Comorbid Depression And Anxiety: When And How To Treat ?
Q: Anxiety and depression are distinct disorders commonly seen in
clinical practice, particularly in the primary care setting. Comorbid
or mixed disorders are also encountered so frequently that a
diagnostic category of "mixed anxiety-depressive disorder" appears in
the appendix of the Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition (DSM-IV).
A:It is crucial for clinicians to recognize both anxiety and depression
early in the clinical course and institute appropriate therapy aimed
at making the patient well (ie, achieving full remission) rather than
merely improving symptoms. Patients with comorbid anxiety and
depression tend to discontinue treatment earlier than those with
depression alone, and they may not respond as robustly to conventional
treatments.
Depression was once postulated to result from dysregulation of the
noradrenergic system alone. Hence, the pathophysiology focused on
levels of norepinephrine and noradrenergic dysfunction.
With the
introduction of the selective serotonin reuptake inhibitors (SSRIs),
attention shifted to the role of serotonin in depression. The exact
mechanisms underlying depression, however, are more complex than