Clinical characteristics and treatment outcomes of patients with major depressive disorder and comorbid anxiety disorders: results from a European multicenter study
Abstract
This naturalistic European multicenter study aimed to elucidate the association between major depressive disorder (MDD) and comorbid anxiety disorders. Demographic and clinical information of 1346 MDD patients were compared between those with and without concurrent anxiety disorders. The association between explanatory variables and the presence of comorbid anxiety disorders was examined using binary logistic regression analyses. 286 (21.2%) of the participants exhibited comorbid anxiety disorders, 10.8% generalized anxiety disorder (GAD), 8.3% panic disorder, 8.1% agoraphobia, and 3.3% social phobia. MDD patients with comorbid anxiety disorders were characterized by younger age (social phobia), outpatient status (agoraphobia), suicide risk (any anxiety disorder, panic disorder, agoraphobia, social phobia), higher depressive symptom severity (GAD), polypsychopharmacy (panic disorder, agoraphobia), and a higher proportion receiving augmentation treatment with benzodiazepines (any anxiety disorder, GAD, panic disorder, agoraphobia, social phobia) and pregabalin (any anxiety disorder, GAD, panic disorder). The results in terms of treatment response were conflicting (better response for panic disorder and poorer for GAD). The logistic regression analyses revealed younger age (any anxiety disorder, social phobia), outpatient status (agoraphobia), suicide risk (agoraphobia), severe depressive symptoms (any anxiety disorder, GAD, social phobia), poorer treatment response (GAD), and increased administration of benzodiazepines (any anxiety disorder, agoraphobia, social phobia) and pregabalin (any anxiety disorder, GAD, panic disorder) to be associated with comorbid anxiety disorders. Our findings suggest that the various anxiety disorders subtypes display divergent clinical characteristics and are associated with different variables. Especially comorbid GAD appears to be characterized by high symptom severity and poor treatment response.
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Patients with depression and comorbid anxiety disorders had impaired social and occupational dysfunction.
“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 [29]
Another study observed a higher suicide risk and greater dysfunction in patients with MDD and at least two anxiety disorders compared with those with a comorbid social anxiety disorder.
“Another study observed a higher suicide risk and greater dysfunction in patients with MDD and at least two anxiety disorders compared with those with a comorbid SAD [29].”
From Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome (2018) · cites this paper as [29]
The neural architecture of blame-related feelings differs between non-anxious and anxious forms of major depressive disorder, the latter being predominant in populations with treatment-resistant depression.
“This is in keeping with the hypothesis that the neural architecture of blame-related feelings differs between non-anxious and anxious forms of MDD, the latter being predominant in populations with treatment-resistant depression ( Dold et al., 2017 , Domschke et al., 2010 , Gaspersz et al., 2017 ).”
From Self-blame-selective hyper-connectivity between anterior temporal and subgenual cortices predicts prognosis in major depressive disorder (2023) · cites this paper as Dold et al., 2017
Patients with anxious major depressive disorder did not benefit from neurofeedback.
“Notably, patients with anxious MDD, commonly encountered in treatment-resistant and chronic MDD populations and which is associated with a poor prognosis ( Dold et al., 2017 , Domschke et al., 2010 , Fava et al., 2008 , Gaspersz et al., 2017 ), did not benefit from neurofeedback ( Jaeckle et al., 2021 ).”
From Self-blame-selective hyper-connectivity between anterior temporal and subgenual cortices predicts prognosis in major depressive disorder (2023) · cites this paper as Dold et al., 2017
Co-morbidities themselves can contribute to clinical outcomes, which is particularly evident with the reported association between co-morbid anxiety disorders in major depressive disorder and poorer clinical outcomes.
“Moreover, co-morbidities themselves can contribute to clinical outcomes, which is particularly evident with the reported association between co-morbid anxiety disorders in MDD and poorer clinical outcomes ( Dold et al., 2017 , Domschke et al., 2010 , Fava et al., 2008 ).”
From Self-blame-selective hyper-connectivity between anterior temporal and subgenual cortices predicts prognosis in major depressive disorder (2023) · cites this paper as Dold et al., 2017
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References 35 · Cited by 131
- Authors
- Dold, M., Bartova, L., Souery, D., Mendlewicz, J., Serretti, A., Porcelli, S., Zohar, J., Montgomery, S., & Kasper, S.
- Affiliations
- Medical University of Vienna (AT)
- Université Libre de Bruxelles (BE)
- University of Bologna (IT)
- Sheba Medical Center (IL)
- University of London (GB)
- Corresponding author
- Kasper, Siegfried
- ORCID
- Venue
- Journal of Psychiatric Research
- Publisher
- Elsevier BV
- Published
- 2017-08
- Volume
- 91
- Pages
- 1-13
- ISSN
- 0022-3956 (ISSN-L)
- OpenAlex
- W2594117279
- Cited by
- 131
- References
- 35
- Citations by year
- 2026: 12 · 2025: 16 · 2024: 14 · 2023: 16 · 2022: 19 · 2021: 18 · 2020: 15 · 2019: 11 · 2018: 6 · 2017: 4
- FWCI
- 6.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychiatric Research (publishedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- 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
- major depressive disorder, comorbid anxiety disorders, generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, suicide risk, depression severity, benzodiazepines, pregabalin, antidepressant augmentation, treatment response, clinical features
- MeSH terms
- Adult, Aged, Antidepressive Agents, Anxiety Disorders, Cross-Sectional Studies, Depressive Disorder, Major, Major Depressive Disorder, Europe, Female, Humans, International Cooperation, Male, Middle Aged, Psychiatric Status Rating Scales, Psychotherapy, Retrospective Studies, Treatment Outcome
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