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Mixed Anxiety and Depressive Disorder 1

Mixed Anxiety and Depressive Disorder
What is mixed anxiety and depressive disorder?

Anxiety and depression are two different types of mood problems and they often occur together.

A person may suffer from mixed anxiety and depressive disorder (MADD) when both anxiety and depressive symptoms are present, but neither type of symptoms is of the severity that warrants a separate diagnosis on its own. When anxiety and depression symptoms have been deteriorating to reach certain degree of severity, a person can be diagnosed with anxiety and depressive disorders at the same time.

Nevertheless, individuals affected by MADD can be as distressed as those affected by anxiety or depressive disorders. Their work and daily life can be severely affected too.

 

How common is mixed anxiety and depressive disorder?
Prevalence rate

According to the Hong Kong Mental Morbidity Survey 2010-2013, MADD is the most common mental disorder in Hong Kong, affecting about 7% of Hong Kong people.

Gender ratio

More female people are found with MADD, the male to female ratio is around 1:2.

Age of onset

MADD is most commonly found from people in the 26-35 age group, and after that from the 36-45 and 16-25 age groups.

 

What causes mixed anxiety and depressive disorder?

Similar to anxiety and depressive disorders, the causes of MADD also involve genetic and environmental factors. Family history, stress in daily living and lack of social support are all risk factors for MADD.

 

What are the symptoms of mixed anxiety and depressive disorder?

What are the symptoms of mixed anxiety and depressive disorder?

MADD includes less severe symptoms of anxiety and depressive disorders. 

Mood
  • Consistently unable to feel happy
  • Lose interest to previously enjoyable activities
  • Withdraw from usual social activities
  • Over worry towards issues in work, family or daily living, difficult to relax
Body
  • Dry mouth, dizziness
  • Trembling, muscle tension
  • Rapid heartbeat
  • Easy to get tired
  • Difficult to concentrate
  • Change in appetite
  • Loss of sexual desire
Sleep
  • Poor sleep quality most of the time, sleep disturbances, including difficulties falling sleep and staying asleep, and early morning awakening
  • Preoccupied by problems at work or in daily life, waking up in the middle of the night

If you or someone you know have similar conditions that have occurred over a period of time and have affected the daily life, please seek professional as early as possible.

 

What are the treatments of mixed anxiety and depressive disorder?

Effective treatments for MADD include psychological treatment and medication.

Psychological treatment

A therapist will first explore with the affected individual for the condition and they will then come up with a treatment plan. The individual will then be guided to understand the relationship between emotion, behaviour and cognition, to modify negative ways of thinking step-by-step, and to learn about stress and emotional management techniques. Through treatment, the individual will be able to manage the problems and build a healthier lifestyle.

Medication

Doctors may prescribe medications such as anti-depressants or tranquilizers after assessing the condition of the individuals.

Type Second generation antidepressants Tranquilizers
Common drugs
  • Selective Serotonin Reuptake Inhibitors (SSRI), e.g.
    • Citalopram (Cipram)
    • Fluxetine (Prozac)
    • Sertraline (Zoloft)
  • Serotonin and Noradrenaline Reuptake Inhibitors (SNRI), e.g.
    • Venlafaxine (Efexor)
  • Benzodiazepines, e.g.
    • Diazepam (Valium)
    • Lorazepam (Ativan)
    • Alprazolam (Xanax)
Indications Treatment of anxiety and depression
  • Relieve the symptoms of anxiety
  • Have calming and sleep promoting effects
Mechanism of action Work by regulating the neurotransmitters activities, such as norepinephrine and serotonin in the brain Work by regulating the neurotransmitters activities, such as GABA, serotonin, noradrenaline on the brain GABA receptors
Side effects /points to note
  • SSRIs:
    • Fatigue, nausea, gastro-intestinal upsets, sweating
  • SNRIs:
    • Dry mouth, gastro-intestinal upsets, nausea, fatigue
  • Because it takes 2 to 4 weeks for the medications to bring out symptoms improvement, at the beginning of treatment, the patient might still have much distress from the symptoms
  • Dizziness, drowsiness, somnolence, fatigue, body imbalance, loss of memory, difficulty in carrying out voluntary movements, dry mouth, impaired coordination, drugs dependence, withdrawal symptoms
  • Avoid taking any alcoholic beverages
  • This kind of drugs has a high potency to be abused, so patients must comply with doctors’ instructions when taking these medications

If patients experience any undesirable side effects during drug treatment, please consult the doctor as soon as possible to clarify the worries and make appropriate adjustments.

 

How to support and help patients with mixed anxiety and depressive disorder?
Tips for caregivers:
Avoid blaming:

People with MADD may be mistaken as “creating worries for themselves” or “lazy”, but these are symptoms of the illness, instead of their true character. Avoid blaming them for their symptoms.

Be a good listener:

Encouraging, but not forcing, them to share their feelings and difficulties, listening to them patiently, showing acceptance, and giving time and appropriate supports to them.

Maintain regular life:

Providing a peaceful and comfortable environment for them, and facilitating them to engage in regular daily activities as far as possible.

Encourage social interactions:

Encouraging them to maintain personal interactions with others, such as keeping contacts with those they have good relationship or they feel comfortable to meet.

Get more understandings:

Helping them to gain more understanding of their course of illness, and encouraging or accompanying them to seek treatment and cooperate with mental health care professionals.

Monitor regularly:

Pay attention to any changes in mood and mental state of the individual. If any self-harming behaviours and/or unusual behaviours are noted, one should seek help from health care professionals as soon as possible.

Take care of yourself:

Supporting emotionally disturbed people is a long-term challenge. So carers need to look after their own physical and mental health, to rest and regenerate, and then to accompany patients to get out from troubled time. Ask for help when necessary.

 

1 This disorder was renamed as Major Depressive and Anxiety Disorder in International Classification of Diseases 11th Revision (ICD-11), which has been adopted by World Health Organization in May 2019 and will come into effect in 2022.

 

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賽馬會心導遊計劃 究竟抑鬱症同焦慮症係咩呢? Radio i Care 友心情網上電台 [同路情真] 林建明 - 繼續我的快樂人生 第一節 Radio i Care 友心情網上電台YouTube channel中有關 抑鬱 / 焦慮 的短片