You Take the Mood, You Take the Bad: Mixed Anxiety and Depression

Albert Einstein’s reflection that everything is relative is as true about mental health diagnoses as it is about time and space. Depending on the circumstances and overall state of mental health, a specific symptom can attest to any number of disorders, contribute to a case of mixed comorbidity, or remain a standalone occurrence. It can also reflect a combination of both official and subthreshold conditions, as in the case of anxiety symptoms in depression. Read on to better understand how all of these options might relate to anxiety and depression.

Anxiety symptoms in depression

Diff’rent Strokes: What Anxiety and Depression Look Like Separately

The two most common conditions in the world, anxiety and depression affect millions across the globe, and have been cited as severely detrimental to their well-being. But while these two mental health categories are both quite prevalent, their definitions and presumed root causes tell quite a different story.

The Facts of Life: The Survival Instinct and the Anxiety Disorders Family

Anxiety is generally viewed as an overactive and adverse mental state that is hyperawareness to external and internal stimuli. Anxiety is believed to push the alertness caused by fear to the extreme: while fear signals to the existence of an immediate threat, in an effort to avoid or survive it, anxiety maintains a high level of alertness to the possibility of a possible, future threat. As a result, anxiety can cause frustration, and is tremendously exhausting for the individual experiencing it.

18.1% (or one in 13) of US adults have been diagnosed with a form of anxiety. Anxiety is currently defined as a family of disorders, which are mainly differentiated by the type of trigger that causes their symptoms to manifest. According to the American Psychiatric Association (APA), the anxiety family includes:

  • Generalized Anxiety Disorder: The broadest of the anxiety disorders, GAD is defined by persistent, excessive worrying about one or more life domains.
  • Separation Anxiety Disorder: Developmentally inappropriate distress over the possibility of separating from a loved one. 
  • Specific Phobia: Experiencing extreme tenseness due to a specific object or situation.
  • Panic Disorder: Acute and unexpected attacks of distress, which can in turn cause the next attack.
  • Selective Mutism: Being unable to speak in public.
  • Social Anxiety Disorder: Feeling distress over social situations or interactions that may include scrutiny.
  • Agoraphobia: Great unease from open spaces, closed spaces, using public transport, crowds, or specific situations.


Mixed Anxiety and Depression

A Different World: Major Depressive Disorder and Shutting Down

Unlike the diverse disorders included in the anxiety family, the depressive disorders family is centered on a single disorder: major depressive disorder, commonly known as depression. It is this condition that has received the greatest amount of focus, both in therapy and in scientific research. 

Major depression is one of the earliest mental health disorders to be recognized, with its definition changing and evolving over time. These days, depression is generally seen by mental health practitioners as a deep and unrelenting sadness, in addition to a profound sense of lacking. When experiencing major depression, the individual tends to shut off, turning inward and away from the rest of the world.

6.7% (or one in 15) US adults have been diagnosed with major depression. The APA defines it through two key symptoms: an extremely low mood, and an inability to feel joy (also known as anhedonia). In addition to these symptoms, an official depression diagnosis can include feelings of emptiness or a lack of hope, low self-confidence, self-isolation, self-harm, and suicidal ideation.

Too Close for Comfort: Anxiety Symptoms in Depression

As its name suggests, anxious depression is actually a subtype of major depression. Harkening back to Einstein’s quote on relativity, a number of symptoms found in anxious depression are also symptoms of anxiety. However, anxious depression differs from mixed anxiety and depression, in that anxious depression does not include cases where an official anxiety disorder diagnosis can be reached.

The following symptoms are found in both depression and anxiety diagnoses. As such, if they appear within a case that includes an depression diagnosis, but not an official anxiety diagnosis, they can mark it as a case of anxious depression:

  • Irritability. During childhood and adolescence, major depression can often appear through irritability, instead of sadness. Those experiencing depression as irritability tend to lash out at others, easily losing their patience.
  • Restlessness. Finding it hard to unwind and relax is another symptom common to both depression and anxiety. 
  • Sleep Disturbance. Depression and anxiety can influence the patient’s sleeping habits. As a result of either condition, many patients find themselves escaping to  sleep or avoiding it. They may also find it hard to remain asleep or become easily awakened. 
  • Easily Tired. Grogginess or a lack of energy commonly arise as a result of depression. While anxiety is marked by hyperarousal, its effects can exhaust the individual, eventually leading them to become tired throughout the day.
  • Difficulty Concentrating. Becoming easily distracted and experiencing a loss of focus are also symptoms of anxious depression. This is also the case with anxiety, as the tendency to remain in high alert may cause patients to abruptly shift their focus from one concerning stimulus to another.

Family Ties: On Mixed Anxiety and Depression

The idea of comorbidity cases raises questions as to who it should include: do patients exhibiting anxiety symptoms in depression fall within this mixed bag disorder? What about the other way around, with cases of depressive symptoms appearing within a broader anxiety setting? Should both subthreshold cases and those with official diagnoses of both anxiety and depression be included? Though there is currently no universally agreed upon option, researchers are approaching mixed anxiety and depression as a possible sub-definition that can give patients clarity regarding their current condition. Read on to find out more about this evolving term. 

The World Health Organization, for instance, defines mixed anxiety and depression as cases of comorbidity, where an individual receives both an official diagnosis from the anxiety disorders family, and an official major depression diagnosis. In other words, patients who face both depression and an anxiety disorder are considered having a mixed diagnosis.

Saved by the Bell: Treatments for Depression

These days, treatments for depression include a variety of options. These include: 

Deep TMS meets the demand for empirically-based medical treatments, with the higher tolerability of noninvasive courses of action. By utilizing electromagnetic fields, Deep TMS is able to reach brain structures that have been found to be involved in the appearance of depressive symptoms, and safely regulate their neural activity. Over time, this process has been proven to offer significant symptom relief. As a noninvasive treatment option, Deep TMS does not necessitate the use of anesthesia, and does not cause any severe or long-lasting side effects. Patients undergoing Deep TMS treatment are therefore able to drive themselves to and from treatment, while incorporating Deep TMS sessions into their daily routine. As a result, Deep TMS is able to offer safe and effective treatment to those facing major depression, both as a standalone treatment and in combination with other forms of treatment, such as medication or psychotherapy.