Comorbid anxiety and depression: Illumination of a controversy

International Journal of Psychiatry in Clinical Practice

Volumn 11, Issue 3, 2007, Pages 171-189

  Hranov, Luchezar G ^a,b  

^a MEDICAL UNIVERSITY OF SOFIA   (Bulgaria)

^b Specialised University Hospital for Active Treatment in Neurology and Psychiatry St Naum

Author keywords

Antidepressants; Anxiety; Comorbidity; Depression; Diagnosis; Etiology; Neuroplasticity; Treatment

Indexed keywords

AMFEBUTAMONE; ANTIDEPRESSANT AGENT; ANXIOLYTIC AGENT; BENZODIAZEPINE; CITALOPRAM; DOPAMINE RECEPTOR BLOCKING AGENT; ESCITALOPRAM; FLUOXETINE; FLUVOXAMINE; MIRTAZAPINE; MOCLOBEMIDE; NORADRENALIN UPTAKE INHIBITOR; PAROXETINE; PREGABALIN; SEROTONIN 2 ANTAGONIST; SEROTONIN UPTAKE INHIBITOR; SERTRALINE; TRICYCLIC ANTIDEPRESSANT AGENT; VENLAFAXINE;

ANXIETY; ANXIETY DISORDER; COMORBIDITY; CORRELATION ANALYSIS; DEPRESSION; DIAGNOSTIC ERROR; DISEASE ASSOCIATION; DISEASE COURSE; EXPERIENCE; FOLLOW UP; GENETIC PREDISPOSITION; GENETIC RISK; GENETICS; HEALTH CARE UTILIZATION; HEALTH SERVICE; HUMAN; HUMAN RELATION; ILLUMINATION; MENTAL DISEASE; MONOTHERAPY; MORTALITY; NERVE CELL PLASTICITY; NEUROBIOLOGY; NEUROPROTECTION; PHENOMENOLOGY; PREVALENCE; PRIMARY MEDICAL CARE; PRIORITY JOURNAL; PROGNOSIS; PSYCHOLOGICAL ASPECT; REVIEW; RISK FACTOR; SUICIDE;

EID: 34548851998     PISSN: 13651501     EISSN: 14711788     Source Type: Journal    
DOI: 10.1080/13651500601127180     Document Type: Review

References (239)

1. Angst J. Depression and anxiety: implications for nosology, course, and treatment. J Clin Psychiatry 1997;58(Suppl 8):3-5.
2. Zajecka JM, Ross JS. Management of comorbid anxiety and depression. J Clin Psychiatry 1995;56(Suppl 2):10-3.
3. Boulenger J-P, Lavallee Y-J. Mixed anxiety and depression: diagnostic issues. J Clin Psychiatry 1993;54(Suppl 1):3-8.
4. Wittchen H-U, Essau CA. Comorbidity and mixed anxiety-depressive disorders: is there epidemiologic evidence? J Clin Psychiatry 1993;54(Suppl 1):9-15.
5. Tyrer P. General neurotic syndrome and mixed anxiety-depressive disorders. In: Tyrer P, editor. Classification of neurosis. New York: Wiley; 1989. p 132-64.
6. Shorter E, Tyrer P. Separation of anxiety and depressive disorders: blind alley in psychopharmacology and classification of disease. Br Med J 2003;327(7407):158-160.
7. [Comment Br Med J 2003;327(7419):869-70].
8. Tyrer P. The case for cothymia: mixed anxiety and depression as a single diagnosis (Editorial). Br J Psychiatry 2001;179:191-3.
9. Zinbarg RE, Barlow DH, Liebowitz M, et al. The DSM-IV field trial for mixed anxiety-depression. Am J Psychiatry 1994;151:1153-62.
10. Hoehn-Saric R, McLeod DR, Zimmerli WD. Differential effects of alprazolam amd imipramine in generalized anxiety disorder: somatic versus psychic symptoms. J Clin Psychiatry 1988;49:293-301.
11. Fava GA, Grandi S, Zielezny M, Canestrari R, Morphy MA. Cognitive behavioral treatment of residual symptoms in primary major depressive disorder. Am J Psychiatry 1994;151:1295-9.
12. Katon W, Roy-Byrne PP. Mixed anxiety and depression. J Abnorm Psychol 1991;100:337-45.
13. Cloninger CR. Comorbidity of anxiety and depression. J Clin Psychopharmacol 1990;10(Suppl 3):43-6C.
14. Fowles DC, Gersh FS. Neurotic depression: the endogenous-neurotic distinction. In: Depue RA, editor. The psychobiology of the depressive disorders: implications for the effects of stress. New York: Academic Press; 1979.
15. Frances A, Manning D, Marin D, et al. Relationship of anxiety and depression. Psychopharmacology (Berlin) 1992;106(Suppl):S82-6.
16. Gersh FS, Fowles DC. Neurotic depression: the concept of anxious depression. In: Depue RA, editor. The psychobiology of the depressive disorders: implications for the effects of stress. New York: Academic Press; 1979.
17. Katon W, Von Korff M, Lin E, et al. Population-based care of depression: effective disease management strategies to decrease prevalence. Gen Hosp Psychiatry 1997;19:169-78.
18. Rouillon F. Anxiety with depression: a treatment need. Eur Neuropsychopharm 1999;9(Suppl 3):S87-92.
19. Simon G, Ormel J, Von Korff, Barlow W. Health care costs associated with depressive and anxiety disorders in primary care. Am J Psychiatry 1995;152:352-7.
20. Stavrakaki C, Vargo B. The relationship of anxiety and depression: a review of the literature. Br J Psychiatry 1986;149:7-16.
21. Tollefson GD, Holman SL, Sayler ME, Potvin JH. Fluoxetine, placebo, and tricyclic antidepressants in major depression with and without anxious features. J Clin Psychiatry 1994;55:50-9.
22. Tollefson GD, Souetre E, Thomander L, Potvin JH. Comorbid anxious signs and symptoms in major depression: impact on functional work capacity and comparative treatment outcomes. Int Clin Psychopharmacol 1993;8:281-93.
23. Breier A, Charney DS, Heninger GR. Major depression in patients with agoraphobia and panic disorder. Arch Gen Psychiatry 1984;41:1129-35.
24. Kendler KS, Eaves LJ. Models for the joint effect of genotype and environment on liability to psychiatric illness. Am J Psychiatry 1986;143:279-89.
25. Leckman JF, Merikangas KR, Pauls DL, Prusoff BA, Weissman MM. Anxiety disorders and depression: contradictions between family study data and DSM-III conventions. Am J Psychiatry 1983;140:880-2.
26. Breier A, Charney DS, Heninger GR. The diagnostic validity of anxiety disorders and their relationship to depressive illness. Am J Psychiatry 1985;142:787-97.
27. Coryell W, Endicott J, Winokur G. Anxiety syndromes as epiphenomena of primary major depression: outcome and familial psychopathology. Am J Psychiatry 1992;149:100-7.
28. Van Praag HM. Depression, anxiety, aggression: attempts to unravel the Gordian knot. Medicographia 1998;20:107-14.
29. Brown TA, Chorpita BF, Barlow DH. Structural relationships among dimensions of DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect and autonomic arousal. J Abnorm Psychol 1998;107:179-92.
30. Barlow DH, Campbell LA. Mixed anxiety-depression and its implications for models of mood and anxiety disorders. Compr Psychiatry 2000;41(Suppl 1):55-60.
31. Bystritsky A, Waikar SV, Vapnik T. Four-dimensional anxiety and depression scale: a preliminary psychometric report. Anxiety 1996;2:47-50.
32. Mullaney JA. The relationship between anxiety and depression - a review of some principal component analytic studies. J Affect Disord 1984;7:139-48.
33. Widlocher D, Lecrubier Y, LeGoc Y. The place of anxiety in depressive symptomatology. Br J Clin Pharmacol 1983;15(Suppl 2):172-9.
34. Clark LA, Watson D. Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications. J Abnorm Psychol 1991;100:316-36.
35. Liebowitz MR, Hollander E, Schneier F, et al. Anxiety and depression: discrete diagnostic entities? J Clin Psychopharmacol 1990;10(Suppl 3):61-6.
36. Schoevers RA, Deeg JDH, van Tilburg W, Beekman ATF. Depression and generalized anxiety disorder. Co-occurrence and longitudinal patterns in elderly patients. Am J Geriatr Psychiatry 2005;13:31-9.
37. Berk M. Selective serotonin reuptake inhibitors in mixed anxiety-depression. Int J Clin Pharmacol 2000;15(Suppl 2):S41-5.
38. Linden M. The clinical interrelation between anxiety and mood disorder. Presented at the 11th ECNP Congress, 31 October -4 November 1998. Paris, France.
39. Bienvenu OJ, Brown C, Samuels JF, et al. Normal personality traits and comorbidity among phobic, panic and major depressive disorders. Psychiatry Res 2001;102:73-85.
40. Khan AA, Jacobson KC, Gardner CO, Prescott CA, Kendler KS. Personality and comorbidity of common psychiatric disorders. Br J Psychiatry 2005;186:190-6.
41. Beekman ATF, De Beurs E, Van Balkom AJLM, et al. Anxiety and depression in later life: co-occurrence and communality of risk factors. Am J Psychiatry 2000;157:89-95.
42. Wittchen H-U, Kessler RC, Pfister H, Lieb M. Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatr Scand 2000;102(Suppl 406):14-23.
43. Clayton PJ, Grove WM, Coryell W, et al. Follow-up and family study of anxious depression. Am J Psychiatry 1991;148:1512-7.
44. Joyce PR, Romans SE, Ellis PM, Silverstone TS, editors. Affective disorders. Christchurch: Christchurch School of Medicine; 1995.
45. Piccinelli M. Comorbidity of depression and generalized anxiety: is there any distinct boundary? Curr Opin Psychiarty 1998;11:57-60.
46. Merikangas KR. Comorbidity for anxiety and depression: review of family and genetic studies. In: Maser JD, Cloninger CR, editors. Comorbidity of mood and anxiety disorders. Washington, DC: American Psychiatric Press; 1990. p 331-48.
47. Merikangas K, Gelernter CS. Comorbidity of alcoholism and depression. Psychiatr Clin N Am 1990;13:613-33.
48. Prescott CA, Kendler KS. Do anxious and depressive states share common genetic factors? Presented at the 11th ECNP Congress, 31 October-4 November. Paris, France; 1998.
49. Torgersen S. A twin-study perspective of the comorbidity of anxiety and depression. In: Maser JD, Cloninger CR, editors. Comorbidity of mood and anxiety disorders. Washington, DC: American Psychiatric Press; 1990. p 367-78.
50. Weissman MM, Gershon ES, Kidd KK, et al. Psychiatric disorders in the relatives of probands with affective disorders: the Yale University - NIMH Collaborative Study. Arch Gen Psychiatry 1984;41:13-21.
51. Angst J, Vollrath M, Merikangas K, et al. Comorbidity of anxiety and depression in the Zurich Cohort Study of Young Adults. In: Maser JD, Cloninger CR, editors. Comorbidity of mood and anxiety disorders. Washington, DC: American Psychiatric Press; 1990. p 123-37.
52. Wittchen H-U. Common risk factors in anxiety and depressive disorders. Presented at the 11th ECNP Congress, 31 October-4 November 1998. Paris, France.
53. Kendler KS, Neale MC, Kessler RC, Heath AC, Eaves LJ. Major depression and GAD. Same genes, (partly) different environments - revisited. Arch Gen Psychiatry 1992;49:716-22.
54. Kendler KS. Major depression and GAD. Same genes, (partly) different environments - revisited? Br J Psychiatry 1996;168(Suppl 30):68-75.
55. Mombereau C, Kaupmann K, Gassmann M, Bettler B, van der Putten H, Cryan JF. Altered anxiety and depression-related behaviour in mice lacking GABAB(2) receptor subunits. NeuroReport 2005;16:307-10.
56. Rickels K. A new concept in the treatment of anxiety. Presented at the XXth CINP Congress, 23-27 June 1996. Melbourne, Australia.
57. Deakin JFW. 5HT receptor subtypes in depression. In: Bevan P, Cools AR, Archer T, editors. Behavioral pharmacology of 5HT. Hillsdale, NJ: Lawrence Erlbaum Associates; 1989. p 179-204.
58. Deakin JFW, Strickland PL, Dixon J, et al. Social stress, steroid levels, 5HT and depression. J Psychopharmacology 1997;11(Suppl 3):A93.
59. Eison MS. Serotonin: a common neurobiologic substrate in anxiety and depression. J Clin Psychopharmacol 1990;10:26-30S.
60. Johnson J, Weissman MM, Klerman GL. Panic disorder, comorbidity and suicide attempts. Arch Gen Psychiatry 1990;47:805-8.
61. Nutt D, Argyropoulos S, Forshall S. Generalized anxiety disorder: diagnosis, treatment and its relationship to other anxiety disorders. London: Martin Dunitz Ltd; 1998.
62. Schulberg HC, Katon WJ, Shear MK. Management of mood and anxiety disorders in primary care. In: Rush AJ, editor. Mood and anxiety disorders. Philadelphia, PA: Current Science Inc; 1998.
63. Deakin JFW. Roles of serotonergic systems in escape, avoidance and other behaviors. In: Cooper SJ, editor. Theory in psychopharmacology, vol. 2. New York: Academic Press; 1983. p 149-93.
64. Fibiger HC. Neuropathology of depression: focus on dopamine. In: Gessa G, Fratta W, Pani L, et al, editors. Depression and mania: from neurobiology to treatment. New York: Raven Press; 1995. p 1-17.
65. Aoki T, Suetsugi M, Mizuki Y, et al. Differential effects of noradrenergic drugs on anxiety and arousal in healthy volunteers with high and low anxiety. Presented at the XXIst CINP Congress, 12-16 July 1998. Glasgow, UK.
66. Suetsugi M, Mizuki Y, Aoki T, et al. Differential effects of dopaminergic drugs on anxiety and arousal in healthy volunteers with high and low anxiety. Presented at the XXIst CINP Congress, 12-16 July 1998. Glasgow, UK.
67. Nutt DJ. Depression and generalized anxiety disorder: separation evidence. Presented at the 12th ECNP Congress, 21-25 September 1999. London, UK.
68. Walf AA, Frye CA. Antianxiety and antidepressive behavior produced by physiological estradiol regimen may be modulated by hypothalamic-pituitary- adrenal axis activity. Neuropsychopharmacology 2005;30:1-14.
69. Boyer P. Do anxiety and depression have a common pathophysiological mechanism? Acta Psychiatr Scand 2000;102(Suppl 406):24-9.
70. Roy-Byrne PP, Uhde TW, Post RM, Gallucci W, Chrousos GP, Gold PW. The corticotropin-releasing hormone stimulation test in patients with panic disorder. Am J Psychiatry 1986;143:896-9.
71. Rajkowska J. Depression: what we can learn from postmortem studies. Neuroscientist 2003;9:273-84.
72. Westenberg H. Understanding the links across the spectrum of depression and anxiety disorders: a common neurobiology? Presented at the 13th ECNP Congress, 9-13 September 2000. Munich, Germany.
73. Nutt D. Neurobiology of depression and anxiety - is there a common thread? Presented at the XXIInd CINP Congress, 9-13 July 2000. Brussels, Belgium.
74. Feinstein AR. The pretherapeutic classification of comorbidity in chronic disease. J Chron Dis 1970;23:455-68.
75. Burke JD, Wittchen H-U, Regier DA, et al. Extracting information from diagnostic interviews on co-occurrence of symptoms of anxiety and depression. In: Maser JD, Colinger CR, editors. Co-morbidity and anxiety disorders. Washington, DC: APA; 1990. p 649-67.
76. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results of the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8-19.
77. Angst J, Dobler-Mikola A. The Zurich Study VI: a continuum from depression to anxiety disorders? Eur Arch Psychiatr Clin Neurosci 1985;235:179-86.
78. Derogatis LR, Lipman RS, Covi L, Rickels K. Factorial invariance of symptom dimensions in anxious and depressive neuroses. Arch Gen Psychiatry 1972;27:659-65.
79. Goldberg D. A dimensional model for common mental disorders. Br J Psychiatry 1996;168(Suppl 30):44-9.
80. Judd LL, Kessler RC, Paulus MP, et al. Comorbidity as a fundamental feature of generalized anxiety disorders: results from the National Comorbidity Study (NCS). Acta Psychiatr Scand 1998;98(Suppl 393):6-11.
81. Prusoff B, Klerman GL. Differentiating depressed from anxious neurotic outpatients: use of discriminant function analysis for separation of neurotic affective states. Arch Gen Psychiatry 1974;30:302-9.
82. Hirschfeld RMA. The comorbidity of major depression and anxiety disorders: recognition and management in primary care. Primary Care Companion. J Clin Psychiatry 2001;2:244-54.
83. Wittchen H-U. The burden and patterns of comorbidity of generalized anxiety disorder. Presented at the 12th ECNP Congress, 21-25 September 1999. London, UK.
84. Hiller W, Zaudig M, van Bose M. The overlap between depression and anxiety on different levels of psychopathology. J Affect Disord 1989;16:223-31.
85. Kendell RE. The stability of psychiatric diagnoses. Br J Psychiatry 1974;124:352-6.
86. Shapira K, Roth M, Kerr T, et al. The prognosis of affective disorders: the differentiation of anxiety states and depressive illness. Br J Psychiatry 1972;121:175-81.
87. Tyrer P, Alexander J, Remington M, Riley P. Relationship between neurotic symptoms and neurotic diagnosis: a longitudinal study. J Affect Disord 1987;13:13-21.
88. Kraan H, Meertens H, Peters F. Positive affectivity or energy arousal: a dimension discriminating between depression and anxiety. Presented at the 2nd International Conference on New Directions in Affective Disorders, 3-8 September 1995. Jerusalem, Israel.
89. Claghorn J. The anxiety-depression syndrome. Psychosomatics 1970;11:438-41.
90. Downing RW, Rickels K. Mixed anxiety-depression: fact or myth? Arch Gen Psychiatry 1974;30:312-7.
91. Fawcett J, Kravitz HM. Anxiety syndromes and their relationship to depressive illness. J Clin Psychiatry 1983;44:8-11.
92. Fleiss JL, Lawlor W, Platman S, et al. Of the use of inverted factor analysis for generating typologies. J Abnorm Psychol 1971;77:127-32.
93. Kolvin I, Berney TR, Bhate SR. Classification and diagnosis of depression in school phobia. Br J Psychiatry 1984;145:347-57.
94. Roth M, Gurney C, Garsdide RF, Kerr TA. Studies in the classification of affective disorders: the relationship between anxiety states and depressive illnesses, I and II. Br J Psychiatry 1972;121:147-66.
95. VanValkenburg C, Winokur G, Lowry M, Behar D, VanValkenburg D. Depression occurring in chronically anxious persons. Compr Psychiatry 1983;24:285-9.
96. Bowen RC, Kohout J. The relationship between agoraphobia and primary affective disorders. Can J Psychiatry 1979;24:317-22.
97. Rouillon F, Chignon JM. Psychiatric comorbidity of anxiety disorders. In: Costa E, Silva JA, editors. Anxiety disorders in the year 2000: controversies and perspectives. Chester: Adis Int'l Ltd; 1992. p 26-33.
98. Schoevers RA, Beekman ATF, Deeg JDH, Jonker C, van Tilburg W. Comorbidity and risk patterns of depression, generalised anxiety disorder and mixed anxiety-depression in later life: results from the AMSTEL study. Int J Geriatr Psychiatry 2003;18:994-1001.
99. Starcevic V, Bogojevic G. The symptom structure of generalized anxiety disorder revisited. Presented at the 9th AEP Congress, 20-24 September 1998. Copenhagen, Denmark.
100. Goldberg DP, Babigian HM, Locke BA, Rosen BM. Role of non-psychiatrist physicians in the delivery of mental health services: implications from three studies. Pub Health Rep 1978;92:240-5.
101. Jameson J, Schuman LJ, Young WW. The effects of outpatient psychiatric utilization on the cost of providing third party coverage. Med Care 1978;16:383-99.
102. Haug TT, Mykletun A, Dahl AA. The association between anxiety, depression, and somatic symptoms in a large population: the HUNT-II study. Psychosom Med 2004;66:845-51.
103. Stewart A, Sherbourne C, Wells K, et al. Do depressed patients in different treatment settings have different levels of well-being and functioning? J Consult Clin Psychol 1993;61:849-57.
104. Wells K, Rogers W, Burnam A, Greenfield S, Ware JE Jr. How the medical comorbidity of depressed patients differs across health care settings: results from the Medical Outcomes Study. Am J Psychiatry 1991;148:1688-96.
105. Bebbington P, Marsden L, Brewin CR. The need for psychiatric treatment in the general population: the Camberwell Needs for Care Survey. Psychol Med 1997;27:821-34.
106. Jones RL, Badger LW, Ficken RP, Leeper JD, Anderson RL. Inside the hidden mental health network. Gen Hosp Psychiatry 1987;9:287-93.
107. McCombs JS, Nichol MB, Stimmel GL, et al. The cost of antidepressant drug therapy failure: a study of antidepressant use patterns in a medicaid population. J Clin Psychiatry 1990;51(Suppl 6):60-9.
108. Zajecka JM, Ross JS. A systematized approach to the management of the depressed and anxious patient. Int J Clin Pract 1998;2:27-30.
109. Shapiro S, Skinner EA, Kessler LG, et al. Utilization of health and mental health services: three Epidemiologic Catchment Area sites. Arch Gen Psychiatry 1984;41:971-8.
110. Stokes PE. A primary care perspective on management of acute and long-term depression. J Clin Psychiatry 1993;54(Suppl 8):74-84.
111. Goldberg D. The management of anxious depression in primary care. J Clin Psychiatry 1999;60(Suppl 7):39-42.
112. Goldberg DP, Huxley PJ. Common mental disorders: a biosocial model. London: Routledge; 1992.
113. Blazer D, Swartz M, Woodbury M, et al. Depressive symptoms and depressive diagnoses in a community population: use of a new procedure for analysis of psychiatric comorbidity. Arch Gen Psychiatry 1988;45:1078-84.
114. Johnson MR, Lydiard RB, Ballenger JC. Panic disorder: pathophysiology and drug treatment. Drugs 1995;49:328-44.
115. Lepine JP, Wittchen H-U, Essau CA, et al. Lifetime and current comorbidity of anxiety and depressive disorders: results from the international WHO/ADAMHA CIDI field trials. Int J Methods Psychiatr Res 1993;3:67-77.
116. Agoston G, Szadoczky E. The prevalence of mixed anxiety-depression in a sample of the Hungarian population. Presented at the 12th ECNP Congress, 21-25 September 1999. London, UK.
117. Ronnes A, Mykletun A, Dahl AA. Help-seeking behaviour in patients with anxiety disorder and depression. Acta Psychiatr Scand 2005;111:51-8.
118. Murphy JM, Sobol AM, Olivier DC, et al. Prodromes of depression and anxiety: the Stirling county study. Br J Psychiatry 1989;155:490-5.
119. Strauss CC, Last CG, Hersen M, Kazdin AE. Association between anxiety and depression in children and adolescents with anxiety disorders. J Abnorm Child Psychol 1988;16:57-68.
120. Kovacs M, Gatsonis C, Paulauskas SL, Richards C. Depressive disorders in childhood. Arch Gen Psychiatry 1989;46:776-82.
121. Brady EU, Kendall PC. Comorbidity of anxiety and depression in children and adolescents. Psychol Bull 1992;111:244-55.
122. Zahn-Waxler C, Klimes-Dougan B, Slattery MJ. Internalizing problems of childhood and adolescence: prospects, pitfalls, and progress in understanding the development of anxiety and depression. Dev Psychopathol 2000;12:443-66.
123. Smalbrugge M, Jongenelis L, Pot AM, et al. Comorbidity of depression and anxiety in nursing home patients. Int J Geriatr Psychiatry 2005;20:218-26.
124. Medvedev A, Belova M, Kolesnitshenko A, et al. Cross-sectional comorbid mental pathology in the late life major depression. Presented at the 12th ECNP Congress, 21-25 September 1999. London, UK.
125. O'Hara M, Swain A. Rates and risk of postpartum depression - a meta-analysis. Int Rev Psychiatry 1996;8:37-54.
126. Sutter-Dallay AL, Giaconne-Marcesche V, Glatigny-Dallay E, Verdoux H. Women with anxiety disorders during pregnancy are at increased risk of intense postnatal depressive symptoms: a prospective survey of the MATQUID cohort. Eur Psychiatry 2004;19:459-63.
127. Sartorius N, Ustun TB, Lecrubier Y, Wittchen HU. Depression comorbid with anxiety: results from the WHO study on psychological disorders in primary health care. Br J Psychiatry 1996;168(Suppl 30):38-43.
128. Boulenger J-P, Fournier M, Rosales D, Lavallee YJ. Mixed anxiety and depression: from theory to practice. J Clin Psychiatry 1997;58(Suppl 8):27-34.
129. Gaudiano BA, Miller IW. Anxiety disorder comorbidity in bipolar I disorder: relationship to depression severity and treatment outcome. Depress Anxiety 2005;21:71-7.
130. Wittchen H-U, Lieb R, Wunderlich U, Schuster P. Comorbidity in primary care: presentation and consequences. J Clin Psychiatry 1999;60(Suppl 7):29-36. [Discussion 87-8; Review.]
131. Clancy J, Noyes R Jr, Hoenk PR, Slymen DJ. Secondary depression in anxiety neurosis. J Nerv Ment Dis 1978;166:846-50.
132. Stein MB, Kirk P, Prabhu V, Grott M, Terepa M. Mixed anxiety-depression in a primary care clinic. J Affect Disord 1995;34:79-84.
133. Rosenblatt RA, Cherkin DC, Schneeweiss R, Hart LG. The content of ambulatory care medicine in the United States: an interspeciality comparison. New Engl J Med 1983;309:892-7.
134. Robins LN, Regier DA, editors. Psychiatric disorders in America. The Epidemiologic Catchment Area Study. New York: The Free Press; 1991.
135. Barrett JE, Barrett JA, Oxman TE, Gerber PD. The prevalence of psychiatric disorders in a primary care practice. Arch Gen Psychiatry 1988;45:1100-6.
136. Kessler RC, Wittchen H-U. Anxiety, mood, and substance abuse disorders: patterns and correlates of comorbidity. Presented at the 12th ECNP Congress, 21-25 September 1999. London, UK.
137. Paykel ES, Henderson AJ. Application of cluster analysis in the classification of depression: a replication study. Neuropsychobiology 1977;3:111-9.
138. Stahl SM. Mixed anxiety and depression: clinical implications. J Clin Psychiatry 1993;54(Suppl 1):33-8.
139. Fava M. Depression-anxiety comorbidity. Presented at the 11th ECNP Congress, 31 October-3 November 1998. Paris, France.
140. Hamilton M. Distinguishing between anxiety and depressive disorders. In: Last CA, Hersen M, editors. Handbook of anxiety disorders. New York: Pergamon Press; 1988. p 143-55.
141. Salzman C. Practical considerations in the pharmacological treatment of depression and anxiety in the elderly. J Clin Psychiatry 1990;51(Suppl 1):40-3.
142. Lenze EJ, Mulsant BH, Shear MK, et al. Comorbid anxiety disorders in depressed elderly patients. Am J Psychiatry 2000;157:722-8.
143. Steffens DC, McQuoid DR. Impact of symptoms of generalized anxiety disorder on the course of late-life depression. Am J Geriatr Psychiatry 2005;13:40-7.
144. Keller MB, Lavori PW, Mueller TI, et al. Time to recovery, chronicity, and levels of psychopathology in major depression. A 5-year prospective follow-up of 431 subjects. Arch Gen Psychiatry 1992;49:809-16.
145. Mueller TI, Keller MB, Leon AC, et al. Recovery after 5 years of unremitting major depressive disorder. Arch Gen Psychiatry 1996;53:794-9.
146. Alnaes R, Torgersen S. DSM-III personality disorders among patients with major depression, anxiety disorders, and mixed conditions. J Nerv Ment Dis 1990;178:693-8.
147. Bakish D. The patient with comorbid depression and anxiety: the unmet need. J Clin Psychiatry 1999;60(Suppl 6):20-4.
148. Bijl RV, Ravelli A. Current and residual functional disability associated with psychopathology: findings from The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Psychol Med 2000;30:657-68.
149. De Beurs E, Beekman ATF, Van Balkom AJLM, et al. Consequences of anxiety in older persons: its effect on disability, well-being and use of health services. Psychol Med 1999;29:583-93.
150. Emmanuel J, Simmonds S, Tyrer P. Systematic review of the outcome of anxiety and depressive disorders. Br J Psychiatry 1998;173:35-41.
151. Fawcett J. Predictors of early suicide: identification and appropriate intervention. J Clin Psychiatry 1988;49(Suppl 10):7-8.
152. Feske U, Frank E, Kupfer DJ, Shear MK, Weaver E. Anxiety as a predictor of response to interpersonal psychotherapy for recurrent major depression. Depress Anxiety 1998;8:135-41.
153. Judd L. Comorbidity and health costs. Int Med News 1994;92:4-5.
154. Lenze EJ, Mulsant BH, Mohlman J, et al. Generalized anxiety disorder in late life. Lifetime course and comorbidity with major depressive disorder. Am J Geriatr Psychiatry 2005;13:77-80.
155. Liebowitz MR. Depression with anxiety and atypical depression. J Clin Psychiatry 1993;54(Suppl 2):10-4.
156. Liebowitz MR. Mixed anxiety and depression: should it be included in DSM-IV? J Clin Psychiatry 1993;54(Suppl 5):4-7.
157. Murphy JM. Depression in the community: findings from the Stirling county study. Can J Psychiatry 1990;35:390-6.
158. Rovner BW. Depression and increased risk of mortality in the nursing home patient. Am J Med 1993;94:19S-22S.
159. Rush AJ, Zimmerman M, Wisniewski SR, et al. Comorbid psychiatric disorders in depressed outpatients: demographic and clinical features. J Affect Disord 2005;87(1):43-55.
160. Schatzberg AF. Fluoxetine in the treatment of comorbid anxiety and depression. J Clin Psychiatry Monogr 1995;13:2-12.
161. Schoevers RA, Beekman ATF, Deeg JDH, et al. The natural history of late-life depression: results from the Amsterdam Study of the Elderly (AMSTEL). J Affect Disord 2002;76:5-14.
162. Stordal E, Bjelland I, Dahl AA, Mykletun A. Anxiety and depression in individuals with somatic health problems. The Nord-Trøndelag Health Study (HUNT). Scand J Prim Health Care 2003;21:136-41.
163. VanValkenburg C, Akiskal HS, Puzantian V, Rosenthal T. Anxious depressions: clinical, family history, and naturalistic outcome - comparisons with panic and major depressive disorders. J Affect Disord 1984;6:67-82.
164. Gaynes BN, Magruder KM, Burns BJ, et al. Does a coexisting anxiety disorder predict persistence of depressive illness in primary care patients with major depression? Gen Hosp Psychiatry 1999;21:158-67.
165. Loebel AD, Hyde TS, Dunner DL. Early placebo response in anxious and depressed patients. J Clin Psychiatry 1986;47:230-3.
166. Bruce SE, Yonkers KA, Otto MW, et al. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry 2005;162:1179-87.
167. Trivedi MH. Managing residual anxiety in patients with depression. Presented at the XXVth Collegium Internationale Neuro-Psychopharmacorum (CINP) Congress, 9-13 July 2006. Chicago, IL, USA.
168. Wittchen H-U, Zhao S, Kessler RC, Eaton WW. DSM-IIIR generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:355-64.
169. Wittchen H-U, Essau CA, Krieg JC. Anxiety disorders: similarities and differences in comorbidity in treated and untreated groups. Br J Psychiatry 1991;159(Suppl 12):23-33.
170. Ormel J, Kempen GI, Deeg DJ, et al. Functioning, well-being and health perception in late middle-aged and older people: comparing the effects of depressive symptoms and chronic medical conditions. J Am Geriatr Soc 1998;46:39-48.
171. Ormel J, Kempen GI, Penninx BW, et al. Chronic mental conditions and mental health in older people: disability and psychosocial resources mediate specific mental health effects. Psychol Med 1997;27:1065-77.
172. Bronisch T, Hecht H. Major depression with and without a coexisting anxiety disorder: social dysfunction, social integration, and personality features. J Affect Disord 1990;20:151-7.
173. Brown CW, Bifulco A, Harris TO, Bridge L. Life stress, chronic subclinical symptoms and vulnerability to clinical depression. J Affect Disord 1986;11:1-19.
174. Clayton PJ. The comorbidity factor: establishing the primary diagnosis in patients with mixed symptoms of anxiety and depression. J Clin Psychiatry 1990;51(Suppl 11):35-9.
175. Ormel J, Oldehinkel T, Brilman E, vanden Brink W. Outcome of depression and anxiety in primary care. Arch Gen Psychiatry 1993;50:759-66.
176. Preisig M, Merikangas KR, Angst J. The impact of comorbidity on the course of depression and anxiety. Presented at the 9th AEP Congress, 20-24 September 1998. Copenhagen, Denmark.
177. Wetzler S, Katz MM. Problems with the differentiation of anxiety and depression. J Psychiatr Res 1989;23:1-12.
178. Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). J Am Med Assoc 2003;289:3095-101.
179. Hranov LG. Panic disorder. A comprehensive study of a clinical sample. Sofia, Medical University (in Bulgarian); 1995.
180. Lesses S. The relationship of anxiety to depression. Am J Psychother 1982;36:332-48.
181. Merikangas KR, Zhang H, Avenevoli S, et al. Zurich Cohort Study. Longitudinal trajectories of depression and anxiety in a prospective community study. Arch Gen Psychiatry 2003;60:993-1000.
182. Angst J, Vollrath M. The natural history of anxiety disorders. Acta Psychiatr Scand 1991;84:446-52.
183. Coryell W, Endicott J, Andreasen NC, et al. Depression and panic attacks: the significance of overlap as reflected in follow-up and family study data. Am J Psychiatry 1988;145:293-300.
184. Grunhaus L, Rabin D, Greden JF. Simultaneous panic and depressive disorder: response to antidepressant treatments. J Clin Psychiatry 1986;47:4-7.
185. Schweizer E, Rickels K. The long-term management of generalized anxiety in primary care settings: practical concepts of classification and management. J Clin Psychiatry 1996;58(Suppl 11):4-10.
186. Yonkers KA, Warshaw MG, Massion AO, Keller MB. Phenomenology and course of generalized anxiety disorder. Br J Psychiatry 1996;168:308-13.
187. Fawcett J. The detection and consequences of anxiety in clinical depression. J Clin Psychiatry 1997;58(Suppl 8):35-40.
188. Fawcett J, Scheftner WA, Fogg L, et al. Time-related predictors of suicide in major affective disorder. Am J Psychiatry 1990;147:1189-94.
189. Wunderlich U, Bronisch T, Wittchen H-U. Comorbidity patterns in adolescents and young adults with suicide attempts. Eur Arch Psychiatry Clin Neurosci 1998;248:87-95.
190. McGlynn TJ, Metcalf HL, editors. Diagnosis and treatment of anxiety disorders: a physician's handbook. Washington, DC: American Psychiatric Press. 1989; p 8-11, 49.
191. Lepine J-P. The challenge and impact of comorbid anxiety in patients with major depressive disorders Presented at the CINP XXVth Congress, 9-13 July 2006. Chicago, IL, USA.
192. Pollack MH. The problem of concomitant depression in patients with anxiety disorders. Presented at the CINP XXVth Biennal Congress, 9-13 July 2006. Chicago, IL, USA.
193. Schweizer E. Generalized anxiety disorder: longitudinal course and pharmacologic treatment. Psychiatr Clin North Am 1995;18:843-57.
194. Zung WWK, Magruder-Habib K, Velez R, Alling W. The comorbidity of anxiety and depression in general medical patients: a longitudinal study. J Clin Psychiatry 1990;51(Suppl 6):77-80. [Discussion 91.]
195. Rickels K, Downing R, Schweizer E, Hassman H. Antidepressants for the treatment of generalized anxiety disorder. A placebo-controlled comparison of imipramine, trazodone, and diazepam. Arch Gen Psychiatry 1993;50:884-95.
196. Catalan J, Gath D, Edmonds G, Ennis J. The effects of non-prescribing of anxiolytics in general practice. I. Controlled evaluation of psychiatric and
197. Smith BD, Salzman C. Do benzodiazepines cause depression? Hosp Community Psychiatry 1991;42:1101-2.
198. van Meter SA, Doraiswamy PM. Anxiety disorders. In: Rakel RE, Bope ET, editors. Conns Current Therapy 2001. Philadelphia, PA: WB Saunders Co; 2001. p 1137-42.
199. Zamorski MA, Albucher RC. What to do when SSRIs fail: eight strategies for optimizing treatment of panic disorder. Fam Physician 2002;66:1477-84.
200. Judd FK, Burrows GD. Anxiety disorders and their relationship to depression. In: Paykel ES, editor. Handbook of affective disorders. New York: Guilford Press; 1992. p 77-87.
201. Paykel ES. Remission and residual symptomatology in major depression. Psychopathology 1998;31:5-14.
202. Nelson JC, Portera L, Leon AC. Residual symptoms in depressed patients after treatment with fluoxetine or reboxetine. J Clin Psychiatry 2005;66:1409-14.
203. Menza M, Marin H, Opper RS. Residual symptoms in depression: can treatment be symptom-specific? J Clin Psychiatry 2003;64:516-23.
204. Lecrubier Y, Weiller E, Andersen H. Qualitative changes in symptomatology before and after treatment to remission in GAD and major depression. Presented at the CINP XXVth Congress, 9-13 July 2006. Chicago, IL, USA.
205. Silverstone PH, Salinas E. Efficacy of venlafaxine extended release in patients with major depressive disorder and comorbid generalized anxiety disorder. J Clin Psychiatry 2001;62:523-9.
206. Tyrer P, Seivewright N, Murphy S, et al. The Nottingham study of neurotic disorder: comparison of drug and psychological treatments. Lancet 1988;39:235-40.
207. Lipman RD, Covi L, Rickels K, et al. Imipramine and chlordiazepoxide in depressive and anxiety disorders. I. Efficacy in depressed outpatients. Arch Gen Psychiatry 1986;43:68-77.
208. Rickels K, Schweizer E. The treatment of generalized anxiety disorder in patients with depressive symptomatology. J Clin Psychiatry 1993;54(Suppl 1):20-3.
209. Fava M, Rosenbaum J, Hoog SL, et al. Fluoxetine versus sertraline and paroxetine in major depression: tolerability and efficacy in anxious depression. J Affect Disord 2000;59:119-26.
210. Kasper S. Neurobiology and new psychopharmacological strategies for treatment of anxiety disorders. In: Racagni G, Brunelli N, editors. Current therapeutical approaches on panic and other anxiety disorders. Basel: Karger; 1995.
211. Dunbar GC, Fuell DL. The anti-anxiety and anti-agitation effects of paroxetine in depressed patients. Int Clin Psychopharmacol 1992;6(Suppl 4):81-90.
212. Montgomery S, Porto L, Plewes T, et al. Does comorbid anxiety predict antidepressant success or failure? A metaanalysis of 3800 clinical trial patients. Eur Neuropsychopharmacol 1998;8(Suppl 2):S153.
213. Lydiard RB. Effects of escitalopram on anxiety symptoms in depression. Poster presented at the 154th APA Annual Meeting, 5-10 May. New Orleans, LA, USA; 2001.
214. Galinowski A, Tonnoir B, Florea I, Olie J-P. The efficacy of escitalopram in depressed patients with comorbid anxiety. Presented at the 158th annual meeting of the APA, 21-26 May 2005. Atlanta, GA, USA.
215. Boulenger J-PP, Huusom AKT, Florea I, Baekdal T, Sarchiapone M. A comparative study of the efficacy of long-term treatment with escitalopram and paroxetine in severely depressed patients. Curr Med Res Opin 2006;22:1331-41.
216. Laws D, Ashford JJ, Anstee JA. A multicentre double-blind comparative trial of fluvoxamine versus lorazepam in mixed anxiety and depression treated in general practice. Acta Psychiatr Scand 1990;81:185-9.
217. Rausch JL, Hobby H, Shendarkar N, Johnson ME, Li J. Fluvoxamine treatment of mixed anxiety and depression: evidence for serotonergically mediated anxiolysis. J Clin Psychopharmacol 2001;21:139-42.
218. Rapaport MH, Jonas J, Bose A, et al. Escitalopram improves somatic symptoms of depression. Presented at the XXIVth Collegium Internationale Neuro-Psychopharmacorum (CINP) Congress, 20-24 June 2004. Paris, France.
219. Sheline YI, Barch DM, Donnelly JM, et al. Increased amygdale response to masked emotional faces in depressed subjects resolves with antidepressant treatment: an fMRI study. Biol Psychiatry 2001;50:651-8.
220. Rausch JL. A hypothesis of initial conditions: receptor-effector systems as determinants of psychopharmacologic drug response. Int J Neuropsychopharmacol 1998;1:137-51.
221. Fontaine R, Ontiveros A, Elie R, et al. A double-blind comparison of nefazodone, imipramine, and placebo in major depression. J Clin Psychiatry 1994;55:234-41.
222. Fawcett J, Marcus RN, Anton SF, O'Brien K, Schwiderski U. Response of anxiety and agitation symptoms during nefazodone treatment of major depression. J Clin Psychiatry 1995;56(Suppl 6):37-42.
223. Bremmer JD. A double-blind comparison of Org 3770, amitriptyline, and placebo in major depression. J Clin Psychiatry 1995;56:519-26.
224. Feighner JP, Entsuah AR, McPherson MK. Efficacy of once-daily venlafaxine extended release (XR) for symptoms of anxiety in depressed outpatients. J Affect Disord 1998;47:55-62.
225. Trivedi MH, Rush AJ, Carmody TJ, Donahue RM, Bolden-Watson C, et al. Do bupropion SR and sertraline differ in their effects on anxiety in depressed patients? J Clin Psychiatry 2001;62:776-81.
226. Pini S, Amador XF, Dell'Osso L, et al. Treatment of depression with comorbid anxiety disorders: differential efficacy of paroxetine versus moclobemide. Int Clin Psychopharmacol 2003;18:15-21.
227. Cameron OG, Abelson JL, Young EA. Anxious and depressive disorders and their comorbidity: effect on central nervous system noradrenergic function. Biol Psychiatry 2004;56:875-83.
228. Pariante CM, Miller AH. Glucocorticoid receptors in major depression: relevance to pathophysiology and treatment. Biol Psychiatry 2001;49:391-404.
229. Ninan PT, Feigon SA, Knight B. Neurobiology and mechanisms of antidepressant treatment response in anxiety. Psychopharm Bull 2002;36(Suppl 3):67-78.
230. Hen R. Genetic modules of depression and anxiety. Presented at the 158th annual meeting of the APA, 21-26 May 2005. Atlanta, GA, USA.
231. Nibuya M, Morinobu S, Duman RS. Regulation of BDNF and trkB mRNA in rat brain by chronic electroconvulsive and antidepressant drug treatments. J Neurosci 1995;15:7539-47.
232. Duman RS. The neurochemistry of mood disorders: preclinical studies. In: Charney DS, editor. The neurobiology of mental illness. New York: Oxford University Press; 1999. p 333-64.
233. Chambless DL, Sanderson WC, Shoham V, et al. An update on empirically validated therapies. Clin Psychol 1996;49:5-18.
234. Freeston MH, Ladoceur R, Gagnon F, et al. Cognitive-behavioral treatment of obsessive thoughts: a controlled study. J Consult Clin Psychology 1997;65:405-13.
235. Tsao JC, Lewin MR, Craske MG. The effects of cognitive-behavior therapy for panic disorder on comorbid conditions. J Anxiety Disord 1998;12:357-71.
236. Woody S, McLean PD, Taylor S, Koch WJ. Treatment of major depression in the context of panic disorder. J Affect Disord 1999;53:163-74.
237. Paykel ES, Scott J, Teasdale JD, et al. Prevention of relapse in residual depression by cognitive therapy. Arch Gen Psychiatry 1999;56:829-35.
238. Fava GA, Rafanelli C, Grandi S, Canestrari R, Morphy A. Six-year outcome for cognitive behavioral treatment of residual symptoms in major depression. Am J Psychiatry 1998;155:1443-5.
239. Durham RC, Allan T. Psychological treatment of generalized anxiety disorder: a review of the clinical significance of results in outcome studies since 1980. Br J Psychiatry 1993;163:19-26.