Presenting Complaints

• The patient presents with variety of symptoms of anxiety and depression, none sufficient to warrant a diagnosis but together resulting in disability..
• The patient may present initially with one or more physical symptoms (fatigue, pain). Further inquiry will reveal depressed mood and anxiety.

Diagnostic features
(insufficient to satisfy a separate anxiety or depressive diagnosis)

• Low or sad mood
• Loss of interest or pleasure
• Prominent anxiety or worry
• Associate symptoms are frequently present:
  • Disturbed sleep
  • Tremor
  • Fatigue or loss of energy
  • Palpitations
  • Poor concentration
  • Dizziness
  • Disturbed appetite
  • Dry mouth
  • Suicidal thoughts or acts
  • loss of libido
  • tension and restlessness

Differential Diagnosis

• If severe enough to get a diagnosis of depression or anxiety alone, do not use this diagnosis, see section on Depression, Panic, Phobias and Generalized Anxiety.
• If somatic symptoms predominate, see Unexplained somatic symptoms
• If hallucinations (hearing voices, seeing visions) or delusions (strange or unusual beliefs) are present, see also section on Acute Psychotic Disorders about management of these problems. If possible, consider consultation about management.
• If history of manic episode (excitement, elevated mood, rapid speech) is present, see section on Bipolar Disorder.
• If heavy alcohol or drug use is present, see sections on Alcohol Use Disorders, or Drug Use Disorders.