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Depressed or anxious?
Anxiety and depressive disorders are leading causes of disability in the world.1 Anxiety is a large problem on its own, and compounds the problems related to depression. In this workshop, two leading international speakers (Prof Guy Goodwin, UK and Prof Dan Stein, South Africa) discussed these two conditions and the relationships between them.
Anxiety and its treatment
Generalized Anxiety Disorder (GAD) is obviously associated with excessive anxiety and worries, but also with physical symptoms. Patients therefore often present in primary care with a variety of symptoms such as fatigue or lack of concentration, making the diagnosis less clear. GAD is highly comorbid with depression, as well as other conditions. The onset of GAD also often precedes that of depression, so treating anxiety at an early stage may help prevent the development of depression.2 Common pharmacological interventions are associated with increased quality of life in patients with GAD, as well as symptom reductions. Psychoeducation can also be combined with pharmacotherapy to enhance these results.3 These treatment strategies are reflected in treatment guidelines.4
Anxiety and depression
The association between anxiety and depression has been demonstrated in twin studies, showing a strong association of genetic factors between depression and anxiety.5 However, there has traditionally been a hierarchy in the two diagnoses, in which depression is considered the more important condition. Thus, controversially in the DSM 5, there are no references to anxiety in the diagnostic criteria for major depressive disorder – there is only the specifier of anxious depression. This means there may be little attention to the presence of anxiety in patients with depression, an omission that is reflected in the lack of treatment guidelines specifically for anxious depression.
The hierarchy of diagnosis may mean less attention is paid to anxiety in patients with depression
Is treatment of depression also treatment of anxiety?
In clinical practice, treatment of depression also produces reductions in patients’ symptoms of anxiety.6 However, in the absence of a formal diagnosis of anxious depression, information is lacking on how patients with symptoms of both anxiety and depression may differ in their response to treatment from those with depression only. In the future, it will be important that clinicians screen for the presence of anxiety in patients with major depressive disorder, both to ascertain the scale of anxious depression and to assess its response to treatment.
In patients with depression and anxiety, antidepressant therapy typically also relieves their symptoms of anxiety
Supported by Educational Financial Support from Servier.
Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.
References
- https://www.who.int/healthinfo/global_burden_disease/en/
- Alonso J et al. Depress Anxiety 2018;35(3):195–208.
- Hofmann SG et al. Int J Cogn Ther 2009;2(2):160–175.
- Baldwin DS et al. J Psychopharmacol 2014;28(5):403–39.
- Kendler KS. British J Psychiatry 1996;168(Suppl 30):68–75.
- Lewis G et al. Lancet Psychiatry 2019;6(11):903–14