Mixed anxiety-depressive disorder: causes and symptoms

Anxiety disorders are the most prevalent in the general population. After them would go depressive disorders. Traditionally it has been observed from psychology that both types of disorder have many elements in common, being frequent that a situation of anxiety prolonged end up generating depressive symptoms and vice versa.

But in a large number of people, features of both depression and anxiety appear simultaneously. can be classified as cases of mixed anxiety-depressive disorder.

Depression and anxiety: aspects in common

The link between depressive and anxious problems is a well-known circumstance in psychological and psychiatric research. In clinical practice, rarely occurs in its purest form, being very frequent that depressed subjects end up developing anxiety problems. That is why in research it has been frequent to try to find in which specific aspects they are similar and in which they diverge.

One of the main elements in common between anxiety and depression is that in both there is a high level of negative affect. In other words, both disorders share the fact that both have a high level of emotional pain, irritability, discomfort and feelings of guilt and low state of cheer up.

Another point in common is that in both cases people are suffering due to the consideration that they are not, will be or would be able to face life or concrete circumstances of she, suffering from a deep feeling of helplessness and presenting low self-esteem.

However, in depression, in addition to the high negative effect, we would also find low positive affect, which would not occur in anxiety. It is what it produces anhedonia and lack of energy and vital drive. This circumstance does not appear in pure anxiety.

Something specific to anxiety that does not occur in depression (with the exception of some subtypes such as the one that occurs with psychotic symptoms) is hyperarousal. people with anxiety note a powerful increase in arousal, a "rush" of energy coming from the anticipation of possible damage, to which they cannot give a practical outlet. This does not occur in depression, where in fact the person's energy level tends to decrease.

These are some of the elements in which depression and anxiety are similar or different. But what happens when both types of problem appear at the same time? What is mixed anxiety-depressive disorder?

Mixed anxiety-depressive disorder: what is it?

Mixed anxiety-depressive disorder is a type of disorder characterized by the combined presence of symptoms of both depression and anxiety, without having any of the two greater repercussions than the other.

Typical symptoms of this disorder include depressed mood and/or anhedonia that appear along with anxiety, difficulty concentrating, tension and excessive and irrational worry. These symptoms must last for at least two weeks or a month and must not be due to the experience of painful experiences or the presence of other disorders.

In addition, vegetative symptoms such as tremors, intestinal discomfort or tachycardia must appear on occasion. These would be symptoms consistent with a very high level of negative affect, appearing in part also the hyperactivation typical of anxiety disorders and the low positive effect of depressives.

Diagnosis of mixed anxiety-depressive disorder

To diagnose mixed anxiety-depressive disorder the symptoms suffered cannot meet all the necessary conditions to identify with either of the two disorders nor can they be severe enough to require two diagnoses, one of depression and one of anxiety.

One more characteristic, of great importance, is that both types of symptoms must appear in the same period. This consideration is important since it allows distinguishing this disorder to the appearance of anxious symptoms as a consequence of depression or depressive symptoms due to the persistence of depressive symptoms.

Symptoms

At a vital level, this disorder is experienced as distressing by those who suffer from it, and it is not uncommon for those who suffer from it to end up developing a high irritability, autolytic thoughts, substance use as an escape route, deterioration of work or social environments, lack of personal hygiene, insomnia, hyperphagia and hopelessness.

Despite this, as a general rule, it is not considered serious enough by themselves to require consultation. In fact, it is more frequent that the diagnosis is reached after a visit to the doctor for vegetative problems that causes by cognitive problems.

Status of the disorder in the most common diagnostic classifications

The category of mixed anxiety-depressive disorder has aroused controversy in its conception, not being picked up by all existing diagnostic classifications. It is not that its existence is not recognized, but it has sometimes been considered that it is either a depressive disorder with secondary anxious features and not a single disorder.

In the case of the International Classification of Diseases, carried out by the World Health Organization, Mixed anxiety-depressive disorder has been and continues to be recognized and included in both the ICD-10 and the ICD-10. ICD-11.

In the case of the other major diagnostic classification of mental disorders, the DSM, in the drafts of its fifth version it was also going to be included. However, in the final version it has been decided not to include mixed anxiety-depressive disorder as a disorder per se, because it is considered that in the studies carried out the data obtained are not totally reliable. Instead, the specification “with anxiety symptoms” has been added to mood disorders to refer to patients with both depressive and/or bipolar like anxious

applied treatments

As it mentioned above, anxiety and depression are often linked and they can appear together in those who suffer from them. But despite this, they are still disorders with their own characteristics, the treatments applied to each one being different.

In the case of mixed anxiety-depressive disorder, its treatment is complex due to this difference, having to use strategies specific to each type of disorder. Specifically, a strategy based on cognitive behavioral therapy has been used successfully, sometimes combined with pharmacological treatment.

At a psychological level, it is useful to practice activities that make the patient regain a sense of control, increase her self-esteem and make her see the world in a more realistic way.

Psychoeducation is generally used, through which the characteristics of their problem are explained to patients, can be very useful for them to understand what is happening to them and that they are not the only ones who suffer from it. Subsequently, we usually proceed to treat both anxious and depressive symptoms, being used for the first exposure to avoided situations, breathing and relaxation training, and self-instruction techniques.

In problems of a depressive nature, action is taken involving subjects in positive and rewarding activities and cognitive restructuring is used to start acquiring new thought patterns that are more adaptive than those used up to now. It has also been observed that group therapy greatly helps to improve symptoms and to identify maladaptive thought patterns and change them for others.

At the pharmacological level, it has been shown that the application of SSRIs is useful for the control of symptoms, by inhibiting the reuptake of serotonin in a specific way and successfully combat both depressive and anxious symptoms.

Bibliographic references:

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Massón, Barcelona.

• Echeburua, E.; Salaberria, K.; de Corral, P.; Cenea, R. & Barasategui, T. (2000). Treatment of mixed anxiety and depression disorder: results of an experimental investigation. Behavior Analysis and Modification, vol.26, 108. Department of Personality, Evaluation and Psychological Treatments. Faculty of Psychology. University of the Basque Country.

• World Health Organization (1992). International Classification of Diseases. Tenth Edition. Madrid: WHO.

• Santos, J.L.; Garcia, L.I.; Calderón, M.A.; Sanz, L.J.; de los Rios, P.; Left, S.; Roman, P.; Hernangomez, L.; Navas, E.; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Clinical psychology. CEDE PIR Preparation Manual, 02. YIELD. Madrid.