Conceptualization of comorbid anxiety and depressive disorders and approaches to their managing

Close metadata

Recommended articles:

The association of polymorphisms of the serotonin transporter gene SLC6A4 with depression. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(2):135-139

The effect of insomnia on mild cognitive impairment in patients with vascular risks: results of a three-year longitudinal study. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(3-2):30-36

A perspective on the application of CRISPR/CAS9 genome editing system to study of molecular-genetic basis of mental disorders. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(3):27-33

Validation of screening method based on EEG analysis for the risk assessment of psychiatric and behavioral disorders: a pilot study. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(3):88-96

A clinical case of the new-onset bipolar affective disorder in the postcovid period. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(3):125-129

Pathogenetic basis of modern approaches to the therapy of sleep disorders in the clinic of depression. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(4):69-74

Features of the clinical picture of affective disorders in women during the menopausal transition and early postmenopause. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(4):75-79

Targeting NMDAR/AMPAR: a promising pharmacotherapeutic approach for depressive disorders. S.S. Korsakov Journal of Neurology and Psychiatry. 2024;(5):22-30

Compulsive training in eating behavior disorders: features of diagnosis and therapy. Russian Journal of Preventive Medicine. 2024;(3):104-111

Clinical and epidemiological features of atopic type of alopecia areata. Russian Journal of Clinical Dermatology and Venereology. 2024;(2):155-160

Anxiety and depressive disorders are characterized with frequent co-occurance. Depression comorbid to anxiety disorder increases severity of main disorder, aggravates it`s clinical course, worsens social functioning of the patients and decreases life quality, results resistance to therapy and increases the probability of suicidal attempts. In patients with depressive disorders onset of anxiety disorder results increased severity of disorder and decrease in quality of remission. There are different opinions on nature and phenomenology of comorbidity of anxiety and depressive disorders. There are biological and psychological factors of risk of comorbidity. Some scientists consider comorbid disorders to be independent and not to effect each other; others pay attention at common anatomic basis of comorbid disorders, which explains manifestation of comorbid disorder. Hierarchical analysis of clinical features of comorbid disorders favors nosological approach to understanding of comorbidity, and implicates the need for inclusion of transdiagnostic elements. Some authors consider comorbid disorders to be separate type of disorder, characterized with special dynamics of syndromes which reveals transformation of one disorder into another. Phenomenon of comorbidity can be described as part of concept of disease spread which estimates important role of bridge psychic states. Considering clinical features of comorbid disorders, difficulties of their therapy based on concepts of phenomenology of comorbid depressive and anxiety disorders recommendations on prevention, early diagnosing and managing of comorbid disorders were elaborated. Psychotherapy (including CBT, which demonstrated high efficiency) is an essential element of treatment of comorbid depressive and anxiety disorders. Psychotherapy is supposed to be correcting personality traits, cognitive mistakes and maladaptive strategies of coping with disorder, which support the comorbidity.

Keywords:

depression

anxiety

cognitive-behavioral therapy

comorbidity

Authors:

Malygin Y.V.

Evdokimov Moscow State University of Medical Dentistry;
Pirogov Russian National Research Medical University

Orlova A.S.

Sechenov First Moscow State Medical Univesity

Malygin V.L.

Evdokimov Moscow State University of Medical Dentistry

Received:

02.12.2021

Accepted:

23.12.2021

List of references:

Plana-Ripoll O, Pedersen C, Holtz Y, et al. Exploring Comorbidity Within Mental Disorders Among a Danish National Population. JAMA Psychiatry. 2019;76(3):259. https://doi.org/10.1001/jamapsychiatry.2018.3658
Saha S, Lim C, Cannon D, et al. Co-morbidity between mood and anxiety disorders: A systematic review and meta-analysis. Depress Anxiety. 2020;38(3):286-306. https://doi.org/10.1002/da.23113
McGrath J, Lim C, Plana-Ripoll O, et al. Comorbidity within mental disorders: a comprehensive analysis based on 145 990 survey respondents from 27 countries. Epidemiol Psychiatr Sci. 2020;29. https://doi.org/10.1017/s2045796020000633
Yapici Eser H, Kacar A, Kilciksiz C, et al. Prevalence and Associated Features of Anxiety Disorder Comorbidity in Bipolar Disorder: A Meta-Analysis and Meta-Regression Study. Front Psychiatry. 2018;9. https://doi.org/10.3389/fpsyt.2018.00229
Vasil’eva SN, Simutkin GG, Schastnyj ED. Clinical-dynamic characteristics of bipolar affective disorder comorbid with mental disorders. Sibirskij Vestnik Psihiatrii i Narkologii. 2017;2(95):16-20. (In Russ.).
Ferentinos P, Preti A, Veroniki A, et al. Comorbidity of obsessive-compulsive disorder in bipolar spectrum disorders: Systematic review and meta-analysis of its prevalence. J Affect Disord. 2020;263:193-208. https://doi.org/10.1016/j.jad.2019.11.136
Pavlova B, Perlis R, Mantere O, et al. Prevalence of current anxiety disorders in people with bipolar disorder during euthymia: a meta-analysis. Psychol Med. 2016;47(6):1107-1115. https://doi.org/10.1017/s0033291716003135
Saraf G, Paul I, Viswanath B, Narayanaswamy J, Math S, Reddy Y. Bipolar disorder comorbidity in patients with a primary diagnosis of OCD. Int J Psychiatry Clin Pract. 2016;21(1):70-74. https://doi.org/10.1080/13651501.2016.1233344
ten Have M, Penninx B, Tuithof M, et al. Duration of major and minor depressive episodes and associated risk indicators in a psychiatric epidemiological cohort study of the general population. Acta Psychiatr Scand. 2017;136(3):300-312. https://doi.org/10.1111/acps.12753
van Eeden W, van Hemert A, Carlier I, et al. Neuroticism and chronicity as predictors of 9-year course of individual depressive symptoms. J Affect Disord. 2019;252:484-492. https://doi.org/10.1016/j.jad.2019.04.052
Eikelenboom M, Beekman A, Penninx B, et al. A 6-year longitudinal study of predictors for suicide attempts in major depressive disorder. Psychol Med. 2018;49(6):911-921. https://doi.org/10.1017/s0033291718001423
Petrova NN, Palkin JuR, Faddeev DV, et al. Comorbidity of depression and anxiety in clinical practice. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2021;121(4):31-37. (In Russ.). https://doi.org/10.17116/jnevro202112104131
Fountoulakis K, Grunze H, Vieta E, et al. The International College of Neuro-Psychopharmacology (CINP) treatment guidelines for Bipolar disorder in adults (CINP-BD-2017), part 3: The clinical guidelines. International Journal of Neuropsychopharmacology. 2016;pyw109. https://doi.org/10.1093/ijnp/pyw109
Fountoulakis K, Vieta E, Young A, et al. The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 4: Unmet Needs in the Treatment of Bipolar Disorder and Recommendations for Future Research. International Journal of Neuropsychopharmacology. 2016;pyw072. https://doi.org/10.1093/ijnp/pyw072
Fountoulakis K, Yatham L, Grunze H, et al. The International College of Neuro-Psychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 2: Review, Grading of the Evidence, and a Precise Algorithm. International Journal of Neuropsychopharmacology. 2016;pyw100. https://doi.org/10.1093/ijnp/pyw100
Fountoulakis K, Young A, Yatham L, et al. The International College of Neuropsychopharmacology (CINP) Treatment Guidelines for Bipolar Disorder in Adults (CINP-BD-2017), Part 1: Background and Methods of the Development of Guidelines. International Journal of Neuropsychopharmacology. 2016;pyw091. https://doi.org/10.1093/ijnp/pyw091
Masi G, Berloffa S, Mucci M, et al. A naturalistic exploratory study of obsessive-compulsive bipolar comorbidity in youth. J Affect Disord. 2018;231:21-26. https://doi.org/10.1016/j.jad.2018.01.020
Jensen RN, Csillag C, Vinberg M. Anxiety in patients with bipolar affective disorder. Ugeskr Laeger. 2021;183:V12200973.
Bokma W, Batelaan N, Hoogendoorn A, et al. A clinical staging approach to improving diagnostics in anxiety disorders: Is it the way to go? Australian & New Zealand Journal of Psychiatry. 2019;54(2):173-184. https://doi.org/10.1177/0004867419887804
Jeon S, Baek J, Yang S, et al. Exploration of comorbid obsessive-compulsive disorder in patients with bipolar disorder: The clinic-based prevalence rate, symptoms nature and clinical correlates. J Affect Disord. 2018;225:227-233. https://doi.org/10.1016/j.jad.2017.08.012
Saris I, Aghajani M, van der Werff S, et al. Social functioning in patients with depressive and anxiety disorders. Acta Psychiatr Scand. 2017;136(4):352-361. https://doi.org/10.1111/acps.12774
Difrancesco S, Lamers F, Riese H, et al. Sleep, circadian rhythm, and physical activity patterns in depressive and anxiety disorders: A 2-week ambulatory assessment study. Depress Anxiety. 2019;36(10):975-986. https://doi.org/10.1002/da.22949
Gaspersz R, Lamers F, Kent JM, et al. Longitudinal predictive validity of the DSM-5 anxious distress specifier for clinical outcomes in a large cohort of patients with major depressive disorder. J Clin Psychiatry. 2017;78(2):207-213. https://doi.org/10.4088/JCP.15m10221.
Kok A, Plaisier I, Smit J, et al. The impact of conscientiousness, mastery, and work circumstances on subsequent absenteeism in employees with and without affective disorders. BMC Psychol. 2017;5(1). https://doi.org/10.1186/s40359-017-0179-y
ter Meulen W, Draisma S, van Hemert A, et al. Depressive and anxiety disorders in concert — A synthesis of findings on comorbidity in the NESDA study. J Affect Disord. 2021;284:85-97. https://doi.org/10.1016/j.jad.2021.02.004
Anttila V, Bulik-Sullivan B, Finucane H, et al. Analysis of shared heritability in common disorders of the brain. Science (1979). 2018;360(6395). https://doi.org/10.1126/science.aap8757
Levey D, Gelernter J, Polimanti R, et al. Reproducible Genetic Risk Loci for Anxiety: Results From ~200,000 Participants in the Million Veteran Program. American Journal of Psychiatry. 2020;177(3):223-232. https://doi.org/10.1176/appi.ajp.2019.19030256
Purves K, Coleman J, Meier S, et al. A major role for common genetic variation in anxiety disorders. Mol Psychiatry. 2019;25(12):3292-3303. https://doi.org/10.1038/s41380-019-0559-1
Mazo GJe, Kas’janov ED, Nikolishin AE, et al. Family history of affective disorders, the gender factor and clinical characteristics of depression. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2021;121(5-2):75-83. (In Russ.). https://doi.org/10.17116/jnevro202112105275
Kircanski K, LeMoult J, Ordaz S, et al. Investigating the nature of co-occurring depression and anxiety: Comparing diagnostic and dimensional research approaches. J Affect Disord. 2017;216:123-135. https://doi.org/10.1016/j.jad.2016.08.006
Gerritsen L, Staufenbiel S, Penninx B, et al. Long-term glucocorticoid levels measured in hair in patients with depressive and anxiety disorders. Psychoneuroendocrinology. 2019;101:246-252. https://doi.org/10.1016/j.psyneuen.2018.11.019
Hovens J, Giltay E, Wiersma J, et al. Impact of childhood life events and trauma on the course of depressive and anxiety disorders. Acta Psychiatr Scand. 2012;126(3):198-207. https://doi.org/10.1111/j.1600-0447.2011.01828.x
van Tuijl L, Glashouwer K, Bockting C, et al. Self-Esteem Instability in Current, Remitted, Recovered, and Comorbid Depression and Anxiety. Cognit Ther Res. 2018;42(6):813-822. https://doi.org/10.1007/s10608-018-9926-5
Struijs S, Lamers F, Vroling M, et al. Approach and avoidance tendencies in depression and anxiety disorders. Psychiatry Res. 2017;256:475-481. https://doi.org/10.1016/j.psychres.2017.07.010
Stenyaeva NN, Khritinin DF. Mixed Anxiety-Depressive disorders in women in assisted reproductive technology programs. Medical Opponent. 2021;3(15):49-52. (In Russ.).
de Bles N, Rius Ottenheim N, van Hemert A. et al. Trait anger and anger attacks in relation to depressive and anxiety disorders. J Affect Disord. 2019;259:259-265. https://doi.org/10.1016/j.jad.2019.08.023
Pastuh IA, Feoktistova EV, Protopopova MA, et al. Psychological features of patients with comorbid recurrent affective and panic disorder. Sibirskij Psihologicheskij Zhurnal. 2021;80:128-145. (In Russ.). https://doi.org/10.17223/17267080/80/7
Hofmeijer-Sevink M, Batelaan N, van Megen H et al. Presence and Predictive Value of Obsessive-Compulsive Symptoms in Anxiety and Depressive Disorders. The Canadian Journal of Psychiatry. 2017;63(2):85-93. https://doi.org/10.1177/0706743717711170
Choi KW, Kim Y-K, Jeon HJ. Comorbid Anxiety and Depression: Clinical and Conceptual Consideration and Transdiagnostic. In: Anxiety Disorders. Singapore: Springer; 2020;219-235.
Kotov R, Krueger R, Watson D, et al. The Hierarchical Taxonomy of Psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology. 2017;126:4:454-477.
Waszczuk M, Kotov R, Ruggero C, et al. Hierarchical structure of emotional disorders: From individual symptoms to the spectrum. J Abnorm Psychol. 2017;126(5):613-634. https://doi.org/10.1037/abn0000264
Gaetano R, de Filippis R, Segura-Garcia C, et al. Impact of bipolar disorder and obsessive-compulsive disorder comorbidity on neurocognitive profile: a mini-review. Psychiatr Danub. 2020;32(3-4):346-350. https://doi.org/10.24869/psyd.2020.346
Amerio A, Maina G, Ghaemi S. Updates in treating comorbid bipolar disorder and obsessive-compulsive disorder: A systematic review. J Affect Disord. 2019;256:433-440. https://doi.org/10.1016/j.jad.2019.06.015
Shah J, Scott J, McGorry P, et al. Transdiagnostic clinical staging in youth mental health: a first international consensus statement. World Psychiatry. 2020;19(2):233-242. https://doi.org/10.1002/wps.20745
Groen R, Ryan O, Wigman J, et al. Comorbidity between depression and anxiety: assessing the role of bridge mental states in dynamic psychological networks. BMC Med. 2020;18(1). https://doi.org/10.1186/s12916-020-01738-z
Gladstone T, Buchholz K, Fitzgibbon M, et al. Randomized Clinical Trial of an Internet-Based Adolescent Depression Prevention Intervention in Primary Care: Internalizing Symptom Outcomes. Int J Environ Res Public Health. 2020;17(21):7736. https://doi.org/10.3390/ijerph17217736
Netto V, Flores C, Pallanti S. Pharmacological Treatment for Comorbid Bipolar Disorder and Obsessive-Compulsive Disorder in Adults. J Psychiatr Pract. 2020;26(5):383-393. https://doi.org/10.1097/pra.0000000000000499
Tsygankov BD, Agasarjan JeG, Zykova AS. Antipsychotic drugs and their influence on the carbohydrate metabolism in patients with schizophrenia-spectrum disorders. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2014;114(5):86-91. (In Russ.).
Mishin VI, Shevchuk EI, Tsygankov BD, et al. New-onset pulmonary tuberculosis patients with schizophrenia: course and efficiency of treatment. Problemy Tuberkuleza i bolezneǐ Legkikh. 2008;85(6):6-10. (In Russ.).
Khritinin DF, Sumarokova DA, Shchukina EP, et al. Osobennosti terapii antidepressantami bol’nykh shizoafektivnymi rasstroistvami v mezhpristupnom periode. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2021;142(10):81-89. (In Russ.).
van der Veen WAM, Renes JW, Kupka RW, et al. The effects of pharmacological and psychotherapeutic treatment of comorbid anxiety disorders in patients with bipolar disorder. Tijdschr Psychiatr. 2018;60(6):388-396.
Cuijpers P, Cristea I, Weitz E, et al. The effects of cognitive and behavioural therapies for anxiety disorders on depression: a meta-analysis. Psychol Med. 2016;46(16):3451-3462. https://doi.org/10.1017/s0033291716002348
Cuijpers P, Sijbrandij M, Koole S, Huibers M, Berking M, Andersson G. Psychological treatment of generalized anxiety disorder: A meta-analysis. Clin Psychol Rev. 2014;34(2):130-140. https://doi.org/10.1016/j.cpr.2014.01.002
Cuijpers P, Berking M, Andersson G, et al. A Meta-Analysis of Cognitive-Behavioural Therapy for Adult Depression, Alone and in Comparison with other Treatments. The Canadian Journal of Psychiatry. 2013;58(7):376-385. https://doi.org/10.1177/070674371305800702
Ekers D, Webster L, Van Straten A, et al. Behavioural Activation for Depression; An Update of Meta-Analysis of Effectiveness and Sub Group Analysis. PLoS One. 2014;9(6):e100100. https://doi.org/10.1371/journal.pone.0100100
Păsărelu C, Andersson G, Bergman Nordgren L, et al. Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials. Cogn Behav Ther. 2016;46(1):1-28. https://doi.org/10.1080/16506073.2016.1231219
Tsygankov BD, Yaltonskaya AV. Cognitive-behavioral group therapy for depressive disorders. Zhurnal Nevrologii i Psikhiatrii im. S.S. Korsakova. 2012;112(10):68-74. (In Russ.).

Close metadata