Mixed depressive and anxiety disorder

Essential (Required) Features:

• The presence of both depressive and anxiety symptoms for most of the time during a period of 2 weeks or more.
• Depressive symptoms include depressed mood or markedly diminished interest or pleasure in activities.
• There are multiple anxiety symptoms, which may include feeling nervous, anxious, or on edge, not being able to control worrying thoughts, fear that something awful will happen, having trouble relaxing, muscle tension, or sympathetic autonomic symptoms.
• Neither the depressive nor the anxiety symptoms, considered separately, are sufficiently severe, numerous, or lasting to meet the diagnostic requirements of another Depressive Disorder or an Anxiety or Fear-Related Disorder. There is no history of Manic or Mixed Episodes, which would indicate the presence of a Bipolar Disorder.
• The symptoms are not a manifestation of another medical condition (e.g., hypothyroidism, hyperthyroidism) and are not due to the effects of a substance or medication on the central nervous system, including withdrawal effects (e.g., from alcohol, benzodiazepines).
• The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning. If functioning is maintained, it is only through significant additional effort.

Additional Clinical Features:

• Individuals with this mixture of comparatively mild symptoms of depression and anxiety are frequently seen in primary care, but many more cases exist among the population at large, which never come to clinical attention.

Boundary with Normality (Threshold):

• If worry is the only anxiety symptom (i.e., no sympathetic autonomic or other anxiety symptoms are present), a diagnosis of Mixed Depressive and Anxiety Disorder diagnosis is not appropriate.

Course Features:

• Epidemiological studies have yielded varying results regarding the course and onset of Mixed Depressive and Anxiety Disorder.
• While there is some evidence to suggest that approximately half of individuals with Mixed Depressive and Anxiety Disorder will experience remission of symptoms within 1 year of onset, those who do not remit are at increased risk of developing a Mental, Behavioural, Neurodevelopmental Disorder that meets full diagnostic requirements, typically for a Depressive Disorder or an Anxiety or Fear-Related Disorder.

Culture-Related Features:

• There is little information available about cultural influences on Mixed Depressive and Anxiety Disorder. The information on Culture-Related Features for Single Episode Depressive Disorder and Recurrent Depressive Disorder and for Generalized Anxiety Disorder may be relevant.

Sex- and/or Gender-Related Features:

• It is unknown whether there are gender differences in prevalence rates of Mixed Depressive and Anxiety Disorder.

Boundaries with Other Disorders and Conditions (Differential Diagnosis):

• Boundary with other Depressive Disorders and Anxiety or Fear-Related Disorders: If the depressive symptoms or anxiety symptoms meet the diagnostic requirements for a Depressive Episode or an Anxiety or Fear-Related Disorder, then the Depressive or Anxiety or Fear-Related Disorder should be diagnosed rather than Mixed Depressive and Anxiety Disorder. If appropriate, the ‘with prominent anxiety symptoms’ specifier may be applied to Single Episode Depressive Disorder or Recurrent Depressive Disorder diagnoses.
• Boundary with Bipolar or Related Disorders: Mixed Depressive and Anxiety Disorder should not be diagnosed if there is a history of Manic or Mixed Episodes, which would indicate the presence of a Bipolar Disorder.
• Boundary with Adjustment Disorder: If the onset of the symptoms occurs in close association with significant life changes or stressful life events, a diagnosis of Adjustment Disorder is generally more appropriate than Mixed Depressive and Anxiety Disorder.