Mixed anxiety depression should not be included in DSM-5.
Subthreshold anxiety and subthreshold depressive symptoms often co-occur in the general population and in primary care. Based on their associated significant distress and impairment, a psychiatric classification seems justified. To enable classification, mixed anxiety depression (MAD) has been proposed as a new diagnostic category in DSM-5. In this report, we discuss arguments against the classification of MAD. More research is needed before reifying a new category we know so little about. Moreover, we argue that in patients with MAD symptoms and a history of an anxiety or depressive disorder, symptoms should be labeled as part of the course trajectories of these disorders, rather than calling it a different diagnostic entity. In patients with incident co-occurring subthreshold anxiety and subthreshold depression, subthreshold categories of both anxiety and depression could be classified to maintain a consistent classification system at both threshold and subthreshold levels.
Department of Psychiatry, VU University Medical Center and GGZ inGeest, Amsterdam, The Netherlands. n.batelaan@ggzingeest.nl
Neeltje M
NM
Batelaan
Jan
J
Spijker
Ron
R
de Graaf
Pim
P
Cuijpers
D001008:Anxiety Disorders / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000145:classification* / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D003937:Diagnosis, Differential; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D011379:Prognosis; D012008:Recurrence; D009626:Terminology as Topic; D014481:United States