Mixed anxiety and depressive disorder: understanding the overlap of two common conditions

When anxiety and depression co-exist, they often feed into one another: creating a distinct experience that goes beyond either condition alone.

This is sometimes described as mixed anxiety and depressive disorder (MADD), a term used in ICD‑10¹ when symptoms of anxiety and mild depression occur together in roughly equal measure and cause noticeable impairment, but do not fully meet criteria for either disorder separately.

In the UK, the impact of this ‘mixed’ presentation is significant.

One study found that approximately 7.8% of adults exhibit symptoms consistent with mixed anxiety and depression in any one month² – and this group accounts for nearly one‑fifth of all mental health–related days off work.

However, it should be said that a concurrent study found a prevalence rate of only 0.8%³, highlighting the complexities of diagnosing and classifying MADD. Despite these clinical discrepancies, the academic community agrees that MADD is not a marginal condition; it plays a meaningful role in society, in public health, and in day-to-day individual wellbeing.

Mixed anxiety and depressive disorder often appears in primary care⁴, yet can be overlooked due to its subtle presentation compared with ‘full’ anxiety or major depression . People may describe experiencing persistent worry, low mood, fatigue, irritability, or trouble concentrating – possibly with none presenting severely on their own, but cumulating into an overwhelming experience.

Despite not being universally accepted as meeting criteria for a single disorder⁵, MADD can significantly reduce quality of life. When both sets of symptoms combine, they can become more pronounced and resistant to treatment compared with either anxiety or depression alone.

What living with MADD feels like

For many individuals, MADD doesn’t announce itself loudly. Instead, it creeps in gradually, blurring the lines⁶ between tension and hopelessness, worry and weariness. It’s a condition of both: an emotional tug-of-war, where neither anxiety nor depression dominates, yet both are deeply felt. For instance:

• One day may be marked by constant rumination, panic over seemingly minor tasks, or a sense of dread without clear cause.
• The next, that intensity may give way to emptiness, lack of motivation, or emotional numbness.

Many people with MADD can feel caught in limbo – exhausted, but too agitated to rest, and unable to pinpoint exactly why.

These overlapping symptoms can affect virtually every area of life, from sleep and appetite to concentration and relationships. And because neither set of symptoms may appear “severe enough” in isolation, people often go undiagnosed or misdiagnosed, increasing the risk of chronicity.

How MADD presents

The following table illustrates the various aspects of how MADD can present in day-to-day life:

While each individual’s experience varies, the interplay between these domains often leads to a sense of being stuck – too anxious to slow down, too low to move forward. Without recognition and appropriate treatment, these symptoms can become self-reinforcing and, for some, may make recovery feel out of reach.

Why diagnosis matters

Mixed Anxiety and Depressive Disorder is sometimes underestimated, or even dismissed: not because it lacks severity, but because its symptoms can blur diagnostic lines⁷. Individuals may appear “functional,” masking distress under daily routines. Others may be told they’re “just stressed” or “a bit low,” without ever receiving a clear explanation for the full range of what they’re experiencing.

That’s precisely why a formal, informed, medically-led diagnosis matters. This validates the lived reality of people navigating both anxiety and depression simultaneously. It brings clarity, opens access to appropriate treatment pathways, and ensures symptoms are treated as part of an integrated condition, not as isolated episodes.

What causes mixed anxiety and depression?

MADD doesn’t have a single cause. It tends to develop through a combination of biological, psychological, and social factors⁸.

For some, symptoms emerge gradually through ongoing stress or emotional strain. For others, a significant life event (such as bereavement, trauma, or job loss) can trigger anxiety or low mood, which then reinforce each other over time.

Genetics and personality traits can increase vulnerability, especially in people with a family history of mood or anxiety disorders. Neurochemical imbalances, particularly involving serotonin and norepinephrine, may also play a role.

Equally, environmental factors – such as loneliness, financial stress, or lack of support – can compound symptoms. And when early signs go unrecognised, people often experience prolonged distress without clear guidance.

Treatment for Mixed Anxiety and Depressive Disorder

Because MADD involves overlapping symptoms of two distinct conditions, treatment must be carefully tailored to address both sides of the experience⁹.

H4: A personalised, integrated approach

Treatment for MADD might typically combine psychological therapy, lifestyle interventions, and, in some cases, medication. The aim is not only to ease distressing symptoms, but to restore a sense of balance, resilience, and everyday functioning.

Psychological therapies – especially cognitive behavioural therapy (CBT) – are considered first-line treatment¹⁰. CBT helps individuals identify and reframe unhelpful thought patterns, manage anxiety, and build emotional coping strategies. Other approaches, such as interpersonal therapy or compassion-focused therapy, may also be helpful depending on the individual’s specific needs and preferences.

Where symptoms are more persistent or disabling, medication may be considered. Selective serotonin reuptake inhibitors (SSRIs) may be used¹¹, as they can help relieve both depressive and anxiety symptoms. However, medication decisions are made with care, and always in the context of a broader treatment plan.

Lifestyle changes can also play a crucial role, including regular movement, structured routines, and sleep hygiene. For people with MADD, even small daily shifts can have a meaningful impact when sustained over time.

Multidisciplinary, at-home care

For individuals with more complex presentations or difficulty engaging with traditional outpatient care, a multidisciplinary, at-home model can be life-changing.

Collaboratively, a mental health treatment team can provide psychiatric input, psychological therapy, and nurse-led support in the home: building continuity, safety, and trust around the individual’s unique needs. When care is collaborative and consistent, individuals with MADD can begin to feel more stable, more in control, and more connected: both to themselves, and to the people around them.

The last word: living with both anxiety and depression

Living with MADD isn’t just a matter of feeling low or on edge: in fact, it’s more like an emotional tug-of-war between fatigue and restlessness, hopelessness and panic, self-doubt and self-criticism. It’s waking each day unsure whether fear, sadness, or numbness will take the lead. And it’s often invisible to others.

This dual struggle can be overwhelming. But it is not uncommon, and it is not untreatable.

When symptoms blend, blur, and bleed into each other, diagnosis may take time. But with appropriate support, even the most entrenched patterns can begin to shift. Recovery might not mean the complete absence of symptoms, but rather, learning to live with more ease, more insight, and more self-compassion.

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References

1. https://icd.who.int/browse10/2016/en#/F41.2
2. https://www.topdoctors.co.uk/medical-articles/all-about-mixed-anxiety-and-depressive-disorder/#:~:text=All%20about%20mixed%20anxiety%20and%20depressive%20disorder,-Written%20in%20association&text=Mixed%20anxiety%20and%20depressive%20disorder%2C%20when%20individuals%20experience%20symptoms%20of,asked%20questions%20about%20this%20condition.
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC3773528/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC5097109/#:~:text=Abstract,of%20anxiety%20and%20depressive%20disorders.
5. https://pubmed.ncbi.nlm.nih.gov/10788678/
6. https://psychiatryonline.org/doi/10.1176/appi.ajp.2020.20030305
7. https://www.topdoctors.co.uk/medical-articles/all-about-mixed-anxiety-and-depressive-disorder/#:~:text=How%20is%20mixed%20anxiety%20and,accurate%20diagnosis%20and%20appropriate%20treatment.
8. https://thiswayup.org.au/learning-hub/mixed-anxiety-and-depression-explained/#:~:text=What%20Causes%20Anxiety%20&%20Depression?,illness%2C%20substances%2C%20and%20medications.
9. https://pmc.ncbi.nlm.nih.gov/articles/PMC4694550/
10. https://pmc.ncbi.nlm.nih.gov/articles/PMC8382208/
11. https://pubmed.ncbi.nlm.nih.gov/10814773/