Mixed anxiety-depressive disorder (MADD)

Lots of mental health terms can read as slightly confusing because, at the heart of it, many of us didn't have the vocabulary or understanding of what we were experiencing growing up. So if we felt down, uneasy or just generally unable to place how we were feeling, what it actually was is something many of us didn't figure out until later in life.

Often people might confuse anxiety for depression, or vice versa. Or, for many people, what they might be experiencing is known as Mixed Anxiety-Depressive Disorder (MADD).

This article will break down MADD, some of its common characteristics, how it differs from anxiety and depression, and how to spot it in yourself or loved ones. It is not intended to provide a medical diagnosis of MADD and cannot take the place of seeing a mental health professional. If you think you are depressed, anxious or experiencing MADD, we always advise talking with your doctor or a mental health professional.

What it is

Mixed anxiety and depressive disorder is when symptoms of anxiety and depression show up together, but neither set is considered strong enough on its own to meet the criteria for a standalone diagnosis. You're not "just" anxious, and you're not "just" depressed. You're a bit of both at once.

MADD is recognised in the ICD 10 (the classification system doctors use to diagnose health conditions). It's a real anxiety and depressive disorder that professionals know how to work with.

Mixed anxiety and depression is also thought to be surprisingly common. Because the symptoms can feel milder or harder to pin down than a "classic" case of either condition, plenty of people go years without realising there's a name for what they're living with.

Anxiety vs depression: how do they differ?

Broadly speaking, anxiety is worry, restlessness, and feeling like your mind is constantly (or close to it) racing through everything that could go wrong. Depression tends to be more low mood, loss of interest in things you used to enjoy, heaviness, and a sense of hopelessness.

So when people ask themselves "do I have anxiety or depression?", often the honest answer is "some of both". The depression vs anxiety line is blurrier in real life than in books, and MADD sits right in that overlap.

What it feels like

Living with mixed anxiety and depression can feel like being pulled in two directions at once. One part might feel wired: worried, on edge, unable to switch off. Another part might feel flat: tired, unmotivated, and uninterested in things that used to matter.

Common symptoms of anxiety and depression in MADD include:

• Persistent low mood

• Ongoing worry

• Irritability

• Trouble concentrating

• Disturbed sleep

• A general sense of dread or pessimism about the future

Physical symptoms are a big part of the picture too, and they're often the first thing people notice. Muscle tension, headaches, a racing heart, stomach issues, and tiredness that doesn't seem to go away. Some people also experience spikes of severe anxiety, or what feels like an anxiety attack, layered on top of longer stretches of feeling low and drained.

If any of that sounds familiar, understanding what's happening is a great first step.

What causes anxiety and depression?

There's rarely one single cause. When we look at what causes anxiety and depression, it's usually a mix of things: genetics, personality, ongoing stress, difficult life events, loneliness, health problems, or carrying too much for too long without support.

A question that comes up often is: does anxiety cause depression? It can certainly feed into it. Living in a constant state of worry is exhausting, and over time that exhaustion can drag your mood down with it. It works the other way too. When your mood is low, everyday tasks start to feel overwhelming, which creates more worry. The two conditions tend to reinforce each other, which is part of why they so often appear together.

Is mixed anxiety and depressive disorder serious?

Because the individual symptoms of MADD are often described as "milder" than a full diagnosis of either condition, it can be easy to dismiss. People tell themselves it's just stress, or a rough patch, or something they should be able to push through.

But mixed anxiety and depressive disorder can be serious. Even at a lower intensity, the combination of symptoms can chip away at your energy, relationships, work and enjoyment of life. And without support, MADD can develop into more severe anxiety or depression over time. Taking it seriously early, rather than waiting for things to get worse, is very important.

When to see a doctor

Symptoms to notice in yourself

There's no perfect checklist, but some signs of anxiety and depression are worth paying attention to:

• You've felt low, worried or on edge most days for a few weeks or more

• Things you used to enjoy now feel like effort, or don't interest you at all

• Your sleep has changed noticeably, whether that's too little or too much

• You're dealing with physical symptoms, like tension, fatigue or stomach trouble, with no clear medical cause

• You're leaning on things like alcohol, overworking or endless scrolling to get through the day

• You keep telling yourself you're fine, but deep down you know something's off

Signs to look out for in others

Spotting anxiety or depression in someone else can be tricky, because most people get good at hiding it. Behaviours to keep an eye on include withdrawing from friends and family, cancelling plans more often, seeming unusually irritable or snappy, changes in appetite or appearance, and repeatedly brushing things off with "I'm just tired".

With MADD in particular, you might notice someone who seems both restless and flat at the same time. Anxious about everything, yet motivated by nothing. If you're worried about someone, an open, judgement-free question like "how are you doing lately?" or "can I support you with anything?" can open the door to a conversation.

How to deal with anxiety and depression day to day

Self-help isn't a replacement for professional support, but it can be a useful companion. If you're wondering how to cope while you're figuring out next steps, a few things tend to help:

• Keep a loose routine. Structure gives your mind fewer gaps to spiral in, and gives low-energy days a shape.

• Move your body, even a little. A short walk counts. Movement helps regulate both mood and stress.

• Protect your sleep. Poor sleep feeds both worry and low mood, so it's worth prioritising.

• Notice your inputs. Doomscrolling and constant news can crank up anxiety. Small limits help.

• Try slow breathing when anxiety peaks. Longer exhales tell your nervous system it's safe to settle.

• Talk to someone. Saying things out loud, to a friend or a professional, takes weight off in a way that thinking alone never quite does.

It also helps to separate two goals: how to cope on a hard day, and how to overcome MADD in the long run. Coping tools get you through the moment. Overcoming it usually takes consistent support over time, and that's completely normal.

Support on your path to recovery: how Pleso Therapy can help

MADD responds well to support. Therapy for depression and anxiety, particularly approaches like cognitive behavioural therapy, helps people untangle the worry and lift the low mood at the same time, rather than treating them as separate problems. Depending on your situation, treatment for depression and anxiety might also include medication, which is something to discuss with your doctor.

Pleso therapists often point out that recovering from mixed anxiety and depression isn't a straight line, and it doesn't need to be. Progress tends to look like more good days, fewer hard days, and a sense that you're taking back control.

If you've recognised yourself somewhere in this article, awareness is already a first step. If you're ready for the next one, finding help with anxiety and depression is easier than you might think: online therapy lets you talk to a qualified specialist from wherever you feel most comfortable, at a pace that works for you.