Anxious-Depressive Attack: An Overlooked Condition A Case Report

Abstract

Patients with anxiety and/or depressive disorders often experience sudden intense feelings of distressing emotions, including sadness, anxiety, loneliness, gloom and so on, without any apparent psychological reason. Tearfulness often precedes or accompanies such emotional outburst. In addition to these emotional symptoms, mild physiological symptoms similar to those seen in a panic attack, such as palpitations, dizziness, trembling and so on, may appear. Immediately after this emotional outburst, distressing trains of thought or images related to recent or past unpleasant events are experienced and ruminated on repeatedly. They are often manifested as flashbacks with or without visual images. Since these conditions are the bitterest experiences for most patients, they may cope with them in various ways such as deliberate self-harm. These patients generally have a more or less depressive mood. These conditions are considerably different from a panic attack, in that the emotional and cognitive storm dominates the physical one. The author named this condition as an Anxious-Depressive Attack (ADA). In this study, we present five cases of ADA and discuss their psychopathology and differential diagnoses. To the author's knowledge, this is the first report proposing the term ADA, which is a unique but common syndrome. Awareness regarding ADA may help improve understanding and treatment of the patient.

Distinctive Clinical Features of “Anxious-Depressive Attack”

“…These observations do not exclude the possibility of a "seesaw" phenomenon between ADA and panic attacks, which was proposed on the basis of the author's clinical findings. This hypothesis predicts that ADAs precede the onset of PD, then cease when panic attacks are full-blown and recur when panic attacks give way to depression, as reported in a previous case study (Kaiya, 2016, Case 1). 3. e behavior and signi cance of ADA The occurrence rate of ADA among the patients in the present study sample was relatively high (43.2 ) and a large number of patients exhibited ADA for a long time before consulting the author.…”

“…Anxious-depressive attack (ADA) is a proposed novel symptom complex consisting of sudden intense feelings of distressing emotions with no direct psychological cause, followed by intrusive rumination of regretful memories that induce prominent discomfort (Kaiya, 2016). ADA events are typically managed with a range of coping behaviors, including acting out patterns in various disorders involving anxious and/or depressive states (Kaiya, 2016).…”

“…ADA events are typically managed with a range of coping behaviors, including acting out patterns in various disorders involving anxious and/or depressive states (Kaiya, 2016). Thus, ADA seems to manifest as a psychological version of a panic attack.…”

Effects of Rejection Sensitivity on the Development of Anxious-Depressive Attack in Patients with Social Anxiety Disorder

“…Anxious-depressive attack (ADA) is a poorly studied symptom cluster associated with anxiety and mood disorders (Kaiya, 2016(Kaiya, , 2017. In ADA, the following symptoms appear sequentially over time: (1) sudden intense distressing emotions without a direct psychological cause;…”

“…(2) obstinate, intrusive ruminative thinking of various events with a mostly unhappy nature, Original Article o en accompanied by ashbacks; (3) intense worry, unrest, and forlornness against the negative details of the situations; and (4) in most cases, various coping behaviors, including acting out. ADA is not considered a panic attack given the lack of intense physical symptoms (Kaiya, 2016(Kaiya, , 2017. ADA has been observed in various mental disorders, mainly in internalizing disorders, but has been ignored for a long time because most patients do not voluntarily report ADA symptoms.…”