Depressed patients with anxious distress are not only down and out. Unfortunately, it seems like anxious distress is more common than meets the eye. Researchers like Zimmerman et al. (2018) have noted that, in a sample of 260 people with MDD, 75% met criteria for the specifier; this was after controlling for co-occurring anxiety disorders. Imagine the compounded misery of the poor patient!
Anxiety disorders and depressive disorders are highly prevalent conditions that frequently co-occur. Individuals affected by both anxiety and depressive disorders concurrently have generally shown greater levels of functional impairment, reduced quality of life, and poorer treatment outcomes compared with individuals with only one disorder. Anxious distress is more than just occasional feelings of worry or fear—it can cause an individual to feel persistently tormented and tense.
“Do not go where the path may lead, go instead where there is no path and leave a trail.” -Ralph Waldo Emerson
Major Depressive Disorder With Anxious Distress Symptoms
The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), the criteria for With Anxious Distress are:
- Poor concentration due to worry
- Feeling tense
- Restlessness
- The feeling something bad will happen
- The feeling of losing control.
- Individuals with anxious depression display more harm avoidance, a personality trait associated with pessimism, worrying, and becoming easily fatigued.
- These individuals are also more likely to seek help than those with non-anxious depression but less responsive to treatment.
- The association with Depression and anxious distress is more functional impairment with relationships, work, home life, and social situations.
- The association between anxious depression has more suicidal ideation and more suicide attempts than non-anxious depression.
Symptoms must be present more days than not during the Major Depressive episode. Two symptoms= mild, three= moderate, 4 or 5=severe.
Depression with anxious distress has a significant impact on physical health. An individual often has worse emotional and physical functioning, including more physical illness, higher rates of insomnia, and a higher risk of cardiovascular disease. Also, individuals do not stay well for as long with antidepressant treatments and bear a greater side effect burden.
“It is during our darkest moments that we must focus to see the light.”-Aristotle
Anxious Distress Specifier
In general, specifiers are additional descriptors that can be added to a diagnosis to provide more information about the nature or severity of a particular symptom or presentation. For example, the specifier “with anxious distress” may be added to a diagnosis of major depressive disorder to indicate that the person is also experiencing symptoms of anxiety, such as restlessness or worry.
Panic is “special” in that any condition can have a “with panic” specifier. Though uncomfortable, panic is often sporadic and fleeting, while the symptoms of With Anxious Distress must be specially noted because they are chronic and gnawing, adding torment to the person’s condition, creating a dangerous cocktail of psychopathology. Imagine suffering the low feeling of serious depression, coupled with a feeling you can’t gain control, worrying it will never end and being physically tense. This is quite a problem in that the depression is encouraging the anxiety, and the anxiety is encouraging intensifying depression.
Research is not clear if Anxious Distress tends to be a trend in every episode for people prone it, or if it may vary. Perhaps it is more of an inner tension they are experiencing and the patient assumes worrying their life will never get on track is just part of being depressed. Directly asking depressed patients if they’ve developed muscle tension, worry, and feeling they’re losing control takes mere minutes and can have big clinical pay-offs. Assuaging the anxiety will help in managing the MDD.
“Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that.” -Martin Luther King Jr.
Cause Of Major Depressive Disorder With Anxious Distress
Individuals with mood disorders and anxiety have poorer emotional conflict regulation whereas those diagnosed solely with depression offset this deficit by activating other parts of their brain. Those with additional anxiety symptoms did not tend to have the same flexibility.
Brain activity across right and left hemispheres also appears to be more asymmetrical with anxious depression.
Anxious depression is more likely for individuals within specific characteristics and populations. The association between life situations are more disadvantaged and stressful, adding to an individual’s vulnerability to anxious distress and depression.
Anxious Depression is Linked with the Following Demographic Factors:
- Women, specifically African American women.
- Individuals who are married, divorced, or widowed but not single.
- Hispanic ethnicity.
- Lower education level.
- Unemployment.
- Lower socioeconomic status.
- Later onset of depression.
- History of trauma or abuse.
- Parents with multiple mental health disorders, including mania.
“You must be the change you wish to see in the world. “-Mahatma Gandhi
Treatment For Major Depressive Disorder With Anxious Distress
Many types of antidepressants are available, including those below.
Selective serotonin reuptake inhibitors (SSRIs). Doctors often start by prescribing an SSRI. Considering that these drugs are safer and generally cause fewer bothersome side effects than other types of antidepressants. SSRIs include citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and vilazodone (Viibryd).
Serotonin-norepinephrine reuptake inhibitors (SNRIs). Examples of SNRIs include duloxetine (Cymbalta), venlafaxine (Effexor XR), desvenlafaxine (Pristiq, Khedezla) and levomilnacipran (Fetzima).
Atypical antidepressants. These medications don’t fit neatly into any of the other antidepressant categories. They include bupropion (Wellbutrin XL, Wellbutrin SR, Aplenzin, Forfivo XL), mirtazapine (Remeron), nefazodone, trazodone and vortioxetine (Trintellix).
Tricyclic antidepressants. These drugs — such as imipramine (Tofranil), nortriptyline (Pamelor), amitriptyline, doxepin, trimipramine (Surmontil), desipramine (Norpramin) and protriptyline (Vivactil) — can be very effective, but tend to cause more-severe side effects than newer antidepressants. So tricyclics generally aren’t prescribed unless you’ve tried an SSRI first without improvement.
Monoamine oxidase inhibitors (MAOIs). MAOIs — such as tranylcypromine (Parnate), phenelzine (Nardil) and isocarboxazid (Marplan) — may be prescribed, typically when other drugs haven’t worked, because they can have serious side effects. Using MAOIs requires a strict diet because of dangerous (or even deadly) interactions with foods — such as certain cheeses, pickles and wines — and some medications and herbal supplements. Selegiline (Emsam), a newer MAOI that sticks on the skin as a patch, may cause fewer side effects than other MAOIs do. These medications can’t be combined with SSRIs.
Atypical antidepressants. These medications don’t fit neatly into any of the other antidepressant categories. They include bupropion (Wellbutrin XL, Wellbutrin SR, Aplenzin, Forfivo XL), mirtazapine (Remeron), nefazodone, trazodone and vortioxetine (Trintellix).
“If you look at what you have in life, you’ll always have more. If you look at what you don’t have in life, you’ll never have enough.” -Oprah Winfrey
Conclusion
Once beginning to stabilize, the job a therapist is to not only help the episode to continue to remit, but continue to evaluate for any return of the Anxious Distress. In the long run, prevention is the best option. If we know a patient is prone to persistent depressive disorder with Anxious Distress, it is of utmost importance to have a plan in place to immediately return to treatment if they or friends/loved ones recognize the onset of a depressive episode. Keeping the depression at bay likely will help keep the Anxious Distress away.
Though uncomfortable, panic is often sporadic and fleeting, while the symptoms of With Anxious Distress must be specifically noted because they are chronic and gnawing, adding torment to the person’s condition. Imagine suffering the low feeling of serious depression, coupled with a feeling that you can’t gain control, feeling physically tense, and worrying it will never end. This is quite a problem in that the depression encourages the anxiety, and that added anxiety encourages intensifying depression.
Articles
-What Is Major Depression With Anxious Distress?
https://www.psychologytoday.com/us/blog/and-running/202110/what-is-major-depression-anxious-distress
-Anxious distress and major depressive disorder: Recognition, assessment and treatment
-Signs of Major Depression Subtypes: Anxious Distress
Have a Good One,
Cindee Murphy, One Voice – Unstoppable
“The future belongs to those who believe in the beauty of their dreams.” -Eleanor Roosevelt
Leave a Reply