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Key Points

  • Experiencing feelings of both anxiety and depression may indicate mixed anxiety and depressive disorder (MADD).
  • MADD can be more disabling than anxiety or depression alone and more resistant to treatment, with a greater risk of self-harm.
  • If one exhibits changes in sleep behavior, changes in appetite, a decrease in energy, or is isolating themselves, this could be a sign of MADD.
  • MADD is not included in The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), although there is ongoing debate among professionals about its classification.
  • Treatment includes counseling, therapy, medication, and ongoing support.

After the pandemic, so many were struggling with their mental health that the United States Surgeon General declared a mental health crisis in 2022. One common mental health disorder is called mixed anxiety and depressive disorder (MADD).

It’s important to know the signs of MADD so you can get the assistance you or a loved one needs and learn what to expect when working with a mental health professional.

Mixed Anxiety Depressive DisorderMixed Anxiety-Depressive Disorder (MADD): What It Is and What To Do

Anxiety and depression are commonly co-occurring, with some studies reporting 50–75% of patients with major depressive disorder (MDD) also meet the DSM-5 criteria for anxious depression.[1] In one study conducted to determine the prevalence of anxiety and depression, it was reported that over 26% of participants experienced both mental health disorders.[2] In most cases, (60–70%) patients experience anxiety first but pursue treatment for depression.[3]

If you are experiencing feelings of both anxiety and depression, you may have mixed anxiety and depressive disorder (MADD). It’s not an uncommon occurrence, as up to 85% of people with depression often experience anxiety symptoms as well. Similarly, 90% of those with anxiety also experience depression.[4]

Depressed and anxious feelings often play off of each other in a person’s mind. Those feelings can be difficult to process while you try to balance the pressures of work, family, school, and everything else.

Those who suffer from MADD may not exhibit all the symptoms of either major depressive disorder or generalized anxiety disorder, but their symptoms overlap enough to make it an incredibly taxing disorder to handle by themselves. In fact, MADD can be more disabling than anxiety or depression alone and can be more resistant to treatment, with a greater risk of self-harm behavior.[5]

What Are The Symptoms of Mixed Anxiety and Depressive Disorder?

Symptoms of generalized anxiety disorder and depressive disorder often overlap, which may explain why so many have both. For example, if you’re having trouble sleeping, that can be a symptom of both anxiety and depression.

It takes a trained professional to properly diagnose someone with MADD and expertly identify the relevant diagnostic criteria, as the symptoms can be similar to other mental illnesses.[6] Some symptoms of MADD that you as a parent can look for include:

  • Negative or intrusive thoughts
  • Increase in tiredness
  • Feelings of anxiousness
  • Increase in isolation
  • Lack of motivation
  • Irritability
  • Issues focusing on activities or classwork
  • Either an increase or decrease in appetite

How To Identify MADD

Identifying MADD is best left to the professionals, but you may be able to tell when something isn’t right. For example, anxiety before a big meeting or interview is one thing, but if you’re constantly worried to the point where it’s debilitating, this may be cause for concern.

Here are some physical and psychological signs to watch out for if you’re concerned about MADD or another mental health disorder.

Physical Signs

Anxiety and depression affect more than just a person’s mind. There will be some physical signs may include:

  • Changes in sleep behavior: You may sleep a lot longer or have trouble staying asleep.
  • Changes in appetite: Have you noticed that you’re not eating as much as you used to? While some appetite changes can be attributed to stress or just not feeling well, a longer-term issue could indicate an underlying cause.
  • Decrease in energy: If you’re exhausted all the time and have no energy to participate in the activities you love, that could be a sign of MADD.
  • Isolating themselves: You or your loved one may withdraw and isolate from friends and family or avoid typically enjoyed extracurricular activities.

Psychological Signs

Those physical signs are usually accompanied by psychological signs, which may be a bit harder to spot, especially if isolating. Some things to look for include:

  • Loss of self-esteem: If confidence is suddenly lost, that could indicate something’s going on below the surface.
  • Difficulty concentrating: We all have our moments where we can’t focus on something. If loss of focus is becoming a bigger problem, like reduced performance at work or missing assignments completely, it may be time to consider real-life solutions.
  • Increase in mood swings: Some moodiness is inevitable, but if you’re getting increasingly irritable, it may be cause for concern.

How Is Mixed Anxiety-Depressive Disorder Diagnosed?

How Is Mixed Anxiety-Depressive Disorder DiagnosedIf you or a loved one may be suffering from MADD or any other mental disorder, the first step is to find a mental health professional to meet with. That professional will discuss your experiences and assess your behavior over several visits before they determine an official diagnosis.

They will be looking for symptoms of both anxiety and depression and then come up with a treatment plan. While MADD is not included in The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), it is recognized in the World Health Organization’s International Classification of Diseases, 10th Revision (ICD-10), as F41.2.[7] Some argue that inclusion in the DSM-5 could help patients in certain healthcare settings get access to treatment more promptly.

Those with MADD don’t exhibit enough symptoms to get a generalized anxiety disorder or a major depressive disorder diagnosis. A psychiatrist can determine if their patient is suffering from the same impairment of daily living skills and reduced health-related quality of life as those who do have other disorders.[8]

Causes and Risks of Anxiety and Depression

When anxiety and depression occur, there is often some cause associated with it. Perhaps a life event triggered it, or genetics played a role.[9] If any of these causes sound like something that’s happened in your life, let a professional know about these potential risk factors when beginning treatment.

  • Genetics: If there is a family history of anxiety or depression, then you could be more prone to these.
  • Trauma: Any kind of trauma, whether it’s recent or in the past, can lead to anxiety or depression. This can include abuse, a major loss, or a natural disaster.
  • Situational factors: If a certain situation becomes too stressful, it could trigger depression or anxiety. If you and your spouse are divorcing, for example, that could lead to MADD symptoms.
  • Physiological factors: Anything that changes in our bodies, like puberty or a chronic illness, can pave the way for anxiety and depression to arrive.
  • Stress: Long-term stress about something or acute stress from a recent event can cause anxiety or depression.

Holistic Treatment For Mixed Anxiety and Depressive Disorder

If you or a loved one needs help with depression and comorbid anxiety or substance use, reach out to a mental health professional as soon as possible. They can create an individualized treatment plan, which may involve medication, counseling, group therapy, and individual sessions for cognitive-behavioral therapy.

Mental health treatment centers like Absolute Awakenings can provide a safe environment where you can find relief and build resiliency despite experiencing anxiety and depression. You’ll work individually and in groups, talk to a psychiatrist or therapist, and figure out ways to manage MADD in your everyday life.

Treatment programs may include partial care, intensive outpatient, standard outpatient, dual diagnosis treatment, and trauma-informed care. Each program is designed so that you’re free to go home at the end of each day without sacrificing the quality of care.

How To Heal At Home

To thrive at home, there are a few things you can do to create a safe space where you feel comfortable. It’s perfectly natural to feel anxious or sad at times, but share your feelings with a trusted friend or advisor. Other ways to manage symptoms at home include:

  • Practicing relaxation techniques: Work on things like breathing exercises, meditation, and visualization.
  • Set a routine and encourage exercise: Exercise can help reduce symptoms of anxiety and depression. Create a structure or schedule to maintain consistency.
  • Pursue positive experiences: Environmental factors can influence anxiety and depression. Engage in positive activities like family outings, plans with friends, or creative hobbies.
  • Find a supportive therapist: You need someone to talk to, so find a therapist you’re comfortable with and meet on a routine basis.

Help Restore Balance and Improve Your Quality of Life

If you or a loved one are struggling with anxiety and depression, there are many ways to get help. Whether it’s through a therapist or a treatment center, you can find the right therapy that will help improve your quality of life. If you are looking for treatment or support, we can help. Contact us today.

Frequently Asked Questions About Mixed Anxiety-Depressive Disorder

First, be genuine. Let them know it’s okay to feel what they’re feeling and don’t trivialize anything. Make sure you take them seriously. If they don’t feel safe to express their feelings, then it’s less likely they’ll talk to you about what’s going on.

There is no definitive cure for anxiety or depression, but there are medications and treatments that can help a person learn to mitigate the symptoms and manage their illness. With the right treatment plan and support, you can still thrive and be happy.

The changes in a young person’s body during puberty can contribute to depression and anxiety. Pay attention to their progress so you can determine whether or not they’re just acting moody or if there’s something else going on. If your child is isolated and doesn’t seem to have a support group, they may need to be evaluated by a mental health professional.[10]

[1][3]Hopwood, M. (2023, April). Anxiety symptoms in patients with major depressive disorder: Commentary on prevalence and clinical implications. Neurology and therapy. 

[2]Lu, L., Shen, H., Tan, L., Huang, Q., Chen, Q., Liang, M., He, L., & Zhou, Y. (2023, February 15). Prevalence and factors associated with anxiety and depression among community-dwelling older adults in Hunan, China: A cross-sectional study – BMC psychiatry. BioMed Central. 

[4][5][8][9]Möller, H.-J., Bandelow, B., Volz, H.-P., Barnikol, U. B., Seifritz, E., & Kasper, S. (2016, March 22). The relevance of “mixed anxiety and depression” as a diagnostic category in Clinical Practice. European archives of psychiatry and clinical neuroscience.  

[6] Salcedo, B. (2018, January 19). The comorbidity of anxiety and depression. NAMI.   

[7]World Health Organization. (n.d.). International Classification of Diseases, 10th Revision (ICD-10): F41.2. World Health Organization. 

[10] Matthews, D. (2018, May 30). Is it a mental health problem? or just puberty?. NAMI.

Absolute Awakenings Treatment Center Editoral Guideline

At Absolute Awakenings, we take information integrity seriously. We have dedicated our resources to ensure that all content published to our blog is medically sound. As such, all content on our blog has been thoroughly reviewed by a doctorate level clinician such as a Medical Doctor, or Psy.D, so that you can trust all of the data we publish.

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