Does comorbid subthreshold anxiety affect clinical presentation and treatment response in depression? A preliminary 12-month naturalistic study

Abstract

The aim of this study was to evaluate the effects of comorbid subthreshold anxiety on the course and the treatment of Depressive Disorders. The sample studied comprised four groups defined by the DSM-IV Axis I diagnosis: (1) Patients with a Major Depressive Disorder (MDD) and an Anxiety Disorder (DA); (2) patients with MDD and a subthreshold Anxiety Disorder (Da); (3) patients with subthreshold depression and an Anxiety Disorder (dA); (4) patients with subthreshold depression and subthreshold anxiety (da). HAMD, HAMA and CGI rating scales were administered monthly for 12 months while patients were treated with different antidepressants. Significant differences were found among the four groups with respect to the baseline depressive symptoms: Da presented more frequently suicidal ideation (chi2=9.568, d.f.=3, p=0.023), psychomotor retardation (chi2=12.568, d.f.=3, p=0.006), sexual dysfunctions (chi2=7.761, d.f.=3, p=0.05), hypochondriacal ideation (chi2=13.633, d.f.=3, p=0.003), weight loss (chi2=9.520, d.f.=3, p=0.023), and diurnal variation of symptoms (chi2=13.258, d.f.=3, p=0.004). With respect to the treatment response Da patients showed an overall worse response to antidepressants, having a longer latency and a lower reduction of symptoms. These results suggest that patients with Major Depression and subthreshold anxiety present with a more severe baseline clinical picture and seem to have a less efficient response to antidepressants.

Comprehensive Review of Factors Implicated in the Heterogeneity of Response in Depression

“…Anxious depression was associated with poorer acute outcomes than nonanxious depression, and remission was significantly less likely to occur among these patients . In another Level‐2 study, patients with depression and a subthreshold anxiety disorder showed an overall worse response to antidepressants, with a longer latency and less reduction of symptoms …”

Antidepressant Adherence and Medical Resource Use Among Managed Care Patients With Anxiety Disorders

“…The nature and cause of poor medication adherence have been primarily linked to a high incidence of medication-related adverse events, which is also one of the main reasons for a change in therapy (10,28,29). A possible explanation for this finding may be that patients with comorbid anxiety and depression commonly have more severe symptoms and a poorer outcome than patients without comorbid depression and may thus require more aggressive treatment (30,31). A possible explanation for this finding may be that patients with comorbid anxiety and depression commonly have more severe symptoms and a poorer outcome than patients without comorbid depression and may thus require more aggressive treatment (30,31).…”

Neurobiology of Anxious Depression: A Review

“…The large, multi‐center Sequenced Treatment Alternatives to Relieve Depression study (STAR*D) found that demographically, individuals with anxious depression are more likely to be older, unemployed, and less educated . Furthermore, some studies have shown that those with anxious depression have poorer response to antidepressants, including significantly lower response and remission rates, more frequent and intense side effects, and more serious adverse events, despite medication changes or augmentation techniques …”