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Cited by 663Treatment of Major DepressionMental Health Treatment and AccessAnxiety, Depression, Psychometrics, Treatment, Cognitive Processes

The Comorbidity of Major Depression and Anxiety Disorders: Recognition and Management in Primary Care

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Hirschfeld, Robert M. A.·2001·The Primary Care Companion For CNS Disorders
DOI 10.4088/pcc.v03n0609PMC PMC181193
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Abstract

BACKGROUND: Depressive and anxiety disorders commonly occur together in patients presenting in the primary care setting. Although recognition of individual depressive and anxiety disorders has increased substantially in the past decade, recognition of comorbidity still lags. The current report reviews the epidemiology, clinical implications, and management of comorbidity in the primary care setting. METHOD: Literature was reviewed by 2 methods: (1) a MEDLINE search (1980-2001) using the key words depression, depressivedisorders, and anxietydisorders; comorbidity was also searched with individual anxiety diagnoses; and (2) direct search of psychiatry, primary care, and internal medicine journals over the past 5 years. RESULTS: Between 10% and 20% of adults in any given 12-month period will visit their primary care physician during an anxiety or depressive disorder episode (although typically for a nonpsychiatric complaint); more than 50% of these patients suffer from a comorbid second depressive or anxiety disorder. The presence of depressive/anxiety comorbidity substantially increases medical utilization and is associated with greater chronicity, slower recovery, increased rates of recurrence, and greater psychosocial disability. Typically, long-term treatment is indicated, although far less research is available to guide treatment decisions. Selective serotonin reuptake inhibitor antidepressants are the preferred treatment based on efficacy, safety, and tolerability criteria. Knowledge of their differential clinical and pharmacokinetic profiles can assist in optimizing treatment. CONCLUSION: Increased recognition of the high prevalence and negative psychosocial impact of depression and anxiety disorder comorbidity will lead to more effective treatment. While it is hoped that early and effective intervention will yield long-term benefits, research is needed to confirm this.

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  • Comorbid GAD and depression is associated with slower recovery and greater chronicity, recurrence rates, health costs, hospitalization rates, disability days, suicide attempts, and psychosocial disability.

    “This comorbidity is associated with slower recovery and greater chronicity, recurrence rates, health costs, hospitalization rates, disability days, suicide attempts, and psychosocial disability (Hirschfeld, 2001; Wittchen, 2002).”

    From A Multiple-Baseline Evaluation of Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Comorbid Generalized Anxiety Disorder and Depression (2020) · cites this paper as Hirschfeld, 2001

    The “What Are the Consequences of Comorbidity?” section (page unavailable) links depression–anxiety comorbidity to slower recovery, chronicity, recurrence, hospitalization, suicide attempts, and impaired psychosocial functioning. It does not establish these outcomes specifically for comorbid GAD and depression. The copy also does not substantiate higher health costs or more disability days for that pairing; its discussion of disability concerns anxiety or depression alongside general medical illness. (LLM, conf=0.88)

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  • Comorbidity between GAD and depression is very high, especially in primary care settings, and is associated with greater chronicity, recurrence rates, health costs, and psychological disability.

    “The comorbidity between GAD and depression is very high, especially in primary care settings, and has been associated with greater chronicity, recurrence rates, health costs, and psychological disability (Hirschfeld, 2001; Wittchen, 2002; Zhu et al., 2009; Klenk et al., 2011).”

    From A Multiple-Baseline Evaluation of Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Comorbid Generalized Anxiety Disorder and Depression (2020) · cites this paper as Hirschfeld, 2001

    The Epidemiology of Comorbidity section reports high depression–anxiety comorbidity in primary care and identifies GAD among the anxiety disorders involved. The Abstract and “What Are the Consequences of Comorbidity?” section associate depression–anxiety comorbidity with greater chronicity, recurrence, psychosocial disability, and medical utilization. Those consequences are reported for anxiety disorders collectively, not specifically for GAD, and the paper discusses utilization rather than directly establishing higher health costs. (LLM, conf=0.86)

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1 of the 84 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. Murray CJL, Lopez AD, eds. The Global Burden of Disease, vol 2: Global Health Statistics. A Compendium of Incidence, Prevalence, and Mortality Estimates for Over 200 Conditions. Cambridge, Mass: Harvard University Press; 1996
  2. Kessler RC, Stang PE, Wittchen HU, et al. Lifetime panic-depression co- morbidity in the National Comorbidity Survey. Arch Gen Psychiatry 1998;55:801-808
  3. Radloff LS. The CES-D Scale. Appl Psychol Meas 1977;1:385-401
  4. Carney C. Diabetes mellitus and major depressive disorder: an overview of prevalence, complications, and treatment. Depress Anxiety 1998;7: 149-157
  5. Gonzalez MB, Snyderman TB, Colket JT, et al. Depression in patients with coronary artery disease. Depression 1996;4:57-62

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Authors
Hirschfeld, R. M. A.
Affiliations
The University of Texas Medical Branch at Galveston (US)
Corresponding author
Hirschfeld, Robert M. A.
Venue
The Primary Care Companion For CNS Disorders
Publisher
Physicians Postgraduate Press, Inc
Published
2001-12-01
Volume
3
Issue
6
Pages
244-254
ISSN
  • 2155-7772 (ISSN-L)
  • 2155-7780
DOI
10.4088/pcc.v03n0609
PMC
PMC181193
OpenAlex
W2112953965
Cited by
661
References
84
Citations by year
2026: 19 · 2025: 23 · 2024: 27 · 2023: 32 · 2022: 57 · 2021: 62 · 2020: 50 · 2019: 62 · 2018: 57 · 2017: 41 · 2016: 46 · 2015: 39 · 2014: 28 · 2013: 23 · 2012: 18
FWCI
0.00
Type
journal article
Language
en
Open access
Locations
  • The Primary Care Companion For CNS Disorders (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Pfizer
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Keywords
major depressive disorder, anxiety disorders, comorbidities, primary care, medical utilization, recurrence, psychosocial disability, selective serotonin reuptake inhibitors, antidepressant treatment, chronicity

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