Mixed Anxiety-depression Condition: Definition, Causes And Treatment

Mixed anxiety-depressive disorder has been controversial , and not all existing diagnostic classifications include it. It is not that its existence is not recognized, but sometimes it has been considered a depressive disorder with secondary anxiety traits, and not a single disorder.

Mixed anxiety-depression condition symptoms are anxiety and depression, but none of them clearly dominate. Nor do they have sufficient intensity to justify a separate diagnosis.

This disorder manifests itself in a mixture of relatively mild symptoms that are often seen in primary care, and its prevalence is even higher in the general population.

The combination of depressive and nervous symptoms causes a significant deterioration in the function of the affected person.

However, those who oppose this diagnosis have argued that the availability of this diagnosis discourages clinicians from taking the time necessary to obtain a complete psychiatric history in a patient. Such a story would allow them to differentiate real depressive disorders, from real anxiety disorders.

When is mixed anxiety depression diagnosed?

To diagnose it, there must be symptoms of anxiety and depression of low intensity. In addition, there should be some physical symptoms such as tremors, palpitations, dry mouth and abdominal pain.

Some preliminary studies have shown that general practitioners have a low sensitivity to detect syndromes in mixed anxiety depression. However, it is possible that this lack of recognition only reflects the lack of an appropriate diagnostic label for these patients.

Symptoms of mixed anxiety-depression

Clinical manifestations of this disorder combine symptoms of anxiety disorders and symptoms of depressive disorders.

In addition  , symptoms of hyperactivity in the autonomic nervous system, such as gastrointestinal discomfort, are frequent. This is often why patients seek medical attention.

DSM-IV Research Criteria for Mixed Anxiety Depression

The Diagnostic and Statistical Manual of Mental Disorders (DSM) presents a number of criteria for diagnosing this disorder. But as we have mentioned, it is for research purposes only. Let’s see:

The essential feature of this disorder  is a persistent or recurrent dysphoria that lasts at least 1 month. This state of mind is accompanied by additional symptoms of the same duration, including at least four of the following:

• Difficulty with concentration or memory, sleep disturbances, fatigue or lack of energy.
• Acute irritability.
• Recurrent and intense concern.
• Easy to cry or feel hopeless, pessimistic about the future, uselessness and low self-esteem.

• Vigilance, expectation of danger.

These symptoms cause significant clinical discomfort or impairment of social, occupational, or other important activities.

On the other hand, mixed anxiety-depression should not be diagnosed when symptoms are due to direct physiological effects of a drug, or a medical illness. Or if the individual has at any time met the diagnostic criteria for major depressive disorder, persistent depressive disorder, anxiety disorder, or generalized anxiety disorder.

This diagnosis is also inappropriate if the criteria for any other anxiety or mood disorder are met at the same time, even if they are in partial improvement.

It is also necessary that the number of symptoms can not find a better explanation with another mental disorder. Most initial information about this disorder is from primary care centers, where the disorder appears to be more frequent; it probably also has a higher prevalence among outpatients.

What is the effect of mixed anxiety depression?

The coexistence of a major depressive disorder with an anxiety disorder is very common. Two-thirds of patients with symptoms of depression also have clear symptoms of anxiety. One-third of these may meet diagnostic criteria for panic disorder.

Some researchers have reported that 20% to 90% of all patients with anxiety disorders have episodes of major depressive disorder. These data suggest that the coexistence of symptoms of depression and anxiety that do not meet diagnostic criteria for depression or anxiety disorders is very common.

However, there are currently no formal epidemiological data on mixed anxiety-depression condition. However, some researchers have estimated that the prevalence of this disorder in the population is 10%, but in primary care it becomes 50%. More conservative estimates suggest a prevalence of 1% in the general population.

What causes this disorder?

Four lines of research suggest that symptoms of anxiety and depression are associated with identified causes.

First , several researchers have found similar neuroendocrine causes of depressive and anxiety disorders. These include reduction of:

• Cortisol response to adrenocorticotropic
• The growth hormone’s reaction to clonidine
• The thyroid stimulating hormone
• The response  of prolactin to the thyrotropin-releasing hormone

Second, several researchers have presented data identifying hyperactivity in the noradrenergic system as a relevant factor in the onset of depression and anxiety disorders in some patients.

Mark Gluck et al. Learning and memory, 2013.

Specifically, these studies have found that patients with depressive or anxiety disorders who are actively experiencing an anxiety crisis have high concentrations of the norepinephrine metabolite MHPG in their urine, plasma or cerebrospinal fluid.

As with other anxiety and depressive disorders  , serotonin and GABA may also be associated with the onset of mixed anxiety-depression.

Third, many studies have shown that serotonin medications, such as fluoxetine and clomipramine, are useful in treating both depressive and anxiety disorders.

Finally, several family studies have presented data suggesting that anxiety and depressive symptoms are genetically transmitted, at least in some families.

The course of the disturbance and the prognosis

According to current clinical data, it appears that patients may initially have the same likelihood of predominant symptoms of anxiety or predominant symptoms of depression, or a proportionate mixture of them.

During the course of the disease, anxiety and depressive symptoms can change in their influence . A forecast is not yet known.

However, depressive and anxiety disorders alone tend to become chronic without adequate psychological treatment.

Treatment of mixed anxiety-depression condition

As there are no good studies comparing treatment methods for mixed anxiety depression, clinicians tend to provide treatment according to the symptoms shown, their severity and their previous experience with the different treatment methods.

Psychotherapeutic approaches can be used for a short period of time, such as behavioral or cognitive therapy. Yet some clinicians use a less structured psychotherapeutic approach, such as introspection psychotherapy.

Medicine

The pharmacological treatment of mixed anxiety-depression condition is usually with anti-anxiety medication, antidepressant or both. Among anxiolytic drugs, some data indicate that the use of triazolobenzodiazepines (for example alprazolam) may be appropriate because of its effectiveness in treating depression associated with anxiety.

Substances that affect the 5-HT receptor, such as buspirone, may also be appropriate. Among antidepressants, serotoninergics (eg fluoxetine) can be very effective in treating mixed anxiety depression.

Psychological treatment

In any case  , the choice of treatment for these types of pathologies is cognitive behavioral psychotherapy.

On the one hand, before anything else, it is about the patient reducing their level of physiological activation. This is achieved through breathing techniques (e.g. diaphragm opening) and relaxation techniques (progressive muscle relaxation, autogenic training, mindfulness, etc.).

Second, it  is necessary for the patient to improve their mood. This can be achieved in different ways. Behavioral activation therapy can be very effective in this regard.

The idea is that the patient should resume his previous level of activity. To do this, a therapist encourages them to engage in pleasurable activities, either going back to one or joining a new one gradually.

Third, a period of psycho-education is useful. During this period, the patient is given an explanation of what is happening to him or her and why. They learn some basic ideas about the properties of anxiety and depression so that they can normalize their experience.

Afterwards , it may be necessary to change some beliefs or thoughts that may be feeding the problem. This can be with a cognitive restructuring technique.

As you can see, mixed anxiety-depression condition has no specific identity in some diagnostic systems, but it is often found in primary care consultations. It’s pretty common.

It is a disorder that can be treated and if left untreated in time, it can become chronic.

Bibliography:

Bobes García, J. (2001). Senior care workers and depressive mothers in primary care . Barcelona, ​​etc .: Masson.

Derogatis, LR, & Wise, TN (1996). Depressive stressors and employment in primary care . Barcelona: Martinez Roca.

Miguel Tobal, JJ (1990). La ansiedad. In J. Mayor and JL Pinillos (Eds.). Treatment of General Psychology. (Vol.3) . Motivation and Emotion. Madrid: Alhambra.