Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders.

C Brown; Herbert C. Schulberg; Michael J. Madonia; M. Katherine Shear; Patricia R. Houck

doi:10.1176/ajp.153.10.1293

Cited by 312Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and AccessTreatment of Major Depression

Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders.

C Brown, Herbert C. Schulberg, Michael J. Madonia, M. Katherine Shear, Patricia R. Houck·1996·American Journal of Psychiatry

DOI 10.1176/ajp.153.10.1293

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Abstract

OBJECTIVE: Major depression occurs with generalized anxiety disorder and panic disorder in up to 60% of psychiatric and primary care patients. This comorbidity has been associated with greater severity of depression, poorer psychosocial functioning, and poorer treatment outcomes in psychiatric samples. This study examined the clinical outcomes for depressed primary care patients with and without a lifetime anxiety disorder. METHOD: A total of 157 primary care patients who met criteria for major depression were randomly assigned to standardized interpersonal psychotherapy or pharmacotherapy with nortriptyline and were assessed at baseline and at 4 and 8 months on severity of depression, psychosocial functioning, and health-related functioning. RESULTS: Depressed patients with a comorbid anxiety disorder presented with significantly more psychopathology and tended to prematurely terminate treatment more frequently than patients with major depression alone. Both standardized depression-specific treatments were effective for depressed patients with and without a comorbid generalized anxiety disorder, although time to recovery was longer for the former. Patients with lifetime panic disorder showed poor recovery in response to psychotherapy or pharmacotherapy. CONCLUSIONS: Standardized psychotherapy and pharmacotherapy are effective for patients with major depression with and without a generalized anxiety disorder. However, the longer time to recovery for the former group and lack of response to these treatments by patients with lifetime panic disorder suggest that primary care physicians should carefully assess history of anxiety disorder among depressed patients so as to select a proper intervention.

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In patients with a lifetime panic disorder, response rates drop to about 13% for each of the aforementioned therapeutic modalities.
“in patients with a lifetime panic disorder, the response rates drop drastically to about 13% for each of the aforementioned therapeutic modalities (7)”
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Authors: Brown, C., Schulberg, H. C., Madonia, M. J., Shear, M. K., & Houck, P. R.
Affiliations: University of Pittsburgh (US)
ORCID: M. Katherine Shear
Venue: American Journal of Psychiatry
Publisher: American Psychiatric Association Publishing
Published: 1996-10-01
Volume: 153
Issue: 10
Pages: 1293-1300
ISSN: 0002-953X (ISSN-L)
1535-7228
DOI: 10.1176/ajp.153.10.1293
OpenAlex: W1563799145
Cited by: 312
References: 42
Citations by year: 2026: 2 · 2024: 3 · 2023: 5 · 2022: 4 · 2021: 11 · 2020: 10 · 2019: 8 · 2018: 9 · 2017: 8 · 2016: 6 · 2015: 7 · 2014: 11 · 2013: 16 · 2012: 19
FWCI: 15.75
Type: journal article
Language: en
Open access: closed
Locations: American Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: National Institutes of Health (2r01mh045815-05, 5r24mh053817-05)
National Institute of Mental Health (MH-45815, MH53817, MH-18269, T32MH018269)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
Keywords: major depressive disorder, anxiety disorders, comorbidities, generalized anxiety disorder, panic disorder, primary care, interpersonal psychotherapy, nortriptyline, antidepressant treatment, treatment outcomes, treatment discontinuation, time to recovery, psychosocial functioning, health-related functioning
MeSH terms: Adolescent, Adult, Antidepressive Agents, Anxiety Disorders, Combined Modality Therapy, Depressive Disorder, Female, Humans, Male, Middle Aged, Nortriptyline, Primary Health Care, Psychiatric Status Rating Scales, Psychotherapy, Severity of Illness Index, Comorbidity, Panic Disorder, Treatment Outcome

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Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders.

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