The DOI matches its Crossref record; 83 of the 85 references it cites were found in a registry or an index; 2 of the 78 sources its claims cite were checked for support.
Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome
Open accessAbstract
PURPOSE OF REVIEW: Major depressive disorder with a comorbid anxiety disorder or with significant anxiety symptoms (here called anxious depression) is common and has been associated with poor clinical course trajectories. However, various dichotomous as well as dimensional definitions have been used to label anxious depression and it remains unclear to which extent these result in inconsistent findings. This review provides an overview of recent literature on the impact of anxiety in depressed patients on clinical course trajectories, treatment outcomes, and underlying neurobiological dysregulations. RECENT FINDINGS: Anxious depression seems associated with poorer clinical course trajectories and treatment nonresponse as compared with 'pure' depression, regardless of which definition is used. Recent studies have attempted to determine specific efficacy of novel pharmacological treatments for anxious depressed patients, but have not been conclusive because of the insufficient number of studies and differences in definitions and assessment of anxious depression. Neurobiology studies suggest that anxious depression is associated with increased immune dysregulation, more cortical thinning, and corticolimbic dysfunctions as compared with 'pure' depression. SUMMARY: Anxious depression appears to be a common and clinically relevant subtype of depression as it predicts poorer course trajectories. As populations with anxious depression may benefit from specific treatment regimens, further research is necessary to better delineate its definition and neurobiology. The relatively new Diagnostic and Statistical Manual of Mental Disorders-5 anxious distress specifier is a welcome development and should be further investigated and compared against other anxiety constructs.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
Anxious depression—defined variably as MDD with a comorbid anxiety disorder, elevated anxiety symptoms, or DSM-5 anxious distress—is common and associated with poorer clinical course and treatment outcomes. Recent evidence suggests a distinct neurobiological profile involving immune dysregulation, cortical thinning, and altered corticolimbic connectivity, but definitional heterogeneity limits conclusions.
Key findings
- Prevalence is high across definitions: 42–78% of depressed patients have cooccurring anxiety; in lifetime MDD, 46% had at least one lifetime anxiety disorder, and in 12-month MDD, 52% had lifetime anxiety disorders and 42% had 12-month anxiety disorders. Dimensional studies found 53% of 2876 STAR*D MDD patients and 70% of 375 Chinese MDD patients had anxious depression; DSM-5 anxious distress prevalence ranged from 54 to 78%.
- Anxious depression is associated with poorer course trajectories: greater depression chronicity and severity, higher suicide risk, lower quality of life, impaired social/occupational dysfunction, higher readmission rates, and lower remission rates. The DSM-5 anxious distress specifier outperformed DSM-4-based anxiety disorder comorbidity in predicting subsequent chronicity, longer time to remission, and greater functional disability.
- Treatment findings are mixed: traditional antidepressants may be less effective for maintaining response/remission and may cause more side effects in anxious depression. Novel agents show inconsistent results; single-infusion ketamine was more effective in anxious than nonanxious depression, and vilazodone was more effective in 708 anxious versus 155 nonanxious patients, but evidence remains insufficient to establish specific efficacy.
- Neurobiological studies suggest increased immune dysregulation (e.g., higher monocyte counts, higher innate cytokine production capacity), HPA-axis dysregulation, more cortical thinning in orbitofrontal/anterior cingulate cortex, insula, and temporal lobes, and increased corticolimbic functional connectivity compared with nonanxious MDD.
Methods
- Narrative review of recent literature on anxious depression, covering prevalence, clinical course trajectories, treatment outcomes, and underlying neurobiological dysregulations.
- Synthesizes large epidemiological and clinical studies and pharmacological trials, including a 74,045-adult 24-country study, STAR*D (n=2876), a European multicenter study (n=1346), and various randomized/post hoc treatment studies.
- Main analysis is qualitative synthesis, with attention to whether findings depend on the definition or assessment method used for anxious depression; no meta-analysis or systematic search strategy is described.
Limitations
- The paper states that various dichotomous and dimensional definitions and assessment instruments are used, no uniform definition has been established, and different definitions do not necessarily capture the same patients (e.g., DSM-5 anxious distress specifier poorly overlapped with DSM-4-based anxiety disorders, Cohen κ = 0.09).
- The paper states that treatment studies are scarce, often use post hoc analyses with limited sample sizes, and not all directly compare anxious with nonanxious depression, so current evidence is insufficient to establish whether novel pharmacological treatments are specifically beneficial.
- The paper states that neuroimaging and biological studies are limited and use various definitions; evident from the text, the review also lacks a described systematic search or risk-of-bias assessment and excludes bipolar depression and DSM-4 mixed anxious-depressive disorder.
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Claims the paper makes
57 Not checked yet · 16 Own interpretation · 1 Partly supported · accuracy not yet measured
None of the sources cited for this claim have been checked yet.
In the paper
“Two recent small studies showed, however, that dimensional anxiety measures were not associated with hair cortisol levels in female MDD samples [69,70]”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > &&
What the sources say
- Not checked yetcites [69] source
- Could not verifycites [70] sourceExperimental — accuracy not yet measured
The Results (Adults) examine associations between depression symptom severity and cortical measurements, not anxiety measures and hair cortisol. A reference to serum cortisol appears in the References, but our copy does not report the claimed finding in female MDD samples (searched: hair cortisol, anxiety, female MDD). (LLM, conf=0.76)
plain- Asserted: passes — The authors put it forward as true.
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In the 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].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > DIAGNOSTIC ASSESSMENT OF ANXIOUS DEPRESSION
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In the paper
“and that a measure of the DSM-5 anxious distress specifier, the DSM-5 anxious distress specifier interview, had comparable validity as the HAM-A in measuring anxiety in depression [28 & ].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > DIAGNOSTIC ASSESSMENT OF ANXIOUS DEPRESSION
What the sources say
- Not checked yetcites [28 & ]
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“The cooccurrence of anxiety in depression is common [1]”
- Also stated in: § KEY POINTS · plain
“Despite heterogeneity in diagnostic criteria and assessment instruments, anxious depression is common: 42-78% of all depressed patients suffer from cooccurring anxiety.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > INTRODUCTION
What the sources say
- Not checked yetcites [1] source
plain- Asserted: passes — The authors put it forward as true.
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- Also stated in: § KEY POINTS · plain
In the paper
“The Sequenced Treatment Alternatives to Relieve Depression study showed that 53% of 2876 MDD patients had anxious depression (MDD and a HAM-D ASF score !7) [12]”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > PREVALENCE OF ANXIOUS DEPRESSION
What the sources say
- Not checked yetcites [12] source
plainn = 2,876- Asserted: passes — The authors put it forward as true.
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In the paper
“Of persons with lifetime MDD, 46% had at least one lifetime anxiety disorder, and of those with a 12-month MDD, 52% had lifetime anxiety disorders and 42% had 12-month anxiety disorders [30].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > PREVALENCE OF ANXIOUS DEPRESSION
What the sources say
- Not checked yetcites [30] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“Recent studies using the anxious distress specifier definition reported prevalence rates of anxious distress ranging from 54 to 78% in patients with MDD [10,24 & ,27,38 -40].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > PREVALENCE OF ANXIOUS DEPRESSION
What the sources say
- Not checked yetcites [10,24 & ,27,38 -40]
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These findings demonstrate that prevalence rates of anxious depression are high, independent of the used definition.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > PREVALENCE OF ANXIOUS DEPRESSION
boosted- Asserted: passes — The authors put it forward as true.
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In the paper
“and a Chinese population study using the same definition, found that 70% of 375 MDD patients had anxious depression [13].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > PREVALENCE OF ANXIOUS DEPRESSION
What the sources say
- Not checked yetcites [13] source
plainn = 375- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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In the paper
“Additionally, a prevalence rate of 72% of comorbid GAD in 667 psychiatric outpatients with MDD was observed [32].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > PREVALENCE OF ANXIOUS DEPRESSION
What the sources say
- Not checked yetcites [32] source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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- It may state two separate claims as one. 31
- Probably not a substantial claim. 4
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Also anxious depression defined with the anxious distress specifier was associated with greater depression severity, higher suicidal ideation, decreased QOL, greater self-reported impairment, severe insomnia [10,40], and increased incidence of cardiovascular disease [43].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > IMPACT OF ANXIOUS DEPRESSION ON CLINICAL COURSE TRAJECTORIES AND OUTCOMES
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“The DSM-5 includes a new anxious distress specifier to acknowledge the clinical significance of prominent anxiety features in MDD [22].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > DIAGNOSTIC ASSESSMENT OF ANXIOUS DEPRESSION
What the sources say
- Not checked yetcites [22] source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Neurobiology studies suggest that anxious depression is associated with increased immune dysregulation, more cortical thinning, and corticolimbic dysfunctions as compared with 'pure' depression.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > Abstract
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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- Based: unclear — It is unclear why the paper says it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Although it has been suggested that a dimensional definition of anxious depression is clinically most relevant [2,3,21 & ], up until now, no uniform definition has been established.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > DIAGNOSTIC ASSESSMENT OF ANXIOUS DEPRESSION
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“Consequently, various definitions for anxious depression are being used across studies, making results not always directly comparable.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > INTRODUCTION
plaindirect- Asserted: passes — The authors put it forward as true.
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- Load-bearing: fails — The paper’s conclusions may not depend on it.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the 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”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > INTRODUCTION
What the sources say
- Not checked yetcites [2] source
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim.
In the paper
“Of these, four out of five symptoms are typical for generalized anxiety disorder (GAD) and one for panic disorder [23].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > DIAGNOSTIC ASSESSMENT OF ANXIOUS DEPRESSION
What the sources say
- Not checked yetcites [23] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Anxious depression appears to be a common and clinically relevant subtype of depression as it predicts poorer course trajectories.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > Abstract
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Anxious depression seems associated with poorer clinical course trajectories and treatment nonresponse as compared with 'pure' depression, regardless of which definition is used.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > Abstract
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“However, a recent study examining the validity of the specifier suggests that the specifier is a generic anxiety marker, as it did not show specificity with GAD and panic disorder [24 & ].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > DIAGNOSTIC ASSESSMENT OF ANXIOUS DEPRESSION
What the sources say
- Not checked yetcites [24 & ]
hedged- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Of persons with lifetime MDD, 46% had at least one lifetime anxiety disorder, and of those with a 12-month MDD, 52% had lifetime anxiety disorders and 42% had 12-month anxiety disorders [30].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > PREVALENCE OF ANXIOUS DEPRESSION
What the sources say
- Not checked yetcites [30] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
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In the paper
“Recent as well as other previous studies [4,[33][34][35] also showed that generally the onset of anxiety disorders precedes the onset of depression, suggesting that a temporal priority of anxiety disorders may contribute to the development of depression [36,37].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > PREVALENCE OF ANXIOUS DEPRESSION
What the sources say
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“It is important to note that different definitions do not necessarily capture the same patients though; the DSM-5 anxious distress specifier, for example, poorly overlapped with comorbid DSM-4-based anxiety disorders (Cohen k ¼ 0.09) [24 & ].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > PREVALENCE OF ANXIOUS DEPRESSION
What the sources say
- Not checked yetcites [24 & ]
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“In terms of temporal order, of those with lifetime comorbid anxiety disorder and MDD, 68% reported an earlier occurrence of their first anxiety disorder versus their MDD, whereas in 13.5% anxiety followed after MDD onset, and in 18.5% the occurrence of the anxiety disorder was parallel to that of depression [30].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > PREVALENCE OF ANXIOUS DEPRESSION
What the sources say
- Not checked yetcites [30] source
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Either measured with the HAM-D ASF score or HAM-A, depressed patients with anxiety symptoms generally have greater depression chronicity and severity [1,5,6], higher suicide ideation and risks [1,8,9], and lower QOL than MDD patients without anxiety.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > IMPACT OF ANXIOUS DEPRESSION ON CLINICAL COURSE TRAJECTORIES AND OUTCOMES
What the sources say
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“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].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > IMPACT OF ANXIOUS DEPRESSION ON CLINICAL COURSE TRAJECTORIES AND OUTCOMES
What the sources say
- Not checked yetcites [29] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > IMPACT OF ANXIOUS DEPRESSION ON CLINICAL COURSE TRAJECTORIES AND OUTCOMES
What the sources say
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Another recent study reported a higher likelihood to experience antidepressant side-effects only in MDD cases with comorbid panic disorder versus those without, but not in those with comorbid SAD or GAD [50].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > IMPACT OF ANXIOUS DEPRESSION ON TREATMENT OUTCOMES
What the sources say
- Not checked yetcites [50]
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, anxious depression seems to be associated with poorer course trajectories and worse clinical outcomes.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > IMPACT OF ANXIOUS DEPRESSION ON CLINICAL COURSE TRAJECTORIES AND OUTCOMES
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“A previous, large review [14] showed that patients with dimensionally defined anxious depression did respond to traditional antidepressants, but that they were unable to maintain response or remission and suffered from greater frequency of side-effects than patients with nonanxious depression [14].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > IMPACT OF ANXIOUS DEPRESSION ON TREATMENT OUTCOMES
What the sources say
- Not checked yetcites [14] source
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Some of the atypical agents may have an unfavorable side-effect profile [52], limiting its use in depressed patients with comorbid anxiety as they may suffer from greater side-effects [14].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > IMPACT OF ANXIOUS DEPRESSION ON TREATMENT OUTCOMES
hedgedconditional- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Recently, one study showed that within MDD patients, the presence of (DSM-5 based) anxious distress predicted subsequent poor treatment outcomes and a greater frequency of antidepressant side-effects in depressed patients who received adequate antidepressant treatment, whereas presence of comorbid DSM-4-based anxiety disorders did not [38].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > IMPACT OF ANXIOUS DEPRESSION ON TREATMENT OUTCOMES
What the sources say
- Not checked yetcites [38]
plaincorrelational- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“Also, decreased venous blood basophil counts and increased fragmented neutrophils were observed in patients with MDD and higher levels of anxiety [66].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > UNDERLYING NEUROBIOLOGICAL PATHOPHYSIOLOGY OF ANXIOUS DEPRESSION
What the sources say
- Not checked yetcites [66] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“Also, vilazodone -a serotonin reuptake inhibitor and 5-hydroxytryptamine 1A receptor partial antagonist -was more effective in 708 patients with anxious depression than in 155 patients with nonanxious depression, although the sample size of those with nonanxious depression was very small [59].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > IMPACT OF ANXIOUS DEPRESSION ON TREATMENT OUTCOMES
What the sources say
- Not checked yetcites [59] source
plaindirectn = 708- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“Another study also found efficacy for quetiapine therapy in patients with anxious depression, but did not directly compare this with a nonanxious depressed patient group and the sample size was very small (n ¼ 9) [54].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > IMPACT OF ANXIOUS DEPRESSION ON TREATMENT OUTCOMES
What the sources say
- Not checked yetcites [54] source
plaindirectn = 9- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“These alterations in white blood cell subset counts indirectly point to alterations in the immune system, suggesting a role of inflammation in the pathophysiology of anxious depression.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > UNDERLYING NEUROBIOLOGICAL PATHOPHYSIOLOGY OF ANXIOUS DEPRESSION
hedgedconditional- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“Interestingly, the combination of MDD diagnosis and dimensional anxiety measures proved the best fit with functional connectivity patterns, whereas anxiety disorder diagnosis did not add to the model [21 & ].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > &&
What the sources say
- Not checked yetcites [21 & ]
plaincorrelational- Asserted: passes — The authors put it forward as true.
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- Load-bearing: passes — The paper’s conclusions depend on it.
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It may state two separate claims as one.
In the paper
“Fitting with previous literature, MDD diagnosis was associated with reduced functional connectivity between the ACC and striatum and limbic/paralimbic reactivity, whereas both GAD diagnosis and dimensional anxious arousal and distress levels were associated with increased ACC-striatal connectivity and limbic/paralimbic reactivity.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > &&
What the sources say
- Not checked yetcites [21 & ]
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Cortical thinning in these regions have also been observed in MDD relative to controls [75], and thus seem regionally similar but more severe in anxious depression.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > &&
What the sources say
- Not checked yetcites [75] source
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Both anxiety dimensions and comorbid anxiety within MDD were associated with increased functional connectivity between limbic-striatal and prefrontal regions [21 & ,78-81], although decreased fronto-striatal FC has also been observed [79].”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > &&
What the sources say
- Not checked yetcites [21 & ,78-81]
- Not checked yetcites [79] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Taken together, despite the limited number of neuroimaging and biological studies and various definitions and assessment of anxious depression, anxious depression seems to be associated with a distinct neurobiological profile, showing increased immune dysregulation, more severe thinning in temporal and prefrontal areas, and increased corticolimbic functional connectivity patterns compared with non”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > &&
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This suggests that functional connectivity deficits associated with anxiety may vary with symptom levels and are not diagnosis specific.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > &&
hedgedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Poorer clinical and treatment outcomes as well as distinct neurobiological correlates were observed in persons with anxious depression versus persons with 'pure' (nonanxious) depression.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > CONCLUSION
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Evidence demonstrates that anxious depression is common and clinically relevant.”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > CONCLUSION
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“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 [11]
In the citing paper
“because participants were diagnosed with DSM-IV criteria, the DSM-5 anxious distress specifier definition was not assessed [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 [11]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > INTRODUCTION
“MDD with the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 anxious distress specifier (i.e., three out of five general anxiety symptoms).”
§ Patients with anxious depression: overview of prevalence, pathophysiology and impact on course and treatment outcome > DIAGNOSTIC ASSESSMENT OF ANXIOUS DEPRESSION
“The DSM-5 criterion for the anxious distress specifier is endorsement of at least two of the following five symptoms during the majority of a major depressive episode”
Citations
Cites
Kaiser, R. H., Andrews-Hanna, J. R., Wager, T. D., & Pizzagalli, D. A. (2015) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2015.0071 · Cited by 2,281
Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., Mohr, D. C., & Schatzberg, A. F. (2016) · Nature Reviews Disease Primers · doi:10.1038/nrdp.2016.65 · Cited by 2,269
Self-citationfor the ENIGMA-Major Depressive Disorder Working Group, Schmaal, L., Hibar, D. P., Sämann, P. G., Hall, G. B., Baune, B. T., Jahanshad, N., Cheung, J. W., van Erp, T. G. M., Bos, D., et al. (2017) · Molecular Psychiatry · doi:10.1038/mp.2016.60 · Cited by 1,330
Self-citationRegier, 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
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
Lamers, F., van Oppen, P., Comijs, H. C., Smit, J. H., Spinhoven, P., van Balkom, A. J. L. M., Nolen, W. A., Zitman, F. G., Beekman, A. T. F., & Penninx, B. W. J. H. (2011) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.10m06176blu · Cited by 913
Self-citationBeesdo, K., Bittner, A., Pine, D. S., Stein, M. B., Höfler, M., Lieb, R., & Wittchen, H.-U. (2007) · Archives of General Psychiatry · doi:10.1001/archpsyc.64.8.903 · Cited by 731
Kessler, R. C., Sampson, N. A., Berglund, P., Gruber, M. J., Al-Hamzawi, A., Andrade, L., Bunting, B., Demyttenaere, K., Florescu, S., de Girolamo, G., et al. (2015) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796015000189 · Cited by 636
Uher, R., Payne, J. L., Pavlova, B., & Perlis, R. H. (2014) · Depression and Anxiety · doi:10.1002/da.22217 · Cited by 456
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
Cited by
Sorted by citations
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
Anxious Depression Prediction in Real-time Social DataPreprint
Kumar, A., Sharma, A., & Arora, A. (2019) · SSRN Electronic Journal · doi:10.2139/ssrn.3383359 · Cited by 126
Penninx, B. W. J. H., Eikelenboom, M., Giltay, E. J., van Hemert, A. M., Riese, H., Schoevers, R. A., & Beekman, A. T. F. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.03.026 · Cited by 100
Self-citationDetka, J., & Głombik, K. (2021) · Pharmacological Reports · doi:10.1007/s43440-021-00274-8 · Cited by 79
Liu, W.-T., Wu, Z., Sun, M., Zhang, S., Yuan, J., Zhu, D., Yan, G., & Hou, K. (2022) · Bosnian Journal of Basic Medical Sciences · doi:10.17305/bjbms.2021.6754 · Cited by 62
Metadata
- Authors
- Gaspersz, R., Nawijn, L., Lamers, F., & Penninx, B. W. J. H.
- Affiliations
- Amsterdam Neuroscience (NL)
- Corresponding author
- Gaspersz, Roxanne
- Venue
- Current Opinion in Psychiatry
- Published
- 2018-01
- Volume
- 31
- Issue
- 1
- Pages
- 17-25
- ISSN
- 0951-7367 (ISSN-L)
- OpenAlex
- W2767830383
- Cited by
- 139
- References
- 85
- Citations by year
- 2026: 11 · 2025: 14 · 2024: 25 · 2023: 19 · 2022: 15 · 2021: 21 · 2020: 12 · 2019: 16 · 2018: 6
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- other-oa
- Locations
- Current Opinion in Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- Funders
- European Commission
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
- Keywords
- anxious depression, major depressive disorder, anxiety comorbidity, treatment non-response, neurobiology of depression, immune dysregulation, cortical thinning
- MeSH terms
- Antidepressive Agents, Anxiety, Anxiety Disorders, Depressive Disorder, Major, Major Depressive Disorder, Humans, Anti-Anxiety Agents, Comorbidity, Prevalence, Treatment Outcome, Disease Progression, Diagnostic and Statistical Manual of Mental Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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