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The Comorbidity of Major Depression and Anxiety Disorders: Recognition and Management in Primary Care
Open accessAbstract
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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“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
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“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
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Metadata
- 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
- 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
- bronze
- doi.org
- Locations
- The Primary Care Companion For CNS Disorders (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › 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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