Defining anxious depression: a review of the literature

Abstract

The diagnosis of anxious depression is presently inconsistent. The many different definitions of anxious depression have complicated its diagnosis, leading to clinical confusion and inconsistencies in the literature. This paper reviewed the extant literature in order to identify the varying definitions of anxious depression, which were then compared using Feighner’s diagnostic criteria. Notably, these suggest a different clinical picture of patients with anxious depression. For instance, relying on ICD-10 or DSM diagnoses yields a clinical picture of a comparatively mild or transient disorder; in contrast, using dimensional criteria such as DSM criteria combined with additional rating scales—most commonly the anxiety somatization factor score from the Hamilton Depression Rating Scale (HAM-D)—yields a more serious clinical picture. The evidence reviewed here suggests that defining anxious depression in a dimensional manner may be the most useful and clinically relevant way of differentiating it from other types of mood and anxiety disorders, and of highlighting the most clinically significant differences between patients with anxious depression versus depression or anxiety alone.

Recognition of emotional facial expressions in anxious and nonanxious depression

“…Future studies in individuals with primary anxiety disorder diagnoses are needed in order to understand how anxiety may influence emotion recognition. Second, use of the HAM-D anxiety-somatization factor score is only one way to define anxious and nonanxious depression [3]. Information about psychiatric comorbidity in the present MDD sample was not available, so any potential effects of comorbidities on task performance are unknown.…”

“…Anxious depression is a clinically significant subtype of major depressive disorder (MDD) [1-3]. Analyses of a large sample of outpatients with MDD from the Sequenced Treatment Alternatives to Relieve Depression project (STAR*D [1]) defined anxious depression as MDD with co-occurring anxiety symptoms as measured by anxiety-somatization items on the Hamilton Depression Rating Scale (HAM-D [4]).…”

“…Analyses of a large sample of outpatients with MDD from the Sequenced Treatment Alternatives to Relieve Depression project (STAR*D [1]) defined anxious depression as MDD with co-occurring anxiety symptoms as measured by anxiety-somatization items on the Hamilton Depression Rating Scale (HAM-D [4]). Working from this definition, the STAR-D analyses found: 1) that about half of individuals with MDD have anxious depression, and 2) that anxious depression is associated with a unique demographic and clinical profile, comprising higher unemployment, lower levels of education, more melancholic features, greater severity of illness, and greater suicidal ideation than nonanxious depression [1-3]. Anxious depression is also characterized by poorer response to both psychopharmacologic and cognitive-behavioral treatment [5, 6].…”

Cortical thickness and subcortical structure volume abnormalities in patients with major depression with and without anxious symptoms

“…The the anxious depression subgroup included 23 MDD patients with a score of ≥7 on the anxiety/somatization factor score of HAM-D 17 (Ionescu, Niciu, Henter, & Zarate, 2013;, and the nonanxious subgroup who had a score of <7 on the HAM-D 17 scale.…”

Ziprasidone augmentation for anxious depression

“…(Fava et al, 2004, Ionescu et al, 2013) Up to 50% of patients with depression may meet criteria for “anxious” depression, representing a large portion of depressed patients. Anxious depression subtype is also over-represented among patients with treatment-resistant depression (TRD)—representing a large treatment challenge for clinicians.…”