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Mixed anxiety-depressive disorder (or Cothymia) is a diagnostic category defining patients who suffer from both anxiety and depressive symptoms of limited and equal intensity accompanied by at least some autonomic features. The World Health Organization's ICD-10 describes Mixed anxiety and depressive disorder : "...when symptoms of anxiety and depression are both present, but neither is clearly predominant, and neither type of symptom is present to the extent that justifies a diagnosis if considered separately. When both anxiety and depressive symptoms are present and severe enough to justify individual diagnoses, both diagnoses should be recorded and this category should not be used. Mixed anxiety-depressive disorder is a mental health disorder characterized by symptoms of both depression and anxiety. However, the symptoms do not meet the requirements for a diagnosis of either a depression disorder or anxiety disorder. Recognition of mixed anxiety-depressive disorder as a mental health disorder is relatively new. However, the combination of depression and an anxiety disorder has been long recognized as commonly afflicting many people.[1]

Diagnosis[edit | edit source]

The symptoms of anxiety and depression disorders can be very similar. A mixed anxiety-depressive disorder as opposed to a diagnosis of depression or an anxiety disorder can be difficult. The Diagnostic and Statistical Manual of Mental Health Disorders IV has defined certain requirements for diagnosing mixed anxiety-depressive disorder:

  • A dysphoric mood is chronic or recurring for a minimum of 4 weeks and has at least four of the following symptoms: troubles concentrating or with memory, disturbed sleep, tiredness or lack of energy, feeling irritable, worrying, crying easily, enhanced sensory state, expecting the worst, feeling hopeless or pessimistic, or having low self esteem/feeling worthless.
  • The symptoms presented are not caused by medications, drugs, or a health condition.
  • The symptoms cause significant impairments or distresses in aspects of daily life.
  • The symptoms do not meet the criteria for different mental health disorder. Many people experience depression and anxiety symptoms at the same time, often of sufficient severity for both to be diagnosed. Between 10% and 65% of individuals with Panic Disorder also experience Major Depressive Disorder, with approximately a third of such individuals experiencing depression prior to the onset of panic. For others, the restrictions to lifestyle and erosion of social and emotional well-being caused by ongoing anxiety can result in depression.

Risk factors[edit | edit source]

Risk factors for mixed anxiety-depressive disorder include risk factors for either depression or anxiety disorders. These risk factors often overlap and may include:

  • History of mental health disorders in the family, including substance addictions
  • Living in poverty
  • Being female
  • Lack of social or familial support (such as few friends)
  • Having a serious or chronic illness
  • Certain types of personalities such as dependent, pessimistic
  • Low self esteem
  • Childhood trauma
  • Stress

Assessment in children[edit | edit source]

The Paediatric Index of Emotional Distress is a self rating scale for 8-16 which has been particularly designed to assess cothymia.

Treatment[edit | edit source]

Treating mixed anxiety-depressive disorder can be difficult for physicians because some treatments are more effective for depressive symptoms where others are more effective for anxiety symptoms. Most clinical prescriptions are created for patients who only have symptoms of one specific mental health disorder rather than mixed disorders; some treatments such as SSRI antidepressants, sometimes combined with benzodiazepines, have been proven to be effective for both anxiety and depression, so these treatments may be most promising medication-wise for the disorder. The current treatment that has been most effective is cognitive behavioral therapy.

Causes[edit | edit source]

Throughout studies of anxiety disorders and depressive disorders, scientists have come to multiple conclusions about the cause. This disorder is caused by a combination of biological, psychological, and environmental factors. These factors include imbalances to neurotransmitters in the brain, traumas, stresses, and an unstable home environment. Since the possible causes of anxiety disorders and depressive disorders are so similar, it is not surprising that these disorders occur so frequently together: approximately 58% of patients with major depression also have an anxiety disorder, and approximately 17.2% of patients with generalized anxiety disorder also have depression.

Consequences[edit | edit source]

People with this disorder may miss school or work frequently, withdraw from social activities, start to abuse drugs or alcohol, have frequent health problems, or stop taking care of their appearance, amongst others.

See also[edit | edit source]

References[edit | edit source]

  1. ICD-10. URL accessed on 2010-07-10.

Further reading[edit | edit source]

  • American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (Revised 4th ed.). Washington, DC: Author.
  • Howland, Robert H, MD and Michael E. Thase, MD. “Comorbid Depression and Anxiety: When and How to Treat.” Journal of Psychiatry, 329, 11: 891-1047 (2006). Web. <>
  • Tyrer, Peter. “The case for cothymia: mixed anxiety and depression as a single diagnosis.” British Journal of Psychiatry, 179: 191-193 (2001). Web. <>

External links[edit | edit source]

British Journal of Psychiatry editorial

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