Mixed Depression and Anxiety

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When clinical moderate to severe anxiety and depression is experienced at the same time (mixed anxiety and depression).

I needs to be present for a minimum of four weeks, with at least four other clinical signs.

In mixed anxiety and depression neither dominant over the other. 

If a clinician assessed that anxiety and depression separately, neither would score highly in terms of severity. 

However, when added together, their combined impact pushes up the level of severity to a tipping point, so that it is severe is enough to trigger significant distress, negatively affecting you coping with your work and home life.

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Depressed and anxious feelings feed one another; 

• Depressive symptoms may cause a person to postpone activities, causing them to feel pressured and anxious. 
• Anxiety symptoms may cause the person to avoid activities which they would normally enjoy, increasing feelings of depression.

Symptoms vary from person to person. 

When you constantly have to worry about things beyond your control or feel sad and lonely, then you could be experiencing signs of both depression and anxiety.

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Anxiety and depression occur together 75% of the time. 

It is estimated that mixed anxiety and depression affects 1 in 10 adults in any given year. 

7.8% of people meet the criteria for diagnosis. 

Mixed anxiety and depression have been estimated to cause one-fifth of days lost from work in Britain.

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Close friends who are people whom you see very regularly (in person and social media).You feel emotionally close to them They make an effort to spend time together and are shoulders-to-cry-on friends. 

There are also best friends, whom you see less often. Activities with best friends include : laughing together, support during a difficult time, sharing of private thoughts. 

Good friends you those that you make personal contact much less often. They are people you would invite round for a weekend BBQ or a celebratory birthday or anniversary party. 

Just friends, are those that you make an effort to contact infrequently, whom you feel less close to. 

On average, people have 5 close friends, 10 best friends, 35 good friends and 100 just friends. Are you aware who your close, best, good and just friends ?

Joe and Jim differ in relation to their personal friendship network make upwhich means for each person, they have different networks of friends who may spot or not spot signs of mixed anxiety and depression. 

Recemmended read : Friends by Robin Dunbar. "we all have around 140 friends - the dunbar number"

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Mental health problems affect both men and women, but not in equal measure. 

Men are less likely to seek help than women: only 36% of referrals to NHS talking therapies are for men. 

Joe and Jim are experiencing mixed anxiety and depression. 

Below you are given an insight into their personal lives and activities they enjoy. They differ in their motivation to seek help and how aware they are of what is going on in regards their Mental Health. How healthy are their friendship networks ? 

How would you support Joe and Jim ? As a friend, at work or as part of your family ?

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Joe is 45, has two teenage children and is married to Jane. Joe has worked in construction for over 20 years. He enjoys his job and the banter. The work is physically strenuous, because he has to carry heavy loads. Cold weather makes everything hard and slows everything down. Joe uses specialised,sophisticated equipment and tools that are difficult to master.

Joe has no close friends in his life at the moment. Much of his home life is with his kids and Jane. But Joe does have six best friend dart players. Joe does like the pub life and is a member of the fortnightly darts team Royal Oak pub competition, governed by the BDO regulations. His dart average is 50 plus. Twice a month, Joe puts on his police special uniform, working the night shift. He spends much of his time on the streets, doing intelligence-based patrols in crime hotspots.

Joe's interest in sex has been slowly fading over a month, lovemaking is now mechanical with an absence of desire. He has been increasingly irritable with work mates; banter is no longer fun. He has been criticised for being too heavy handedin his special police role. His darts average has plummeted to 20 plus and he is making mistakes with a particular power tool.

Joe not aware of anything changing within himself. Joe is vaguely aware that his concentration is poor but he has not shared this with anyone and feels embarrassed about his absent sexual feelings. Joe fear others will perceive him as weak. He very rarely uses his GP service and would never would go to his supervisor for help.

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Jim is 54, divorced and a Senior Manager working for a large successful company in Cumbria. He is well respected by his senior colleagues. He does not know this but his peers have informally assessed his senior managerial skills: the majority conclusion is that he possesses robust emotional resilience and is admired for his tough inner strength qualities.

Jim is a governor trustee for a local secondary school. He oversees with others the financial performance of the school and holding the school leader to account to ensure that every pupil has the best possible education. Jim also plays rugby. He does notfeel 54 when playingbut feels like he is still 30 years of age when playing rugby. Rugby Union is recognised the world over as one of the toughest and most demanding sports. Jim is a very private person, he has no need for close friends to confide in but he does have 9 best friends at work, (his work peers) and 20 good friends which is all of the rugby players and around80 just friends both at work and in his private life.

Jim for two months, has been experiencing stomach pains that seem to last for hours. It has meant he has stopped playing rugby but does meet his rugby friends on social occasions, Jim also is feeling pessimistic about the value of his work. He cannot control worrying thoughts "I am a failure".

Jim has approached one person that he trusts at work. He became very upset and his feeling just tumbled out. That person was shocked. Jim asked for this conversation to remain private. However, he did not fully reveal that he was struggling with poor mental health for a long time. Jimfeared if he did, it will harm his career. Jim has purchased and used a Mental Health app and has followed the CBT self help programme but has not yet shared this with anyone.