![]() ![]() īy ‘depression’ and ‘anxiety,’ we refer to clinically relevant disorders whose symptoms may cause profound suffering and may interfere with essential activities of daily living. They are more disabling, more resistant to treatment, have a greater risk of suicide, and are associated with more severe psychological, physical, social, and workplace impairment than either condition alone. Co-morbid anxiety and depression may occur at any age, from childhood and adolescence to old age. Similarly, symptoms of depression occur in up to 90 % of patients with anxiety. It has been estimated that about 85 % of patients with depression also experience significant symptoms of anxiety. This may help to reduce patients’ distress, prevent exacerbation to a more serious psychiatric disorder, and ultimately reduce the societal costs of this very common condition. We review the evidence in favor and against MADD and argue that it should be included into classification systems as a diagnostic category because it may enable patients to gain access to appropriate treatment early. Moreover, reviewers have disputed the justification of MADD based on divergent results regarding its prevalence and course, diagnostic stability over time, and nosological inconsistencies between subthreshold and threshold presentations of anxiety and depressive disorders. It has not been included in the recently released DSM-5 since the proposed diagnostic criteria turned out to be not sufficiently reliable. The validity and clinical usefulness of MADD as a diagnostic category are under debate. Although about half of the patients affected remit within a year, non-remitting patients are at a high risk of transition to a fully syndromal psychiatric disorder. It has been associated with similarly pronounced distress, impairment of daily living skills, and reduced health-related quality of life as fully syndromal depression and anxiety. MADD appears to be very common, particularly in primary care, although prevalence estimates vary, often depending on the diagnostic criteria applied. According to ICD-10 criteria, mixed anxiety and depressive disorder (MADD) is characterized by co-occurring, subsyndromal symptoms of anxiety and depression, severe enough to justify a psychiatric diagnosis, but neither of which are clearly predominant.
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