Anxiety-depressive Disorder Combination: Definition, Causes And Treatment

The combination of anxiety and depressive disorder is controversial  and not all existing classifications of symptoms include it. It is not a question of not acknowledging its existence, but it is sometimes seen as a depressive disorder with secondary anxiety traits and not just one disorder.

Symptoms of the combination of anxiety and depressive disorder include anxiety and depression, but neither of them clearly dominates. Nor do they have enough strength to justify a separate diagnosis.

This disease manifests as a mixture of relatively mild symptoms that are often seen in first aid, and its prevalence is even higher in the general population.

The combination of depressive and anxiety symptoms causes a significant decrease in function in people who suffer from it.

However, those who oppose this diagnosis say that the easy “availability” of this diagnosis persuades physicians and therapists to give up the time they need to acquire a full psychiatric patient history. Such a history would allow them to distinguish real depressive disorder from real anxiety disorder.

When was the anxiety-depressive disorder combination diagnosed?

To diagnose the disease,  there must be symptoms of low intensity of anxiety or depression. In addition, there must be vegetative symptoms such as tremors, palpitations, dry mouth, or abdominal pain.

Some preliminary studies have shown that  GPs have poor perception ability to detect symptoms of anxiety depression. However, it is possible that this lack of identification only reflects the fact that they do not have a proper name for their diagnosis.

Symptoms of the anxiety-depressive disorder combination

The clinical manifestations of this disease combine the symptoms of anxiety disorder and depressive disorder. In addition,  symptoms of autonomic nervous system hyperactivity, such as indigestion, are common. For this reason, patients often go to outpatient clinics.

DSM-IV study criteria for the combination of anxiety-depressive disorder

The Diagnostic and Statistical Manual of Mental Disorders (DSM) presents a series of criteria for diagnosing this disease. However, as we have already mentioned, it is for research purposes only. Let’s take a closer look at it:

The main feature of this disease is persistent or recurrent dysphoria that lasts for at least a month at a time. Such a state of mind is accompanied by additional symptoms lasting for an equal period of time, including at least four of the following:

• Difficulty concentrating, memory or sleeping, tiredness and lack of energy.
• Sudden irritability.
• Repeated and intense concern.
• Sensitivity to crying or feeling hopeless, pessimistic about the future, feeling useless and low self-esteem.
• Over vigilance, danger anticipation.

These symptoms cause  significant clinical discomfort or impairment of social, work-related, and other important activities.

On the other hand, the combination of anxiety and depressive disorder should not be diagnosed when the symptoms are directly due to the physiological effects of the substances or the medical condition, or if the person has at some point been diagnosed with severe or persistent depressive disorder, anxiety disorder, or generalized anxiety disorder.

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

It is also important that there is no better explanation for the symptoms with another mental illness. The earliest data on this disease come from the emergency department, where the disease appears to be more common; it is also more common among outpatients.

What is the effect of the combination of anxiety and depression?

Coexistence of severe depression and anxiety disorder is very common. Two-thirds of patients with depressive symptoms also have clear symptoms of anxiety. One-third of these are diagnosed with panic disorder.

Some researchers have reported that 20-90% of all patients with anxiety disorder suffer from periods of major depressive disorder. This information indicates that coexistence of depressive and anxiety symptoms that is not diagnosed with depressive or anxiety disorder is very common.

However, there is currently no official epidemiological data on the combination of anxiety and depressive disorder. But some researchers have estimated that  the incidence of this disease in the general population is 10%, yet in first aid, its incidence is 50%. More conservative estimates suggest that its prevalence is 1% of the general population.

What causes this disease?

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

First,  several researchers have found similar endocrine causes of nervous system depression and anxiety disorders. This includes the following symptoms:

• decreased response of cortisol to adrenotropic hormone
• decreased response of growth hormone to clonidine
• a decrease in thyroid stimulating hormone
• decreased response of prolactin to thyrotropin-releasing hormone

Second, several researchers have provided data that suggest  overactivity of the noradrenergic system in some patients as  an essential factor in the early stages of depression and anxiety disorder.

In particular, these studies have shown that patients with depressive or anxiety disorder who are currently undergoing an anxiety crisis have  high levels of the norepinephrine metabolite MHPG in their urine, plasma or cerebrospinal fluid.

As with other anxiety and depression disorders,  serotonin and GABA may be associated with the onset of an anxiety and depression disorder combination.

Third,  many studies have shown that serotonergic drugs such as fluoxetine and clomipramine are useful in the  treatment of both depression and anxiety.

Finally, several family studies have provided data showing that symptoms of anxiety and depression are genetically advanced, at least in some families.

The course of disease and prognosis

Based on current clinical data, it appears that patients may initially have a similar likelihood of the predominant symptoms of anxiety or depression or their relative mixture.

During the course of this disease, the prevalence of symptoms of anxiety and depression may vary. The forecast is not yet known.

However, depressive and anxiety disorders separately tend to become chronic without proper psychological treatment.

Anxiety-depressive disorder combination treatment measures

Because there are no good studies comparing treatments for the anxiety-depressive disorder combination, experts tend to give treatment based on the symptoms that occur, their severity, and their previous experience with different treatments.

A psychotherapy approach, such as behavioral therapy or cognitive therapy, can be used as a therapeutic measure for a short period of time. Yet some therapists use a less constructed psychotherapeutic approach, such as self-examination psychotherapy.

Medication

The pharmacological treatment for the combination of anxiety and depressive disorder is  usually drugs for anxiety or depression, or both. With regard to anxiolytic drugs, some data suggest that the use of triazolobenzodiazepines (e.g., alprazolam) may be appropriate due to its efficacy in the treatment of depression, which is also associated with anxiety.

Agents that act on the 5-HT receptor, such as buspirone, may also be suitable. Among antidepressants, serotonergics (e.g., fluoxetine) may be truly effective in treating the combination of anxiety-depressive disorder.

Psychological treatment

In any case, the  choice of treatment for these diseases is cognitive and behavioral psychotherapy.

On the other hand, it is above all about reducing the level of physiological activity of the patient. This is achieved through breathing techniques (e.g., diaphragmatic breathing) as well as relaxation techniques (progressive muscle relaxation, autogenic exercise, conscious presence, and so on).

Second,  it is important for the patient to improve their mood. This can be achieved in different ways. Behavior activating therapy can be really effective in this case.

The idea is to restore the patient to their previous level of activity. To accomplish this, the Therapist encourages the patient to do pleasurable activities either by returning to one or taking part in a new one in stages.

Third, the  teaching of psychotherapy is helpful. At this point, the patient gets an explanation of what is happening to him and why. She learns some basic things about the characteristics of anxiety and depression so she can normalize her experience.

Afterwards,  it may be necessary to change some beliefs and thoughts that may be fueling the problem. This may be part of a cognitive reconstruction technique.

As you can see, the combination of anxiety and depressive disorder does not have a specific identifier in some diagnostic systems, but it is commonly seen in first aid consultations. It is relatively common.

It is a disease that can be treated, and if not treated in time, it can become chronic.

Literature sources:

Bobes García, J. (2001). Trastornos de meritsad and trastornos depresivos en atención primaria . Barcelona, ​​etc .: Masson.

Derogatis, LR, & Wise, TN (1996). Trastornos depressive and de meritsad en enistencia primaria . Barcelona: Martinez Roca.