Mixed anxiety and depression: clinical implications.

Although depressive and anxious symptoms frequently coexist, clinical studies have tended to separate anxiety disorders from depression. A number of developments are now reversing this trend. One of these developments is the reworking of the concept of generalized anxiety disorder (GAD) from that of a residual category (anxiety after all other anxiety disorders are removed) to a generalized anxiety syndrome that includes symptoms of mild depression that are less severe than the symptoms of anxiety. GAD is thereby expanded to a broader concept, namely mixed anxiety/depression (MAD). A second major development, however, posits a different definition of MAD: a stable core of subsyndromal symptoms that do not reach the threshold for the diagnosis of GAD or depression, but which, under stress, will decompensate to an overt anxiety disorder or depression.