Mixed depressive-anxiety disorder: causes and symptoms

According to the ICD manuals, this disorder presents the symptoms of both depression and anxiety.

Anxiety disorders are the most prevalent in the general population. They are followed by 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 prolonged anxiety ends up generating depressive symptoms and vice versa.

But in a great number of people, characteristics of both depression and anxiety appear simultaneously, being able to be catalogued as cases of mixed anxious-depressive disorder..

Depression and anxiety: aspects in common

The link between depressive and anxious problems is a circumstance well known in psychological and psychiatric research. In clinical practice it rarely occurs in a pure formIt is very frequent that depressed subjects end up developing anxiety problems. That is why in the investigation it has been frequent to try to find in which concrete 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 anxiety and depression. is that in both there is a high level of negative affect. In other words, both disorders share the fact that in both there is a high level of emotional pain, irritability, discomfort and feelings of guilt and low mood.

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

However, in depression in addition to the high negative effect we would also find a low positive affect, which would not occur in anxiety. This 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 the one with psychotic symptoms) is hyperarousal. People with anxiety notice a powerful increase of arousala "rush" of energy coming from the anticipation of possible harm, 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 some of the elements in which depression and anxiety resemble or differ from each other.But what happens when both types of problem appear at the same time? What is the mixed depressive-anxiety disorder?

Mixed depressive-anxiety disorder: what is it?

The mixed depressive-anxiety disorder is a type of disorder that is characterized by the combined presence of symptoms of both depression and anxiety, with neither having a greater impact than the other.without either having a greater impact than the other.

The typical symptoms of this disorder include depressive mood and/or anhedonia that appear together with anguish, difficulty concentrating, tension, and excessive and irrational worry.. These symptoms must have a duration of at least two weeks to one 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 should appear on occasion. These symptoms are consistent with a very high level of negative affect, with the hyperarousal characteristic of anxious disorders and the low positive affect of depressive disorders also appearing in part.

Diagnosis of the mixed anxious-depressive disorder

For the diagnosis of mixed depressive-anxious disorder the symptoms suffered cannot meet all the necessary conditions to be identified with either of the two disorders, nor can they be of sufficient severity to be nor can they be severe enough to require two diagnoses, one of depression and one of anxiety.

A further feature, 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 consideration is important since it allows to distinguish this disorder to the appearance of anxious symptomatology as a consequence of depression or depressive symptomatology 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 sufferers to develop high irritability, self-injurious thoughts, substance use as a means of escape, deterioration in the work or social environment, lack of personal hygiene, insomnia, hyperphagia and hopelessness.

In spite of this, as a general rule, they do not consider it serious enough to go for consultation. In fact, it is more more often the diagnosis is made after a visit to the doctor because of the vegetative problems it causes than because of the cognitive problems. vegetative problems than because of 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 included in all the existing diagnostic classifications.. It is not that its existence is not recognized, but sometimes it has been considered to be 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, the mixed anxious-depressive disorder has been and continues to be recognized and included in both ICD-10 and ICD-11.

In the case of the other major diagnostic classification of mental disorders, the DSMin 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 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 features.

Treatments applied

As mentioned above, anxiety and depression are often linked and may appear together and may appear together in those who suffer from them. However, they are still disorders with their own characteristics, and the treatments applied to each one are 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 successfully used, sometimes in combination with pharmacological treatment.

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

Psychoeducation is generally used.This can be very useful in helping patients to understand what is happening to them and that they are not the only ones suffering from the problem. Subsequently, both anxious and depressive symptoms are usually treated, using for the former exposure to avoided situations, breathing and relaxation training, and self-instruction techniques.

Depressive problems are treated by involving the subjects in positive activities. involving the subjects in positive and rewarding activities and using cognitive restructuring and cognitive restructuring is used to acquire new thinking patterns that are more adaptive than those used so far. 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 symptom control, by inhibiting serotonin reuptake in a specific way and successfully combating both depressive and anxious symptoms.

Bibliographical references:

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.

• Echeburúa, E.; Salaberría, K.; de Corral, P.; Cenea, R. & Barasategui, T. (2000). Treatment of mixed anxiety and depressive disorder: results of an experimental investigation. Análisis y modificación de conducta, vol.26, 108. Department of Personality, Assessment 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. ; García, L.I. ; Calderón, M.A. ; Sanz, L.J. ; de los Ríos, P. ; Izquierdo, S. ; Román, P. ; Hernangómez, L. ; Navas, E. ; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Psicología Clínica. Manual CEDE de Preparación PIR, 02. CEDE. Madrid.