Many people struggling with depression also struggle with anxiety, which creates a more complex condition known as major depressive disorder with anxious distress. This subtype is also known as anxious depression and is one of the most common forms of major depressive disorder (MDD), affecting between 40-60% of individuals diagnosed with depression.
What is Major Depressive Disorder with Anxious Distress?
Major depressive disorder (MDD) is a serious mood disorder that affects how a person feels, thinks, and interacts with the world. It’s characterized by a persistent sense of despair and a loss of interest in once-enjoyable activities.
MDD is one of the most widespread mental health conditions, affecting almost 300 million people worldwide and ranking among the leading causes of disability. As research continues to evolve, experts are uncovering the ways MDD presents in different people, including a subtype known as major depressive disorder with anxious distress. This type of MDD involves increased levels of anxiety and adds on even more emotional and cognitive challenges.
MDD with Anxious Distress vs. Non-Anxious Depression
MDD with anxious distress differs from non-anxious depression in several ways. Studies show that those with this subtype face a higher risk of severe symptoms and poorer outcomes. Differences include:
- MDD with anxious depression is more severe than non-anxious depression
- Higher levels of anxiety make symptoms harder to manage
- Poorer response to standard depression treatments
- Increased difficulty with daily tasks and decision making
- Greater risk of suicidal thoughts and behaviors
Symptoms of Major Depression with Anxious Distress
Major depressive disorder with anxious distress includes both core symptoms of depression and increased anxiety-related symptoms. The combination of these symptoms can result in greater emotional turmoil and difficulty coping with stress.
Depressive Symptoms
Per the DSM-5-TR, MDD is diagnosed when a person experiences at least five symptoms over a two-week period, with at least one being depressed mood or loss of interest or pleasure. These symptoms include:
- Depressed mood most of the day, nearly every day (feeling sad, empty, hopeless, or appearing tearful)
- Loss of interest or pleasure in most activities, nearly every day
- Significant weight loss or gain, or changes in appetite
- Insomnia or excessive sleep nearly every day
- Noticeable restlessness or slowed movements
- Fatigue or lack of energy nearly every day
- Feelings of worthlessness or excessive guilt
- Difficulty concentrating or making decisions
- Recurrent thoughts of death, suicidal ideation, or suicide attempts
These symptoms cannot be due to substance use or another medical condition and must interfere with work, relationships, or daily responsibilities.
Anxious Distress Symptoms
The anxious distress specifier is applied when an individual experiences at least two of the following symptoms on most days during a major depressive episode:
- Feeling keyed up or tense
- Feeling unusually restless
- Difficulty concentrating due to worry
- Fear that something awful may happen
- Feeling loss of control of himself or herself
The severity of anxious distress is categorized based on the number of symptoms present:
- 0 or 1 symptom = no anxious distress,
- 2 symptoms = mild anxious distress,
- 3 symptoms = moderate anxious distress, and
- 4-5 symptoms = moderate to severe anxious distress (psychomotor agitation must be present)
How to Treat Major Depressive Disorder with Anxious Distress
While effective treatment options are available, they may require longer adjustment periods or a combination of approaches to achieve the best results. Psychotherapy, medications, and transcranial magnetic stimulation (TMS) are among the most common treatments for MDD with anxious distress.
Psychotherapy
Cognitive-Behavioral Therapy (CBT) is a go-to therapy for many people struggling with MDD with anxious distress. It helps individuals identify and challenge irrational thoughts, change negative self-perceptions, and develop healthier coping skills for depression and anxiety.
By addressing distorted thinking patterns and managing anxiety triggers, CBT can reduce symptoms over time. Research has shown that those undergoing CBT experience a significant decrease in depression, anxiety, and stress levels.
Medications
Medications can also be used to treat MDD with anxious distress as they help regulate mood and reduce excessive worry. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line treatments used for MDD and anxiety disorders.
SSRI and SNRI medications increase serotonin and/or norepinephrine levels in the brain. Pregabalin, though mainly used for nerve pain and epilepsy, has also shown effectiveness in treating anxiety-related symptoms.
For those who do not respond to first-line medications, second-line medications may be considered:
- Imipramine
- Bupropion
- Benzodiazepines
- Buspirone
- Hydroxyzine
- Quetiapine
Since treatment response can vary, medication selection is usually individualized, and adjustments may be required to find the most effective regimen with the fewest side effects.
Repetitive Transcranial Magnetic Stimulation
Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive, FDA-approved treatment for depression that uses magnetic pulses to stimulate specific areas of the brain that are involved in mood regulation. Unlike medication that affects the entire body, rTMS directly targets the prefrontal cortex, which is often underactive in those with MDD.
rTMS is especially beneficial for those who have not responded well to antidepressants or therapy. It doesn’t require anesthesia, has minimal side effects, and allows patients to go about their day immediately after a treatment session. Sessions are usually done a few times per week for several weeks with results gradually improving over time.
Research shows that rTMS can also provide relief for individuals with MDD and anxious distress. A study found that patients undergoing rTMS experience an average reduction of 50% or greater in both Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) scores.
Find Relief With Cura Behavioral Health
At Cura Behavioral Health, we specialize in evidence-based care that’s customized to your unique needs. Whether you’re struggling with anxiety, depression, or both, our team is here to help you explore your treatment options and develop a plan that works for you. Reach out today to learn more about our mental health services.
Sources:
- Brain structural and functional abnormalities in affective network are associated with anxious depression – BMC Psychiatry
- Major depressive disorder: hypothesis, mechanism, prevention and treatment – Signal Transduction and Targeted Therapy
- Utilizing the DSM-5 Anxious Distress Specifier to Develop Treatment Strategies for Patients With Major Depressive Disorder – The Journal of Clinical Psychiatry
- DSM-5-TR diagnostic criteria for a major depressive episode – UpToDate
- Anxiety Symptoms in Patients with Major Depressive Disorder: Commentary on Prevalence and Clinical Implications – Neurology and Therapy
- Cognitive Behavior Therapy As Effective Treatment Of Major Depressive Disorder With Anxious Distress And Atypical Features: A Case Report – Journal of Namibian Studies
- A Preliminary Study of Different Treatment Strategies for Anxious Depression – Neuropsychiatric Disease and Treatment
- The Anxiolytic and Antidepressant Effects of Transcranial Magnetic Stimulation in Patients With Anxious Depression – The Journal of Clinical Psychiatry
