Anxiety-Originated Depression and Subtype-Specific Bipolar Transition: A Neuroprogressive Model of Partially Irreversible Damage with Clinical Intervention Thresholds

Anxiety-originated depression (AoD) is a neurodevelopmentally distinct and clinically understudied affective subtype characterized by unique neurobiological features, diverging from typical major depressive disorder. AoD is marked by diminished prefrontal regulatory control, aberrant synaptic reorganization, and early-stage white matter compromise, all of which reduce neural resilience to stress and accelerate affective instability. This paper proposes a neuroprogressive model suggesting that AoD poses a disproportionately high risk for subtype-specific bipolar conversion—particularly toward Bipolar II or Rapid Cycling presentations—due to cumulative neurotoxic load and delayed intervention. We review the literature on chronic stress–related circuit degradation, including HPA axis dysregulation, glucocorticoid-induced neurotoxicity, and prefrontal–hippocampal disintegration. Furthermore, we explore how pharmacological overload, especially involving SSRIs and benzodiazepines, may exacerbate energy metabolism disruption in adolescents with AoD. In clinical contexts, AoD’s presentation is often misclassified as unipolar depression, delaying stratified care. This paper advocates for early subtyping based on behavioral inhibition, stress history, and white matter integrity. Ethical treatment prioritization favors psychological-first strategies in youth populations, while phase-specific neuroprotective interventions may delay or prevent irreversible conversion. Recognizing AoD as a biologically distinct prodrome opens new avenues for early diagnosis, longitudinal tracking, and personalized intervention pathways, shifting the treatment paradigm toward anticipatory, developmentally informed models of care.