Mixed anxiety and depression disorder has generated great controversy about its concept, which has not been adopted by all existing diagnostic classifications, this does not mean that its existence has not been recognized, but is sometimes considered a depressive disorder with secondary anxiety characteristics. not as a single disorder.
In mixed anxiety and depression disorders, symptoms of anxiety and depression are present, but none of them clearly predominate or are strong enough to warrant a separate diagnosis.
This disorder manifests itself in a combination of relatively mild symptoms.
The combination of depressive symptoms and anxiety results in a significant alteration in the life of the person suffering from this disorder, however, those who oppose this diagnosis argue that the existence of this concept discourages physicians from spending the time necessary to perform a complete psychiatric history. A story that, in turn, allows us to differentiate between real depressive disorders and anxiety disorders.
To make the diagnosis it is necessary to look for symptoms of anxiety and depression of low intensity, in addition to vegetative symptomatology, such as tremors, palpitations, dry mouth and stomach pain.
Some preliminary studies have indicated that the sensitivity of the general practitioner for the identification of mixed anxiety syndrome and depressive disorder is low, however, this difficulty may reflect the lack of recognition of the proper name for the diagnosis of these patients.
The clinical manifestations of this disorder combine symptoms of anxiety disorders with symptoms of depressive disorders. In addition, symptoms of autonomic nervous system hyperactivity, such as gastrointestinal disorders, are common, which means that people with this disorder are often seen by doctors. ‘Offices.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) proposes a number of criteria for the diagnosis of this disorder, on the other hand, as we have already mentioned, the objective of establishing these criteria is to investigate, let’s see what they are.
Rather, it should be noted that the fundamental characteristic of this disorder is a persistent or recurrent dysphoric mental state that lasts at least 1 month, this mood is accompanied by complementary symptoms of the same duration, including at least four of the following symptoms:
These symptoms cause significant clinical distress or important social, professional, or other areas of the person’s activities. On the other hand, mixed anxiety and depression disorder should be excluded when the symptoms are physiological effects of a substance or medical condition, or even if at some point the individual met the diagnostic criteria for major depressive disorder, dysthymia, or disorder. generalized anxiety or anxiety disorder.
This diagnosis should also not be made if, at the same time, the patient’s symptoms are part of another anxiety or mood disorder, even in partial remission.
It is also necessary that the symptomatic picture cannot be better explained by the presence of another mental disorder. Most of the initial information about this condition was collected in primary care facilities, where the disorder appears to be more common. higher prevalence in outpatients.
The coexistence of a major depressive disorder and anxiety disorder is very common; two-thirds of patients with depressive symptoms have clear symptoms of anxiety and one-third meet the criteria for diagnosing anxiety disorder.
Some researchers have reported that 20 to 90% of all patients with anxiety disorders have episodes of major depressive disorder, data suggesting that the coexistence of depressive and anxiety symptoms that do not meet the criteria for diagnosing depressive or anxiety disorders is very common.
However, there are currently no formal epidemiological data on mixed anxiety and depression disorder, in this case some researchers have estimated that the incidence of this disorder in the general population is 10% and 50% in the primary care population. More conservative estimates suggest a 1% impact on the general population.
Four experimental lines suggest that anxiety symptoms and depressive symptoms are related to identified causes.
First, several researchers have found similar neuroendocrine causes in depressive and anxiety disorders. These symptoms include a lower slope in cortisol’s response to adrenocticotropic hormone, a lower slope in growth hormone’s response to clonidine, and a lower slope in the thyroid hormone and prolactin’s response to thyrotropin-releasing hormone.
Second, several researchers have presented data identifying the hyperactivity of the noradrenergic system as a relevant factor in the origin of depressive and distress disorders in some patients.
Specifically, these studies found that depressed patients with anxiety disorders who actively experienced an anxiety attack had high levels of norepinephrine metabolite (MHPG) in urine, plasma, or cerebrospinal fluid.
As with other depressive and anxiety disorders, Serotonin and Gamma-Aminobutyric Acid (GABA) may also be associated with a mixed anxiety and depression disorder.
Third, numerous studies have shown that Serotonin drugs, such as fluoxetine and clomipramine, are useful in treating depressive and anxiety disorders. Finally, several family studies have presented evidence that anxiety and depressive symptoms are genetically related, at least in some families.
According to current clinical information, it appears that at first, patients may have the same probability of having predominant symptoms of anxiety or predominant symptoms of depression, or a proportional combination of both.
During the course of the disease the prevalence of symptoms of anxiety and depression was altered, it is not yet known what the prognosis is. Separately, depressive and anxiety disorders tend to become chronic without proper psychological treatment.
Because there are no adequate studies comparing treatment modalities for mixed anxiety and depression disorders, doctors tend to offer treatments based on symptoms, severity, and previous experience with different treatment modalities.
Psychotherapeutic approaches can be limited over time, such as cognitive or behavioral therapy. In contrast, some doctors use a less structured psychotherapeutic approach, such as introspection psychotherapy.
Pharmacological treatment for mixed anxiety and depression disorders is based on anxiolytics, antidepressants or both. Among anxiolytics, there is some evidence that the use of benzodiazepines (e. g. alprazolam) may be indicated by its effectiveness in treating anxiety-associated depression.
Substances affecting the 5-HT receptor, such as buspirone, may also be indicated. Among antidepressants, Serotonin (e. g. Fluoxetine) can be very effective in treating mixed anxiety and depression disorder.
In any case, the treatment of choice for this type of pathologies is cognitive behavioral psychotherapy, on the one hand, the goal is that the patient is able, at first, to reduce their level of physiological activation, which is achieved through breathing. techniques (e. g. diaphragmatic breathing) and relaxation techniques (progressive muscle relaxation, autogenous training, mindfulness, etc. ).
Secondly, it is necessary for the patient to improve their mood, which can be done in different ways. Behavioral activation therapy can be very effective in this regard, that is, the patient who returns to their previous level of activity, for this purpose is encouraged to perform pleasant activities, either to resume or start participating gradually in a new activity.
Third, a period of psychoeducation is very useful, in which the patient is explained what happens to him and why, in order to provide the patient with basic knowledge of the characteristics of anxiety and depression to formalize their experience.
After that, it may be necessary to change certain beliefs or thoughts that may sustain the problem. This can be done using the cognitive restructuring technique.
Finally, mixed anxiety and depression disorder is treated and, if not treated in time, can become chronic.
Bibliography
Bobes García, J. (2001). Anxiety disorders and depressive disorders in primary care. Barcelona, etc. : Masson.
Derogatis, L. R. et Wise, T. N. (1996). Depressive and anxious disorders in primary care. Barcelona: Martinez Roca.
Miguel Tobal, J. J. (1990). Anxiety. J. Major and J. L. Pinillos (Eds. ). Treaty on General Psychology. (Vol. 3). Motivation and emotion. Madrid: Alhambra.