Mixed Anxiety-Depressive Disorder

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 (comorbid) has been long recognized as commonly afflicting many people.

How is Mixed Anxiety-Depressive Disorder Diagnosed?

The symptoms of anxiety and depression disorders can be very similar. Thus, diagnosing 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 (DSM IV) has defined certain parameters 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:

  • Trouble concentrating, 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.

What are the Signs of Mixed Anxiety-Depressive Disorder?

In addition to the symptoms listed under the diagnostic criteria of mixed anxiety-depressive disorder, the disorder can cause numerous other symptoms such as social impairment. If you have this disorder, you may frequently miss school or work, withdraw from social activities, abuse drugs and/or alcohol, experience chronic health problems and/or neglect your appearance.

How Prevalent is Mixed Anxiety-Depressive Disorder?

Mixed anxiety-depressive disorder is common. This disorder occurs in eight in every 1,000 people, worldwide. In medical settings, the prevalence rate associated with mixed anxiety-depressive disorder is very common at about 1.3 – 2%. This disorder is the one of the most common mental health disorders. It was recently included in the upcoming DSM-5 so it is hard to get accurate information concerning the widespread prevalence rate of mixed anxiety-depressive disorder.

Who is at Risk For Mixed Anxiety-Depressive Disorder?

Risk factors for mixed anxiety-depressive disorder include:

  • You have a family history of mental health disorders and/or substance addictions.
  • You live in poverty.
  • You are a female.
  • You lack social or familial support.
  • You have a serious and/or chronic illness.
  • You have a dependent and/or pessimistic personality.
  • You have low self-esteem.
  • You experienced a childhood trauma.
  • You are under a lot of stress.

What Causes Mixed Anxiety-Depressive Disorder?

In the numerous studies of anxiety disorders and depressive disorders, experts have come to similar results about their causes. Both disorders are likely caused by a combination of biological, psychological, and environmental factors. Biological factors include imbalances to neurotransmitters in your brain as well as a genetic predisposition. Psychological factors may include traumas or stresses. Environmental factors are linked to psychological factors and include an unstable home environment or social-economic factors.

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.

How is Mixed Anxiety-Depressive Disorder Treated?

Treating mixed anxiety-depressive disorder can prove difficult because some treatments are more effective for depressive symptoms, where others are more effective for anxiety symptoms. Fortunately, medications such as SSRI anti-depressants have proven effective for both anxiety and depression. Thus, these treatments may be the most promising treatment for this disorder.

Medications are prescribed based on the symptoms that are causing you the most emotional, physical and social impairment. In cases where your anxiety symptoms are causing you the most problems, medications that sedate or anti-anxiety medications may be need to treat the condition. Benzodiazepines are commonly prescribed for severe anxiety, but are less likely to be prescribed for mixed anxiety-depressive disorder unless you present serious symptoms.

Numerous psychological treatments have proven effective for both depression and anxiety disorders. As with medications, there have been few significant studies on the effectiveness of these treatments for mixed anxiety-depressive disorder. However, the current consensus is that cognitive behavioral therapy is the most effective psychological approach for treating this disorder.


American Psychiatric Association. (2001). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.

Howland, R. H., & Thase, M. E. (2006). Comorbid depression and anxiety: When and how to treat. Journal of Psychiatry, 329, 11: 891-1047

Tyrer, P. (2001). The case for cothymia: mixed anxiety and depression as a single diagnosis. British Journal of Psychiatry, 179: 191-193


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