C. Brown et al., TREATMENT OUTCOMES FOR PRIMARY-CARE PATIENTS WITH MAJOR DEPRESSION AND LIFETIME ANXIETY DISORDERS, The American journal of psychiatry, 153(10), 1996, pp. 1293-1300
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.