Patient presents with symptoms consistent with a diagnosis of Mixed Anxiety and Depressive Disorder (MADD).  The patient reports experiencing both anxiety and depressive symptoms, with neither clearly predominating, for a duration exceeding two weeks.  Symptoms reported include depressed mood, anhedonia, difficulty concentrating, fatigue, irritability, sleep disturbance, restlessness, excessive worry, and muscle tension.  These symptoms cause clinically significant distress in social, occupational, or other important areas of functioning.  The patient denies suicidal ideation or intent, but expresses feelings of hopelessness and worthlessness.  No evidence of manic or hypomanic episodes.  Symptoms do not meet criteria for a major depressive episode or a generalized anxiety disorder.  Differential diagnoses considered include generalized anxiety disorder, major depressive disorder, adjustment disorder with mixed anxiety and depressed mood, and medical conditions that may mimic anxiety and depression.  A thorough review of systems was conducted, along with relevant laboratory tests, to rule out organic causes.  Diagnosis of Mixed Anxiety and Depressive Disorder is based on patient self-report, clinical observation, and DSM-5 criteria.  Treatment plan includes initiation of cognitive behavioral therapy (CBT) focused on anxiety and depression management techniques, and consideration of pharmacotherapy with a selective serotonin reuptake inhibitor (SSRI) pending further evaluation and discussion of risks and benefits.  Patient education provided on MADD, treatment options, and coping strategies.  Follow-up scheduled in two weeks to monitor symptom improvement and adjust treatment plan as needed.  ICD-10 code F41.2 will be used for billing and coding purposes.  Prognosis is generally favorable with appropriate treatment and patient adherence.