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Poor Treatment Outcome For Depressed Patients May Stem From Coexisting Anxiety
> 2/26/2008 1:26:05 PM

Clinically significant anxiety accompanies depression in about half of patients with major depressive disorder, and treatment for these patients may be more difficult due to the concurrent anxiety. According to one study, which was published in the American Journal of Psychiatry, patients with both depression and anxiety are less likely to benefit from antidepressant medication.

With data from the large STAR*D study, the researchers compared the treatment outcome of patients with what they called anxious depression to those with depression only. Of 2,876 participants, 52% had significant symptoms of anxiety in addition to depression. All participants took the antidepressant citalopram (Celexa). After 14 weeks, 42% of the patients with anxious depression had responded to treatment, but 53% of those with depression only had seen a response. Only 22% of those with anxious depression reached remission through treatment with the antidepressant, while 33% of those without anxiety achieved total relief from their symptoms. Not only was remission less likely for those with anxious depression, it also took longer for symptoms to subside for those who did remit, and all of these results remained significant when the researchers controlled for the severity of symptoms at the beginning of the study. After the first round of treatment, the 1,292 participants who did not achieve remission were randomly selected either to take a second antidepressant in addition to the existing one or to switch completely to another antidepressant. Again, the combination of depression and anxiety was associated with poorer treatment outcomes, regardless of whether the participant had switched to another antidepressant or added a second to augment the first.

In this study, patients with anxious depression often had other related difficulties; they were more likely to be unemployed, have less education, have lower socioeconomic standing, be suicidal, have more severe depression, and to have more comorbid disorders. Patients in this group also experienced more adverse side effects from their medication and accounted for more hospitalizations than those who were depressed but did not have anxiety. Cause and effect is a complex issue, and any these problems could contribute to anxiety and depression or stem from them. Stress caused by these difficulties may be partially responsible for the poor treatment outcomes associated with this group, but other reasons may also contribute to depression that is hard to treat and accompanied by anxiety. Future studies should investigate the factors that may underly this.

This is the largest study to date to examine the effectiveness of antidepressants for patients with depression and anxiety compared to those with depression only, and it's results illustrate the gap in treatment outcomes between these two groups. Patients with anxiety in addition to depression are less likely to respond to antidepressants or achieve remission with these medications, and identifying those most likely to have difficulties during treatment may be an important factor in effectively treating both depression and anxiety.

Comments
I am a 65 year old female living in a state of the art retirement community with my husband of 16 years. They boast of over 1000 clubs and activities to choose from. I find myself uninterested in most of them and cannot find joy in my daily activities. I am hypothyroid since age 13 and have suffered with this most of my 65 years. I have just been diagnosed with anxious depression although I have been depressed for as long as I can remember. I was dyslexic in school and teased and ridiculed for being so. ONce dyslexic, always dyslexic and some of these taunting behaviors are coming back to me from my peers at age 65. You are not good enough to walk to school with us now has become you are not good enough to play golf with us. this year has been the worst in declining health for me. suddenly after my 65 birthday, my health declined, my antidepressant paxil quit working and I tried to commit suicide by inhaling exhaust fumes for two hours while my husband played golf. I was baker acted and sent to a state run hospital for five days. It was truly the most awful experience of my life. I am currently being treated for anxious depression at an wonderful outpatient facility in Ocala Fl. I was recently diagnosed with anxious depression by a psychiatrist who specializes in the elderly population. Reading this article further depresses me as it is impossible for me to get rid of negative thought patterns in my daily life. I have received excellent therapy at this treatment facility for one week and even cried for the first time in 16 or more years. Today, I felt hopeless about getting better in the future and felt my own pronosis was poor. I asked my therapist how long my treatment would be and she said, a long time as my suicide attempt was very severe. I have lost most of my friends due to this illness, but my husband is my rock of support. He ran a residential treatment facility for combat veterans in California after having been diagnosed with PTSD himself. After reading this article I am disheartened to find that treating patients like myself is not very easy and their prognosis is not good. What help can you give me. I am currently taking celexa after being on Paxil for a number of years. I do believe the paxil contributed to my suicide attempt when it quit working.

Posted by: Phyllis Bartolo 3/14/2008 5:29:09 AM