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Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders.
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, the response rates drop drastically to about 13% for each of the aforementioned therapeutic modalities (7)”
From Decreases in State and Trait Anxiety Post-psilocybin: A Naturalistic, Observational Study Among Retreat Attendees (2022) · cites this paper as [7]
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BackgroundFluoxetine treatment of depressed patients with comorbid anxiety disorders
Sonawalla, S. B., Farabaugh, A. H., Johnson, M. W., Morray, M., Delgado, M. L., Pingol, M. G., Rosenbaum, J. F., & D, M. F. M. (2002) · Journal of Psychopharmacology · doi:10.1177/026988110201600304 · Cited by 22
“Introduction Major depressive disorder (MDD) accompanied by comorbid anxiety disorders is characterized by distinct pathophysiology, course and treatment response (Hiller et al., 1989; Brown et al., 1996; Fava et al., 1997).”
BackgroundInfluentialEthical Considerations in Psychotherapy Effectiveness Research: Choosing the Comparison Group
Areán, P. A., & Alvidrez, J. (2002) · Ethics & Behavior · doi:10.1207/s15327019eb1201_4 · Cited by 23
Tsai, J., Thase, M. E., Mao, Y., Ng-Mak, D., Pikalov, A., & Loebel, A. (2017) · CNS Spectrums · doi:10.1017/s1092852917000074 · Cited by 22
The Prospective Role of Depression, Anxiety, and Worry in Stress Generation
Judah, M. R., Grant, D. M., Mills, A. C., Lechner, W. V., Slish, M. L., Davidson, C. L., & Wingate, L. R. (2013) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2013.32.4.381 · Cited by 23
Do hormone treatments for prostate cancer cause anxiety and depression?
Sharpley, C. F., Christie, D., & Bitsika, V. (2013) · International Journal of Clinical Oncology · doi:10.1007/s10147-013-0569-y · Cited by 22
“In addition, depression is often comorbid with anxiety, and that comorbidity predicts resistance to treatment [13–15], delayed recovery, poorer quality of life, and increased suicide risk [16, 17], and has been reported in 10.”
BackgroundPetersen, T., Andreotti, C., Chelminski, I., Young, D., & Zimmerman, M. A. (2009) · Psychiatry Research · doi:10.1016/j.psychres.2008.10.036 · Cited by 23
“2005), and lower psychosocial functioning (Brown et al., 1996).”
BackgroundKashdan, T., & Roberts, J. E. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.10.002 · Cited by 22
Cassano, P., Soares, C. N., Cohen, L. S., Lyster, A. K., & D, M. F. M. (2004) · Archives of Women s Mental Health · doi:10.1007/s00737-004-0051-y · Cited by 19
“…on treatment response in subjects with MDD, to our knowledge no studies have addressed sex- and age-related differences in response in the anxious and non-anxious subtype of depression (Brown et al., 1996) (Russell et al., 2001) (Frank et al., 2000) (Grunhaus et al., 1988) (Dew et al., 1997).”
BackgroundCoussement, C., Longueville, X. D., & Heeren, A. (2021) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2021.152294 · Cited by 21
The Roles of Exercise and Yoga in Ameliorating Depression as a Risk Factor for Cognitive Decline
Mathersul, D. C., & Rosenbaum, S. (2016) · Evidence-based Complementary and Alternative Medicine · doi:10.1155/2016/4612953 · Cited by 20
“…physiologists with tertiary training in exercise prescription are associated with reduced dropout and increased motivation to exercise among people with an affective disorder [111], highlighting the importance ofmultidisciplinarymental health teams to ensure the translation of findings into real…”
BackgroundBlay, S. L., Fillenbaum, G. G., Mello, M. F., Quintana, M. I., Mari, J. D. J., Bressan, R. A., & Andreoli, S. B. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.02.023 · Cited by 22
Symptoms of Major Depression and Tricyclic Side Effects in Primary Care Patients
Rollman, B. L., Block, M. R., & Schulberg, H. C. (1997) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.1997.012005284.x · Cited by 19
Bandelow, B., Bauer, M., Vieta, E., El-Khalili, N., Gustafsson, U., Earley, W. R., & Eriksson, H. (2014) · The World Journal of Biological Psychiatry · doi:10.3109/15622975.2013.842654 · Cited by 18
“…and poorer outcomes and these patients may have higher levels of social distress, suicide rates, incidence of alcohol and drug abuse, and use of healthcare services than patients without comorbid conditions (Brown et al. 1996; Kessler et al. 1996; Roy-Byrne et al. 2000; Belzer and Schneier 2004).”
BackgroundOutcomes Focused Service Delivery: Developing an Academic-Management Partnership
Tobin, M. J., & Hickie, I. B. (1998) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048679809065524 · Cited by 18
The impact of psychiatric comorbidities associated with depression: a literature review
Platona, R. I., Căiță, G. A., Voiţă-Mekereş, F., Peia, A. O., & ENĂTESCU, V. R. (2024) · Medicine and Pharmacy Reports · doi:10.15386/mpr-2700 · Cited by 20
“Brown et al. (1996) found that depressed patients who have panic disorder during their lifetime, show a greater severity of depressive symptoms, a more important impairment of physical and psychosocial functioning.”
BackgroundSharpley, C. F., Bitsika, V., Wootten, A. C., & Christie, D. (2014) · Psycho-Oncology · doi:10.1002/pon.3566 · Cited by 17
“suicide risk [21,22] and has been reported in 10.”
BackgroundEmotion Regulation Among Adolescents With Pediatric Depression As a Function of Anxiety Comorbidity
Dochnal, R., Vetró, Á., Kiss, E., Baji, I., Lefkovics, E., Bylsma, L. M., Yaroslavsky, I., Rottenberg, J. A., Kovács, M., & Kapornai, K. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00722 · Cited by 18
“It has been reported that the treatment of depression is more difficult in the presence of anxiety: comorbidity lengthens the duration of treatment and decreases the response to interventions (49, 50).”
Background[Depressive disorder burden: global epidemiological issues and information needs in Portugal].
Gusmão, R., Xavier, M., Heitor, M. J., Bento, A., & Caldas‐de‐Almeida, J. M. (2005) · PubMed · doi:10.20344/amp.1012 · Cited by 32
Screening for anxiety disorders in depressed patients
Zimmerman, M. A., & Chelminski, I. (2006) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2005.03.001 · Cited by 16
Incidence and nature of anxiety–depression comorbidity in prostate cancer patients
Sharpley, C. F., Bitsika, V., & Christie, D. (2010) · Journal of Men s Health · doi:10.1016/j.jomh.2010.03.003 · Cited by 16
“This is surprising since comorbidity of anxiety and depression among other patient groups has been shown to predict impaired improvement following treatment [20–22], delayed recovery, poorer quality of life, and increased suicide risk [23,24].”
Achieving Long-Term Optimal Outcomes in Geriatric Depression and Anxiety
Mulsant, B. H., Whyte, E. M., Lenze, E. J., Lotrich, F. E., Karp, J. F., Pollock, B. G., & Reynolds, C. F. (2003) · CNS Spectrums · doi:10.1017/s1092852900008257 · Cited by 16
Bjelland, I. (2004) · NORA - Norwegian Open Research Archives · Cited by 16
Guaiana, G., Andretta, M., Griez, E. J. L., Biancosino, B., & Grassi, L. G. (2011) · Annals of General Psychiatry · doi:10.1186/1744-859x-10-24 · Cited by 15
“However, since anxiety and depression are closely intermingled, the former often being an indicator of the severity of the latter and vice versa [30], this limitation does not necessarily invalidate our main conclusions.”
ResultShankman, S. A., & Klein, D. N. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(01)00302-0 · Cited by 15
Metadata
- 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
- Published
- 1996-10-01
- Volume
- 153
- Issue
- 10
- Pages
- 1293-1300
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- 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
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Pharmacology (medical) › 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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