TREATMENT OUTCOMES FOR PRIMARY-CARE PATIENTS WITH MAJOR DEPRESSION AND LIFETIME ANXIETY DISORDERS

Objective: Major depression occurs with generalized anxiety disorder a nd panic disorder in up to 60% of psychiatric and primary care patient s. This comorbidity has been associated with greater severity of depre ssion, poorer psychosocial functioning, and poorer treatment outcomes in psychiatric samples. This study examined the clinical outcomes for depressed primary care patients with and without a lifetime anxiety di sorder. Method: A total of 157 primary care patients who met criteria for major depression were randomly assigned to standardized interperso nal psychotherapy or pharmacotherapy with nortriptyline and were asses sed at baseline and at 4 and 8 months on severity of depression, psych osocial functioning, and health-related functioning. Results: Depresse d patients with a comorbid anxiety disorder presented with significant ly more psychopathology and tended to prematurely terminate treatment more frequently than patients with major depression alone. Both standa rdized depression-specific treatments were effective for depressed pat ients with and without a comorbid generalized anxiety disorder, althou gh time to recovery was longer for the former. Patients with lifetime Panic disorder showed poor recovery in response to psychotherapy or ph armacotherapy. Conclusions: Standardized psychotherapy and pharmacothe rapy are effective for patients with major depression with and without a generalized anxiety disorder. However, the longer time to recovery for the former group and lack of response to these treatments by patie nts with lifetime panic disorder suggest that primary care physicians should carefully assess history of anxiety disorder among depressed pa tients so as to select a proper intervention.