Mixed Anxiety and Depressive Disorder: Type 3 Anxiety/Depression

Did you know that mixed anxiety and depressive disorder, where anxiety and depressive symptoms occur together, is not only common but also challenging to diagnose effectively? These conditions are common in our society, yet they aren’t the same for everyone.

Traditional psychiatry often uses a cookie-cutter approach to diagnosing and treating mixed anxiety and depressive disorder, leading to many treatment failures and unnecessary suffering. For example, physicians may throw medicated-tipped darts in the dark, guessing which antidepressants or anti-anxiety pills—or both—might work.

Traditional psychiatry continues to diagnose and treat people with anxiety and depression in a cookie-cutter fashion. Share on X

However, only one-third of people with depression respond fully to treatment with antidepressants, according to a randomized controlled trial. And anti-anxiety pills, known as benzodiazepines, may be helpful in the short term, but they can lead to long-term problems, including reduced brain activity, addiction, and memory loss.

When they don’t work, it contributes to unnecessary frustration, added expenses, and a sense of personal failure. Many treatment failures in mixed anxiety and depressive disorder stem from conventional psychiatry’s lack of focus on brain imaging, which is crucial to understanding the unique brain patterns associated with this condition.

The brain SPECT imaging work at Amen Clinics, which has the world’s largest database of functional brain scans related to behavior (over 250,000 scans from 155 countries), has identified seven brain patterns associated with anxiety and depression. Each type needs its own treatment protocol.

This blog series will explore each type, including the common symptoms, brain SPECT findings, and effective interventions.

WHAT IS MIXED ANXIETY AND DEPRESSIVE DISORDER?

Mixed anxiety and depressive disorder is a mental health condition characterized by the simultaneous presence of both Pure Anxiety and Pure Depression, significantly affecting daily functioning and quality of life.

Unlike major depressive disorder (MDD) or generalized anxiety disorder (GAD), mixed anxiety/depression involves a blend of mood and anxiety symptoms. This condition, also known as mixed anxiety-depressive disorder (MADD), can involve persistent feelings of sadness, hopelessness, and nervousness, along with panic attacks, changes in appetite, sleep patterns, and energy levels.

Mixed anxiety/depression is a common mental health issue that can affect individuals of any age, gender, or background.

According to the World Health Organization (WHO), this condition is a significant public health concern, affecting millions of people worldwide. The dual nature of mixed anxiety/depression means that individuals may experience a fluctuating dominance of either anxiety or depressive symptoms, making it a complex and often challenging condition to manage.

Based on the patient population at Amen Clinics, anxiety and depression co-occur 75% of the time. It’s also common for these people to self-medicate with toxic substances, such as alcohol or marijuana, that calm the brain.

COMMON SYMPTOMS OF MIXED ANXIETY DEPRESSIVE DISORDER

Individuals with mixed anxiety and depressive disorder experience a blend of anxiety and depression symptoms, which may vary in intensity but are persistently present. One type may predominate at any point in time, but both symptom clusters are present regularly.

Anxiety symptoms include:

• Frequent feelings of nervousness or anxiety
• Panic attacks
• Avoidance of people or places due to a fear of having anxiety or panic attacks
• Symptoms of heightened muscle tension (headaches, sore muscles, hand tremors)
• Periods of heart-pounding, nausea, or dizziness
• A tendency to predict the worst
• Multiple persistent fears or phobias (such as dying or doing something crazy)
• Conflict avoidance
• Excessive fear of being judged or scrutinized by others
• Being easily startled or having a tendency to freeze in anxiety-provoking or intense situations
• Shyness, timidity, and getting easily embarrassed
• Biting fingernails or picking skin

Depression symptoms include:

• Persistent sad or “empty” mood
• Loss of interest or pleasure in activities that are usually fun, including sex
• Restlessness, irritability, or excessive crying
• Feelings of guilt, worthlessness, helplessness, hopelessness, pessimism
• Sleeping too much or too little, early-morning awakening
• Loss of appetite and/or weight loss, or overeating and weight gain
• Decreased energy fatigue, feeling “slowed down”
• Thoughts of death or suicide, or suicide attempts
• Difficulty concentrating, remembering, or making decisions
• Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain
• Persistent negativity or chronic low self-esteem
• Persistent feelings of dissatisfaction or boredom

CAUSES AND RISK FACTORS

The causes of mixed anxiety and depressive disorder are not fully understood but are believed to involve a mix of genetic, environmental, and psychological factors, including traumatic life events, chronic stress, and personality traits.

Several risk factors can increase the likelihood of developing this condition, including:

• Family History of Mental Health Disorders: A family history of anxiety disorders, depressive disorders, or other mental health conditions can increase the risk.
• Traumatic Life Events: Experiences such as abuse, neglect, or significant loss can trigger mixed anxiety/depression.
• Chronic Stress: Prolonged exposure to stressful situations, whether personal or professional, can contribute to the development of this condition.
• Substance Abuse: The use of drugs or alcohol can exacerbate symptoms and increase the risk of mixed anxiety/depression.
• Medical Conditions: Certain medical issues, such as thyroid disorders or chronic pain, can be linked to mixed anxiety/depression.
• Personality Traits: Traits like perfectionism, low self-esteem, or a tendency towards negative thinking can make individuals more susceptible.
• Head Injuries: Published research, as well as the brain-imaging work at Amen Clinics indicates that mild traumatic brain injuries significantly increase the risk of developing depression and anxiety.

Significant life changes, such as the loss of a loved one, job changes, or moving to a new home, can also act as triggers for mixed anxiety/depression. Understanding these risk factors can help in identifying and managing the condition more effectively.

TYPE 3: MIXED ANXIETY/DEPRESSION IN THE BRAIN

Brain-imaging studies using SPECT (single photon emission computed tomography) scans at Amen Clinics have shown that individuals with mixed anxiety and depressive disorder often exhibit excessive activity in the basal ganglia and deep limbic system, highlighting the need for tailored treatment approaches.

Anxiety disorders, characterized by excessive fear and hyperawareness of potential threats, often coexist with depression, complicating diagnosis and treatment. On SPECT scans, this type shows excessive activity in two areas of the brain—the basal ganglia and the deep limbic system.

• Basal ganglia: This set of large structures toward the center of the brain surrounds the limbic system. They are involved with integrating feelings, thoughts, and movement, along with helping to shift and smooth motor behavior.

  Research suggests the basal ganglia are involved in forming habits. At Amen Clinics, we’ve noticed they are also involved with setting the body’s anxiety level.

  In addition, the basal ganglia help to modulate motivation and are involved with feelings of pleasure and ecstasy (which is why drugs like cocaine and methamphetamines work in this part of the brain).

• Deep limbic system: Considered the brain’s emotional center, this system is one of the most interesting and critical parts of being human. It is power-packed with functions, all of which are crucial for human behavior and survival.

  The limbic system typically includes the thalamus (involved in relaying information), amygdala (fear center), hippocampus (memory center), hypothalamus (emotional center), and olfactory cortex (sense of smell).

DIAGNOSIS AND DIFFERENTIAL DIAGNOSIS

Historically, depressive and anxiety disorders were understood and classified within the psychiatric community as manifestations of a single affective spectrum disorder. However, they were later defined as separate entities in the DSM-III (Diagnostic and Statistical Manual of Mental Disorders), which significantly influenced treatment and diagnostic guidelines.

The complexity and evolving definitions of anxiety and depressive disorders in clinical settings highlight the significant burden these conditions impose on patients and the healthcare system, necessitating comprehensive diagnostic criteria.

A comprehensive evaluation by a mental health professional is essential for an accurate diagnosis. It’s important to choose a mental health care provider who understands that mental health is really brain health. A complete diagnostic process should involve:

• Clinical Interview: A detailed interview to assess the individual’s symptoms, medical history, and mental health history.
• Neuropsychological Assessments: Tools such as questionnaires or rating scales to evaluate the severity of anxiety and depression symptoms.
• Lab Work (if needed): When necessary, blood work can help rule out any underlying medical conditions that might be contributing to the symptoms.
• Functional Brain Imaging: Scanning the brain with SPECT offers valuable biological data that helps mental health professionals more accurately diagnose and treat co-existing anxiety and depression.

Differential diagnosis is crucial to distinguish mixed anxiety/depression from other mental health conditions with similar symptoms, such as:

• Major Depressive Disorder (MDD)
• Generalized Anxiety Disorder
• Bipolar Disorder
• Post-Traumatic Stress Disorder (PTSD)
• Substance Use Disorder

A mental health professional will work closely with the individual to develop a personalized treatment plan that addresses their specific symptoms and needs. Treatment for mixed anxiety/depression often includes a combination of interventions to achieve the best outcomes.

MIXED ANXIETY AND DEPRESSION TREATMENT OPTIONS

Mixed anxiety and depressive disorder involve a blend of symptoms that require a comprehensive treatment plan. This type is best treated with a brain-body approach that can include personalized nutraceuticals, lifestyle changes, helpful forms of psychotherapy, and targeted medications (when necessary).

Cognitive behavioral therapy (CBT) has proven to be a particularly effective treatment for mixed anxiety and depressive disorder, addressing negative thought patterns that exacerbate both anxiety and depressive symptoms.

In terms of medication, a growing body of research, including a fascinating study in Psychiatry Research, shows that SPECT neuroimaging can predict who will respond to certain antidepressants, such as SSRIs (selective serotonin reuptake inhibitors). Knowing which patients are more likely to respond well to certain medications and which aren’t improves outcomes.

In terms of natural solutions, try a combination of therapies for anxiety and depression, such as regular exercise, a healthy diet, meditation, and journaling. For treatment to be effective, any toxic substances, such as mood-altering drugs or alcohol, must be stopped.

With a comprehensive, targeted approach tailored to your brain and individual needs, you are much more likely to overcome the root causes of mixed anxiety/depression rather than just masking the symptoms.