As a psychiatrist in Washington, D.C. specializing in psychopharmacology and the management of complex, treatment-resistant conditions, I frequently care for patients experiencing both depression and anxiety. These disorders are among the most common in the region, and they often present together in ways that complicate diagnosis and treatment. Effective management requires not only advanced treatment options, but also psychiatric expertise to address the underlying mechanisms that make these conditions so difficult to treat. In this blog, we’ll discuss why these conditions often occur together, how we approach treatment for co-occurring conditions, and the importance of psychiatric oversight throughout.
Understanding Depression and Anxiety
Depression and anxiety are distinct but overlapping disorders. Depression is characterized by persistent sadness, loss of interest, fatigue, and impaired concentration. Anxiety is marked by excessive worry, restlessness, and physical symptoms such as tension, rapid heartbeat, and disrupted sleep. When combined, patients often describe being “stuck in two gears at once,” immobilized by depression while simultaneously overstimulated by anxiety.
Why These Conditions Often Co-Occur — Especially in the DMV
Depression and anxiety frequently appear together because biological vulnerabilities interact with environmental stressors, amplifying symptoms and complicating treatment. National data show that nearly 50% of individuals with depression also meet criteria for an anxiety disorder. In Washington, D.C., over 40% of adults report depression or anxiety symptoms annually.
The stressors unique to living in Washington, D.C., Maryland, or Virginia intensify this problem. Patients routinely cite:
- The high cost of living and escalating housing pressures.
- High-demand careers in government, law, consulting, and policy that often lead to burnout.
- Congested commutes and long hours, draining time and energy.
- Political and global uncertainty, felt most acutely in the nation’s capital.
- Healthcare inequities and community stressors that exacerbate existing vulnerabilities.
These environmental pressures converge with biological predispositions to drive comorbidity, making psychiatric expertise indispensable.
A Stepped Care Approach to Treatment
I structure treatment using a step-by-step, evidence-based approach, making sure patients get the right level of care at the right time. We start with foundational lifestyle changes and, if symptoms persist, move on to therapy, medication, or advanced interventional treatments. By combining these approaches, I create a plan that fits each patient’s needs and supports long-term recovery. This ensures that anyone seeking anxiety or depression treatment in Washington, D.C. receives compassionate, personalized care every step of the way.
- Lifestyle Interventions
Foundational changes- including structured exercise, improved sleep hygiene, mindfulness practices, and moderation of alcohol or other substances, significantly improve outcomes and supports brain health.
- Psychotherapy
Cognitive Behavioral Therapy (CBT) remains the most effective psychotherapeutic approach for anxiety and is often highly beneficial for depression as well. By addressing negative thought patterns and behavioral avoidance, CBT provides patients with concrete strategies for symptom management.
- Pharmacotherapy
When symptoms persist, medication is a crucial next step. Careful selection and adjustment of antidepressants, anxiolytics, or mood stabilizers can relieve suffering and optimize functioning. Effective psychopharmacology requires deep knowledge of drug interactions, augmentation strategies, and the nuances of treating comorbid conditions only achieved with years of clinical experience treating patients.
- Advanced Interventions
For patients who remain symptomatic despite standard care, interventional psychiatry offers powerful options:
- Ketamine (IV or IM): Rapid mood improvement, with meaningful effects on both depression and anxiety through glutamate modulation.
- Transcranial Magnetic Stimulation (TMS): FDA-approved for depression and, more recently, anxious depression- a major advancement given the frequency of this comorbidity.
- Stellate Ganglion Block (SGB): An emerging treatment that can reset the overactive fight-or-flight response, offering relief from severe anxiety and trauma-related symptoms.
The Importance of Psychiatric Oversight
Many patients come to us after unsuccessful experiences at freestanding ketamine or TMS clinics. These facilities are often operated by anesthesia-trained nurses or emergency physicians. While these providers may be skilled in administering procedures, they are not trained in psychiatry, mental health, or psychopharmacology.
This limitation may have serious consequences:
- Comorbid diagnoses such as bipolar disorder, trauma, or personality vulnerabilities are overlooked.
- Medications are not optimized or coordinated with interventional treatments.
- Therapy is not integrated, leaving patients without long-term coping strategies.
The result is a high rate of treatment failure, not because ketamine or TMS are ineffective, but because they were delivered without the necessary psychiatric framework.
At Washington Interventional Psychiatry, all treatments are conducted under the supervision of psychiatrists with expertise in complex mental illness. We consider the full spectrum of biological, psychological, and social contributors and build individualized treatment plans that combine lifestyle, therapy, pharmacology, and interventional options when appropriate.
Taking the Next Step
If you are experiencing both depression and anxiety, you do not have to navigate these conditions alone. With psychiatric oversight, advanced interventional tools, and a comprehensive treatment strategy, it is possible to achieve meaningful recovery.
At Washington Interventional Psychiatry, my colleagues and I are committed to delivering the highest level of psychiatric expertise to every patient encounter. I encourage you to schedule an appointment with one of our psychiatrists to review your history and discuss appropriate medication options.
For individuals who have already tried therapy and medications without sufficient relief, it may be time to explore advanced treatments. You can schedule a free consultation with one of our interventional specialists to learn more about ketamine, TMS, or stellate ganglion blocks, and begin developing a plan tailored to your needs.
