Anxiety-depressive Disorder: Definition, Cause U0026 Treatment

Anxiety-depressive disorder has been controversial and not all existing diagnostic classifications include it. It is not that its existence has been denied, but that it has sometimes been considered a depressive disorder with secondary anxiety-related elements rather than a single disorder.

The symptoms of anxiety-depressive disorder are anxiety and depression, but none are predominant. In addition, they do not have sufficient intensity to justify a separate diagnosis.

This condition manifests itself in the form of a mixture of comparatively mild symptoms that are frequently seen in primary care, and its prevalence is relatively high in the general public.

The combination of depressive and anxiety symptoms causes a significant deterioration in the function of the affected person.

Those who oppose this diagnosis, however, claim that its availability leads to doctors not taking the time needed to fully examine the patient’s psychiatric history. It could make them differentiate from depressive disorders from anxiety disorders.

To diagnose it , there must be symptoms of anxiety and depression of low intensity. Furthermore, there must be some vegetative symptoms, such as tremors, palpitations, dry mouth and abdominal pain.

Some preliminary studies have indicated that GPs have low susceptibility to detect anxiety-depressive disorder. However, it is possible that this lack of recognition only reflects the lack of a correct diagnostic label for these patients.

Clinical manifestations of this disorder combine symptoms of anxiety disorders and symptoms of depressive disorders. Furthermore , symptoms of hyperactivity in the autonomic nervous system, such as gastrointestinal discomfort, are common. This is often why patients seek care.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) presents a series of criteria for diagnosing this disorder. As we have already mentioned, however, it is only for research purposes. Let’s take a look.

The basic characteristics of this disorder are a persistent or recurrent dysphoria that lasts for at least a month. This state of mind comes along with additional symptoms of the same duration, including at least four of the following:

• Difficulty with concentration or memory, difficulty sleeping, fatigue or lack of energy.
• Acute irritability.
• Recurring and intense anxiety.
• Crys easily or has feelings of hopelessness, pessimism about the future, worthlessness and low self-esteem.
• Hyper wakefulness, anticipation of danger.

These symptoms cause significant clinical discomfort or deterioration in social and work environments as well as in other important activities.

On the other hand, anxiety-depressive disorder should not be diagnosed when the symptoms are caused by direct physiological effects of a substance or drug. It should also not be done if the patient meets the criteria for major depression, persistent depressive disorder, anxiety disorders or generalized anxiety disorder.

This diagnosis is also inappropriate if the criteria for other anxiety or mood disorders are met at the same time, even if they are partially in remission.

It is also necessary that the extent of the symptoms does not have a better explanation, in the form of another mental illness. Most of the initial information about this condition comes from centers for primary care, where the condition seems to be more frequent; it probably also has more prevalence in outpatient patients.

The coexistence of major depression and an anxiety disorder is very common. Two-thirds of all patients with depressive symptoms also have clear symptoms of anxiety. One third of these may meet the diagnostic requirements for panic disorder.

Some researchers have reported that 20-90% of all patients with anxiety disorder have episodes of major depression. This data suggests that the coexistence of symptoms of depression and anxiety that do not meet the diagnostic requirements for depression or anxiety disorders is very common.

At the time of writing, however, there are no formal epidemiological data on anxiety-depressive disorder. However, some researchers estimate that the prevalence of this disorder among the population is 10%, which is increased to 50% in primary care. More conservative estimates put the prevalence at 1% of the population.

Four research lines suggest that symptoms of anxiety and depression are linked to identified causes. Several researchers have found similar neuroendocrine causes for depression and anxiety syndrome. These include a reduction of:

• Cortisol’s response to adrenocorticotropic hormone.
• The growth hormone response to clonidine.
• The thyroid stimulating hormone.
• Prolactin’s response to the thyrotropin-secreting hormone.

Furthermore, several researchers have presented data that identify hyperactivity of the noradrenergic system as a relevant factor for the origin of depression and anxiety syndrome in some patients.

Mark Gluck et al. Learning and Memory, 2013.

More specifically, these studies have found that patients with depression or anxiety syndrome who are actively experiencing an anxiety crisis have high concentrations of MHPG in their urine, plasma or spinal fluid.

As with other anxiety disorders and depressive disorders , serotonin and GABA may also be associated with the origin of anxiety-depressive disorder.

Furthermore, many studies have found that serotonergic drugs, such as fluoxetine and clomipramine, are useful in treating both depression and anxiety disorders.

Finally, several family studies have presented data indicating that anxiety and depression symptoms are passed on genetically, at least in some families.

According to current clinical information, it appears that patients initially have the same risk of dominant symptoms of anxiety or depression, or a mixture of both.

During the course of the disease, anxiety and depressive symptoms can alternate in their dominance. There is no forecast yet. Separately, however, depression and anxiety disorders tend to become chronic without adequate psychological treatment.

Because there are no good studies comparing treatment methods for anxiety-depressive disorder, doctors tend to provide treatment according to the symptoms shown, their severity and their previous experience of different treatment methods.

Psychotherapeutic methods can be used for a short time, such as behavioral or cognitive therapy. However, some doctors use a less structured psychotherapeutic method, such as introspection psychotherapy.

The pharmacological treatment of anxiety-depressive disorders usually includes anti-anxiety drugs, antidepressants or both. Among the anxiolytic drugs, some data indicate that the use of triazolobenzodiazepines (eg alprazolam) may be appropriate due to its efficacy in the treatment of anxiety associated with anxiety.

Substances that affect the 5-HT receptor, such as buspirone, may also be appropriate. Among the antidepressants, serotonergic agents (fluoxetine, for example) may be effective in treating this condition.

However, the preferred method for these types of pathologies is cognitive behavioral therapy. Above all, the initial goal is for the patient to reduce their level of physiological activation. This is achieved through breathing techniques (for example breathing with a diaphragm) as well as relaxation techniques (progressive muscle relaxation, autogenic training, conscious presence, etc.).

Furthermore , it is necessary for the patient to improve his mood. This can be achieved in different ways. Behavioral activation therapy can be very effective. The idea is that the patient should resume their previous level of activation. To do this, a therapist encourages the person to engage in enjoyable activities, either one from earlier in life or a brand new one.

A period of psycho-education is also useful. During this period, the patient receives an explanation of what has affected him and why. The person gets to learn basic ideas about the characteristics of anxiety and depression so that he can normalize his experience.

Afterwards , it may be necessary to change certain beliefs or thoughts that feed the problem. This can be done with a cognitive restructuring technique.

As you can see, anxiety-depressive disorder has no specific identity in some diagnostic systems, but is frequently detected in primary care. It is relatively common.

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