The DOI matches its Crossref record; 35 of the 36 references it cites were found in a registry or an index.
Defining anxious depression: a review of the literature
Open accessAbstract
The diagnosis of anxious depression is presently inconsistent. The many different definitions of anxious depression have complicated its diagnosis, leading to clinical confusion and inconsistencies in the literature. This article reviewed the extant literature in order to identify the varying definitions of anxious depression, which were then compared using Feighner's diagnostic criteria. Notably, these suggest a different clinical picture of patients with anxious depression. For instance, relying on The International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses yields a clinical picture of a comparatively mild or transient disorder; in contrast, using dimensional criteria such as DSM criteria combined with additional rating scales—most commonly the anxiety somatization factor score from the Hamilton Depression Rating Scale (HAM-D)—yields a more serious clinical picture. The evidence reviewed here suggests that defining anxious depression in a dimensional manner may be the most useful and clinically relevant way of differentiating it from other types of mood and anxiety disorders, and of highlighting the most clinically significant differences between patients with anxious depression versus depression or anxiety alone.
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“Anxious depression is present in approximately half of the MDD population and is commonly defined either syndromally (i.e., co-occurring MDD and anxiety disorder diagnoses) or using 17-item Hamilton Rating Scale Depression (HRSD17) criteria (i.e., MDD diagnosis and an HRSD17 anxiety/somatisation factor score of ≥7 [9–11]).”
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 [9]
In the citing paper
“Generally, the term 'anxious depression' has been used interchangeably in recent literature to denote three common dichotomous anxiety-depression definitions: major depressive disorder (MDD) with a comorbid full-blown anxiety disorder, MDD with anxiety symptoms measured as an above cutoff score on an anxiety severity scale [2], and MDD with the Diagnostic and Statistical Manual of Mental Disorders”
From Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome (2018) · cites this paper as [2]
In the citing paper
“However, various scales and different cutoff points to determine relevant anxiety symptoms have been used, resulting in heterogeneity in the dimensional definition as well [2,3].”
From Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome (2018) · cites this paper as [2]
In the citing paper
“Consequently, various definitions for anxious depression are being used across studies, making results not always directly comparable.”
From Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome (2018) · cites this paper as [2]
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Citations
Cites
Diagnostic criteria for use in psychiatric research.
Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A., Winokur, G., & Munoz, R. A. (1972) · Archives of General Psychiatry · doi:10.1001/archpsyc.1972.01750190059011 · Cited by 5,491
Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E. A., & Kupfer, D. J. (2013) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2012.12070999 · Cited by 1,163 · cited 2×
“Most notably, a recent estimate of test–retest reliability of mixed anxiety depressive disorder found that the diagnosis could not be reliably separated from MDD or GAD.(17) In this field trial, MDD and GAD had low reliability, in part because of their high comorbidity with other disorders and their heterogeneous popu…”
Time-related predictors of suicide in major affective disorder
FAWCETT, J. A., Scheftner, W. A., Fogg, L., Clark, D. C., Young, M. A., Hedeker, D., & Gibbons, R. D. (1990) · American Journal of Psychiatry · doi:10.1176/ajp.147.9.1189 · Cited by 1,058
Fava, M., Rush, A. J., Alpert, J. E., Balasubramani, G. K., Wisniewski, S. R., Carmin, C. N., Biggs, M. M., Zisook, S., Leuchter, A., Howland, R., et al. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2007.06111868 · Cited by 927
Nock, M. K., Hwang, I., Sampson, N., Kessler, R. C., Angermeyer, M., Beautrais, A., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., et al. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000123 · Cited by 912
FAVA, M., ALPERT, J. E., CARMIN, C. N., WISNIEWSKI, S. R., TRIVEDI, M. H., BIGGS, M. M., SHORES-WILSON, K., MORGAN, D., SCHWARTZ, T., BALASUBRAMANI, G. K., et al. (2004) · Psychological Medicine · doi:10.1017/s0033291704002612 · Cited by 406
Penninx, B. W. J. H., Nolen, W. A., Lamers, F., Zitman, F. G., Smit, J. H., Spinhoven, P., Cuijpers, P., de Jong, P. J., van Marwijk, H. W. J., der Meer, K. V., et al. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.03.027 · Cited by 354
Anxiety disorders in major depression.
Fava, M., Rankin, M. A., Wright, E. C., Alpert, J., Nierenberg, A., Pava, J. A., & Rosenbaum, J. (2000) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(00)90140-8 · Cited by 347
Follow-up and family study of anxious depression
Clayton, P. J., Grove, W. M., Coryell, W. H., Keller, M. B., Hirschfeld, R. M. A., & FAWCETT, J. A. (1991) · American Journal of Psychiatry · doi:10.1176/ajp.148.11.1512 · Cited by 235
The DSM-IV field trial for mixed anxiety-depression
Zinbarg, R. E., Barlow, D. H., Liebowitz, M. R., Street, L. L., Broadhead, E., Katon, W. J., Roy‐Byrne, P., Lépine, J., Teherani, M., & Richards, J. C. (1994) · American Journal of Psychiatry · doi:10.1176/ajp.151.8.1153 · Cited by 215
Research works printed but not linked: 3
- 1992, International Statistical Classification of Diseases and Related Health Problems
- 1994, Diagnostic and Statistical Manual of Mental Disorders: DSM-IV
- Cleary, 1977, Factor analysis of the Hamilton depression scale, Drugs Exp Clin Res, 115
Cited by
Sorted by citations
Prognosis and improved outcomes in major depression: a review
Kraus, C., Kadriu, B., Lanzenberger, R., Zarate, C. A., & Kasper, S. (2019) · Translational Psychiatry · doi:10.1038/s41398-019-0460-3 · Cited by 482
Self-citationComorbid Anxiety and Depression: Clinical and Conceptual Consideration and Transdiagnostic Treatment
Choi, K. W., Kim, Y., & Jeon, H. J. (2020) · Advances in experimental medicine and biology · doi:10.1007/978-981-32-9705-0_14 · Cited by 339
Pharmacological approaches to the challenge of treatment-resistant depression
Ionescu, D. F., Rosenbaum, J. F., & Alpert, J. E. (2015) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2015.17.2/dionescu · Cited by 228
Self-citationGaspersz, R., Nawijn, L., Lamers, F., & Penninx, B. W. J. H. (2018) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000376 · Cited by 139
Braund, T. A., Tillman, G., Palmer, D. M., Gordon, E., Rush, A. J., & Harris, A. W. F. (2021) · Translational Psychiatry · doi:10.1038/s41398-021-01533-1 · Cited by 135
Metadata
- Authors
- Ionescu, D. F., Niciu, M. J., Henter, I. D., & Zarate, C. A.
- Affiliations
- National Institutes of Health (US)
- Corresponding author
- Ionescu, Dawn F.
- Venue
- CNS Spectrums
- Publisher
- Cambridge University Press (CUP)
- Published
- 2013-03-14
- Volume
- 18
- Issue
- 5
- Pages
- 252-260
- ISSN
- 1092-8529 (ISSN-L)
- 2165-6509
- PMC
- PMC3773528
- OpenAlex
- W2143273593
- Cited by
- 119
- References
- 36
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 16 · 2023: 5 · 2022: 11 · 2021: 11 · 2020: 12 · 2019: 16 · 2018: 6 · 2017: 9 · 2016: 5 · 2015: 8 · 2014: 6 · 2013: 1
- FWCI
- 1.10
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- CNS Spectrums (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99 MH999999)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Keywords
- anxious depression, diagnostic criteria, dimensional assessment, Hamilton Depression Rating Scale, ICD, DSM, mood disorders, anxiety disorders
- MeSH terms
- Anxiety Disorders, Depressive Disorder, Humans, International Classification of Diseases, Diagnostic and Statistical Manual of Mental Disorders
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