PHENOMENOLOGY AND SEVERITY OF MAJOR DEPRESSION AND COMORBID LIFETIME ANXIETY DISORDERS IN PRIMARY MEDICAL-CARE PRACTICE

The psychiatric history and presenting clinical characteristics of 276 depressed primary care patients with and without a lifetime comorbid anxiety disorder were studied in a randomized control trial of treatme nts for major depression. Our findings indicate that distinctive patte rns of depressive symptoms and severity, functional impairment, comorb idity of other DSM-III-R Axis I and Axis II disorders, and treatment p articipation are associated with lifetime histories of panic and gener alized anxiety disorder. The most consistent differences are evident b etween patients with major depression alone and those with major depre ssion and a lifetime panic disorder The latter presented with greater depressive severity, greater impairment in physical and psychosocial f unctioning, and were more likely to have a history of alcohol dependen ce, somatization disorder, and avoidant personality disorder Discrimin ant function analysis indicated that 66% of depressed patients with li fetime panic disorder could be correctly distinguished from chose with out such comorbidity on the basis of the severity of somatic and affec tive symptoms bat not cognitive symptoms of depression. Further depres sed patients with lifetime panic disorder were more likely to prematur ely terminate both pharmacotherapy and psychotherapy during each treat ment's acute phase. Implications for the diagnosis and treatment of ma jor depression with comorbid anxiety disorder in primary care patients are discussed. (C) 1996 Wiley-Liss, Inc.