What clinical and symptom features and comorbid disorders characterize outpatients with anxious major depressive disorder: A replication and extension

Massachusetts General Hospital, Boston, Harvard Medical School, MA 02114, USA.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.41). 12/2006; 51(13):823-35.
Source: PubMed

ABSTRACT We previously found that 46% of the first 1450 outpatients with depression participating in the multicentre Sequenced Treatment Alternatives to Relieve Depression (STAR*D) project qualified for the designation of anxious depression. This study was designed to replicate and extend our initial findings in a subsequent, larger cohort of outpatient STAR*D participants with nonpsychotic major depressive disorder (MDD).
Baseline clinical and sociodemographic data were collected on 2337 consecutive STAR*D participants. A baseline 17-item Hamilton Depression Rating Scale Anxiety-Somatization factor score of 7 or higher was designated as anxious depression. We identified concurrent Axis I disorders with the Psychiatric Diagnostic Screening Questionnaire (PDSQ), using a 90% specificity threshold. Depressive symptoms were assessed by clinical telephone interview with the 30-item Inventory of Depressive Symptomatology-Clinician-Rated (IDS-C30).
The prevalence of anxious depression in this population was 45.1%. Patients with anxious MDD were significantly more likely to be in primary care settings and to be women, nonsingle, unemployed, Hispanic, less educated, and suffering from severe depression, both before and after adjustment for overall depression severity. Patients with anxious depression were significantly more likely to meet PDSQ thresholds for generalized anxiety disorder, panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder, agoraphobia, hypochondriasis, and somatoform disorder, both before and after adjusting for baseline depression severity. Individuals with anxious depression were also significantly less likely to endorse IDS-C30 items concerning atypical features and were significantly more likely to endorse items concerning melancholic-endogenous depression features, both before and after adjusting for baseline depression severity.
This study clearly replicates our previous STAR*D findings and supports the notion that anxious depression may be a valid diagnostic subtype of MDD, with distinct psychiatric comorbidities and clinical and sociodemographic features.

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    • "Anxious depression is associated with more severe depressive symptoms, greater duration of current episode, suicidal ideation and history of suicide attempt, and more medical comorbidities (Rao and Zisook, 2009). Patients with both depressive and anxiety symptoms are less likely to achieve treatment response or remission (Fava et al., 2008; Kennedy, 2008), more likely to have delayed treatment response (Clayton et al., 1991), and are more likely to report adverse events during antidepressant treatment, including bursts of anxiety or agitation (Fava et al., 2006). Residual anxiety symptoms are also associated with an increased risk of MDD relapse (Ramana et al., 1995; Flint and Rifat, 1997). "
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    ABSTRACT: Anxiety symptoms are prevalent in patients with major depressive disorder. A post-hoc analysis of two phase III trials was conducted to evaluate the efficacy of vilazodone on depression-related anxiety. Using the 17-item Hamilton Depression Rating Scale (HAMD17) Anxiety/Somatization subscale, patients were classified as anxious or nonanxious. Improvements in depressive symptoms were based on least squares mean changes in HAMD17 and Montgomery-Asberg Depression Rating Scale total scores. Anxiety symptoms in the anxious subgroup were evaluated using Hamilton Anxiety Rating Scale (HAMA) total and subscale (Psychic Anxiety, Somatic Anxiety) scores, HAMD17 Anxiety/Somatization subscale and item (Psychic Anxiety, Somatic Anxiety) scores, and the Montgomery-Asberg Depression Rating Scale Inner Tension item score. Most of the pooled study population [82.0% (708/863)] was classified with anxious depression. After 8 weeks of treatment, least squares mean differences between vilazodone and placebo for changes in HAMA total and HAMD17 Anxiety/Somatization subscale scores were -1.82 (95% confidence interval -2.81 to -0.83; P<0.001) and -0.75 (95% confidence interval -1.17 to -0.32; P<0.001), respectively. Statistically significant improvements with vilazodone were also found on all other anxiety-related measures, except the HAMA Somatic Anxiety subscale. Vilazodone may be effective in treating patients with major depressive disorder who exhibit somatic and/or psychic symptoms of anxiety.
    International Clinical Psychopharmacology 06/2014; 29(6). DOI:10.1097/YIC.0000000000000045 · 3.10 Impact Factor
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    • "In STAR*D (Rush et al., 2006) the subgroup of patients with anxious depression, defined by a score ≥7 on the anxiety/somatisation factor of the Hamilton Depression Rating Scale (Cleary and Guy, 1977), were less likely to respond, had a longer time to remission and were more intolerant to pharmacological treatment (side effect frequency , intensity and burden) than depressed patients without anxious depression (Fava et al., 2008). Furthermore, patients with features of anxious depression were different to depressed patients without anxious symptoms regarding sociodemographic characteristics such as gender, age, educational and family status (Fava et al., 2006). They were more likely to have a later onset of depression, a lower school education and more often lived alone. "
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    ABSTRACT: BACKGROUND: Anxious depression (AD) is common in patients with unipolar depression. It remains unclear if they have a higher level of depressive symptoms, a higher risk of non-response, a poorer prognosis and a higher relapse rate compared to non-anxious depressed (non-AD) patients. METHODS: 168 patients took part in all three measurement points: (1) intake, (2) discharge and (3) follow-up. Patients fulfilled the criteria for anxious depression if they had a baseline score >7 on the anxiety/somatisation factor of the Hamilton Rating Scale for Depression (HRSD). Patients with AD and non-AD were compared regarding symptom reduction from intake to discharge as well as from discharge to one year after discharge. Primary outcome measure was the HRSD. RESULTS: The prevalence of AD was considerably high (81%). At intake, patients with AD had a significant higher score in the modified HRSD (M=20.67±4.12 vs. M=14.35±5.06). Both patient groups showed a significant and comparable intake-to-discharge symptom reduction in all inventories. Remission rates at discharge did not differ between AD and non-AD patients. At 1-year follow-up, AD patients showed a similar symptom severity compared to non-AD patients. CONCLUSION: Symptoms of anxiety are common in depressive disorders are associated with higher depressive symptoms at the beginning of treatment. Acute and longer-term treatment outcome of AD patients was comparable to that of non-AD patients. LIMITATIONS: Limitations of this study are the naturalistic design, treatment was not standardized and comorbid anxiety disorders were not assed using a structured interview.
    Journal of Affective Disorders 06/2013; 150(3). DOI:10.1016/j.jad.2013.05.043 · 3.71 Impact Factor
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    • "Two approaches are used to define anxious depression: the dimensional approach defined as a high degree of anxiety symptom severity or the syndromal approach defined by the presence of a comorbid anxiety disorder. Controversy exists on which assessment approach best captures anxious depression (Silverstone and von Studnitz, 2003), although there is probably a substantial overlap between the two forms (Fava et al., 2006). "
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    ABSTRACT: BACKGROUND: A secondary analysis was conducted to compare treatment outcomes for anxious depression and nonanxious depression in previous published OPERATION trials of a variety of antidepressants and augmentation strategies for patients with treatment-resistant depression (TRD). METHODS: A total of 375 patients that met DSM-IV criteria for major depressive disorder (MDD) and the stage 2 TRD criteria (described by Thase & Rush) were enrolled. Anxious depression was defined as MDD with a HRSD-17 anxiety/somatization factor score ≥7. Data were derived from an earlier study, designed to compare efficacy and tolerability of fixed dosage of extended-release venlafaxine, mitazapine, paroxetine, and risperidone, sodium valproate, buspirone, trazodone or thyroid hormone augmenting to paroxetine in those patients. Treatment outcomes were compared between patients with anxious and nonanxious TRD. RESULTS: Nearly 70% of participants had anxious depression. Remission rates were significantly lower and ratings of adverse event frequency were significantly greater in patients with anxious TRD than in those with nonanxious TRD. Presence of anxious depression predicted worse outcomes. LIMITATIONS: Lack of a placebo control arm prevents us from ruling out placebo effects. The two groups were non-randomly allocated to medications. Only patients with stage 2 TRD were enrolled, which may limit generalizablity to patients without a history of resistance. Comorbid anxiety disorders that might confound the specific treatment effects were not addressed. CONCLUSIONS: The findings support and extend the hypothesis that anxious depression is associated with poorer outcomes. It suggests a dimensional assessment of co-occurring anxious features of MDD patients may be clinically feasible for countries like China where difficulties in making comorbidity diagnosis exist.
    Journal of Affective Disorders 04/2013; 150(3). DOI:10.1016/j.jad.2013.03.012 · 3.71 Impact Factor
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