Is generalized anxiety disorder an anxiety or mood disorder? Considering multiple factors as we ponder the fate of GAD

Depression and Anxiety (Impact Factor: 4.41). 04/2008; 25(4):289 - 299. DOI: 10.1002/da.20493
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Generalized anxiety disorder (GAD) and major depressive disorder (MDD) demonstrate a strong relationship to each other at both genotypic and phenotypic levels, and both demonstrate substantial loadings on a higher-order negative affectivity factor [see Watson, 2005: J Abnorm Psychol 114:522–536]. On the basis of these findings, there have been a number of calls to reclassify GAD in the same category as MDD (the “distress disorders”). However, any consideration of the reclassification of GAD should also take into account a number of other factors not only related to GAD and MDD but also to the overlap of these disorders with other anxiety and mood disorders. First, GAD has established reliability and validity in its own right, and specific features (e.g., worry) may become obscured by attempts at reclassification. Second, examination of the nature of the overlap of GAD and MDD with each other and with other disorders suggests a more complex pattern of differences between these conditions than has been suggested (e.g., MDD has strong relationships with other anxiety disorders, and GAD may be more strongly related to fear than it may first appear). Third, although findings suggest that GAD and MDD may have overlapping heritable characteristics, other evidence suggests that the two disorders may be distinguished by both environmental factors and temporal presentations. Finally, although overlap between GAD and MDD is reflected in their relationships to negative affectivity, temporal relationships between these disorders may be demonstrated by functional changes in emotional responsivity. Depression and Anxiety 25:289–299, 2008. © 2008 Wiley-Liss, Inc.

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    • "As such, it remains possible that the presence of generalized anxiety with pervasive worry causes demoralization which is more likely to lead to depression as a separate disorder, than is the more episodic phenomenon of panic attacks experienced in panic disorder. Whether or not GAD and depression are truly separate disorders (Mennin et al. 2008), our study suggests that late adolescence is a period where GAD symptoms are common and are linked to an increased prevalence of depression subsequently. It is important to recognize the developmental context: the period from age 15 to 18 years is when the sharpest rise in the incidence of depression is observed, a disorder that has huge public health importance. "
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    ABSTRACT: Generalized anxiety disorder (GAD) and panic disorder (PD) differ in their biology and co-morbidities. We hypothesized that GAD but not PD symptoms at the age of 15 years are associated with depression diagnosis at 18 years. Using longitudinal data from the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort we examined relationships of GAD and PD symptoms (measured by the Development and Well-Being Assessment) at 15 years with depression at 18 years (by the Clinical Interview Schedule - Revised) using logistic regression. We excluded adolescents already depressed at 15 years and adjusted for social class, maternal education, birth order, gender, alcohol intake and smoking. We repeated these analyses following multiple imputation for missing data. In the sample with complete data (n = 2835), high and moderate GAD symptoms in adolescents not depressed at 15 years were associated with increased risk of depression at 18 years both in unadjusted analyses and adjusting for PD symptoms at 15 years and the above potential confounders. The adjusted odds ratio (OR) for depression at 18 years in adolescents with high relative to low GAD scores was 5.2 [95% confidence interval (CI) 3.0-9.1, overall p < 0.0001]. There were no associations between PD symptoms and depression at 18 years in any model (high relative to low PD scores, adjusted OR = 1.3, 95% CI 0.3-4.8, overall p = 0.737). Missing data imputation strengthened the relationship of GAD symptoms with depression (high relative to low GAD scores, OR = 6.2, 95% CI 3.9-9.9) but those for PD became weaker. Symptoms of GAD but not PD at 15 years are associated with depression at 18 years. Clinicians should be aware that adolescents with GAD symptoms may develop depression.
    Psychological Medicine 08/2015; -1:1-13. DOI:10.1017/S003329171500149X · 5.94 Impact Factor
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    • "Additionally, heterotypic continuity also indicates an overlap between them, as proposed by transdiagnostic theories (Insel et al. 2010; Wilamowska et al. 2010). Furthermore, there are developmental differences in the phenotypic and genetic relationship between depression and different anxiety disorders (Axelson & Birmaher, 2001; Bergen et al. 2007; Moffitt et al. 2007; Goldberg, 2008; Hettema, 2008; Mennin et al. 2008; Beesdo et al. 2009, 2010; Waszczuk et al. 2014). For example, we recently found age differences in phenotypic and genetic overlap between depression and a range of anxiety symptoms, with the association between these symptoms increasing markedly from adolescence, indicating developmentally dynamic etiology of internalizing problems (Waszczuk et al. 2014). "
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    ABSTRACT: Depression and anxiety persist within and across diagnostic boundaries. The manner in which common v. disorder-specific genetic and environmental influences operate across development to maintain internalizing disorders and their co-morbidity is unclear. This paper investigates the stability and change of etiological influences on depression, panic, generalized, separation and social anxiety symptoms, and their co-occurrence, across adolescence and young adulthood. A total of 2619 twins/siblings prospectively reported symptoms of depression and anxiety at mean ages 15, 17 and 20 years. Each symptom scale showed a similar pattern of moderate continuity across development, largely underpinned by genetic stability. New genetic influences contributing to change in the developmental course of the symptoms emerged at each time point. All symptom scales correlated moderately with one another over time. Genetic influences, both stable and time-specific, overlapped considerably between the scales. Non-shared environmental influences were largely time- and symptom-specific, but some contributed moderately to the stability of depression and anxiety symptom scales. These stable, longitudinal environmental influences were highly correlated between the symptoms. The results highlight both stable and dynamic etiology of depression and anxiety symptom scales. They provide preliminary evidence that stable as well as newly emerging genes contribute to the co-morbidity between depression and anxiety across adolescence and young adulthood. Conversely, environmental influences are largely time-specific and contribute to change in symptoms over time. The results inform molecular genetics research and transdiagnostic treatment and prevention approaches.
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    • "Although this overlap is well documented, and has been intensively reviewed (First, 2007), the relationship between GAD and mood disorders is complex. GAD has been shown to have a number of core, unique features (e.g., worry and fear of uncertainty) validating its separate diagnosis as an anxiety disorder (Mennin et al., 2008). We recruited lay people as a comparison sample to determine whether the proposed visual causal model presentation was as effective for mental health patients as for lay people. "
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