Anxious distress predicts subsequent treatment outcome and side effects in depressed patients starting antidepressant treatment
Abstract
Evidence has shown that the DSM-5 anxious distress specifier captures a clinically valid construct that predicts a worse clinical course. Although of importance for treatment planning and monitoring, however, the specifier's ability to predict treatment outcome is unknown. This is the first study to examine the ability of the DSM-5 anxious distress specifier to predict treatment response and side effects in depressed patients who recently initiated antidepressant treatment. Patients were from the Netherlands Study of Depression and Anxiety, an ongoing longitudinal cohort study. Baseline, 1-year and 2-year follow-up data were used from 149 patients (18-65 years) with current Major Depressive Disorder (MDD) who recently started adequately dosed antidepressant medication. Five self-report items were used to construct the DSM-5 anxious distress specifier. Treatment outcomes were depression severity after 1 year and 2 years, remission of MDD after 2 years and antidepressant side effects during treatment. For comparison, analyses were repeated for comorbid DSM-IV-based anxiety disorders as a predictor. In depressed patients who received antidepressant treatment, the anxious distress specifier (prevalence = 59.1%) significantly predicted higher severity (1 year: B = 1.94, P = 0.001; 2 years: B = 1.63, P = 0.001), lower remission rates (OR = 0.44, P = 0.0496) and greater frequency of side effects (≥4 vs. 0: OR = 2.74, P = 0.061). In contrast, the presence of comorbid anxiety disorders did not predict these treatment outcomes. The anxious distress specifier significantly predicts poorer treatment outcomes as shown by higher depression severity, lower remission rates, and greater frequency of antidepressant side effects in patients with MDD on adequate antidepressant treatment. Therefore, this simple 5-item specifier is of potential great clinical usefulness for treatment planning and monitoring in depressed patients.
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In patient samples, the anxious/distressed specifier predicts a poor course of MDD.
“In patient samples, the anxious/distressed specifier predicts a poor course of MDD.20,21”
From Epidemiology of Adult <i>DSM-5</i> Major Depressive Disorder and Its Specifiers in the United States (2018) · cites this paper as [20]
No differences in frequency of side effects between people with syndromal and non-syndromal anxious depression were found by Gaspersz et al.
“However, these associations are not found in all definitions of anxious depression, with Gaspersz et al. [14]. finding no differences in the frequency of side effects between people with syndromal and non-syndromal anxious depression.”
From Antidepressant side effects and their impact on treatment outcome in people with major depressive disorder: an iSPOT-D report (2021) · cites this paper as [14]
A greater side effect severity has been found at various study endpoints in people with anxious depression compared to people with MDD only.
“A greater side effect severity has also been found at various study endpoints in people with anxious depression compared to people with MDD only [13–15].”
From Antidepressant side effects and their impact on treatment outcome in people with major depressive disorder: an iSPOT-D report (2021) · cites this paper as [14]
Syndromal anxious depression did not predict severity of side effects (Gaspersz et al.).
“Gaspersz et al. [14]. found that syndromal anxious depression did not predict severity of side effects.”
From Antidepressant side effects and their impact on treatment outcome in people with major depressive disorder: an iSPOT-D report (2021) · cites this paper as [14]
Patients with depression and comorbid anxiety disorders had higher readmission rates.
“Recently, multiple large-scale studies have reported that patients with depression and comorbid anxiety disorders had higher readmission rates [35], lower remission rates [41], greater depression severity [31 && ,41], higher suicidal risks [29,31 && ], a lower quality of life (QOL) [32,41], impaired social and occupational dysfunction [29], and an increased comorbidity of somatic conditions such”
From Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome (2018) · cites this paper as [35]
MDD with comorbid anxiety disorders is associated with chronic course trajectories and poor clinical outcomes in clinical samples.
“Substantial evidence suggests that MDD with comorbid anxiety disorders is associated with chronic course trajectories [7,35] and poor clinical outcomes [4,29,31 && ,32,41,42] in clinical samples.”
From Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome (2018) · cites this paper as [35]
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- Authors
- Gaspersz, R., Lamers, F., Kent, J. M., Beekman, A. T. F., Smit, J. H., van Hemert, A. M., Schoevers, R. A., & Penninx, B. W. J. H.
- Affiliations
- Amsterdam Public Health (NL)
- University Medical Center Groningen (NL)
- Corresponding author
- Gaspersz, Roxanne
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2017-01
- Volume
- 84
- Pages
- 41-48
- ISSN
- 0022-3956 (ISSN-L)
- OpenAlex
- W2521670955
- Cited by
- 88
- References
- 36
- Citations by year
- 2026: 11 · 2025: 6 · 2024: 15 · 2023: 7 · 2022: 8 · 2021: 7 · 2020: 8 · 2019: 11 · 2018: 11 · 2017: 4
- FWCI
- 7.01
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Funders
- International Business Machines Corporation
- ZonMw
- 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 › Social Psychology › Mental Health Treatment and Access
- Keywords
- anxious distress, major depressive disorder, antidepressant treatment outcome, antidepressant side effects, depression severity, remission, comorbid anxiety disorders, treatment response prediction, treatment planning
- MeSH terms
- Adolescent, Adult, Aged, Antidepressive Agents, Anxiety, Major Depressive Disorder, Depressive Disorder, Major, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Netherlands, Prognosis, Psychiatric Status Rating Scales, Severity of Illness Index, Stress, Psychological, Treatment Outcome, Young Adult, Self Report
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