You start to notice the fog lifting. Getting out of bed feels a little less heavy, and your thoughts stop pulling so hard toward the worst-case storyline. Then you look around and realize something awkward: The worry still shows up. Your body still feels tense. Your mind still runs ahead of you.
That pattern can feel confusing, especially when you expect everything to move together. But depression and anxiety often share space without sharing a timeline. Sometimes you see real progress in mood while anxiety symptoms stay stuck in place. That split does not automatically mean you picked the wrong plan. It usually means your care team has learned something specific about what your symptoms need next.
Why Mixed Progress Is Common
A 2024 managed-care study followed adults taking antidepressants and tracked symptom change with the PHQ-9 for depression and the GAD-7 for anxiety over about three months. The researchers found that most people improved in a “synchronous” way, meaning both sets of scores rose or fell together. That group made up about 72% of patients.
However, roughly 28% showed an “asynchronous” pattern, where one set of symptoms improved without the other keeping pace. The study included 577 adults, so this was not a tiny outlier sample.
This finding changes the emotional meaning of what you are experiencing. When your mood improves, but anxiety hangs on, you do not have to label it as failure. You can treat it as a common branch in the road during depression treatment.
Depression and Anxiety Often Respond to Different Parts of Treatment
Depression often improves when the brain and body start to regain basic capacity. Sleep and appetite stabilize, energy returns in small increments, and you feel more able to start tasks. Many people reach that point through psychiatric treatment that supports mood regulation and reduces the intensity of depressive symptoms.
Anxiety plays by different rules. Anxiety often feeds on prediction, scanning, avoidance, and physical arousal, and those patterns can stay active even when mood improves. You might feel less hopeless and still feel keyed up. You might feel more motivated and still avoid the situations that trigger panic. That is why clinicians often treat anxiety as its own target rather than a leftover symptom that will fade on its own.
This is also where psychotherapy matters in a specific way. Many anxiety-focused approaches ask you to practice new responses repeatedly in real situations. That work can feel slow at first because it changes habits, not just feelings. You can see mood improve early while the anxiety system keeps running on old settings.
When Anxiety Persists, It Can Signal Higher Baseline Burden or a Missing Anxiety-Specific Target
If anxiety keeps showing up after mood improves, it often says something about baseline severity or about what the plan has addressed so far.
A 2024 VA study looked at Veterans with new-onset depression and examined how anxiety severity related to follow-up outcomes and care patterns. The dataset was large, with models that included over 92,000 people for treatment analyses and over 86,000 for follow-up depression symptom models. Compared with minimal anxiety, severe anxiety was linked to higher depression severity at follow-up by about 3.16 points on the PHQ-9. Moderate anxiety still mattered, with about a 1.35-point difference.
That same study also found something easy to miss. Severe anxiety is associated with a slightly lower likelihood of starting psychotherapy, with an odds ratio of 0.92 compared with minimal anxiety. High anxiety can make it harder to initiate or stay engaged in structured work, especially early on when everything feels overwhelming.
So, if your anxiety treatment feels incomplete, you might not need a brand-new plan. You might need a sharper plan that meets anxiety at the point where it blocks follow-through. Sometimes that means changing how care gets delivered, not just what care you receive.
How Clinicians Decide Whether to Stay the Course or Adjust the Plan
Clinicians lean on measurement here because memory plays tricks when symptoms fluctuate. Tools like the PHQ-9 and GAD-7 help separate a bad week from a real plateau. The 2024 trajectory study mentioned earlier used those tools for a reason. Structured measures make symptom patterns visible when day-to-day life feels noisy.
Persistent anxiety also matters enough that U.S. guidance has started to reflect it. In 2023, the U.S. Preventive Services Task Force recommended screening for anxiety disorders in adults, and it framed treatment benefits in practical terms. The evidence review behind that recommendation described psychological interventions as offering a moderate benefit for reducing anxiety symptoms, while pharmacotherapy showed a small to moderate benefit for adults. In other words, clinicians have reason to take persistent anxiety seriously rather than treating it as a side note.
A split response becomes meaningful when anxiety stays at a moderate or severe level over time, or when anxiety starts to limit sleep, work, or relationships even as mood improves. Those are the points where care stops feeling like it supports your life.
What a Combined, Updated Approach Can Look Like When Symptoms Split
A combined approach often pairs careful medication strategy with structured therapy work. The VA findings hint at why that combination matters, since higher anxiety severity links to more complicated care patterns and less therapy initiation. A plan that acknowledges that friction can make therapy feel more doable, instead of feeling like one more thing you cannot manage.
The 2024 SAMHSA national report, based on NSDUH survey data from 2023, found that 8.3% of U.S. adults reported a past-year major depressive episode, and 7.4% of adults reported moderate or severe anxiety symptoms in the prior two weeks.
If anxiety lingers, you do not have to invalidate the progress you already made. You can treat depression improvement as evidence that your plan has traction, then treat persistent anxiety as the next clinical target.
Coordinated Care Helps You Target What’s Still Lingering
You can hold two truths at once. You can see meaningful improvement in mood, and you may still need more support for anxiety. That split happens often in real treatment timelines, and research shows a sizeable minority of patients experience it.
You also do not need to interpret persistent anxiety as a verdict on your effort. Sometimes anxiety starts as the heavier load, and it keeps shaping outcomes until care targets it directly. Measurement tools help clinicians spot that pattern early, and U.S. guidance supports taking anxiety seriously rather than waiting indefinitely.
If your mood has improved but anxiety symptoms still run your day, we can help. At Zeam, we coordinate psychiatric treatment so the plan addresses depression and anxiety as they show up in real life. Reach out to us to talk through options and what a more targeted next step could look like.
Key Takeaways
- Mixed progress during treatment is common — up to 28% of patients improve in one symptom area while another lags.
- Depression and anxiety respond to different mechanisms and may require separate clinical targets.
- Persistent anxiety after mood improvement can indicate higher baseline burden or barriers to therapy engagement.
- Measurement tools like PHQ-9 and GAD-7 help clinicians identify split-response patterns and guide next-step decisions.
- A coordinated plan — combining medication strategy and anxiety-focused psychotherapy — often leads to better long-term outcomes.
Citations
- Symptom trajectories & asynchronous response between depression and anxiety – Clinical outcomes study exploring synchronous vs. asynchronous treatment response patterns in adults treated with antidepressants, using PHQ-9 and GAD-7 to track mood and anxiety change over time.
- VA cohort analysis — anxiety severity & follow-up outcomes – Large VA data evaluation examining how baseline anxiety severity relates to depression outcomes, care engagement, and psychotherapy initiation among adults with new-onset depression.
- National prevalence of depression & anxiety symptom burden (NSDUH report) – SAMHSA national survey reporting U.S. rates of major depressive episode and moderate–severe anxiety symptoms among adults, highlighting unmet treatment needs and care access patterns.
