Psychiatria pre prax 2/2013

Depression in anxiety disorders

The co-occurrence of depression and anxiety can be perceived as a depressive episode with prominent anxiety symptoms (anxious depression) or as comorbid anxiety and depression. Furthermore, there is a question whether anxious depression represents an individual category. Some preclinical and clinical studies suggest that anxious depression has certain specific features. Anxious depression is associated with a worse outcome, chronicity, and poor treatment response. Concerning the treatment in both depressive and anxiety disorders, the first and second choice drugs are antidepressants with preference for newer antidepressants such as SSRIs and SNRIs. In nonresponding patients, augmentation with atypical antipsychotics comes to the fore. Some patients with anxious depression need a lower starting dose, slower escalation, a higher end dose, and a longer duration of treatment and/or augmentation.

Keywords: comorbidity, anxious depression, antidepressants, atypical antipsychotics.