Reviewed by: Pavel Kornilov, MD, psychiatrist · updated 6 Nov 2026
Key facts
- Who leads the session
- a psychiatrist, working together with a psychotherapist when needed
- Format
- video consultations; audio-only is available if the camera makes your anxiety worse
- Duration
- initial appointment 40–60 minutes, follow-ups every 2–4 weeks; a course lasts several months
- Anonymity
- consultations without your surname; medical confidentiality under Kazakhstan law
- When it is urgent
- suicidal thoughts, agitation with an inability to calm down—call 103 or 112
- Outcome
- reduced anxiety and low mood, restored sleep and ability to work, and a prevention plan
What you should know
Why do depression and anxiety so often go hand in hand? They share biological mechanisms: dysregulation of the stress system, changes in the serotonin and norepinephrine systems, and increased activity in the brain regions responsible for responding to threats. Clinical classifications recognize both depression with prominent anxiety and mixed anxiety and depressive disorder, in which neither component reaches the full diagnostic threshold.
The combination of anxiety and depression is more than the sum of its symptoms. Clinical data show that this form is more often accompanied by insomnia, physical complaints, and a higher suicide risk, and it requires careful treatment selection. The online format is convenient: anxiety often makes it hard to go somewhere unfamiliar, and a video appointment from home—without a rush-hour drive across the bridges between the right and left banks—eases tension before the conversation even begins.
Signs of Anxious Depression
- low mood is combined with constant inner tension
- it is hard to relax, and anxious thoughts about the future keep going around in circles
- you have trouble falling asleep because of worry and wake up early feeling anxious
- you have physical symptoms: a pounding heart, a lump in your throat, heaviness in your chest
- you feel irritable and restless and find it hard to sit still
- you have lost interest and pleasure, but instead of emptiness, you feel fear
- anxiety and despair are worse in the morning, and you feel a little better by evening
If at least two points apply and the state lasts longer than two weeks, it is worth seeing a specialist. Phone consultation is free. If life is at risk, call 112 or 103.
Why Anxiety and Depression Feed Each Other
The mechanism resembles a feedback loop. Anxiety makes you avoid situations that seem dangerous, and avoidance narrows your life, deprives you of enjoyable experiences, and deepens depression. Depression, in turn, lowers your confidence in your ability to cope, and anxiety grows. Chronic activation of the stress system drains your resources and disrupts sleep and appetite, and both components become entrenched.
Risk factors include prolonged stress, high responsibility at work, sleep deprivation, traumatic experiences, and anxious personality traits. Seasonal conditions also play a part: shorter daylight hours in winter, fewer walks because of the cold and wind, and less physical activity. Anxious depression often develops on the background of a long-standing anxiety disorder that has gone untreated for years.
How Anxious Depression Is Treated Online
The psychiatrist clarifies which came first—anxiety or depression—assesses the severity of both components using rating scales, and rules out physical causes: thyroid dysfunction, heart rhythm problems, medication side effects, and too much caffeine. If the camera makes your anxiety worse, you can start with an audio call. To prepare, write down your symptoms, the time of day when they are strongest, and what makes them worse. The doctor will then suggest a plan and a follow-up schedule.
An ECG, lab tests, and a physical examination cannot be done online—the doctor will refer you for them if needed. Prescribing prescription medications depends on Kazakhstan law and the requirement for an initial in-person examination. With severe agitation, suicidal thoughts, or an inability to stay safe, an in-person examination or inpatient care is needed; if there is a threat to life, call 103 or 112.
How we help
Cognitive behavioral therapy
CBT addresses both components: it reduces catastrophizing and anxious predictions, gradually decreases avoidance, and restores enjoyable activities. Patients learn to notice automatic thoughts and test them against reality. The method adapts well to the online format, including homework between sessions and exercises for working with anxiety.
Medication
Clinical guidelines recommend antidepressants that are effective for both depression and anxiety. At the start of treatment, anxiety can temporarily increase, so the doctor chooses an approach that takes this into account and explains in advance what to expect. Medications for short-term anxiety relief are used sparingly and with caution because of the risk of dependence.
Working with the body and sleep
Anxious depression comes with muscle tension, rapid breathing, and disrupted sleep. Evidence-based techniques—diaphragmatic breathing, progressive muscle relaxation, and cognitive behavioral therapy for insomnia—help reduce the physical symptoms. They are easy to learn online and then practice on your own, even on a short winter day.
Monitoring and prevention
Regular appointments make it possible to track anxiety and depression separately: sometimes mood improves faster than anxiety subsides, or the other way around. Treatment is adjusted accordingly. After remission, a prevention plan is drawn up that takes into account your personal triggers and seasonal risks, so that the first signs of a return can be spotted early.
Myths and facts
MythAnxiety is just your personality—it can’t be treated
FactAnxiousness as a personality trait and an anxiety disorder are different things. When anxiety interferes with your life and comes with low mood and poor sleep, it is a condition that responds well to psychotherapy and medication.
MythThe best remedy for anxiety is sedatives
FactFast-acting anti-anxiety medications can cause dependence and do not treat depression. Clinical guidelines recommend antidepressants and psychotherapy as the foundation of treatment, with fast-acting medications used only briefly and when clinically indicated.
MythIf I’m anxious, it can’t be depression
FactAnxiety is a common part of depression. A person may not feel classic sadness but still experience loss of interest, tension, and insomnia. This form requires particular attention from the doctor and the right choice of treatment.
How an online appointment works
- Message or callWrite on WhatsApp or call — our coordinator replies within minutes, day or night. You don't have to give your surname.
- Doctor and timeWe match you with a psychiatrist, addiction specialist or psychotherapist and agree on a time — often the same day.
- Video consultationA secure 50–60 minute video call: the doctor takes a detailed history and uses standardised scales if needed.
- Treatment planYou receive a clear summary, recommendations and a plan: what we do online and what needs an in-person visit or home call.
- Follow-upOnline follow-up sessions, messenger contact with your doctor, and treatment adjustments until you get a stable result.
Prices in Astana
| Online psychiatrist consultation (50–60 min) | 15 000 ₸ |
| Follow-up online consultation | 12 000 ₸ |
| One month of online psychiatric care | 60 000 ₸ |
The final cost is agreed before treatment starts. Prices are in tenge and do not constitute a public offer.
Where to get help
Psychiatry Online in Astana: same-day video appointments and two branches for in-person visits — 72 Bogenbay batyra St., Astana and 37 Petrova St., office 23, Astana. Our mobile team works around the clock: all city districts and nearby settlements. If you live elsewhere in Astana and Akmola Region, starting online is usually easiest.
Confidential and private
Information about your visit, diagnosis and treatment is protected by medical confidentiality under the Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”. We never share it with your employer, school or relatives without your consent; the only exceptions are those expressly set out by law. For an online consultation your first name is enough, video runs over a secure channel and nothing is recorded without your consent.
Questions and answers
How is anxious depression different from regular depression?
In anxious depression, low mood and loss of interest are accompanied by pronounced worry, tension, and physical symptoms of anxiety. This affects the choice of treatment: the doctor takes into account a possible temporary increase in anxiety at the start of therapy and the need to address insomnia.
How long does treatment take?
The first improvements usually appear after 2–6 weeks. Anxiety and depression may ease at different rates. After remission, treatment continues for several months. The overall duration depends on severity, whether there have been previous episodes, and how long the condition lasted before you sought help.
Can it be treated without medication?
When symptoms are mild, often yes: CBT, relaxation techniques, and insomnia therapy work well. For moderate to severe anxious depression, a combination with medication is usually recommended. The decision is made together with your doctor after your condition has been assessed.
Is online treatment suitable if my anxiety is severe?
Yes—for many people, online is the very way to get started. There is no need to travel somewhere unfamiliar, wait in line, or interact with strangers. You can start with an audio call. If the anxiety comes with agitation and thoughts of self-harm, the doctor will recommend in-person care.
Does my work schedule affect treatment?
Chronic overload is a common factor that keeps anxious depression going, especially among government and office employees in the Yesil and Nura districts. The doctor helps you build a realistic routine, and online appointments fit easily into your schedule without adding to your workload.
What should I do if my anxiety suddenly gets worse at night?
If there is a threat to life or you have suicidal thoughts, call 103 or 112. If there is no danger but the anxiety is unbearable, you can contact the Psychiatry Online on-call psychiatrist, who will help bring down the intensity and decide whether additional measures are needed.
Where can I be seen in Astana?
Online — from anywhere in the city or region. In person — at two branches: 72 Bogenbay batyra St., Astana and 37 Petrova St., office 23, Astana. Both are open 24/7; home visits cover all city districts and nearby settlements.
Sources and methodology
This page was prepared by the Psychiatry Online medical editorial team based on:
- International Classification of Diseases ICD-10 and ICD-11, World Health Organization
- Clinical diagnosis and treatment protocols of the Ministry of Health of the Republic of Kazakhstan
- Code of the Republic of Kazakhstan “On Public Health and the Healthcare System”
- NICE (UK) and APA (US) guidelines on the treatment of mental disorders
- WHO recommendations on telemedicine and digital health
This information is for reference only and does not replace a consultation with a specialist. Editorial policy
