mixed anxiety and depressive disorder

the validity and clinical usefulness of madd as a diagnostic category are under debate. due to the large number of reports in the literature, and possibly also as a reaction to icd-10, the dsm-iv anxiety disorders workgroup proposed madd for inclusion into dsm-iv [17]. moreover, it has been observed that in a longitudinal perspective diagnostic conversion between anxiety and depressive disorders is not unlikely to occur [34, 35]. [27] identified 85 cases with madd according to icd-10 criteria and found that only 1 of them still met the diagnostic criteria for madd after 1 year. [7] found madd (defined in accordance with icd-10) to account for about half of the cases of common mental disorder, with a 1-month prevalence of 8.8 % and an impact on health-related quality of life comparable to that of syndromal anxiety or depression.

there is an ongoing debate as to whether a diagnostic category of madd is required for appropriately classifying patients with co-morbid, subthreshold anxiety and depression. as regards the second proposal, to classify patients with co-morbid, subthreshold depression and anxiety as either suffering from anxiety or depressive disorder, epidemiological studies indicate that approximately half of the patients with madd develop a syndromal psychiatric disorder within about a year [27, 72]. one reason for the underrecognition of madd may be the lack of a suitable diagnostic category in the ‘dsm world’ and the vagueness of, or difficulty in using, the diagnostic category provided in icd-10 [23–25]. while it has been argued that subthreshold symptoms of anxiety and depression may thus mainly be either self-limiting or a prodromal stage to a syndromal condition, not warranting a diagnostic entity in its own right [27, 79], the same findings can also be interpreted as evidence that the development of a more severe form of affective disorder could likely be prevented in a substantial fraction of patients by early recognition and appropriate treatment of madd, saving both patients’ suffering as well as healthcare and economic resources. this is why we think that a diagnostic category of madd is both justified and helpful in clinical practice.

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