The relevance of ‘mixed anxiety and depression’ as a diagnostic category in clinical practice

Summary & key facts

This paper looks at whether 'mixed anxiety and depressive disorder' should be an official diagnosis. That label describes people who have both anxiety and depression symptoms that are real and limiting, but not strong enough to count as a full disorder on their own. The authors review studies that support and question the label. They point out that many people seen in regular medical clinics meet this description, that these people can be as distressed and impaired as those with full disorders, and that about half get better within a year while others can get worse. The authors conclude that keeping the label might help people get treatment earlier and could prevent some cases from becoming more serious.

Key facts:

• Mixed anxiety and depressive disorder means having both anxiety and depression symptoms at the same time, but each symptom set is not strong enough to be a full disorder on its own.
• This condition appears to be common, especially among patients seen in regular primary care clinics.
• People with this mixed condition can have levels of distress and difficulty doing daily tasks similar to people who have full anxiety or full depression.
• About half of people with the mixed condition get better within one year.
• People who do not get better are at higher risk of developing a full anxiety disorder or a full depressive disorder later on.
• The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, did not add this diagnosis because proposed rules for diagnosing it were not reliable enough.
• Researchers and reviewers disagree about how common the condition really is and how stable the diagnosis is over time.
• The authors argue that naming the condition in diagnostic systems could help patients get treatment earlier and might prevent worsening and reduce costs for society, but this remains a debated point.

Abstract

According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe enough to justify a psychiatric diagnosis, but neither of which are clearly predominant. MADD appears to be very common, particularly in primary care, although prevalence estimates vary, often depending on the diagnostic criteria applied. It has been associated with similarly pronounced distress, impairment of daily living skills, and reduced health-related quality of life as fully syndromal depression and anxiety. Although about half of the patients affected remit within a year, non-remitting patients are at a high risk of transition to a fully syndromal psychiatric disorder. The validity and clinical usefulness of MADD as a diagnostic category are under debate. It has not been included in the recently released DSM-5 since the proposed diagnostic criteria turned out to be not sufficiently reliable. Moreover, reviewers have disputed the justification of MADD based on divergent results regarding its prevalence and course, diagnostic stability over time, and nosological inconsistencies between subthreshold and threshold presentations of anxiety and depressive disorders. We review the evidence in favor and against MADD and argue that it should be included into classification systems as a diagnostic category because it may enable patients to gain access to appropriate treatment early. This may help to reduce patients' distress, prevent exacerbation to a more serious psychiatric disorder, and ultimately reduce the societal costs of this very common condition.

Topics

Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Child and Adolescent Psychosocial and Emotional Development Psychosomatic Disorders and Their Treatments

Categories

Experimental and Cognitive Psychology Psychology Social Sciences

Tags

Anxiety Clinical psychology Depression (economics) Distress Economics Exacerbation Immunology Macroeconomics Medicine Psychiatry Psychology

Conditions & symptoms

Anxiety Depression