Many people arrive at the psychologist's office after having already seen their family doctor, a cardiologist, a gastroenterologist. They've had tests done, and the tests come back normal. Yet the body keeps sending signals: fatigue that won't go away, tension, digestive problems, a weight on the chest.
It's one of the most common and most misunderstood patterns: anxious depression, meaning the co-presence of depressive and anxious symptoms. And its most typical feature is exactly this: the body speaks before the mood does.
What is anxious depression
Anxiety and depression are often described as two opposite conditions: one speeds you up, the other slows you down. In clinical practice, they appear together far more often than people think, and their combination has a recognizable profile.
It's not simply “anxiety plus depression.” It's a state in which anxious activation stays switched on — the body on alert, the mind ruminating — while energy and the capacity to feel pleasure are already declining. You're exhausted and, at the same time, unable to stop. It's this combination that makes it so draining.
The physical symptoms
These are the most visible part, and often the only ones mentioned to the doctor:
- Constant fatigue, present already upon waking, that rest doesn't repair
- Muscle tension in the neck, shoulders, and jaw; widespread pain with no apparent cause
- Gastrointestinal disorders: nausea, irritable bowel, a heavy feeling in the stomach, altered appetite
- Tachycardia, palpitations, a feeling of tightness in the chest
- Shortness of breath or the sensation of not being able to take a full breath
- Sleep disorders: difficulty falling asleep because the mind keeps spinning, or waking up very early
- Headaches recurring, dizziness, tingling
- Reduced sexual desire
Taken one by one, these seem like separate problems. This is why people end up getting each one checked out, without anyone looking at the overall picture.
Why the body speaks up first
There are two reasons, and it's worth knowing both.
The first is physiological. A state of prolonged activation keeps stress hormones elevated, and this has real, measurable effects on digestion, sleep, muscle tone, and the immune system. It's not imagination: it's a body that has been running in emergency mode for too long.
The second is cultural. Saying “my stomach hurts” is socially acceptable; saying “I don't feel like doing anything anymore” is much less so. So, often without realizing it, suffering finds the outlet that the context allows. It's not fake — the symptoms are authentic — but it does explain why these particular ones show up.
The psychological symptoms, which usually come later
- Constant worry, hard to interrupt voluntarily
- Irritability and impatience, often directed at the people closest to you
- Difficulty concentrating and remembering simple things
- Loss of interest in activities that used to bring pleasure
- A sense of inadequacy and constant self-criticism
- A feeling of constantly being behind, or not being able to keep up
- Gradual withdrawal from relationships, masked as tiredness
Why anxiety and depression often go together
The most common sequence is this. A prolonged period of anxiety consumes resources: you sleep poorly, stay on alert, avoid things. At some point the system can no longer sustain that level of expenditure and gives way, and that's when flatness and loss of drive appear.
The reverse path holds true as well: a low mood makes everything harder, and that difficulty generates anticipatory anxiety about what will have to be faced.
These are two directions that feed each other, which is why waiting for it to pass on its own rarely works.
First of all: get checked by a doctor
Several organic conditions can produce a similar picture: thyroid disorders, anemia, vitamin deficiencies, sleep apnea, diabetes, medication side effects.
If you have persistent physical symptoms, the first step is your family doctor. Not to rule out that it's “psychological,” but because the two things can coexist, and because knowing you've checked removes a doubt that would otherwise keep nagging at you for months.
What helps
Putting the pieces back together. The first useful step is often the simplest one: understanding that those separate symptoms belong to a single picture. It removes the feeling of having ten problems and leaves just one, manageable one.
Working on bodily activation. The Autogenic training acts exactly here: it teaches how to actively modulate the body's state of alertness, and for a picture dominated by physical symptoms it is a particularly suitable tool.
Breaking the cycles. Rumination, control, avoidance, and social withdrawal keep both components going. These are the targets that cognitive-behavioral work addresses directly.
Rebuilding the rhythm. Regular sleep, movement, gradual reactivation of what has been abandoned. Not very exciting, but very effective.
Understanding what the body is signaling. It's the longest part, and it's the one that makes the change lasting rather than temporary.
In some cases it is appropriate to combine this with a psychiatric evaluation. This is not a failure of the psychological process: it is the correct way to treat the more severe cases.
When to ask for help
If the symptoms have lasted for weeks, if medical tests have not found a cause, if sleep has steadily worsened, or if you have stopped doing things you used to do, a consultation makes sense.
If thoughts of hurting yourself or not wanting to be here anymore appear, don't wait: talk to your doctor right away, go to the emergency room, or call the 112.
Frequently Asked Questions
Can depression cause only physical symptoms?
Yes. There are forms in which the somatic component is clearly predominant, and the low mood is only noticed later, sometimes only by people close to the person. This is one of the reasons why these conditions are recognized late.
How can I tell if it's anxiety or depression?
In practice, a clear-cut distinction is often artificial, because they coexist. A general guideline: anxiety is future-oriented and activating, depression is present-oriented and shuts you down. If you recognize yourself in both, you're not misreading yourself.
Do physical symptoms go away on their own?
They go away when the state that produces them is reduced. As long as the activation remains high, they tend to shift from one system to another: the stomachache resolves and insomnia appears.
Do I need to take medication?
That's a medical evaluation, not mine to make. In some cases, combining medication with psychotherapy is the most effective path; in others, the psychological process alone is sufficient. The decision is made by the doctor, based on the specific situation.
How long does it take to feel better?
Physical symptoms are often the first to ease, and some improvement can come within a few weeks. Consolidation takes longer, because it involves the mechanisms that produced that state.
A journey in Florence or online
If you recognize yourself in this picture, you can contact me for an initial introductory session. I receive in my office in Florence, at Via Tommaso Campanella 5, in the Campo di Marte – Coverciano area, and online.
You can find insights on the signs of depression, on how to understand if you suffer from anxiety and on the difference between anxiety and stress.
Quando ansia e umore basso si presentano insieme, conviene affrontarli insieme: qui trovi il percorso per la depressione a Firenze.
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