Cognitive therapy for anxious depression in STAR(*) D: what have we learned?
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Background Anxious depression, defined as MDD with high levels of anxiety symptoms, has been associated with lower rates of antidepressant response and remission as well as greater chronicity, suicidality and antidepressant side-effect burden. The primary aim of this study was to assess the effectiveness of cognitive therapy (CT) alone or in combination with medications for anxious versus non-anxious depression.Methods We assessed the STAR(⁎)D study participants who were partial or non-responders to citalopram. Subjects were then either switched (n=696) to a new antidepressant or to CT alone, or they were kept on citalopram and augmented (n=577) with another antidepressant or CT. We compared response and remission rates, across treatment conditions, between those who met criteria for anxious depression and those who did not.Results Those with anxious depression had significantly lower remission rates based on the QIDS, whether assigned to switch or augmentation, compared to those with non-anxious depression. Those with anxious depression, compared to those without, had significantly lower response rates based on the QIDS only in the switch group. There was no significant interaction between anxious depression and treatment assignment.Limitations Limitations include the use of citalopram as the only Level 1 pharmacotherapy and medication augmentation option, the relatively small size of the CT arms, use of depression-focused CT rather than anxiety-focused CT, and focus on acute treatment outcomes.Conclusions Individuals with anxious depression appear to experience higher risk of poorer outcome following pharmacotherapy and/or CT after an initial course of citalopram and continued efforts to target this challenging form of depression are needed.
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When generalized anxiety disorder and major depressive disorder co-occur, subjective distress and functional impairment may be greater and treatment response may be worse.
“When co-occurring, the subjective distress and functional impairment may be even larger, and the treatment response worse (Farabaugh et al., 2012; Newman, Przeworski, Fisher, & Borkovec, 2010; Olatunji, Cisler, & Deacon, 2010).”
From Changes in Decentering and Reappraisal Temporally Precede Symptom Reduction During Emotion Regulation Therapy for Generalized Anxiety Disorder With and Without Co-Occurring Depression. (2019) · cites this paper as Farabaugh et al., 2012
The Introduction defines anxious depression broadly as MDD with either a co-occurring anxiety disorder or high anxiety symptoms, and the Discussion reports poorer treatment response in that group than in patients with depression alone. The paper does not establish that result specifically for co-occurring generalized anxiety disorder and MDD, nor does it report greater subjective distress or functional impairment for that pairing. Page numbers are unavailable in our copy. (LLM, conf=0.86)
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Papakostas, G. I., D, M. F. M., Freeman, M. P., Shelton, R. C., Thase, M., Jha, M. K., Trivedi, M. H., Dirks, B., Liu, K., & Stankovic, S. (2020) · European Neuropsychopharmacology · doi:10.1016/j.euroneuro.2020.09.080
Self-citationAnxiety in late-life depression
van der Veen, D. C. (2021) · doi:10.33612/diss.179793202
Working with Co‐Morbid Depression and Anxiety Disorders
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Emotion Regulation Therapy III: Foundations and Frontiers in Investigating Efficacy and Mechanism
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Emotion Regulation Therapy (ERT) II: Treatment Mechanisms and Components
Clayton, M., Hernandez, M., Mennin, D. S., & Fresco, D. M. (2025) · Springer eBooks · doi:10.1007/978-3-032-00353-9_12
- Authors
- Farabaugh, A., Alpert, J., Wisniewski, S. R., Otto, M. W., Fava, M., Baer, L., Perlis, R., Friedman, E., Nyer, M., Bitran, S., Balasubramani, G. K., Inamori, A., Trivedi, M., & Thase, M. E.
- Affiliations
- Massachusetts General Hospital (US)
- Harvard University (US)
- University of Pittsburgh (US)
- Boston University (US)
- The University of Texas Southwestern Medical Center (US)
- Corresponding author
- Farabaugh, Amy
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2012-12
- Volume
- 142
- Issue
- 1-3
- Pages
- 213-218
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC3483355
- OpenAlex
- W1985073203
- Cited by
- 52
- References
- 39
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 3 · 2023: 1 · 2022: 2 · 2021: 4 · 2020: 7 · 2019: 6 · 2018: 3 · 2017: 1 · 2016: 8 · 2015: 5 · 2014: 5 · 2013: 3
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Affective Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (MH-90003)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- anxious depression, cognitive therapy, STAR*D, citalopram, antidepressant response, remission, treatment switching, antidepressant augmentation, major depressive disorder, anxiety comorbidity, treatment outcomes
- MeSH terms
- Adult, Antidepressive Agents, Anxiety Disorders, Major Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Remission Induction, Citalopram, Comorbidity, Cognitive Behavioral Therapy, Treatment Outcome
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