The Link Between Social Anxiety and Depression

Jennifer E. Engen

Social anxiety can sometimes lead to depression, but the right support can help you manage both conditions.

If you live with social anxiety, it can be tempting to avoid social situations that might cause uncomfortable anxiety symptoms. As humans, we’re programmed to keep pain at bay, after all.

So, what happens when you’re sitting at home alone after backing out of plans with your friends at the last minute?

For some people with social anxiety, the isolation it brings can come with feelings of inadequacy, sadness, or even shame, sometimes mimicking or causing depression.

Social anxiety that leads to a diagnosis like major depressive disorder (MDD) can sometimes mean dealing with anxiety and depression symptoms that are harder to treat.

But a care approach that supports you in addressing social anxiety symptoms head-on while acknowledging and treating your depressive symptoms can help.

When people bring up social anxiety, they usually mean social anxiety disorder, an anxiety disorder also called “social phobia.“

Fear around social situations is the main feature of social anxiety, according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). But this fear can come up at different times, depending on what kind of social anxiety you have.

For example, some people have “performance only” social anxiety, meaning their anxiety only flares up in situations where they must speak or perform in front of others. They might not experience anxiety at parties, their workplace, or the grocery store, as is common for other people with social anxiety.

Since social anxiety causes fear in social situations, it’s not uncommon to become isolated if you live with the condition. While isolation doesn’t always cause loneliness, it often can — and this loneliness often leads to depression.

Who experiences social anxiety?

A 2015 review found that roughly 8% to 13% of people will experience social anxiety disorder in their lifetime, but this can vary depending on your culture.

Research from 2017 also suggests that while women are more likely to experience severe social anxiety symptoms, men may be more likely to seek treatment for it.

The difference between social anxiety disorder and the social stress many of us experience from time to time is that social anxiety tends to cause fear that’s out of proportion to the situation you’re worried about.

For instance, if you live with social anxiety, the thought of an upcoming work meeting might trigger strong physical anxiety symptoms, like nausea and dizziness.

According to the DSM-5, you might have social anxiety if you:

  • fear social interaction, being watched, or performing in front of other people
  • worry others will notice your anxiety symptoms and judge you for them
  • feel stressed when thinking about upcoming social situations
  • often worry about being rejected or looked down on by others
  • avoid social situations due to your anxiety
  • experience intense stress when you force yourself to socialize

Symptoms of social anxiety disorder typically last for at least 6 months, often longer.

A mental health professional may ask how these symptoms impact your day-to-day life, such as work and relationships, before confirming a diagnosis.

Social anxiety isn’t technically a symptom of depression, but the two conditions can occur together.

According to a 2017 study, living with depression can make you more likely to experience social anxiety. Research from 2015 also linked social anxiety disorder to persistent depressive disorder (dysthymia), a milder but longer-lasting form of depression.

Still, more research tends to focus on how social anxiety causes depression — and for 7 in 10 people with those co-occurring conditions, the social anxiety starts first.

Social anxiety vs. depression

Depression and social anxiety can look similar from the outside, but their root causes tend to be different.

For example, both depression and social anxiety can cause the following symptoms, but the symptoms themselves often have different sources:

  • Withdrawing from others. In the case of social anxiety, fear causes the avoidance. If you live with depression, withdrawing from others could have more to do with loss of motivation and lack of enjoyment in that activity.
  • Feelings of shame or worthlessness. While depression usually causes these feelings in a more straightforward way, someone with social anxiety might experience these symptoms as a result of avoiding social situations.
  • Confusion or brain fog. When depression causes these symptoms, it’s more likely due to feeling numb or tired. But when social anxiety causes them, it can be a result of your fight, flight, or freeze response making it harder to communicate.
  • Substance use. People with depression may misuse substances in an effort to manage emotions, like guilt or hopelessness. Meanwhile, people with social anxiety may use substances in social settings to dull the anxiety those situations cause.

Additionally, 2014 research suggests that someone living with co-occurring depression and social anxiety is less likely to have feelings of self-acceptance than someone with just one of those conditions.

If depression doesn’t necessarily cause social anxiety, what does? Some likely causes include:

  • Family history. According to the DSM-5, your chance of experiencing social anxiety disorder increases 2 to 6 times if you have a first degree relative, like a biological sibling or parent, with the condition.
  • Chemical imbalances. Some experts suggest imbalances in brain chemicals known as neurotransmitters could influence whether you’re prone to social anxiety.
  • Your childhood. While a history of adverse childhood experiences (ACEs) isn’t a proven cause of social anxiety disorder, you may be more likely to have social anxiety if those experiences were part of your childhood, per the DSM-5.
  • Temperament. If you tend to hold back in social situations, fear judgement from others, or experience low moods more often than other people, the DSM-5 suggests your chances of fitting the criteria for social anxiety disorder are higher.
  • Rejection. Research from 2017 suggests the social pain that often comes from rejection could contribute to social anxiety for some people.
  • Fear of judgement. Research from 2019 also indicates that the chemical imbalances and brain differences that may come with social anxiety can make you more sensitive to other people’s facial expressions, meaning you’re more attuned to rejection or judgement from others.

Research from 2014 suggests that it’s more common for social anxiety to cause depression than the other way around. In fact, anywhere from 44% to 74% of people with social anxiety disorder experience major depressive disorder (MDD) in their lifetime.

One reason social anxiety often leads to depression is loneliness caused by avoiding social situations. Research from 2019 recognizes that while loneliness, social anxiety, and depression are separate issues, they often appear together.

A 2018 study linked social anxiety to depression through avoidance. In particular, behaviors like avoiding social interaction in small groups or parties and the fear of being watched while you work were strongly connected to symptoms of depression.

Research from 2015 also suggests that people with social anxiety who later develop depression tend to worry more about what others think and have more trouble with social interaction overall.

People with both social anxiety and depression are more likely to have trouble reducing their symptoms with the usual anxiety treatment approaches, and this can lead to stronger feelings of hopelessness.

Living with both social anxiety and depression can feel isolating, but support that addresses both conditions can help you manage them.

Therapy

Talk therapy is a common treatment for both social anxiety and depression, and it could also help you manage symptoms when they occur together.

Cognitive behavioral therapy (CBT), which focuses on identifying and changing your thinking patterns to better serve you, is often used to treat both conditions.

A small 2016 study found online CBT helpful for reducing symptoms of both social anxiety and co-occurring depression.

Medication

When it comes to medication for co-occurring social anxiety and depression, research is limited but ongoing. You’ll likely need an approach that’s tailored to your specific symptoms if you use medication to manage both conditions.

Antidepressants like selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are often prescribed to treat depression that occurs alongside an anxiety disorder.

Your doctor might also recommend benzodiazepines, an anti-anxiety medication, to avoid panic attacks in situations that might cause you a lot of anxiety.

Self-care

While it’s important to seek professional support if you have severe symptoms of social anxiety and depression, you can also take steps to manage these conditions on your own. You may want to consider:

  • Challenging your cognitive distortions. Negative thought patterns tend to be more common in people with anxiety and depression. Here’s how to handle them.
  • Meditating. Mindfulness practices like meditation could help reduce symptoms of both social anxiety and depression.
  • Considering your habits. Sleep, nutrition, and exercise can all impact depression and social anxiety. You might ask yourself: “Could I form a new habit — such as a bedtime routine, intentional snack break, or walking plan — that supports me in managing my symptoms?”
  • Connecting with support. Especially in the case of social anxiety, this can be easier said than done. But even sending a simple message to an online support group could bring you one step closer to emotional support from people who “get it.”

Whether you’re living with social anxiety, depression, or both, it’s possible to manage your symptoms and reduce their impact on your day-to-day life.

Although co-occurring social anxiety and depression can be trickier to treat, you’re far from alone when it comes to resources that can help. You can:

  • Read about how to rebound from a tough episode of depression and anxiety.
  • Check out these free worksheets and workbook for social anxiety disorder.
  • Find support at Blurt, a blog that focuses on depression (while addressing how it intertwines with anxiety, too).

If you’re ready to seek help but don’t know where to begin, Psych Central’s guide to finding mental health care can be an excellent first step.

https://psychcentral.com/anxiety/social-anxiety-and-depression

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