Yesterday, a patient was referred by a teacher from our medical school student office, saying that he had been treated for depression for 1 year with poor results. I diagnosed after detailed examination: 1. anxiety disorder; 2. social phobia; 3. obsessive-compulsive disorder. According to the latest American diagnostic criteria, these 3 neurological disorders are anxiety disorders. Then last week, experts from Zhongshan Medical Hospital hosted a seminar on difficult cases, and I attended their seminar as an invited reviewer. I diagnosed both cases of so-called refractory depression as anxiety disorders. After detailed and careful examination and observation, or after a period of treatment, many of them were rediagnosed as anxiety disorders or anxiety-related disorders, rather than depression. Mental illnesses are the result of a combination of endogenous and exogenous factors, but each has its own focus. The etiology of depression is mainly intrinsic biological factors, and treatment is based on antidepressant medication, which is mostly effective (a recent study found that major depression has shrinkage of brain tissue structures such as temporal lobe and hippocampus, which returned to normal after treatment with antidepressant medication); psychotherapy is usually used as an adjunctive treatment, especially for major depression. The etiology of anxiety disorders or anxiety-related disorders (e.g., neurosis, neurasthenia, adjustment disorder, obsessive-compulsive disorder, dysthymia, somatoform disorder, social phobia, fatigue syndrome, etc.) is based on extrinsic psychosocial factors and personality traits, so psychotherapy and active self-adjustment of the patient are more important, and medication is used as adjunctive treatment. If anxiety or anxiety-related disorders are treated with medication alone, the condition is prone to fluctuation, relapse and chronicity after stopping medication, thus becoming the so-called “intractable depression”. Although anxiety disorders are also treated with antidepressants, the antidepressants with good anxiolytic effects are usually chosen (note: some new antidepressants claim to be good for anxiolytic effects, but in fact they are not, and sometimes they are far worse than the old ones, but some patients and their families always believe that the more expensive the drug is, the better the effect is, Yu Jinlong). The purpose of antidepressants for anxiety is to quickly control symptoms and create conditions for psychotherapy or self-adjustment of the patient. And the purpose of antidepressant drugs for depression is to cure the disease directly, and the importance is to treat in full doses and in full courses. The dosage and course of medication for anxiety disorders are very flexible, with some doses being very large and some requiring only a small dose, and some courses being very long and some very short, and are influenced by a variety of factors, requiring the doctor to have a thorough understanding of the patient’s situation. In terms of combination therapy and adjuvant medication, depression and anxiety disorders are even further apart, sometimes even the opposite, because there is a lot of content in this area, so I won’t talk about it here, but I will talk about it in another article. When depression improves, after consolidation and maintenance treatment, it is usually not difficult to reduce the medication and stop it. In anxiety disorders, it is often how to reduce and discontinue medication that tests the clinical experience and level of the physician. The prevalence of anxiety disorders is much higher than that of depression (this may be especially true in our country due to cultural factors), but the number of diagnosed depressions in our country is much higher than that of anxiety disorders, which suggests that the recognition rate of anxiety disorders among psychiatrists in our country is low, and the treatment aspect is even more inadequate because psychotherapy is still in its infancy in our country and there are few psychiatrists who have mastered standardized psychotherapy techniques. Once again, we call on our national psychiatrists to attach great importance to the clinical diagnosis, differential diagnosis, and treatment of anxiety disorders, because the chronic torture and suffering brought by severe anxiety disorders and anxiety-related illnesses cannot be imagined by those who have never had such illnesses.