Mixed anxiety and depression: should it be included in DSM-IV?

DSM-IV is provisionally including a category of mixed anxiety and depression for several reasons. First, it will be included in ICD-10, and therefore used worldwide. The ICD-10 category and the mixed anxiety and depression category now being included in the appendix of DSM-IV are subsyndromal in that they include patients with both anxious and depressive symptoms that fail to meet criteria for an established anxiety or depression diagnosis. Primary-care physicians regularly report a high incidence of patients whose symptoms fit this subsyndromal definition of mixed anxiety and depression. Such patients are not easily classifiable using DSM-III or DSM-III-R criteria, yet they often manifest sufficient distress and/or disability to require treatment. Those who oppose establishing the diagnosis of mixed anxiety and depression make the following points: (1) patients considered eligible for this diagnosis will actually meet criteria for a current DSM disorder; (2) mixed anxiety and depression will become a "wastebasket" category for a heterogeneous group of patients; (3) if any new subsyndromal diagnosis is needed, minor depression should suffice; and (4) mixed anxiety and depression will overlap extensively with adjustment reaction.