Effect of concurrent anxiety on response to sertraline and imipramine in patients with chronic depression

Anxiety commonly complicates the clinical presentation of depression and ha s been associated with poorer long-term outcome, but little information is available on the clinical correlates, and comparative effect on treatment r esponse, of subsyndromic or secondary anxiety. Patients diagnosed with chro nic major or double depression were randomized to 12 weeks of double-blind treatment with either sertraline or imipramine in a 2:1 ratio. A high anxie ty subgroup was operationally defined by a HAM-D anxiety/somatization facto r score greater than or equal to 7. The effect of study treatment was measu red utilizing the NAM-D, CGI, HAM-D anxiety/somatization factor as well as a quality of life measure (Q-LES-Q) and a measure of psychosocial functioni ng (the MOS-SF-36). Two hundred nine patients were treated with imipramine and 426 patients were treated with sertraline. Thirty-six percent of the to tal met criteria for the high anxiety subgroup. According to Kaplan-Meier p robability estimates, patients with significant concurrent anxiety symptoms were more likely to respond by 12 weeks (66.4%) than those without signifi cant anxiety symptoms (54.2%). There was no significant difference in respo nse rates for sertraline vs. imipramine. Both drugs were effective at treat ing high baseline levels of anxiety, with 60% of sertraline patients and 58 % of imipramine patients having 50% or greater reduction from baseline in H AM-D anxiety/somatization factor scores, and only 4.6% and 9.9%, respective ly, reporting treatment-emergent worsening in anxiety at study endpoint. De spite the chronicity of depressive illness, acute treatment with both sertr aline and imipramine significantly improved psychosocial and quality of lif e measures. High baseline levels of anxiety did not reduce overall antidepr essant response but did somewhat delay the onset of response to sertraline or imipramine in patients with chronic depression. (C) 2001 Wiley-Liss, Inc .