Effects of anxiety on the long-term course of depressive disorders
Open accessAbstract
Background: It is well established that the presence of prominent anxiety within depressive episodes portends poorer outcomes. Important questions remain as to which anxiety features are important to outcome and how sustained their prognostic effects are over time. Aims: To examine the relative prognostic importance of specific anxiety features and to determine whether their effects persist over decades and apply to both unipolar and bipolar conditions. Method: Participants with unipolar (n = 476) or bipolar (n = 335) depressive disorders were intensively followed for a mean of 16.7 years (s.d. = 8.5). Results: The number and severity of anxiety symptoms, but not the presence of pre-existing anxiety disorders, showed a robust and continuous relationship to the subsequent time spent in depressive episodes in both unipolar and bipolar depressive disorder. The strength of this relationship changed little over five successive 5-year periods. Conclusions: The severity of current anxiety symptoms within depressive episodes correlates strongly with the persistence of subsequent depressive symptoms and this relationship is stable over decades.
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Symptoms of anxiety are often experienced during a depressive episode, and are predictive of more persistent depressive symptoms and increased suicidal ideation.
“Symptoms of anxiety are often experienced during a depressive episode, and are predictive of more persistent depressive symptoms311 and increased suicidal ideation.312”
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ResultCLINICAL FEATURES OF BIPOLAR DISORDER COMORBID WITH ANXIETY DISORDERS DIFFER BETWEEN MEN AND WOMEN
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“Despite the importance of separation anxiety in PTSD and the persistence of anxiety and mood disorders (Benvenuti et al., 2010; Cassano et al., 1997; Coryell et al., 2012; Frank, Shear et al., 2000; Frank, Cyranowski et al., 2002; Milrod et al., 2014; Rucci et al., 2009; Shear, 1996), no treatment…”
BackgroundUnveiling the neuroprotective potential of dietary polysaccharides: a systematic review
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“This appears to be also true for age [58], although some studies found older age to be linked to longer episodes or a greater proportion of time with depressive symptoms [10].”
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Pavlová, B., Perroud, N. A., Cordera, P., Uher, R., Alda, M., Dayer, A. G., & Aubry, J. (2017) · Journal of Affective Disorders · doi:10.1016/j.jad.2017.08.048 · Cited by 24 · see citing works
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“The comorbidity between bipolar and anxiety disorders is associated with an exacerbation and extended duration of depressive symptoms (Simon et al., 2007; Goes et al., 2012; Coryell et al., 2012).”
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“Patients exhibiting major depressive disorder (MDD), comorbid anxiety resulted in poorer outcomes, such as a decrease in antidepressant response rate and prolonged recovery from a depressive episode.(8) Interestingly, recent studies showed that significant risks reported during pregnancy included subjects exhibiting a…”
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“Anxiety is known to be related to the persistence of depression in adults (Coryell et al., 2012; Gaynes et al., 1999).”
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Detecting Mental Disorders with Wearables: A Large Cohort Study
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“Since depressive and anxiety disorders are usually long-term conditions [7, 23], we chose a time window of 60 days for the wearable features unless stated otherwise.”
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“Because of this and the fact that anxiety severity has been shown by several studies to correlate with poor treatment outcome in mood disorders,[9, 10] it is proposed that the severity dimension of anxiety, be rated by the clinician, along with a mood disorder diagnosis in DSM-5.”
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“There is debate about whether this is co-morbid or simply part of the depressive syndrome (See Andrescu & Lenze, 2012; Coryell et al., 2012).”
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“Also, among NIMH Collaborative Depression Study BD (and unipolar depression) participants, number/severity of current anxiety symptoms (but not presence of pre-existing anxiety disorder) was associated with spending more time depressed (Coryell et al., 2012).”
BackgroundComorbid anxiety and depression: bête noire or quick fix?
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“During depressive episodes, there are overlapping clinical presentations of BD and MDD (9, 10), in which anxiety symptoms are the most commonly comorbidity symptoms (11) and the severity of current anxiety symptoms are strongly associated with the subsequent persistence of depressive symptoms (12).”
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“Additionally, chronic anxiety symptoms may perpetuate mood instability (Coryell et al. 2012) through behavioral mechanisms including sleep disruption and substance use as self-medication.”
- Authors
- Coryell, W., Fiedorowicz, J. G., Solomon, D., Leon, A. C., Rice, J. P., & Keller, M. B.
- Affiliations
- University of Iowa Hospitals and Clinics (US)
- Brown University (US)
- Columbia University (US)
- Washington University in St. Louis (US)
- Corresponding author
- Coryell, William
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2012-03
- Volume
- 200
- Issue
- 3
- Pages
- 210-215
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- PMC
- PMC3290796
- OpenAlex
- W2131171085
- Cited by
- 92
- References
- 29
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 9 · 2023: 6 · 2022: 8 · 2021: 4 · 2020: 1 · 2019: 7 · 2018: 7 · 2017: 5 · 2016: 8 · 2015: 4 · 2014: 6 · 2013: 7 · 2012: 13
- FWCI
- 5.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Massachusetts General Hospital
- National Institute of Mental Health (R01MH025478)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- anxiety symptoms, depressive disorders, bipolar depression, major depressive disorder, long-term prognosis, depressive episode duration, anxiety levels, persistent depressive symptoms, longitudinal follow-up
- MeSH terms
- Adult, Anxiety, Bipolar Disorder, Major Depressive Disorder, Epidemiologic Methods, Female, Humans, Male, Prognosis, Psychiatric Status Rating Scales, Severity of Illness Index, Time Factors, Disease Progression, Young Adult
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