Many people who suffer from mental health conditions regularly experience comorbid conditions, and often depression and anxiety are experienced together. For some, this could mean a diagnosis of Mixed Anxiety and Depressive Disorder (MADD), so here, we are taking a look at what this is, the signs and symptoms to watch out for, how it is diagnosed, treatment options, self-care tips, and more. 

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest, so if you have questions about Mixed Anxiety and Depressive Disorder, we’re here to help. 

What is Mixed Anxiety and Depressive Disorder? 

Mixed Anxiety and Depressive Disorder (MADD) is very similar to what the name suggests, as it involves both anxiety and depression. However, this condition can be differentiated from comorbid depression and anxiety as it does not usually show one more predominantly than the other. Instead, the two are severe enough to require a psychiatric diagnosis without one being the ‘primary’ condition or meeting the full diagnostic criteria for a separate condition such as Generalised Anxiety Disorder (GAD) or Major Depressive Disorder (MDD). Other studies have included the criteria that Mixed Anxiety and Depressive Disorder requires at least some autonomic features, and symptoms cannot be a result of stressful life events.

The NHS estimates that Mixed Anxiety and Depressive Disorder could affect 1 in 10 adults in any given year, however the condition presents challenges as it blurs the traditional diagnostic boundaries of both anxiety and depression. This makes it more difficult to identify, and as a result, more difficult to treat.

You may find some more helpful information about depression and anxiety in our guides: 

• How Is Reactive Depression Different?
• What Does Endogenous Depression Mean?
• Low Mood vs Depression: What's Going On?
• The Different Types Of Anxiety, And When To Seek Help

What are the signs and symptoms of MADD?

Mixed Anxiety and Depressive Disorder usually entails a mostly equal balance of mild to moderate anxiety and depression symptoms, and a person could experience fluctuations between the two. Although neither may be more profound than the other, both sets of symptoms will usually impair their ability to continue enjoying life as normal.

On the anxiety side, symptoms could include:

• Trouble focusing 
• Trouble making decisions
• Feelings of irritability
• Tension in the body 
• Feelings of restlessness
• Physical symptoms such as nausea, abdominal discomfort or heart palpitations
• Trouble sleeping
• Feelings of impending danger
• Feelings of panic 
• Feelings of intense worry 
• Reduced quality of life (according to studies)

On the depression side, symptoms could include: 

• Feelings of sadness or pessimism
• Feelings of emptiness, hopelessness or despair 
• Feelings of frustration or restlessness 
• Feelings of guilt 
• Loss of interest in hobbies or activities once enjoyed 
• Physical fatigue or lack of energy 
• Trouble focusing or making decisions 
• Trouble sleeping (or oversleeping) 
• Changes in appetite 
• Suicidal thoughts or attempts 
• Physical symptoms such as muscle tension, headaches, sexual dysfunction and more (according to studies)

What is the relationship between anxiety and depression?

"Anxiety is when a person is in a fight or flight state of mind whereas depression is when a person has negative thoughts about themselves and low mood. Both sides worsen each other." - Dr Hina Rehman, Consultant Psychiatrist

Anxiety and depression often exist together. Studies have reported 45.7% of people with lifetime Major Depressive Disorder also experienced a lifetime history of one or more anxiety disorders. It also found that these disorders commonly coexisted in the same time period, with 41.6% of people who experienced 12 months of major depression also having one or more anxiety disorders in the same 12 month period.

Anxiety can often become a precursor to depression due to prolonged stress eventually leading to feelings of hopelessness. Conversely, the despondency experienced in depression can lead to anxiety symptoms such as feelings of restlessness, creating a bidirectional interaction and a vicious cycle. Understanding this relationship can help to effectively diagnose and treat both conditions.

"When you combine these states of mind together, people may have an overwhelming amount of negative beliefs about themselves and external worries. They may experience thought blocking, unable to think clearly because everything is so muddled in their mind and therefore they struggle to comprehend it and speak." - Dr Hina Rehman, Psychiatrist

What causes Mixed Anxiety and Depressive Disorder?

Anxiety and depression are very closely linked, as both can be caused by a person’s genetic predisposition, environmental factors and more. Both disorders also involve alterations in neurotransmitter levels, particularly serotonin, which can affect mood regulation and emotional responses. As a result, Mixed Anxiety and Depressive Disorder could occur. 

The exact origins of MADD are unknown, but are thought to be similar to the origins of anxiety and depression individually. As with both of these conditions, the causes are often related to:

• Genetics and biology: Those with a family history of anxiety or depression may be predisposed to MADD. Studies suggest that anxiety and depressive disorders are “moderately heritable” in approximately 40% of cases. This could be because among all internalising disorders, the highest level of shared genetic risk is thought to be with Major Depressive Disorder and Generalised Anxiety Disorder.
• Psychological development: Early life experiences such as trauma and chronic stress can lead to the development of MADD due to the brain’s tendency to create maladaptive coping mechanisms and cognitive patterns. Also, neurological imbalances (such as in serotonin and dopamine levels) can play a role in the onset of this condition. 
• Environmental factors: Stresses in a person’s environment, such as relationship conflicts or financial difficulties can trigger or exacerbate symptoms of MADD. Some of the most common non-genetic risk factors associated with anxiety and depression are things like early life adversity, parenting style, and current stress exposure.
• Physical Illness: When someone experiences a physical illness, particularly a chronic one, they may also experience anxiety or depression which are associated symptoms. Someone with a worrying illness may start to experience anxiety around their health outcomes, as well as depression due to their limited abilities. 
• Medications: Certain medications can cause symptoms of depression and anxiety as side effects, so it is important to let your prescribing doctor know if you start to experience any of these symptoms while taking them. This could mean your dosage must be adjusted, or you need to be put on alternative medication. 
• Substance use: Alcoholism and other substance abuse issues are often linked to symptoms such as anxiety and depression. This is often due to underlying mental health issues, or could be due to the circumstances of their addiction. Those with substance use issues should seek professional help before anxiety or depression create further challenges in their life.

Is it MADD, or is it a comorbidity?

Mixed Anxiety and Depressive Disorder may sound very similar to comorbid anxiety and depression as described earlier, however the two are distinct. If you are wondering how this condition differs from someone experiencing comorbid depression and anxiety, MADD is a mild or moderate level of depression and anxiety experienced together, when one is not more pronounced than the other.

Also, a 2021 study states that Mixed Anxiety and Depressive Disorder can be defined by symptoms of both occurring on the majority of days for a period of two weeks or more.

Although it may appear that both could be treated in the same way, understanding the difference between this condition and comorbid depression and anxiety is important, as studies have found having two or more mental health conditions together may be associated with a range of issues. These include worse symptom severity, lower social support, a decreased quality of life, and an increased risk of suicidal thinking or suicide. 

How is Mixed Anxiety and Depressive Disorder diagnosed?

This condition, like all mental health conditions, will require an evaluation from a mental health professional who can determine whether the person is experiencing comorbid anxiety and depression, or indeed Mixed Anxiety and Depressive Disorder. This remains difficult, as MADD is not included in the most up-to-date DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). 

Diagnosing this condition may involve:

• Answering questions about their specific symptoms 
• Answering questions about their current situation
• Undergoing structured assessments 
• Completing rating scales to determine more about the potential condition
• Further tests to rule out other mental health conditions with similar presentations

How is Mixed Anxiety and Depressive Disorder treated?

Treatment for MADD typically involves addressing symptoms of both the depression element of the condition and the anxiety element. For both, this may involve tackling the root causes and the current needs of the person, such as the type of treatment that is likely to suit them and their lifestyle. 

Some treatment options that have been found to work for both depression and anxiety symptoms include things like: 

Psychotherapy

Types of therapy such as cognitive behavioural therapy (CBT) can help individuals to unlearn problematic behaviours by identifying and changing destructive thought patterns. This can impact thought processes related to both depression and anxiety, and develop healthy coping mechanisms in their place. Comorbid anxiety and depression has been found to respond well to cognitive behavioural therapy, so it is believed that those with MADD could benefit from this too. You may find more information in our guides: The Difference Between Psychotherapy vs Counselling and The Differences Between CBT vs Counselling. 

Medications

Often similar medications can be used to treat both anxiety and depression, and psychiatrists or doctors can prescribe certain medications to help treat both, either separately or together. Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) are known to address symptoms of both conditions.

Lifestyle modifications

According to studies, changes to a person’s lifestyle can impact their anxiety and depression symptoms. This could be things like getting regular exercise, managing stress with personalised techniques, getting more sleep, addressing financial issues, limiting social media use, and more. 

It is impossible to say how long depression or anxiety may last, because everyone experiences this in a different way and for varying lengths of time. The prognosis for Mixed Anxiety and Depressive Disorder is thought to be relatively positive, with studies suggesting around half of affected patients enter remission from symptoms within a year. 

What are some self-care tips to help cope with MADD symptoms?

Similar to the lifestyle modifications mentioned above, here are a few self-care tips that could help to improve and manage ongoing symptoms of Mixed Anxiety and Depressive Disorder:

• Establish a consistent routine 
• Prioritise sufficient sleep
• Maintain a balanced diet and stay hydrated 
• Engage in regular physical activity, such as walking or yoga
• Practice mindfulness, such as meditation or deep breathing exercises
• Set realistic goals
• Practice self-compassion
• Seek social support from friends or support groups
• Limit exposure to stressors
• Practise cognitive strategies to help retrain negative thought processes 

When it comes to anxiety, turning your worries into purposeful actions can help you feel like you are regaining control of a situation. Instead of ruminating on what could go wrong, focus on what you can control and try to use the cognitive strategies mentioned above to ease your mental burden about the things you cannot control. 

How do I access treatment and support for MADD?

Accessing treatment and support for Mixed Anxiety and Depressive Disorder (MADD) usually begins with reaching out to your GP to discuss how you are feeling and what options may be available to you. Often there are delays in accessing treatment for mental health conditions through the National Health Service in the UK, so you may wish to seek help from private psychiatrists or therapists who can assist with further evaluation and treatment. 

You may find more information in our guide: Stuck on a waiting list? There are some things that you can do in the meantime.

You may also find support groups and other resources in local mental health clinics and community centres that can provide more options for accessing support services in your area. 

At Augmentive, our specialists can diagnose and treat depression and anxiety whether you are experiencing these as a comorbidity or as potential Mixed Anxiety and Depressive Disorder. 

Please note: Augmentive is not an emergency mental health service, so if you are having suicidal thoughts you should call Samaritans on 116 123 or reach out to someone you trust for help.

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from private psychiatric assessments to helping you find a therapist near you for support on your journey. 

If you have a question about mental health, like how to support someone with anxiety, we’re here to assist on your journey. Our free 15 minute consultation can guide you to the most relevant specialists to answer your questions and discuss next steps.

DISCLAIMER: The content published by Augmentive is not designed to treat, diagnose, cure, or prevent any disease or condition. Always consult your GP or a qualified healthcare provider with any questions regarding a medical condition and before starting any diet, exercise, or other health-related programme.