Living with anxiety and depression (mixed anxiety-depressive disorder)

“Our greatest glory is not in never falling, but in rising every time we fall.”

-Confucius-

Anxiety and depression in mixed anxiety-depressive disorder

The link between anxiety and depression is well-known in the psychological and psychiatric fields. Experts in the field, such as David Barlow, director of the Center for Mood Disorders at Boston University, tell us that even from a neurobiological point of view they seem to share the same processes.

Studies, such as the one carried out at Emory University (Atlanta, United States), are revealing. Both realities would have their origin in our brain’s amygdala. That is to say, this structure in which our “fear center” is located is sometimes too reactive. This means, for example, that any event or stimulus is experienced disproportionately, accompanied by very intense negative emotions.

With depression, our reality is frozen. Suspended in a state of feeling helpless and hopeless at the same time. However, this excessive fear causes us to continue to anticipate ideas and to see tomorrow with great anxiety, anguish, and despair.

On the other hand, the reason why we come to develop these conditions or the reason why we are more susceptible to suffering from them would be,  for many experts, a predisposition (genetic) factor, which would be added to the context that may surround us and our lack of tools when facing various circumstances.

What are the symptoms of mixed anxiety-depressive disorder?

The first question that may come to mind is: if I suffer from anxiety and depression, do I then suffer from some kind of psychological disorder? Well, in light of this question, we must understand that we are all susceptible to experiencing these realities at certain times.

The problem arises when these states become persistent and appear together. The clinical manifestations must coexist permanently (more than one month) and to the same degree. In addition, the following characteristics must also appear:

• Concentration problems and memory lapses.
• Constant worry.
• Fatalistic thoughts, pessimism, and hopelessness.
• Sleep disturbances.
• Anhedonia (lack of motivation, vitality, energy, and spirit…)
• Irritability and constant bad mood.
• Feelings of worthlessness, guilt, low self-esteem…
• Hypervigilance. A feeling of always being on alert, with the feeling that something is going to happen…
• Gastrointestinal problems.

On the other hand, the most striking thing about this condition is the extreme to which many patients can reach: lack of hygiene, social isolation, inability to go to work… Epidemiological data tell us that only 50% of those who suffer from this disorder are diagnosed in primary care (either because they do not go to or because they are not referred to specialized professionals).

How is mixed anxiety-depressive disorder treated?

The therapeutic approach depends on many variables, but if there is one that is important, it is the personal reality of each patient. There will be those who present mild symptoms and therefore benefit from a psychological approach. In other cases, in those where the situation is more serious, the psychological intervention will be complemented with pharmacological intervention.

In any case, patients should benefit from a multidisciplinary approach, which does not exclude, for example, social, care, and even psychoeducational aspects. A person with a mixed anxiety-depressive disorder needs as much support as possible. These would therefore be the most common strategies:

• Cognitive-behavioral therapy (aimed at cognitive restructuring, reducing hypervigilance, fear, and anxiety).
• Relaxation techniques.
• Mindfulness.
• Pharmacological treatment (antidepressants and anxiolytics).
• Psychoeducation: the patient is taught the reality of his or her situation, letting him or her know what depression is, what anxiety is, and what strategies he or she can use to treat and prevent it.