He Mixed anxiety disorder Is a very frequent condition, and consists of a diagnostic category where patients who present both Anxiety symptoms As of depression in equal measure, but less intensely. The most frequent is that the symptoms of anxiety are more pronounced than those of depression .
These patients do not meet the specific diagnostic criteria for anxiety or depression separately. In addition, it is characterized by an appearance of symptoms that does not depend on stressful life events (Kara, Yazici, Güleç & Ünsal, 2000).
This classification is relatively new and poorly studied, since it seems to function as a"tailor's box"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, has an impact on their daily functioning.
Causes of Mixed Depressed Anxiety Disorder
After numerous studies, it has been concluded that both anxiety and depressive disorders appear to arise from a combination of biological, psychological and environmental factors, and there are many different causes.
As the causes of both disorders are so similar, it is not strange that they occur together. In fact, approximately 58% of patients with Major depression Have also an anxiety disorder, and 17.2% of those affected by generalized anxiety present depression.
- Biological factors: Encompassing imbalances in certain brain neurotransmitters such as Serotonin wave Dopamine And their receptors, in addition to genetic predispositions.
- Psychological factors: personality , Cognitive schemas of the person, values, beliefs, etc.
- Environmental factors: Have grown up in dysfunctional families, unstable environments, have a lower socio-economic level (as it translates into a life with more difficulties).
Mixed anxiety-depressive disorder stands out for persistent sadness and anxiety that stretches for more than a month, and tends to be chronic.
It can cause numerous signs, symptoms and consequences such as:
- Disturbances in care and in the memory Which translate into lack of concentration and difficulty in learning and remembering information.
- Sleep disorders Like insomnia or Hypersomnia , Although difficulties may also occur in falling asleep or waking earlier in the count.
- Tiredness and fatigue during the day.
- Recurrent worry, irritability and easy crying.
- Apathy, with an important loss of interest for the activities that previously pleased him.
- Negative vision or hopelessness towards the future.
- Hypervigilance to the feared stimuli or symptoms, usually accompanied by the feeling that something dangerous for yourself or other important people is going to happen.
- More associated with anxiety, there are symptoms of tachycardia, tremors, dry mouth, feeling of running out of air or Paraesthesia Even intermittently.
- Social deterioration, since they can avoid contact with others.
- Low selfsteem .
- They do not fulfill their responsibilities: they usually miss school or work or perform below normal.
- Appearance sloppy, lacking personal cleanliness.
- Drug or alcohol abuse , Since they usually adopt these habits with the aim of alleviating or diminishing the symptoms that torment them.
- In some cases it can be accompanied by Suicidal ideation .
Usually these patients request help in consultation due to physical symptoms, such as alterations in appetite or sleep and panic attacks, without knowing that they hide behind depressive-anxious pictures.
To diagnose this disorder, there must be symptoms of anxiety and depression, which can be very similar. In addition, none of these should clearly predominate over another, or should not present sufficient intensity to make differentiated diagnoses.
Rather, many of the symptoms that the person may manifest have originated as much as from 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 of anxiety and depression at the same time; But it would not be part of the disorder described here.
For all this, it may be very difficult to correctly detect this problem and it is normal to get incorrect diagnoses.
The ICD-10 of the World Health Organization includes this disorder, indicating that there should be severe anxiety accompanied by a somewhat milder depression; And if they are at similar levels, depression should be prioritized. In addition, ICD-10 should include mild or non-persistent anxiety depression.
Somatic symptoms such as palpitations, tremors, stomach discomfort, dry mouth, etc. are required to detect it. And it is important to consider that the symptoms are not due to complicated or stressful life events, such as a major loss or painful experience. Since, if so, it would be classified as an adaptation disorder.
In a study by Kara, Yazici, Güleç & Unsal (2000), a group of 29 patients with Mixed Anxious Depressive Disorder with 31 patients with Major Depressive Disorder To see how they differed and how they looked. The former were found to be more anxious and less depressed than the latter.
In addition, they observed biological variables such as thyroid hormones, or hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axes, without finding differences between both groups.
However, the study concludes that there is insufficient evidence to indicate that mixed anxiety-depressive disorder should be a separate diagnostic category. A proof of this is that this condition does not appear in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V).
There is a great debate between including this disorder as a diagnostic category, because on the one hand it seems that it is not a disorder because it does not present different and typical features of it; But on the other, it can not be left without diagnosis (and therefore without help) to many people who are suffering due to this condition.
Tyrer (1989) proposed for this disorder the term" Cothymia ", Indicating that it was necessary to take into account in clinical practice.
What is its prevalence?
Mixed Anxiety-Depressive Disorder is one of the most common mental disorders, occurring in 8 out of 1,000 people worldwide. It is more common in women than in men.
What are the risk factors?
A person is more likely to develop Mixed Anxiety-Depressive Disorder if they are exposed to the following conditions:
- Having relatives with mental disorders, especially anxiety or depression, or with problems of drug addiction .
- Dependent personality Or pessimistic, or have low self-esteem.
- Low socioeconomic level.
- To be a woman. Since in women this disorder is more common than in men. This seems to be due to hormonal factors that make women prone.
- Lack of social or family support.
- Have experienced some traumatic or very negative experience for the person in childhood or childhood.
- Being under high pressure and stress levels.
- Have serious or chronic illness.
It is common for these patients not to be treated, first because of the difficulties associated with the diagnosis; And secondly because the clinical manifestations are often imprecise or somewhat milder and therefore not given importance.
The patient learns to coexist with these symptoms and does not usually go to a doctor's office until he or she has no physical symptoms that seriously damages his daily life insomnia , for example). From what is observed, the majority of those affected do not demand psychological or psychiatric care.
Before these patients, it is usual to help them feel better through pharmacological treatment combined with other techniques, especially if panic attacks or agoraphobia .
Previously it was complicated to choose pharmacological treatment for this condition, since some Antidepressants Y Anxiolytics Function differently. However, antidepressants selective serotonin reuptake inhibitors (SSRIs) Which is 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 like paroxetine or venlafaxine. Although most often, it is used together Antidepressants Y Benzodiazepines .
Obviously, pharmacological treatment will be aimed at alleviating those symptoms that are more pronounced in each patient, that is, those that cause deterioration in their life and are more urgent.
For example, if anxiety symptoms are the ones that accentuate the problems, focus on anti-anxiety drugs. However, benzodiazepines are not usually prescribed alone in patients with mixed depressive disorder.
One mistake that should not be made is to focus on pharmacological treatment, forgetting other techniques that are more useful. It is important to know that the drugs themselves will not solve the problem, but are complementary to other interventions and facilitate them; Promoting energy and well-being in the patient to follow other therapies.
Research in treatment only in Mixed Anxiety-Depressive Disorder is very scarce, although we can follow the steps to treat anxiety and depression.
In this way, psychological therapy Cognitive behavioral (CBT) Is the one that has demonstrated better results, mainly if in some cases it is combined with pharmacological treatment.
In this therapy are combined both cognitive and referenced methods to change the person's point of view, beliefs and mental schemas. Here the Cognitive restructuring Or detention of thought.
Behavioral methods are also used, aimed at the patient gradually implementing behaviors that will bring some benefit.
Thus, it increases desirable behaviors in the person as being able to get out of bed to go to work, reduces undesirable behaviors, such as always carry alcohol or pills in the bag, or teach the person to start behaviors New beneficial ones.
Other very useful techniques for anxiety are controlled exposure to feared stimuli, intense physical exercise, or Relaxation techniques .
Among the relaxation techniques are the Jacobson progressive relaxation , Breathing techniques or autogenous relaxation.
- Boulenger, J.P. & Lavallée, Y.J. (1993). Mixed anxiety and depression: diagnostic issues. J Clin Psychiatry, 54: 3-8.
- ICD-10 F41. (S.f.). Retrieved on July 21, 2016, from Psicomed.net.
- Dan J. S., Eric H., Barbara O. R. (2009). Chapter 15: Mixed Anxiety - Depressive Disorder. In Textbook of Anxiety Disorders (pp. 241-253). American Psychiatric Publishing: Washington, DC.
- Kara, S., Yazici, K. M., Güleç, C., & Ünsal, I. (2000). Mixed anxiety-depressive disorder and major depressive disorder: comparison of the severity of illness and biological variables. Psychiatry Research, 94, 59-66.
- Mixed anxiety-depressive disorder. (S.f.). Retrieved on July 21, 2016, from Psychology Wiki.
- Mixed Anxiety-Depressive Disorder. (S.f.). Retrieved on July 21, 2016, from Disorders.org.
Tyrer, P. (2001). The case for cothymia: Mixed anxiety and depression as a single diagnosis. The British Journal of Psychiatry, 179 (3), 191-193.