Volume 3 Issue 9 September, 2013
This is one of the most common disorders in general practice. Consultants from other specialties prescribe Amitryptiline (Tryptomer) alone or in combination with chlordiazepoxide to most of the patients with so called ‘vague symptoms’. If one looks closely, ‘mixed anxiety depressive disorder’ would be the most common diagnosis that can be given to these patients! Thus these groups of patients have symptoms of both anxiety and depression but neither in sufficient severity to meet criteria for independent diagnosis.
Nosological status: it is classified in WHO ICD-10 under anxiety disorders (Code: F41.2). DSM-IV TR describes this in
appendix.
Epidemiology: Information on sex, age at onset, chronicity, course and treatment is less. Thus there is scope for
research in this area. Prevalence varies from 0.8- 2.5% in epidemiological studies and from 5-15% in primary care
settings.
Clinical Features: Such patients usually report consistent low or dysphoric mood for at least 1 month, accompanied by
additional symptoms that include prominent worries, anxious feeling, restlessness along with some autonomic
symptoms (tremor, palpitations, dry mouth, stomach churning etc). Often these patients present with somatic
symptoms like headache, neck pain, back aches, indigestion etc and mood / anxiety symptoms come up only on enquiry by treating doctor. There may be significant distress but functional impairment is usually minimal. It is important to differentiate this condition from other anxiety disorders, major depressive disorder (meet specific criteria), adjustment disorder (presence of stressful life event), grief, dysthymia etc. It is important to enquire about suicidal ideation in routine practice so that a life is saved by early diagnosis and treatment of severe depression.
Treatment: Pharmacological treatment includes use of Selective Serotonin Reuptake Inhibitors, Serotonin
Norepinephrine Reuptake Inhibitor. Medications should be given in recommended doses so that patient is relieved of
symptoms. Non-pharmacological treatments like cognitive behavioral therapy, relaxation, yoga are also helpful.
Duration of treatment is controversial but it should be for at least 3-6 months after remission of symptoms or for at least duration of past episode if present.
Prognosis: As many as 50% patients may receive lifetime diagnosis of General Anxiety Disorder / Major Depressive
Disorder.
Importance: All doctors should be made aware that this condition as it is not so uncommon in general practice, it is
often not recognized (miss the diagnosis) causing significant suffering to patients. Referral of patient to a Psychiatrist
may be fruitful in order to avoid continuation of morbid state.
Assistant Professor, MGM, Aurangabad
