Mixed messages for MADD


Mixed anxiety depressive disorder (MADD) occurs with alarming frequency in young people, yet the American Association of Anxiety Disorders does not list the disorder on its website. This exclusion and omissions by other prominent mental health resources may have to do with the mental health industry having trouble reconciling anxiety and depression under one diagnosis.

Numbers don’t lie

In the fifth and latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), MADD graduated from the appendix and into the main text. One reason for this prior exile had to do with its “neither fish nor fowl” status. A person with depression and anxiety may meet the DSM-5 criteria for one but not both. Historically, psychiatrists did not combine the two into a single diagnosis because they are separate moods.

According to a 2011 notice on the DSM Development website, MADD was slated to join other conditions in Part III of the manual. This section is for conditions that require further study. One possible explanation comes from data in a 2010 Clinical Psychology article by Judy Garber and V. Robin Weersing, where the authors write that 15 to 20 percent of youths in the U.S. meet the standard for anxiety, and roughly 1 in 5 will experience a MADD episode by the time they are 18.

The influence of genetics

Garber and Weersing point to a number of factors contributing to MADD, with genetics playing a big role. Offspring of depressed parents are at high risk for developing depressive disorders. The same goes for children of parents with anxiety disorders. But they also write, “Copious evidence also implicates parenting behaviors.” They note parental rejection is high on the list of parenting behaviors that can foster both anxiety and depression in a child.

Treatments for MADD

Two avenues of treatment have proven effective with young adults with MADD. On the pharmacological front, selective serotonin reuptake inhibitors work well treating both anxiety and depression. On the counseling end of things, the authors report cognitive behavioral therapy has had positive results with all types of anxiety as well as with moderate levels of depression. They note one reason why the therapy is effective is it utilizes exercises that are beneficial to both conditions. These exercises include problem solving, assertiveness training, relation techniques and family communication skills training.

A good, not great, prognosis

A year-long British study of 250 adults yielded positive results with respect to individuals with MADD. Not all participants had the disorder, but of those who met the standard, two-thirds showed no significant psychological stress at three months or at the end of the year. Researchers found, compared to participants without the disorder, those with it had a significantly higher risk of stress and a lower quality of life. Psychologist Michael Yapko, Ph.D., notes, “A young person is not likely to outgrow anxiety unless treated and taught cognitive skills.” But, he adds, treatment of anxiety when it first surfaces can prevent the development of depression.

White River Academy is a boarding school located near the Great Basin in Utah. Our student population is comprised of young men from age 12 to 17. Each comes to us with either behavioral problems, substance abuse issues or both. A young man who attends our school receives a quality education and treatment for his respective issues. Call our 24/7 helpline for more information.

About the author:

Darren Fraser is a content writer, worked two and half years as reporter and researcher for The Yomiuri Shimbun until they realized he did not read, speak or write Japanese and fired him. Undeterred, he channels his love of research into unearthing stories that provide hope to those dealing with addiction and mental illness. Darren loves the Montreal Canadiens hockey club and horror films and would prefer to enjoy these from the comforts of his family’s farm in Quebec.

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