The mixed anxiety-depressive disorder It is a condition in which patients present both anxiety and depression symptoms in equal measure, but less intensely. Most often, the symptoms of anxiety are more pronounced than those of depression.
These patients do not meet specific diagnostic criteria for anxiety or depression separately. In addition, mixed anxiety-depressive disorder is characterized by an onset of symptoms that is not dependent on stressful life events..
This classification is relatively new and little studied, since it seems to function as a “mixed bag” for those who do not fit with other diagnostic criteria. However, it is clear that it constitutes a disease that affects the mental health of the person and, therefore, affects their daily functioning.
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After numerous studies, it has been concluded that both anxiety and depressive disorders seem to arise from a combination of biological, psychological and environmental factors, with many different causes.
Since the causes of both disorders are so similar, it is not surprising that they occur together. In fact, approximately 58% of patients with major depression also have an anxiety disorder, and 17.2% of those with generalized anxiety have depression.
- Biological factors: encompass imbalances in certain brain neurotransmitters such as serotonin or dopamine and their receptors, as well as genetic predispositions.
- Psychological factors: personality, cognitive schemes of the person, values, beliefs, etc..
- Environmental factors: having grown up in dysfunctional families, unstable environments, having a lower socio-economic level (since it translates into a life with more difficulties).
Mixed anxiety-depressive disorder is characterized by persistent sadness and anxiety that lasts for more than a month, and tends to be chronic. It can cause numerous signs, symptoms, and consequences such as:
- Alterations in attention and memory that result in lack of concentration and difficulty in learning and remembering information.
- Sleep disorders such as insomnia or hypersomnia, although there may also be difficulties falling asleep or waking up earlier than necessary.
- Tiredness and fatigue during the day.
- Recurring worry, irritability, and easy crying.
- Apathy, with a significant loss of interest in previously liked activities.
- Negative vision or hopelessness towards the future.
- Hypervigilance to feared stimuli or symptoms, usually accompanied by the feeling that something dangerous to oneself or other important people is going to happen.
- More associated with anxiety, there are symptoms of tachycardia, tremors, dry mouth, feeling of being out of breath or paresthesia even intermittently.
- Social decline, as they can avoid contact with others.
- Low selfsteem.
- They do not fulfill their responsibilities: they usually miss school or work or perform poorly.
- Neglected appearance, a lack of personal hygiene may be noted.
- Drug or alcohol abuse, since they tend to adopt these habits in order to alleviate or reduce the symptoms that torment them.
- In some cases it may be accompanied by suicidal ideation.
Usually, these patients request help in consultation due to physical symptoms, such as changes in appetite or sleep and panic attacks, without knowing that they hide behind depressive-anxious pictures.
To diagnose this disorder, symptoms of anxiety and depression must be present, which can be very similar. In addition, none of these must clearly predominate over the other, or they must not present sufficient intensity to make differentiated diagnoses..
Rather, many of the symptoms that the person may manifest have originated from both anxiety and depression, this overlap being responsible for the complexity in distinguishing anxiety from depression.
On the other hand, it is possible that both disorders are present and meet the diagnostic criteria, in which case the patient could be diagnosed with anxiety and depression at the same time; but it would not be part of the disorder we describe here.
For all this, it may be very difficult to correctly detect this problem and it is normal for incorrect diagnoses to be given..
The ICD-10 of the World Health Organization includes this disorder, indicating that there must be severe anxiety accompanied by somewhat milder depression; and if they are at similar levels, depression should be prioritized. In addition, it must include, according to the ICD-10, mild or non-persistent anxiety depression.
To detect it, somatic symptoms such as palpitations, tremors, stomach discomfort, dry mouth, etc. are required. And it is important to consider that the symptoms are not due to complicated or stressful life events, such as a major loss or a painful experience. Since, if so, it would be classified as an adjustment disorder.
There is a great debate between including this disorder as a diagnostic category, since on the one hand it seems that it is not a disorder because it does not present different and typical features; but on the other, many people who are suffering due to this condition cannot be left undiagnosed (and therefore without help).
Tyrer (1989) proposed the term "cothymia”(In English), indicating that it was necessary to take into account in clinical practice.
Mixed anxiety-depressive disorder is one of the most common mental disorders, occurring in 8 out of every 1,000 people, worldwide. It is more common in women than in men.
A person is more likely to develop mixed anxiety-depressive disorder if exposed to the following conditions:
- Having family members with mental disorders, especially anxiety or depression, or drug addiction problems.
- Dependent or pessimistic personality, or having low self-esteem.
- Low socioeconomic status.
- To be a woman. Since in women this disorder is more common than in men. This appears to be due to hormonal factors that make women prone to.
- Lack of social or family support.
- Having experienced a traumatic or very negative experience for the person in infancy or childhood.
- Being under high levels of pressure and stress.
- Have serious or chronic illnesses.
These patients are often not treated, first due to difficulties associated with diagnosis; and second, because the clinical manifestations are usually imprecise or somewhat milder and for this reason it is not given importance.
The patient learns to live with these symptoms and does not usually go to the doctor's office until he presents some physical symptom that seriously damages his day-to-day life (such as insomnia, for example). From what is observed, most of those affected do not demand psychological or psychiatric attention.
In these patients, the usual thing is to help them feel better through drug treatment combined with other techniques, especially if they have panic attacks or agoraphobia.
It was previously difficult to choose drug treatment for this condition, since some antidepressants and anxiolytics work differently. However, selective serotonin reuptake inhibitor (SSRI) antidepressants are currently used, which have been shown to have the quality of being valid for both depression and anxiety.
There are antidepressants that also seem very effective if you have depression and generalized anxiety disorder such as paroxetine or venlafaxine. Although the most common is to use antidepressants and benzodiazepines together.
Obviously, pharmacological treatment will be aimed at alleviating those symptoms that are more accentuated in each patient, that is, those that cause deterioration in their life and are more urgent.
For example, if anxiety symptoms are what accentuate the problems, focus on drugs that combat anxiety. However, benzodiazepines alone are not usually prescribed alone in patients with mixed anxiety-depressive disorder..
A mistake that should not be made is only to focus on drug treatment, forgetting other techniques that are more useful. It is important to know that drugs by themselves are not going to solve the problem, but that they are complementary to other interventions and facilitate them; promoting energy and well-being in the patient to follow other therapies.
Research on treatment only in mixed anxiety-depressive disorder is very scarce, although we can take steps to treat anxiety and depression.
In this way, cognitive behavioral psychological therapy (CBT) is the one that has shown the best results, mainly if in some cases it is combined with pharmacological treatment..
In this therapy, cognitive and related methods are brought together to change the point of view, beliefs and mental schemes of the person. This is where cognitive restructuring or the arrest of thought would come in..
Behavioral methods are also used, aimed at the patient starting behaviors little by little that will bring him some benefit..
Thus, it increases desirable behaviors in the person such as being able to get out of bed to go to work, reduces undesirable behaviors such as, for example, always carrying alcohol or pills in the bag, or teaches the person to implement behaviors new beneficials.
Other very useful techniques for anxiety are controlled exposure to feared stimuli, intense physical exercise or relaxation techniques..
Relaxation techniques include Jacobson's progressive relaxation, breathing techniques, or autogenous relaxation.
Tyrer, P. (2001). The case for cothymia: Mixed anxiety and depression as a single diagnosis. The British Journal Of Psychiatry, 179 (3), 191-193.
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