Background: Anxious-depressive attack (ADA) is a proposed novel symptom complex associated with anxiety and mood disorders. Its main features are (1) sudden intense distressing emotions with no direct psychological cause, (2) intrusive memories of various negative events, (3) worry and agitation about the details of the rumination and (4) various coping behaviors, including acting out. The author has reported five previous cases of ADA. The present study investigates the clinical significance of ADA.

Method: First, to compare clinical characteristics between subjects with and without ADA, 331 consecutive new outpatients were examined (Study I). Second, because of the similarities between ADA and panic attack, the characteristics of ADA were examined in 65 panic disorder (PD) patients (Study II).

Results: The overall incidence of ADA was 43.2%. In PD and social anxiety disorder patients, those exhibiting ADA were significantly younger and had significantly more severe depression and social anxiety than those without ADA (Study I). In PD patients with ADA, ADA preceded panic attacks, and ADA frequency was correlated with the severity of depression and social anxiety but not with panic symptoms (Study II). ADA was often managed with acting out behavior (Study II).

Conclusion: ADA appears to be relatively common among people with anxiety and mood disorders. We found that ADA was correlated with the severity of social anxiety, but not PD. PD patients exhibited a “seesaw” phenomenon between ADA and panic attacks. ADA may be a core symptom complex of a severe form of anxious depression.