Mixed Anxiety and Depression: From Theory to Practice

The 10th International Classification of Disease (ICD-10) introduced the concept of mixed anxiety-depression to define patients presenting both anxiety and depressive symptoms of limited numberand/or intensity, not sufficiently severe to fulfill criteria for a specific diagnosis of depressive or anxietydisorder. Epidemiologic surveys have shown that these patients may display significant levels offunctional impairment, have unexplained somatic symptoms and a high use of nonpsychiatric medicalcare, have long-lasting symptoms, and are at risk for more severe psychiatric disorders. A DSM-IVfield trial concluded that patients with affective symptoms not meeting thresholds for DSM-III-R disorderswere at least as common as patients with anxiety or mood disorders, and that their symptomswere associated with significant distress or impairment. Although some of these patients present residualsymptoms from previous psychiatric episodes and may request treatment specific to these conditions,it is not known if those without a psychiatric history could benefit from pharmacologic or psychologicaltreatments usually used in mild outpatient cases.