Mixed Anxiety and

Depressive Disorder

Introduction
Many studies have shown that
anxious and depressive symptoms
frequently coexist in patients seen
clinical practice

Terminology
Mixed anxiety and depression is a
potentially ambiguous term because
it is often used to refer to different
situations.
First, it refers to symptoms of mixed
anxiety-depression found in any
patient. In this sense, the
abbreviation MADS is used to stand
for mixed anxiety and depressive
symptoms.

Terminology
Second, it refers to the simultaneous
presence or the comorbidity or
oncomitant occurance of treshold
levels of two disorders such as major
depression and generalized anxiety
disorder or major depression and
panic disorder or major depression
and social phobia

Terminology
Third, it refers to subsyndromal or
subtreshold level of one disorder
concomitant with the treshold level
of another disorder such as major
depression with anxiety symptoms or
generalized anxiety disorder with
depressive symptoms or panic
disorder with depressive symptoms.

Terminology
Fourth, it refers to a specific disorder
according to ICD-10 or DSM IV or any
specific criteria for which the
abbreviation MADD is used to stand
for mixed anxiety and depressive
disorder
Fifth, it refers to subsyndromal mixed
anxiety-depression that doesnt meet
criteria of ICD-10 or DSM-IV

Epidemiology
Epidemiologic studies carried out in
the commonly have shown that
subsyndromal mixed anxietydepression occurs in 0,8% to 2,5% in
the general population

How to Diagnose MADD

Criteria Diagnosis
Pocket book PPDGJ III page 75
F41.2 Mixed anxiety and depressive
disorder

There are so many possible

combinations of comparatively mild
symptoms for these disorders that
specific criteria are not given, other than
those already in the diagnostic guidelines

Causes
This disorder is caused by a
combination of biological,
psychological, and environmental
factors. These factors include
imbalances to neurotransmitters in
the brain, traumas, stresses, and an
unstable home environment.

Treatment
Treating mixed anxiety-depressive
disorder can be difficult for
physicians because some treatments
are more effective for depressive
symptoms where others are more
effective for anxiety symptoms

Treatment
SSRI (Fluoxetine)
antidepressants, sometimes
combined with benzodiazepines,
have been proven to be effective for
both anxiety and depression
The current treatment that has been
most effective is Cognitive
Behavioral Therapy.

Prognosis
The majority with MADD improved,
but individuals had an increased risk
of significant distress at 3 months
and a lower quality of life. As we
cannot currently predict those with a
poorer prognosis these patients
should be actively monitored in
primary care