Mixed anxiety-depressive disorder: causes and symptoms

Anxiety disorders are the most common in the general population. After them would come the depressive disorders. Psychology has traditionally observed that the two types of disorders have many things 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 there are simultaneous features of depression and anxiety, can be categorized as a mixed anxiety-depressive disorder.

Depression and anxiety: points in common

The link between depressive and anxiety problems is a well-known circumstance in psychological and psychiatric research. In clinical practice, it is rarely given in pure formIt is very common for people who are depressed to develop anxiety problems. That is why in research it has been common to try to find out what concrete aspects they look like and in which they diverge.

One of the main common elements 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 in both cases there is a high level of emotional pain, irritability, discomfort, and feelings of guilt and bad mood.

Another common point is that, in both cases, people suffer because they consider that they are not, will be or would be able to cope with life or specific circumstances thereof, suffer from a deep sense of helplessness and exhibiting low self-esteem.

However, in depression more than the high negative effect, we would also find low positive affect, which would not occur in anxiety. This is what produces anhedonia and the lack of energy and dynamism. This circumstance does not appear in pure anguish.

One thing specific to anxiety that does not occur in depression (except for certain subtypes like the one with psychotic symptoms) is overactivation. Anxious people they notice a sharp increase in arousal, A “surge” of energy coming from the anticipation of a possible damage, which cannot give a practical outcome. This does not happen in depression, in which a person’s energy level actually tends to drop.

these are some of the things 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 anxiety-depressive disorder: what is it?

Mixed anxiety-depressive disorder is the type of disorder characterized by the combined presence of symptoms of depression and anxiety, Without neither having greater repercussions than the other.

Typical symptoms of this disorder include depressed mood and / or anhedonia which appear alongside anxiety. difficulty concentrating, stress, and excessive and irrational worry. These symptoms should last at least two weeks or a month and should not be due to experiencing painful experiences or the presence of other disorders.

In addition, vegetative symptoms such as tremors, intestinal discomfort or tachycardia should sometimes appear. These are symptoms consistent with a very high level of negative affect, also appearing in part due to the overactivation of anxiety disorders and the weak positive effect of depressants.

The diagnosis of mixed anxiety-depressive disorder

To diagnose mixed anxiety-depressive disorder the symptoms experienced may not meet all of the conditions necessary to identify with one or the other the disorders also cannot be severe enough to make two diagnoses, one of depression and the other of anxiety.

Another very important feature is that both types of symptoms should appear during the same period. This consideration is important because it makes it possible to distinguish this disorder with the onset of anxiety symptoms following depression or depressive symptoms due to the persistence of depressive symptoms.


At the vital level, this disorder is felt as distressing by those who suffer from it, and it is not uncommon for those who suffer from it to end up developing strong irritability, autolytic thoughts, the use of substances as an escape, a deterioration of the work. or social activities. settings., poor personal hygiene, insomnia, overeating and hopelessness.

However, as a rule, they do not consider themselves serious enough to go for a consultation. In fact, it’s more common to be diagnosed after a doctor visit for vegetative problems which causes this by cognitive problems.

Location of the disorder in the most common diagnostic classifications

The category of mixed anxiety-depression disorder has sparked controversy in its design, not be taken into account by all existing diagnostic classifications. It is not that its existence is not recognized, but it has sometimes been considered to be either a depressive disorder with secondary anxiety characteristics and not a single disorder.

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

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

treatments applied

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

In case of mixed anxiety-depressive disorder, its treatment is complex because of this difference, having to use strategies specific to each type of disorder. More specifically, a strategy based on cognitive behavioral therapy has been used with success, sometimes in combination with pharmacological treatment.

Psychologically, the practice of activities that allow the patient to regain control, increase their self-esteem and make them see the world in a more realistic way are helpful.

Psychoeducation is generally used, Through which the characteristics of their problem are explained to patients, can be very helpful for them to understand what is happening to them and that they are not the only ones suffering from it. Subsequently, anxiety and depressive symptoms are usually treated, the former being used for exposure to avoided situations, breathing and relaxation training, and self-learning techniques.

It acts on problems of a depressive nature involve subjects in positive and enriching activities and cognitive restructuring is used to shift to acquiring new thought patterns that are more adaptive than those used so far. Group therapy has also been observed to go a long way in improving symptoms and identifying unsuitable thought patterns and changing them for others.

Pharmacologically, the application of SSRIs has been shown to be useful for symptom control, by inhibiting the reuptake of serotonin in a specific way and successfully combating depressive and anxiety symptoms.

Bibliographical references:

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
  • Echeburúa, E .; Salaberría, K .; from Corral, P .; Cenea, R. and Barasategui, T. (2000). Treatment of mixed anxiety and depression disorder: results of experimental research. Behavior Modification Analysis, Vol. 26, 108. Department of Personality, Psychological Assessment and Treatment. Faculty of Psychology. University of the Basque Country.
  • World Health Organization (1992), International Classification of Diseases. Tenth edition. Madrid: WHO.
  • Sants, JL; Garcia, LI; Calderon, MA; Sanz, LJ; of rivers, P .; Left, S .; Román, P .; Hernangómez, L .; Navas, E .; Lladre, A and Álvarez-Cienfuegos, L. (2012). Clinical Psychology. CEDE PIR preparation manual, 02. CEDE. Madrid.

Leave a Comment