How are Social Anxiety and Depression Linked?

Social Anxiety Disorder Can Cause Other Issues to Occur

depressed man laying on couch
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Do you feel anxious or depressed about the future? It's not surprising, given the established relationship between depression and anxiety.

When it comes to social anxiety disorder (SAD) in particular, feelings of anxiety and worry about being around others can eventually evolve into feeling down in general. To get a better handle on how these disorders are connected, it helps to learn about the relationship between the two.

Social Anxiety and Depression Go Hand-in-Hand

Research shows that there is a strong relationship between having social anxiety disorder (SAD) and developing depression later in life.

If you have been diagnosed with social anxiety disorder, you are up to six times more likely to develop:

The risk of developing these secondary disorders also increases in relation to the number of social fears that you have.

Risks Associated With Comorbidity

Comorbidity, or the occurrence of other illnesses alongside a particular disorder, of SAD and depression is associated with

In addition, if you have been diagnosed with social anxiety disorder and also suffer with depression, you are more likely to have more severe and chronic symptoms.

What Comes First -- Anxiety or Depression?

Although developing SAD at an early age has been linked developing depression later on, not everyone who has social anxiety disorder becomes depressed.

We do know, however, that when SAD appears at a young age, appropriate treatment may reduce the risk of developing depression at a later age.

Social Withdrawal Differs Between Social Anxiety Disorder and Depression

Imagine a young college student who wants to make friends and go to parties but fears that she will embarrass herself in front of others.

As a result, she stays in her dorm room night after night, wishing she could be a part of the group. 

Contrast this with the student who avoids social contact because it's just not any fun to her–the thought of going to parties or getting together with a friend holds no promise of enjoyment.

Although both SAD and depression may involve social withdrawal, the cause of the withdrawal is different.

  • People with social anxiety disorder withdraw out of fear of negative evaluation by others.
  • People with depression withdraw due to a lack of enjoyment.

People with SAD expect that they could enjoy themselves if they could somehow interact appropriately with others, whereas those with depression don't ever expect to enjoy themselves.

Treatment of SAD and Depression

Depression is often what leads people to seek help, even though social anxiety disorder may be the underlying problem.

Usually people who have SAD will not speak to anyone about the problems that they face and often do not realize that they have a treatable illness. As a result, most people with social anxiety disorder do not usually receive treatment unless the disorder occurs alongside another condition.

Unless a medical professional is trained to look for secondary disorders, SAD may continue to go misdiagnosed.

Unfortunately, treating depression without addressing the underlying social anxiety disorder can be ineffective.

Although many of the treatments recommended for depression are also effective in treating SAD, such as selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT), treatment must still be tailored to the specific disorder.

If you suffer with both SAD and depression, your doctor or mental health professional will devise a treatment plan designed to address symptoms of both disorders.


Douglas S. Comorbid major depression and social phobia. Primary Care Companion Journal of Clinical Psychiatry: Psychotherapy Casebook. 2001; 3(4): 179-180.

Hales RE, Yudofsky SC. (Eds.). (2003). The American psychiatry publishing textbook of clinical psychiatry. Washington, DC: American Psychiatric.

Stein MB, Fuetsch M, Müller N, Höfler M, Lieb R, Wittchen H-U. Social anxiety disorder and the risk of depression: A prospective community study of adolescents and young adults. Archives of General Psychiatry. 2001; 58: 251-256.

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