Depression and Comorbid Anxiety: An Overview of Pharmacological Options

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Educational Objectives

After reading this article, you will be familiar with:

• Ways to recognize and assess comorbid depression and anxiety
• Pharmacological treatment approaches
• Treatment for comorbidity of depression and specific anxiety disorders

Who will benefit from reading this article?
Psychiatrists, psychologists, primary care physicians, nurse practitioners, and other health care professionals. To determine whether this article meets the continuing education requirements of your specialty, please contact your state licensing and certification boards.

Although depressive and anxiety disorders are classified as distinct groups of illnesses, studies document their frequent co-occurrence and provide evidence of a common biological substrate and a shared vulnerability.¹ Comorbid depression and anxiety disorders are most frequently seen in primary care and in the general community, and the prevalence of comorbidity has been estimated to be as high as 10% to 20%.¹ The comorbid­ity of depression and anxiety tends to have an earlier age of onset, increased severity of illness, more functional impairment, and poorer outcome (including greater risk of suicide) than does depression or anxiety alone.² Research data and clinical experience suggest that depression comorbid with anxiety disorders may show less robust response to both pharmacotherapy and psychosocial interventions and may lead to more residual symptoms and increased vulnerability to relapse.^3,4

General guidelines
Early recognition is an important first step in the management of depression with comorbid anxiety. Co-occurrence may take several forms. Depression may be present comorbidly with one or more anxiety disorders. Alternatively, the depression may be primary, with significant anxiety symptoms that do not meet criteria for a disorder (subsyndromal anxiety). Many patients may also present with an equal admixture of depressive and anxiety symptoms, neither of which meets criteria for full disorders (mixed depression-anxiety). Thus, the assessment of patients with depression should explore the presence of subsyndromal anxiety symptoms and mixed depression-anxiety, as well as specific anxiety disorders.

Several easy-to-use self-rated scales are available for monitoring symptoms:

• Depression Anxiety Stress Scale (42-item or shorter 21-item)

• Beck Depression Inventory

• Beck Anxiety Inventory

• Yale-Brown Obsessive Compulsive Scale