Major depressive disorder is one of the most prevalent psychiatric disorders. It has a lifetime prevalence of around 12%, but this varies by age, gender, race, location, and marital status. Major depressive disorder is a serious health problem with several causes and contributing factors. It is also very likely to coexist alongside obsessive-compulsive disorder, social anxiety disorder, panic disorder, and substance abuse.
There are subsets to major depressive disorder as well, one of which is a major depressive disorder with anxious distress.
What Is Major Depressive Disorder with Anxious Distress?
Major depression with anxious distress is a subtype of MDD. It presents with additional symptoms beyond what is seen in MDD, primarily higher levels of anxiety and physical symptoms.
Symptoms of Major Depression with Anxious Distress
So, how do the symptoms differ between these two?
Core Symptoms of MDD
The core symptoms of major depressive disorder are at least five of the following that must be present during the same two-week time frame:
- Prolonged sadness, emptiness, and hopelessness severe enough to be observed by others
- Diminished interest in all activities that someone once liked
- Significant weight loss or weight gain when a person is not trying to diet, generally 5% of their body weight or more in a given month
- Hypersomnia or insomnia nearly every day
- Psychomotor agitation or retardation nearly every day
- fatigue or a complete loss of energy nearly every day
- Loss of interest in activities
- A diminished ability to think or concentrate or indecisiveness nearly every day
- Suicidal thoughts
Someone with major depressive disorder will experience these symptoms to such a degree that they cause significant distress or impairment in important areas of function, including social function, occupational function, and daily living.
Additional Symptoms of Anxious Distress
Someone who has additional symptoms of anxious distress will struggle with high levels of anxiety, like feeling that they can’t control themselves, feeling restless or anxious, and having an overwhelming worry that something terrible might happen. Someone who is presenting with anxious distress might struggle with gastrointestinal issues as well as palpitations.
How MDD Anxious Distress Affects Daily Functioning
The way in which major depressive disorder with anxious distress presents looks different from one patient to the next. For example:
Linda is a 27-year-old single mother. During her teens and early twenties, she struggled with major depressive disorder in large part because she was the youngest of her siblings and grew up in a household with moderate abuse. She married her high school sweetheart and moved away from home where she could go to college. He worked as a police officer to support her. They bought a house together, and Linda was in her final semester of college, pregnant, when her husband was killed in the line of duty.
Prior to that Linda had experienced moderate depression but was able to control it. Now, her depression got worse, and she had to work even harder to graduate and find a job immediately so that she could continue making the payments on the house they had and raise the child on her own.
She was very depressed, but her therapist noticed that she was physically tense, wringing her hands and feeling as though she would never get ahead again, that she couldn’t possibly win because, in order to keep the house and establish a safe living environment for her new child, she wasn’t spending any time with him.
Linda presented with problems concentrating because of her concerns, feelings of tension physically, and feeling like she was completely losing control of herself and that something terrible was going to happen soon.
Her therapist knew that she had depression, with a diagnosis of major depressive disorder that was long-standing, but now she was presenting with MDD and anxious distress.
Diagnosing MDD with Anxious Distress
Diagnosing MDD with anxious distress starts with a diagnosis of MDD, a subsequent diagnosis of the anxious distress specifier.
Anxious Distress Specifier in the DSM-5
The specifier of “anxious distress” is a subtype in the DSM. This is defined as having at least two of the following symptoms during the majority of the time that a major depressive episode is happening:
- Feeling keyed up or tense
- Feeling unusually restless
- Having problems concentrating because of worry or anxiety
- Experiencing extreme fear that something terrible may happen
- Feeling that you might lose control of yourself
MDD with anxious distress can have four levels of severity as well:
- Mild: 2 of the symptoms above
- Moderate: 3 of the symptoms above
- Moderate-Severe: 4 of the symptoms above
- Severe: 4 or 5 of the symptoms above with motor agitation
High levels of anxiety increase the risk of non-response to treatment, suicide, and a longer duration of the illness itself, which is why it’s essential to plan an individual treatment approach with a correct diagnosis and monitor the response you have to your treatment plan.
Clinical Evaluation Process
During the clinical evaluation process a qualified mental health professional will review the DSM 5 criteria for both MDD and anxious distress specifiers.
Importance of Accurate Diagnosis
It is important to get an accurate diagnosis because MDD anxious distress has a much worse prognosis compared to major depressive disorder on its own if it’s left untreated. There is a greater risk of the following:
- Poor treatment outcome
- Relapse
- Increased suicidal ideations
For these reasons, it’s essential that anyone who believes that they or someone close to them has MDD with anxious distress get a proper evaluation from a licensed mental health provider so that a multidisciplinary treatment approach can be created.
Treatment Options for Major Depressive Disorder with Anxious Distress
There are many treatment options for those who have major depressive disorder with anxious distress.
Psychotherapy
Psychotherapy is one of the most important forms of treatment, especially cognitive behavioral therapy, as this is a well-established treatment option for depression and anxiety alike.
Medications
Medications like SNRIs or SSRIs can be used as a treatment for major depression with anxious distress.
Lifestyle Modifications
Lifestyle modifications go a long way toward dealing with depression and anxiety symptoms. Spending time with friends, getting regular exercise, sleeping properly, and having a healthy diet can help diminish the symptoms of both aspects of the condition and increase the natural production of things like serotonin.
Mindfulness and Relaxation Techniques
Mindfulness and relaxation techniques are additionally supportive measures as they can help control stress and reduce anxiety levels and physical manifestations of anxious distress.
Conclusion
Overall, it is important to get a proper diagnosis and individualized treatment plan for major depression with anxious distress. The right treatment will include mindfulness and relaxation techniques, lifestyle modifications, medication, and therapy. The efficacy of these measures should be monitored by a professional with appropriate changes made where necessary. If you are experiencing any of these symptoms, seek professional help today for a proper diagnosis and treatment plan.