Effects of Co-Occurring Depression on Treatment for Anxiety Disorders: Analysis of Outcomes From a Large Primary Care Effectiveness Trial

Department of Psychiatry, University of California, San Diego, 8939 Villa La Jolla Drive, Ste 200, La Jolla, CA 92037 .
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 12/2012; 73(12):1509-16. DOI: 10.4088/JCP.12m07955
Source: PubMed


Co-occurring depression is common in patients seeking treatment for anxiety; however, the literature on the effects of depression on anxiety treatment outcomes is inconclusive. The current study evaluated prescriptive and prognostic effects of depression on anxiety treatment outcomes in a large primary care sample.
Data were analyzed from a randomized controlled effectiveness trial that compared coordinated anxiety learning and management (CALM) to usual care. The study enrolled 1,004 patients between June 2006 and April 2008. Patients were referred by their primary care provider and met DSM-IV criteria for generalized anxiety disorder, panic disorder, posttraumatic stress disorder, and/or social anxiety disorder. They were treated for approximately 3 to 12 months with CALM (computer-assisted cognitive-behavioral therapy, medication management, or their combination) or usual care. Outcomes were evaluated by blinded assessment at 6, 12, and 18 months. Effects of baseline major depressive disorder (MDD) on anxiety symptoms, anxiety-related disability, and response/remission rates were evaluated using statistical models accounting for baseline anxiety and patient demographics.
MDD did not moderate the effects of CALM (relative to usual care) on anxiety symptoms, anxiety-related disability, or response/remission rates. Greater improvements in anxiety symptoms and anxiety-related disability were observed in depressed patients, regardless of treatment assignment (P values < .005). However, cross-sectionally depressed patients displayed higher anxiety symptom and anxiety-related disability scores at baseline and all subsequent assessments (P values < .001). Depressed patients also displayed lower remission rates at each follow-up (P values < .001).
CALM had comparable advantages over usual care for patients with and without MDD. Depressed patients displayed more severe anxiety symptoms and anxiety-related disability at baseline, but their clinical improvement was substantial and larger in magnitude than that observed in the nondepressed patients. Results support the use of empirically supported interventions for anxiety disorders in patients with co-occurring depression. identifier: NCT00347269.

1 Follower
17 Reads
  • Source
    • "Our findings are in line with several prior studies reporting that depressive symptoms do not hinder the effectiveness of CBT for SAD (Erwin et al., 2002; Joormann et al., 2005; Turner et al., 1996; Van Velzen et al., 1997). Similarly, the current results are consistent with the findings of a large randomized controlled trial (N ¼ 1004) which showed that although comorbid depression was associated with starting and ending treatment with more severe anxiety symptoms in a sample of individuals with mixed anxiety disorders 2 , co-occurring depression did not interfere with the magnitude of gains from computerized CBT, medication management, or both (Campbell-Sills et al., 2012). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Major depressive disorder (MDD) and bipolar disorder (BD) commonly co-occur in individuals with social anxiety disorder (SAD), yet whether these comorbidities influence the outcomes of cognitive behavioral therapy (CBT) for SAD is unclear. The present study examined the degree to which individuals with SAD and comorbid MDD (SAD+MDD; n=76), comorbid BD (SAD+BD; n=19), a comorbid anxiety disorder (SAD+ANX; n=27), or no comorbid diagnoses (SAD+NCO; n=41) benefitted from CBT for SAD. Individuals were screened using the Structured Clinical Interview for DSM-IV and then completed the Social Phobia Inventory and the Depression Anxiety Stress Scales before and after 12-weeks of group CBT for SAD. At pretreatment the SAD+MDD and SAD+BD groups reported higher social anxiety symptoms than the SAD+ANX and SAD+NCO groups. All groups reported large and significant improvement in social anxiety with CBT. However, at posttreatment the SAD+MDD and SAD+BD groups continued to have higher social anxiety symptoms than the SAD+NCO group, and the SAD+ANX group did not differ in social anxiety symptoms from any group. The sample also showed small and statistically significant improvement in depressive symptoms with CBT for SAD. Information about medication was not collected in the present study, and we did not assess the long-term effects of CBT. Our results suggest that CBT for SAD is an effective treatment even in the presence of comorbid mood disorders in the short-term, although extending the course of treatment may be helpful for this population and should be investigated in future research.
    Journal of Affective Disorders 06/2014; 162:61-6. DOI:10.1016/j.jad.2014.03.015 · 3.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Test anxiety, although being a very common, severe, and impairing psychological disorder, is not coded as a separate diagnosis in the DSM or ICD. In the present study we investigated whether the Test Anxiety Inventory can be used to discriminate clinical and subclinical levels of test anxiety by comparing patients who seek treatment for their test anxiety in an outpatient clinic with carefully matched students with normal test anxiety. The data from 47 test-anxious patients as well as 41 healthy university students were examined. Results show that a cutoff score of ≥80 in the Test Anxiety Inventory can discriminate the clinical group from the control students. The symptom pattern of test anxiety was very consistent in the clinical group regardless of the principal diagnosis allocated by the treating clinician. Comorbid depression did not affect the severity of test anxiety. The motivation to avoid failure was one of the most important differences between patients who sought help for their test anxiety and students with nonclinical levels of test anxiety.
    Behavior therapy 03/2014; 45(2):222-31. DOI:10.1016/j.beth.2013.11.001 · 3.69 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Depression and social anxiety disorder (SAD) are two of the most common mental health conditions, and often occur together. Depression is usually identified as the presenting problem, which may result in SAD being overshadowed and undertreated among those with this particular comorbidity. In this case study, diagnostic overshadowing results in successful treatment of depression but delayed identification of SAD, causing an attenuated anxiety treatment response. We present recommendations on how clinicians may more thoroughly assess for comorbid Axis I diagnoses, avoid diagnostic overshadowing, and better integrate treatment approaches for SAD-major depressive disorder (MDD) comorbidity. Mechanisms underlying cognitive-behavioral treatments such as behavioral activation and exposure hold particular promise for promoting improvement in SAD and major depression simultaneously.
    Clinical Case Studies 06/2014; 13(3):265-281. DOI:10.1177/1534650113508220
Show more