression severity, poor treatment response, lower overall function, and increased suicidality

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