Mixed Anxious-depressive Disorder: Causes And Symptoms
Anxiety disorders are the most prevalent in the general population. After them would come depressive disorders. Traditionally, it has been observed in psychology that both types of disorders have many elements in common, and it is common for a situation of prolonged anxiety to end up generating depressive symptoms and vice versa.
But in a large number of people, characteristics of both depression and anxiety appear simultaneously, which can be classified as cases of mixed anxious-depressive disorder.
The link between depressive and anxious problems is a well-known circumstance in psychological and psychiatric research. In clinical practice, it is rarely given in pure form and it is very common for depressed individuals to end up developing anxiety problems. That is why in research it has been common 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 present a high level of emotional pain, irritability, discomfort and feelings of guilt and low mood.
Another point in common is that in both cases people are suffering due to the consideration that they are not, will not be or would not be able to face life or its specific circumstances. suffering from a deep feeling of helplessness and presenting low self-esteem.
However, in depression, in addition to the high negative affect, we would also find low positive affect, something that would not occur in anxiety. It is what 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 those with psychotic symptoms) is hyperarousal. People with anxiety notice a powerful increase in arousal a “rush” of energy coming from the anticipation of possible harm, for which they cannot give a practical outlet. This does not happen 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 problems appear at the same time? What is mixed anxiety-depressive disorder?
Mixed anxious-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 either of them having a greater impact than the other.
Typical symptoms of this disorder include depressed mood and/or anhedonia that appear together with anxiety, difficulty concentrating, excessive and irrational tension and worry. These symptoms must last for at least two weeks or a month and must not be due to 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 that agree with a very high level of negative affect, also appearing in part the hyperactivation typical of anxious disorders and the low positive effect of depressive disorders.
The 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 serious enough that it is necessary to make two diagnoses, one for depression and the other for 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 us to distinguish This disorder is the appearance of anxious symptoms as a consequence of depression or depressive symptoms due to the persistence of depressive 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 high irritability, self-harming thoughts, substance use as a means of escape, deterioration in work or social environments, lack of personal hygiene, insomnia, hyperphagia and hopelessness.
Despite this, as a general rule it is not considered by them to be serious enough to go for consultation. In fact, It is more common that a diagnosis is reached after a visit to the doctor for vegetative problems which causes cognitive problems.
Status of the disorder in the most common diagnostic classifications
The category of mixed anxious-depressive disorder has aroused controversy in its conception, not being collected by all existing diagnostic classifications. It is not that its existence is not recognized, but sometimes it has been considered that it is either a depressive disorder with secondary anxious characteristics and not a single disorder.
In the case of the International Classification of Diseases, carried out by the World Health Organization, mixed anxious-depressive disorder has been and continues to be recognized and included in both the ICD-10 and the ICD-11.
In the case of the other major diagnostic classification of mental disorders, the DSM was also going to be included in the drafts of its fifth version. However, in the final version we have chosen not to include mixed anxious-depressive disorder as a disorder per se, because it is considered that the data obtained in the studies carried out 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 and anxious characteristics.
As 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, strategies specific to each type of disorder must be used. Specifically, a strategy based on cognitive behavioral therapy has been used successfully, sometimes in combination with pharmacological treatment.
On a psychological level, it is useful to practice activities that make the patient regain a sense of control, increase their self-esteem and make them 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, both anxious and depressive symptoms are usually treated, using exposure to avoided situations, breathing and relaxation training, and self-instruction techniques for the former.
In depressive problems, action is taken involving subjects in positive and rewarding activities and cognitive restructuring is used to acquire new thought patterns that are more adaptive than those used until now. It has also been observed that group therapy greatly helps to improve symptoms and identify maladaptive thought patterns and change them to new ones.
At a 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 combating both depressive and anxious symptoms.
