Comorbidity of depression and anxiety in clinical practice

Close metadata

OBJECTIVE

The study was the comparative characterization of depressed patients depending on the presence of comorbid anxiety.

MATERIAL AND METHODS

Thirty patients of the Clinic of neuroses named after acad. I.P. Pavlov Clinic of Neuroses. Comparison groups included 15 patients with comorbid anxiety and depressive disorders and 15 patients with depressive disorder without comorbid anxiety. The groups were comparable by sex and age. Clinical-catamnestic, clinical-therapeutic, and clinical-scale methods, including the Hamilton Depression and Anxiety Scales, were used during the study.

RESULTS

The structure of clinically diagnosed comorbid anxiety and depressive disorders was shown to be characterized by high representation of somato-vegetative symptoms and higher level of depression in comparison to depressive disorder without comorbid anxiety. According to psychometric assessment results, the level of anxiety did not differ in comparison groups, while clinically, according to ICD-10 criteria, anxiety was not diagnosed, indicating a discrepancy between clinical and scale assessments of anxiety and depressive disorders and greater accuracy of clinical and scale assessment of the condition. The effectiveness of combined treatment, including psychotropic therapy and psychotherapy, was lower in patients with comorbidity of anxiety and depression according to parameters of the degree of reduction of psychopathological symptoms, duration of treatment, and quality of remission. The structure of incomplete remission was similar in patients with comorbid anxiety and depressive disorders and depression.

CONCLUSION

The obtained data suggest the expediency of continuous systematization of affective disorders and the need to improve the diagnostic criteria of comorbid anxiety and depressive disorders on the basis of combined clinical and scale assessment.

Keywords:

depression

anxiety

comorbidity

diagnosis

therapy

Authors:

Petrova N.N.

Saint-Petersburg State University

ORCID: 0000-0003-4096-6208

Palkin Yu.R.

Pavlov City Psychiatric Hospital No. 7

Faddeev D.V.

Pavlov City Psychiatric Hospital No. 7

Zinovieva A.G.

Saint-Petersburg State University

Received:

18.02.2021

Accepted:

07.04.2021

List of references:

Kessler RC, Berglund P, Demler O et al. National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289:3095-3105.
Saarni SI, Suvisaari J, Sintonen H et al. Impact of psychiatric disorders on health-related quality of life: general population survey. Br J Psychiatry. 2007;190:326-332.
Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017 Licence: CC BY-NC-SA 3 IGO.
Salcedo B. The Comorbidity Of Anxiety And Depression. National Alliance on Mental Illness. 2018;325-333.
Moscati A, Flint J, Kendler KS. Classificaion of anxiety disorders comorbid with major depression: common or distinct influences on risk? Depress Anxiety. 2016;33(2):120-127. Epub 2015 Sep 29.
Fang Y. Comorbidity of depressive and anxiety disorders: challenges in diagnosis and assessment. Shanghai Arch Psychiatry. 2014;26(4):227-231.
Fava M, Alpert JE, Carmin CN et al. Clinical correlates and symptom patterns of anxious depression among patients with major depressive disorder in STAR*D. Psychol Med. 2004;34(7):1299-1308. https://doi.org/10.1017/S0033291704002612
Fava M, Rush AJ, Alpert JE et al. Difference in treatment outcome in outpatients with anxious versus nonanxious depression: A STAR*D Report. Am J Psychiatry. 2008;165:342-3351.
Regier DA, Narrow WE, Clarke DE, et al. DSM-5 Field Trials in the United States and Canada, Part II: Test-Retest Reliability of Selected Categorical Diagnoses. Am J Psychiatry. 2012;170:59-70. https://doi.org/10.1176/appi.ajp.2012.12070999
Barkow K, Heun R, Wittchen HU, Bedirhan Ustun T, Gansicke M, Maier W. Mixed anxiety-depression in a 1 year follow-up study: shift to other diagnoses or remission? J Affect Disord. 2004;79(1):235-239.
Dunlop BW, Scheinberg K, Dunlop AL. Ten ways to improve the treatment of depression and anxiety in adults. Ment Health Fam Med. 2013;10(3):175-181.
Batelaan NM, Spijker J, de Graaf R, Cuijpers P. Mixed anxiety depression should not be included in DSM-5. J Nerv Ment Dis. 2012;200(6):495-498.
Spijker J, Batelaan N, de Graaf R, Cuijpers P. Who is MADD? Mixed anxiety depressive disorder in the general population. J Affect Disord. 2010;121(1-2):180-183. https://doi.org/10.1016/j.jad.2009.06.008
Ionescu DF, Niciu MJ, Henter ID, Zarate CA. Defining Anxious Depression: A Review of the Literature. CNS Spectr. 2013;18(5):252-260. https://doi.org/10.1017/S1092852913000114
Seo HJ, Jung YE, Kim TS, et al. Distinctive clinical characteristics and suicidal tendencies of patients with anxious depression. J Nerv Ment Dis. 2011;199(1):42-48.
Hranov LG. Comorbid anxiety and depression: illumination of a controversy. Psychiatry Clin Pract. 2007;11(3):89-171.
Paykel E, Andrade LH, Njenga F, Phillips MR.Changes needed in the classification of depressive disorders: options for ICD-11. World Psychiatry. 2012;11(suppl 1):37-42.
Cameron OG. Understanding Comorbid Depression and Anxiety. Psychiatric Times. 2007;24(14):51-56.
Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, van Balkom AJ, Nolen WA, Zitman FG, Beekman AT, Penninx BW.Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry. 2011;72(3):341-348. Epub 2011 Jan 25. https://doi.org/10.4088/JCP.10m06176blu
Moffitt TE, Harrington H, Caspi A, Kim-Cohen J, Goldberg D, Gregory AM, Poulton R. Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Arch Gen Psychiatry. 2007;64(6):651-660.
Zhou Y, Zh Cao, Yang M, et al. Comorbid generalized anxiety disorder and its association with quality of life in patients with major depressive disorder. Scientific Reports. 2017;7:40511. https://doi.org/10.1038/srep40511
Galyamina A.G., Kovalenko I.L., Smagin D.A., Kudryavtseva N.N. The relationship between depression and anxiety in the development of mixed anxiety-depressive disorder. Experimental study of the mechanisms of comorbidity (review). Pavlov's Journal of Higher Nervous Activity. 2016; 66 (2): 181-201.
Смулевич А.Б. Депрессии в общей медицине. Руководство для врачей. М.: Медицинское информационное агентство; 2001.
Smulevich A.B., Dubnitskaya E.B., Chitlova V.V. Anxiety depression: the problem of typology and constitutional predisposition. Journal of Neurology and Psychiatry. S.S. Korsakov. 2013; 113 (1): 56-68.
Lesch KP, Bengel D, Heils A, Sabol SZ, Greenberg BD, Petri S, et al. Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region. Science. 1996;274:1527-1531.
Caspi A, Sugden K, Moffitt TE, et al. Influence of Life Stress on Depression: Moderation by a Polymorphism in the 5-HTT Gene. Science. 2003;301(5631):386-389. https://doi.org/10.1126/science.1083968
Fawcett J, Cameron RP, Schatzberg AF. Textbook of anxiety disorders, 2nd ed. Am J Psychiatry. 2010;167(5):606-607. https://doi.org/10.1176/appi.ajp.2009.09121838
Mosolov S.N. Anxiety and Depressive Disorders: Comorbidity and Therapy. M.: ArtinfoPublishing; 2007.
Petrova N.N. Optimization of antidepressant therapy. Review of Psychiatry and Medical Psychology. V.M. Bekhterev. 2013; 2: 83-97.
Bauer M, Pfennig A, Severus E, et al. World Federation of Societies of Biological Psychiatry (WFSBP). Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 1: Update 2013 on the acute and continuation treatment of unipolar depressive disorders. The World Journal of Biological Psychiatry. 2013;14:334-385.
Coplan JD, Aaronson CJ, Panthangi V, Kim Y. Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches. World J Psychiatry. 2015;5(4):366-378.
Stein DJ, Kennedy SH. Hum Psychopharmacol. 2013;28:151-159.
Gushanskaya E.V., Frolova V.I., Medvedev V.E. Anxiety depression therapy (experience with Valdoxan). Psychiatry and psychopharmacotherapy. 2015; 1: 17-21.
Medvedev V.E. The use of Valdoxan (agomelatine) in the combination therapy of moderate and severe depressions of a non-psychotic level. Journal of Neurology and Psychiatry. S.S. Korsakov. 2012; 112: 5: 1: 37-40.
Tsipriani A., Furukama TA, Salanti JS et al. Comparative efficacy and tolerability of an antidepressant used in the management of major depressive disorder in adults: a systematic review and network meta-analysis. Comparative efficacy and tolerability of an antidepressant used for treatment of major depressive disorder in adults: a systematic review and network meta-analysis. Journal of Social and Clinical Psychiatry. 2018; 28 (4): 61-69
Courtet P, Vaiva G, Corruble E, et al. Depression comorbid with generalised anxiety disorder. Baseline characteristics and response to treatment: data from the DIMENSION study. P. 2. f. 017. Eur Neuropsychopharmacol. 2013;23:S405. https://doi.org/10.1016/S0924-977X(13)70640-0
Möller HJ, Bandelow B, Volz H-P, et al. The relevance of ‘mixed anxiety and depression’ as a diagnostic category in clinical practice. Eur Arch Psychiatry Clin Neurosci. 2016;266(8):725-736.
Kunik ME, Roundy K, Veazey C, Souchek J, Richardson P, Wray NP, Stanley MA. Surprisingly high prevalence of anxiety and depression in chronic breathing disorders. Chest. 2005;127(4):1205-1211.

Close metadata