Definition

Mixed anxiety-depressive disorder (MADD) is a psychiatric condition that presents with both anxiety and depression symptoms. The severity of anxious and depressive symptoms is equal, and neither is more dominant than the other. To diagnose MADD, it is necessary to rule out separate diagnoses for anxiety and depression. If both symptoms are sufficient to be diagnosed independently, then anxiety and depression will be diagnosed as separate disorders.

Causes

Mixed anxiety-depressive disorders have a complex nature that involves biological, psychological, and social components. The biological factors include chemical compounds in the brain, such as neurotransmitters and hormones. Neurotransmitters play a vital role in delivering messages to the brain, and imbalances of these chemicals can be found in people with anxiety and depressive disorders. Hormonal changes can also affect a person's mood, such as during pregnancy and menopause, which may trigger depression in some individuals.

Individuals with certain personality traits, such as low self-confidence, dependence on others, pessimism, and self-criticism, are more prone to this disorder.

Social factors can take the form of childhood experiences that cause trauma or traits that are instilled during growth and development.

Anxiety disorders can be related to various medical conditions, including heart disease, diabetes, thyroid problems, respiratory issues, substance abuse, prolonged pain, and cancer/tumors.

Risk factor

Factors that may increase the risk of mixed anxiety-depressive disorder may include:

• Traumatic experiences, whether childhood or adulthood, such as physical or sexual violence, death or loss of a loved one, unhealthy relationships, and financial problems. This stress and trauma can also accumulate, causing anxiety and depression
• Stress due to illness, especially chronic illness, such as cancer, stroke, chronic pain, or heart disease. This stress can also occur due to thoughts about the future and therapy
• Certain personality traits such as lack of self-confidence, being too dependent on others, being pessimistic, and liking to criticize yourself increase the risk of this condition.
• There is a history of other mental disorders, such as depression, anxiety disorders, post-traumatic stress disorders, eating disorders, and so on
• Having a family history of similar conditions or other mental disorders such as depression, bipolar, anxiety, alcoholism, or ending your life
• Abuse of substances such as alcohol, cigarettes, as well as narcotics, psychotropics and addictive substances (NAPZA)
• Abuse of substances such as alcohol, cigarettes, as well as narcotics, psychotropics and addictive substances (NAPZA)
• Having different sexual orientations (lesbian, gay, bisexual), transgender experience variations in the development of different sexual organs so that it is difficult to distinguish between men and women, especially in an environment that does not support

Symptoms

In mixed anxiety-depressive disorder, symptoms of both anxiety and depression are present and of equal magnitude, but are not sufficient to be diagnosed separately. Symptoms of anxiety or anxiety disorders may include:

• Feeling nervous, restless, or tense
• Feeling like danger, panic, or the apocalypse is approaching
• Increase in heart rate
• Breathe fast
• Cold sweat
• Shiver
• Feeling weak or tired
• Difficulty concentrating or thinking about things other than what you're worried about
• Hard to sleep
• Experiencing digestive symptoms such as nausea or diarrhea
• Difficulty controlling worry
• Try hard to avoid things that trigger anxiety

Meanwhile, depressive symptoms can include:

• Feeling sad, empty, hopeless
• Experiencing outbursts of anger, annoyance, or frustration over small things
• Loss of interest or pleasure in doing things you usually enjoy
• Sleep disorders, both difficulty sleeping and sleeping too much
• Feeling tired and lacking energy, so even light tasks require great effort
• Appetite problems, either low appetite and weight loss or too high appetite and weight gain
• Nervous
• Think, talk, and move slowly
• Feeling insignificant and guilty, focusing on past mistakes, and blaming yourself
• Difficulty thinking, concentrating, making decisions, and remembering things
• Often thinking about death, wanting to end life, and trying to end life
• Experiencing physical symptoms difficult to explain, such as back pain or headache. 

Anxiety and depression share many similar symptoms, and having both conditions can intensify their effects. One common symptom of these disorders is rumination, which involves repeatedly thinking about negative or terrifying things. Anxiety makes it hard to let go of the worst possible outcomes, while depression makes it challenging to stop blaming oneself, even for things beyond one's control.

Diagnosis

Diagnosing this disorder can be challenging as it requires an in-depth understanding of the symptoms and conditions. Typically, a single appointment may not be sufficient for a definitive diagnosis. Only qualified healthcare professionals, including general practitioners, psychologists, and psychiatrists, can diagnose accurately. It is strongly advised against attempting to diagnose or treat yourself as it can lead to biased symptom interpretation and pose a risk to your well-being and that of others.

When seeking medical attention, the first step is to explain your symptoms or complaints to the health worker. They will ask you questions about how long you have been experiencing the symptoms and how they affect your daily life. It is important to be honest and open about your condition so the health worker can fully understand your situation. A good health professional will listen to you without judgment, offer support, and help you manage your symptoms.

To help with a definite diagnosis of this disorder, health workers can order laboratory tests to rule out possible conditions that can cause anxious and depressive symptoms.

Management

Management of mixed anxiety-depressive disorder involves psychotherapy and drug therapy. Psychotherapy is therapy that is carried out by discussing and talking with your therapist, such as 

• Cognitive behavioral therapy (CBT), which can help you adjust your thoughts and behavior to a problem
• Interpersonal therapy, which can help you communicate better
• Problem-solving therapy, which can help you manage your symptoms

If you are being treated by a doctor or a psychiatrist for your mental health, you might be prescribed antidepressants and/or anti-anxiety medication to manage your symptoms. It is essential to follow the instructions given by your doctor while taking these medicines since they can lead to unwanted side effects. In some cases, certain types of drugs can even be addictive if consumed excessively.

Some other things you can do yourself are:

• Exercise. Exercising outdoors can boost your mood by releasing endorphins associated with happiness. Doing this regularly, 3-5 times a week is recommended.
• Relax and meditate. It is important to remember that being productive all the time is not necessary, and taking some time to relax is equally important. Relaxation can be achieved through various means, such as watching TV, listening to music, going on nature trips, etc. You can also try yoga, meditation, and breathing exercises to promote relaxation further.
• Balance your eating. Anxiety and depression can lead to increased carbohydrate consumption. Additionally, caffeine, sugar, and preservatives can exacerbate anxiety and depression symptoms. Eating a balanced diet with low protein, vegetables, and fruit can improve nutritional intake.
• Clean up your surroundings. You don't have to tackle all the tasks at once. Start by organizing your room, email, and wardrobe one at a time.
• Sharpening creativity. If you enjoy activities such as singing, playing music, composing poetry, photography, or design, you can do these things to relax.

Complications

Complications of mixed anxiety and depressive disorders can stem from the combination of anxiety disorders and depression. These can lead to various complications, such as:

• Overweight
• Higher risk of heart disease
• Substance abuse
• Withdrawing from others
• Difficulty carrying out daily activities
• Hurt yourself
• Death due to end of life or other medical condition.

Prevention

Mixed anxiety and depression disorders can often go unnoticed. Still, there are steps you can take to help prevent them, such as: 

• Seek help as soon as possible
• Active in activities with other people in a healthy environment
• Tell stories to family, close friends, or other loved ones
• Avoid using illegal substances, alcohol, and cigarettes

When to see  a doctor?

If you are experiencing constant feelings of anxiety or have a persistently low mood with or without a discernible cause, it may be helpful to seek medical advice. You can visit your local community health center to get a referral to a nearby psychologist or psychiatrist, who can provide an accurate diagnosis and assist in managing your condition.