📑 Anxious-Depressive Attack: An Overlooked Condition. A Case Report〈Hisanobu Kaiya〉

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.

Title: Anxious-Depressive Attack: An Overlooked Condition. A Case Report

Author: Hisanobu Kaiya

URL: https://www.jstage.jst.go.jp/article/jsad/8/1/8_22/_article

Date: 2016

Found thanks to Do You Have Sad Attacks, Too? - by Jesse Meadows - Sluggish.

I don’t really have anything to say about these cases, except for additionally highlighting one detail: at least 2/5 participants thought that their extreme emotional experiences were normal. “Everyone experiences that”, “this is a part of my personality”…

I think there’s no specific term for this phenomenon – though I see such cases a lot while reading about autistic people’s experiences – that I had to come up with something of my own so I can collect relevant posts under one tag. For now, it’s “Projection Bias (in context of extreme negative experiences)”, but I’d prefer to invent something shorter eventually.

…and yeah, I had those. Such a shitty experience, and one of the worst parts is how uncontrollable these are.

In all the cases reported here, it was common for the ADA to appear spontaneously, irrespective of self-will. ADAs always began with an emotional outburst, followed by unpleasant memory intrusion, and finally, coping behaviors. […] In most cases, the emotional outburst is followed or accompanied by weeping. Furthermore, ADAs occur suddenly without any identifiable psychological trigger.

Another important idea is that “an ADA primarily concerns troubles related to interpersonal relationships.” More recent studies by Hisanobu Kaiya explore this idea even further:

A previous study showed that patients with ADA were more socially anxious and more depressive than those without ADA, regardless of their diagnoses. Social anxiety disorder (SAD) is one of such disorders with a high prevalence of ADA (44.4%). According to clinical reports, patients with SAD appear hypersensitive to rejection or criticism. ¹

Interestingly, future ADA research could be the key to treatment-resistant depression:

Depression comorbid with anxiety is often treatment-resistant where anxious-depressive attack (ADA) often lurks. […] As the basic psychopathology of ADA, rejection sensitivity (RS) was revealed by a structural equation model. It is said that the presence of RS in depressive disorders implies a poor prognosis. […] Manipulation of the μ-opioid receptor function together with the DRD4 function may culminate in a treatment for RS, which could contribute to the development of a treatment for TRD via the improvement of ADA. ²

I wonder whether this research would benefit from considering not only rejection sensitivity, but also cPTSD:

Complex post-traumatic stress disorder (CPTSD, cPTSD, or hyphenated C-PTSD) is a stress-related mental disorder generally occurring in response to complex traumas (i.e., commonly prolonged or repetitive exposure to a traumatic event (or traumatic events), from which one sees little or no chance to escape). ³

On the somewhat related note, the article’s description of ataque de nervios seems to be rather similar to traumatic grief. Wish I could run some kind of automated term analysis to determine how much these terms actually overlap.

Ataque de nervios (attack of nerves) a syndrome among individuals of Latino descent, is characterized by symptoms of intense emotional upset, including acute anxiety, anger, or grief; screaming and shouting uncontrollably; attacks of crying; trembling; heat in the chest rising into the head; and becoming verbally and physically aggressive. Dissociative experiences (e.g., depersonalization, derealization, and amnesia), seizure-like or fainting episodes, and suicidal gestures are prominent in some ataques but absent in others. A general feature of an ataque de nervios is a sense of being out of control. Attacks frequently occur as a direct result of a stressful event related to the family, such as news of the death of a close relative, conflicts with a spouse or children, or witnessing an accident involving a family member.

Traumatic grief or complicated mourning where trauma and grief coincide. There are conceptual links between trauma and bereavement since loss of a loved one is inherently traumatic. If a traumatic event was life-threatening, but did not result in a death, then it is more likely that the survivor will experience post-traumatic stress symptoms. If a person dies, and the survivor was close to the person who died, then it is more likely that symptoms of grief will also develop. When the death is of a loved one, and was sudden or violent, then both symptoms often coincide. ³

While differential diagnostics is important, I can’t help but think about a study on how fragmented psychology has become with thousands of new methods, measures and concepts published every year only for the most of them to never be reused outside of the original study. ⁴ It doesn’t seem like the term “anxious-depressive attack” was widely adopted, and I can only wonder – what even makes contemporary psychological studies influential?

Sources

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• Anvari, Farid, Taym Alsalti, Lorenz Oehler, et al. ‘A Fragmented Field: Construct and Measure Proliferation in Psychology’. Preprint, OSF, 14 June 2025. https://doi.org/10.31234/osf.io/b4muj_v3.
• Kaiya, Hisanobu, Shota Noda, Eri Takai, et al. ‘Effects of Rejection Sensitivity on the Development of Anxious-Depressive Attack in Patients with Social Anxiety Disorder’. Anxiety Disorder Research 12, no. 1 (2020): 37–44. https://doi.org/10.14389/jsad.12.1_37.
• Kaiya, Hisanobu. ‘Anxious-Depressive Attack and Rejection Sensitivity—Toward a New Approach to Treatment-Resistant Depression’. Neuropsychopharmacology Reports 44, no. 1 (2024): 17–28. https://doi.org/10.1002/npr2.12399.
• Meadows, Jesse. ‘Do You Have Sad Attacks, Too?’ Sluggish, 11 August 2025. https://www.sluggish.xyz/p/do-you-have-sad-attacks-too.
• Wikipedia, ‘Complex post-traumatic stress disorder’, 15 September 2025, https://en.wikipedia.org/w/index.php?title=Complex_post-traumatic_stress_disorder&oldid=1311564036.