Options for Patients with Comorbid Depression and Anxiety

Depression and Anxiety are Often Comorbid

depression and anxietyDepressive and anxiety disorders may be distinct, but their co-occurrence is common—10 to 20 percent common—due to their common biological substrates and shared vulnerability.[1] In fact, the comorbidity often has a lower age of onset, increased severity, more functional impairment, and a poorer outcome than depression or anxiety alone.1 Patients who suffer from this comorbidity often respond poorer to both pharmacotherapy and psychotherapy interventions.1

Therefore, the first step to a better outcome is early recognition. Either disorder could be primary with the other as a secondary—it depends upon the patient and the symptoms they present.1 There are several self-rated scales available for clinicians to monitor symptoms: Depression Anxiety Stress Scale, Beck Depression Inventory, Beck Anxiety Inventory, and the Yale-Brown Obsessive Compulsive Scale.1 The onset and course of the patient’s symptoms, as well as the influence of any stressors, help to formulate a proper diagnosis and management plan. The clinician will often take into account the cost of available treatments, the presence of other comorbid conditions (if any), and past or family history of treatment and the general response to it.1 It is important for the clinician to give the patient a clear overview of their diagnosed disorder and what the best treatment path for them will be.1

Medicines to Treat Both Depression and Anxiety

There have been many psychotropic agents investigated for the treatment of both depression and anxiety separately. Together, few trials have been completed, making the choice difficult and, unfortunately, more of a process of trial and error. For antidepressants, selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) are most commonly used for treatment due to their few side effects and overall agreeability with most.1 However, they also appear somewhat effective with decreasing anxiety. Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) are not used as often, as they have a higher frequency of adverse effects, drug-to-drug reactions, and dietary restrictions.1

Buspirone, a serotonin partial agonist, is approved for the treatment of generalized anxiety disorder (GAD), but it may also have useful antidepressant effects.1 It is also well-tolerated, making it a possible treatment choice.1

Antipsychotics are also often thought of as a possible treatment, as several—such as haloperidol, pimozide, and loxapine—have shown a degree of efficacy in treating both depression and anxiety.1 However, they are also known to worsen depression at times and have several burdensome adverse effects that limit their use.1

Benzodiazepines are often used to treat anxiety disorders, such as panic; however, they have also shown some improvement in mild depression.1 Unfortunately, this class of medicine is extremely addictive and habit-forming; therefore, it should not be a clinician’s first choice.1

More Studies Needed Regarding Comorbid Depression and Anxiety

In conclusion, comorbid anxiety and depression is a common occurrence. While most antidepressants have shown to have anxiolytic properties, and SSRIs and SNRIs continue to be the first line treatments, few studies have actually assessed their anxiolytic effectiveness.1 Short-term benzodiazepine use may also be implemented, to hold the patient over until their antidepressant begins to work at its full potential, but long-term use is not suggested.1

[1] Ravindran, A. V., & Ravindran, L. N. (2009, June 10). Depression and Comorbid Anxiety: An Overview of Pharmacological Options. Psychiatric Times. Retrieved April 16, 2013, from http://www.psychiatrictimes.com/mdd/content/article/10168/1421225


  • Thurman

    November 5, 2013, 5:46 am

    Thanks for talking about Options for Patients with Comorbid Depression and Anxiety. Loved it!

  • Eric

    November 5, 2013, 5:45 pm

    Howdy! This blog post could not be written any better! Looking at
    this article reminds me of my previous roommate! He always kept preaching about this.

    I am going to forward this article to him. Pretty sure he’s going to have a
    very good read. Thank you for sharing!

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