Major Depressive Disorder And Generalized Anxiety Disorder

Major Depression And Generalized Anxiety Share The Same Hereditary Risk Factors

Major Depressive Disorder (MDD) & Generalized Anxiety Disorder (GAD)

Having a close member of your family who has experienced either major depression or generalized anxiety disorder will put you at increased risk for having both conditions. To clarify, this means that if you had a parent or grandparent who was diagnosed with clinical depression, youll have a greater chance of developing either MDD or GAD .

Many mental health experts speculate that this is because major depression and GAD are at least partially caused by shared genetic factors, and indeed research indicates that this association is quite strong. Studies have been carefully structured to eliminate the possibility that environmental causes might mimic genetic effects, which allows scientists to confirm that heredity is a major contributing factor in many observed cases of comorbidity.

D Anxiety As A Residual Component Of Depression

Anxiety disturbances may characterize the residual phase of major depression , which favor residual disability and increase the risk of relapse, up to 60% after 5 years , as the following case illustrates.

Clinical Presentation

Assessment and Diagnosis

Macroanalysis. The patient satisfied the DSM-5 criteria for major depressive illness, but careful evaluation disclosed hypochondriacal fears, worry for health, and marital crisis . In the macroanalysis , the clinician could give priority to pharmacotherapy of major depressive disorder, leaving the other components to post-therapy assessment . If the clinical decision of tackling one syndrome may be taken during the initial assessment, the subsequent steps of macroanalysis require a reassessment after the first line of treatment has terminated .

Fig. 4.

Macroanalysis of Marks clinical case before and after first-line treatment.

Staging. Based on the staging model of unipolar depression , the patient was first at stage 3 and went back to stage 2 after the diagnosis of spondylarthrosis.

Treatment Options

The Relationship Between Anxiety And Depression

Helpful Links

While anxiety is generally considered a high-energy state and depression a low-energy state, anxiety and depression are more closely related than you might think. A person with depression often experiences a lot of anxiety, possibly even to the extent of having panic attacks.1

Anxiety disorders involve more than common nervousness and worry. They can cause terrifying fear about things other people wouldnt think twice about. Many people with anxiety disorders fully comprehend that their thoughts are irrational. But they still cant stop them. Feelings of losing inner control haunt them. This angst is one of the entry ways for depression.2

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Joint Features Of Multiple Conditions

The scientists searched for brain regions that were either more active or less active in the participants with mental health conditions than among the control group. As expected, the researchers found that certain features of brain activity were consistent across mood disorders, PTSD, and anxiety disorders.

Perhaps surprisingly, they found the most significant differences between the two groups of participants when they searched for hypoactive regions. The authors outline their primary findings:

detected statistically robust transdiagnostic clusters of hypoactivation in the inferior prefrontal cortex/insula, the inferior parietal lobule, and the putamen.

These regions are significant because they are all involved in emotional and cognitive control. Specifically, they play an important role in stopping cognitive and behavioral processes and switching to new ones.

Senior author Dr. Sophia Frangou explains: These brain imaging findings provide a science-based explanation as to why patients with mood and anxiety disorders seem to be locked in to negative mood states. They also corroborate the patients experience of being unable to stop and switch away from negative thoughts and feelings.

The authors also outline how these findings lend support to earlier studies in people with these disorders, which found deficits of large effect size in stopping and shifting responses in a range of tasks.

Those Who Develop Both Conditions Can Benefit From Inpatient Care

Postpartum depression &  anxiety distinct from other mood disorders ...

Many people are able to recover from major depression and generalized anxiety disorder with outpatient care. But when these conditions occur together, intensive residential carel that facilitates a full-time focus on wellness is more likely to produce transformative and sustainable results.

Recovery regimens for a dual diagnosis of MDD and GAD will include a full menu of therapeutic services and complementary healing methodologies appropriate for all symptoms that are being experienced. Blended recovery plans can be highly effective for men and women who are determined to heal and recover, and are prepared to tackle all the challenges associated with overcoming multiple mental or behavioral health disorders.

Major depressive disorder and generalized anxiety disorder are a potent combination. But a well-rounded, evidence-based recovery program can provide a powerful and effective antidote to these persistent conditions.

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Improving Functioning As A Treatment Goal In Comorbid Major Depressive Disorder And Generalized Anxiety Disorder

At the 35th ECNP Congress in Vienna, Austria , in a symposium entitled Functioning as a treatment goal in major depressive disorder : How can we improve patient outcomes? Professor Raymond Lam discussed how the definition of recovery in major depressive disorder has evolved from only addressing symptoms to one that includes functional recovery and quality of life. These can be particularly impacted, and harder to treat, in people who have MDD comorbid with generalised anxiety disorder , who may account for around a third of patients diagnosed with either condition. Prof Andrea Fagiolini discussed how some antidepressants can improve functional performance in people with MDD. However few have been studied in people comorbid for MDD and GAD and there is a need for investigation into the best treatments to improve functional outcomes in patients with such comorbidity.

Functional recovery in major depressive disorder

In 2017, the World Health Organization estimated that there are 322 million people globally living with major depressive disorder , making it the leading medical cause of disability.1 More recently, it was estimated that during the COVID-19 pandemic, MDD diagnoses increased by 27.6% worldwide.2 These figures have added to The Lancet-World Psychiatry Association Commissions call for an united action on depression.3

Key goals in MDD centre around functional recovery4

Antidepressant treatment can improve functioning in comorbid patients

How Are Stress Anxiety And Depression Connected

Anxiety and depression can be caused by several things, including:

  • Sleep disturbances, like difficulty falling or staying asleep
  • Distress or impairment in social, occupational or other important areas of functioning

Advanced signs of a major depressive disorder include:

  • Feeling down or depressed most of the day, nearly every day
  • Diminished interest in activities you once enjoyed
  • Significant changes in your weight
  • Difficulty with sleep, like difficulty falling, staying asleep or sleeping too much
  • Fatigue or frequently feeling tired
  • Difficulty concentrating
  • Distress or impairment in social, occupational or other important areas of functioning

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Differences Between Anxiety And Depression Symptoms

The primary difference between the diagnoses of a Major Depressive Episode and Generalized Anxiety Disorder is that a person who experiences depression usually describe their mood as sad, hopeless, feeling down in the dumps or blah while a person who struggles with Generalized Anxiety Disorder reports feeling constantly worried and having a hard time controlling the worry. The physical symptoms of depression and anxiety can also help us differentiate between the diagnoses.

E Demoralization Secondary To Anxiety Disorder

Generalized Anxiety Disorder vs. Depressive Disorder | Merck Manual Professional Version

Demoralization is a feeling state characterized by a patients perception of impotence and inability to deal/cope with pressing problems and receive adequate support from others . A feeling of having failed to meet their own or other expectations and lack of hope that problems will be solved are also present . It can be encountered with anxiety disorders , particularly in agoraphobia and panic . It can be associated with major depression or occur independently, as in the case here illustrated.

Clinical Presentation

Liza is a 45-year-old, single, architect. She has suffered from generalized anxiety since she was 20 years old the family doctor managed anxiety by prescribing alprazolam 0.25 mg, when needed. In the last 2 months, she perceived to be unable to cope with pressing problems at work, when she had tight deadlines and inadequate support from others. In addition, she had the feeling of having failed to meet her own expectations and believed there were no solutions for these problems and difficulties.

Assessment and Diagnosis

Macroanalysis. The patient satisfied DSM-5 criteria for generalized anxiety disorder she also suffered from demoralization, according to the Diagnostic Criteria for Psychosomatic Research . Due to demoralization, Liza tended to avoid social situations and spent her spare time on the sofa taking naps or watching TV, although she felt highly dissatisfied by her lifestyle.

Fig. 5.

For additional information:

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Study Design And Participants

The study design was a two-stage cross-sectional survey. Consecutive participants were recruited from the out-patient department at Wuhan Mental Health Center. This hospital is the largest psychiatric specialty hospital in central China. It has more than 1000 inpatient beds and provides mental health services for over 10 million residents. In the first stage, patients with potential mood disorders were screened using the HADS. Those who scored 8 on the HADS were invited to participate in the second stage, which involved a diagnostic interview.

The study was conducted between April 2013 and April 2015. The study protocol was approved by the ethics committee of Wuhan Mental Health Center before the formal study began, and all participants provided their informed consent. The study was conducted in accordance with the guidelines of the Declaration of Helsinki and its amendments.

The inclusion criteria used to target patients were: aged 1875 years, meet the diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition for MDD, agreed to participate in the study and had a HADS score 8, and had at least a primary school level of educational. The exclusion criteria included: aged fewer than 18 years or more than 75 years, had bipolar disorder, schizophrenia or other psychotic disorder alcohol dependence or severe cognitive disorder or neurological disease, or refused to participate in the study.

Critical Thinking About What Qualifies As An Anxious Distress Specifier:

Though Liz experienced an anxiety disorder at baseline, Social Anxiety, it does not make the fact she experienced an anxiety disorder and a depressive episode together as “with anxious distress.” These would be considered independent, co-occurring diagnoses. The anxiety symptoms that arose with the MDD episode were a direct consequence of her mood “owned by the depression,” if you will, and therefore meet the criteria for With Anxious Distress specifier. Interested readers are directed to Yang et al. who explores this in detail.

You may be asking yourself, “What about if the person develops panic attacks from being so overwhelmed by the depression?” Panic is “special” in that any condition can have a “with panic” specifier. Just because someone experiences a panic attack or occasional attacks, also doesn’t mean they have Panic Disorder.

There must also be significant fear of future attacks and or maladaptive behaviors to try to keep future attacks at bay, like avoiding exercise and sex because the exertion can lead to feelings that are reminiscent of panic symptoms and there is fear it may evolve into an attack. Of course, someone may have MDD and Panic Disorder if full criteria for the latter are also met. Readers are directed to page 214 of the DSM-5 for more information on this nuance.

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Finding The Right Resources To Answer Your Questions And Meet Your Complex Needs

Just as anxiety and depression tend to be worse when occurring together, treatment of these disorders is most effective when both conditions are addressed at the same time.1

Hartgrove Behavioral Health System provides integrated care that treats these and other mental health issues simultaneously. As part of our comprehensive care, medical specialists and therapists work together to help bring healing and balance in our patients lives a feeling of being in charge of their inner self again.

2 How to Cope With Anxiety and Depression. Everyday Health, August 27, 2015.

3 Anxiety Disorders. National Institute on Mental Health, March 2016.

4 Depression. National Institute on Mental Health, October 2016.

What Does Gad Feel Like

Are you Depressed

If you have GAD, you may feel as if your problems or your anxiety are out of control. Daily life may feel like one long round of worry, fear, and dread. You may also notice physical symptoms, such as clenched muscles, sweating, trembling, or twitching. The anxiety may last for months or years. Sometimes its present from childhood, but it commonly begins around the

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Generalized Anxiety Disorder Vs Major Depressive Disorder: How To Tell Them Apart

Understanding your diagnosis is an important part of getting the right treatment. Anxiety and depression are two common mental illnesses that often co-occur, meaning that many people may suffer from both disorders. There are many symptoms which overlap between Depression and Anxiety, such as irritability, restlessness, problems sleeping, and difficulties with concentrating. However, each diagnosis has its own cause and emotional and physical symptoms. The best way to confirm your condition is with a diagnosis from a mental health professional.

To Cope With Anxiety And Depression Try These Tips:

Try diaphragmatic and square breathing techniques.

Diaphragmatic breathing involves taking a deep breath from your diaphragm. Your stomach should expand as you breathe in. Square breathing techniques involve taking a deep breath in for five counts, holding this deep breath for five counts, exhaling for five counts and finally holding for five counts before repeating. The entire time should be spent focusing on your breath versus the stressful event.

Challenge your thoughts.

This involves not judging situations good or bad and focusing on what you’re feeling and identifying what’s in your control. Your primary areas of control are acknowledgement of your emotions, feelings and your reaction to stressful situations. It is also important to focus on the facts of the situation. Sometimes your anxious and depressive thoughts are not always based in facts. Facts are 100% absolute not assumptions.

Ask yourself:
  • How would I like the situation to turn out?
  • What are the facts?

Then identify small, specific goals to get to your desired outcome. If you fail to acknowledge your emotions and feelings and attach a negative thought to a situation, the outcome of that situation will result in avoidance and increased anxiety and depression.

Focus on the facts.

Challenge yourself to find the facts in a situation and acknowledge whatever emotions and feelings the situation reveals. Doing so increases the likelihood you’ll be able to cope effectively with a stressful situation.

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Univariate And Multivariate Analyses On Involving Factors Related To Psychological Qol

Independent sample t-tests showed that MDD patients who were unemployed, had a marital status of other, had a low level of subjective social support and utilization of social support , had poor sleep quality and suffered from GAD had poor psychological QOL .

After entering all the variables that were significantly associated with psychological QOL into the multiple linear regression model, we found that comorbid GAD was still significantly associated with poor psychological QOL .

Table 4 Multiple linear regression analyses on the relationship between comorbid GAD and psychological QOL.

Health Intervention Under Review

Treating co-occurring GAD and depression: Expert tips to keep your clients from getting stuck

Three common types of psychotherapy for the treatment of major depressive disorder and generalized anxiety disorder are cognitive behavioural therapy , interpersonal therapy, and supportive therapy.12

The Royal Australian and New Zealand College of Psychiatrists defines structured psychotherapy as the treatment of mental or emotional illness by using defined psychological techniques, pre-planned with clear goals and employed within a specific timeframe.13 According to the College, patients must be seen by their treatment provider, either individually or in a small group, on at least a monthly basis.13 CBT and interpersonal therapy are considered structured psychotherapies, but supportive therapy is not.13

Cognitive behavioural therapy focuses on helping patients become aware of how certain negative automatic thoughts, attitudes, expectations, and beliefs contribute to feelings of sadness and anxiety.12 Patients learn how these thinking patterns, which may have developed in the past to deal with difficult or painful experiences, can be identified and changed to reduce unhappiness.12

Interpersonal therapy focuses on identifying and resolving problems in establishing and maintaining satisfying relationships.12 Such problems may include dealing with loss, life changes, conflicts, and increasing ease in social situations.12

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Treatment Of Anxiety And Depression

A treatment plan for co-occurring anxiety and depression should be designed to help the person manage and reduce symptoms of both disorders at the same time.

Several forms of psychotherapy are widely available and effective for both anxiety and depression.

  • Cognitive Behavioral Therapy : This short-term therapy works to replace negative and unproductive thought patterns with more realistic and useful ones. This treatment focuses on taking specific steps to manage and reduce symptoms.

  • Interpersonal talk therapy: This attachment-focused therapy centers on resolving interpersonal problems and symptomatic recovery.

  • Problem solving therapy: This treatment helps people learn tools to effectively manage the negative effects of stressful life events.

Both anxiety and depressive disorders respond to treatment with selective serotonin reuptake inhibitor and serotonin norepinephrine reuptake inhibitor medications.

Long-term, combined treatment is typically recommended for people with co-occurring anxiety and depression.

More on this topic

Associations With The Metabolic Syndrome

Seven hundred and seventy-three of the men in the Vietnam Experience Study were identified as having the metabolic syndrome. Aside from differing on all the components of the metabolic syndrome, participants with it were slightly older, had lower IQ scores and a briefer education, were less likely to be divorced, widowed or separated and more likely to come from ethnic groups other than white or black, i.e. Hispanic. Full details of the characteristics of those with and without the metabolic syndrome are shown in Table 3.

Metabolic syndrome

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