Defining Anxious Depression: Going beyond Comorbidity

OBJECTIVE: Since publication of the DSM-IV, there remains a group of patients with depression and anxiety symptoms who are not well classified. We therefore wanted to determine more accurately the type of patients best described by the term "anxious depression." We also wanted to review the literature to assess the most appropriate treatment(s) for these patients. METHOD: We surveyed the medical literature published after 1994 for all articles containing the relevant terms and assessed all possible articles in detail to determine those relevant to the diagnosis and those that involved relevant clinical studies. RESULTS: The term anxious depression can encompass 3 groups of patients: those with comorbid major depressive disorder (MDD) and an anxiety disorder, those with MDD but with subthreshold anxiety symptoms, and those with subthreshold depressive and subthreshold anxiety symptoms (also called mixed anxiety and depressive disorder). CONCLUSIONS: Based upon our literature review, we believe that the term anxious depression should only be used for the second group; that is, those patients with an MDD and subthreshold anxiety symptoms. From our literature review to determine the most appropriate treatment for this group of patients, it appears likely that drugs inhibiting the reuptake of both noradrenaline and serotonin may have greater clinical utility than single-action drugs such as the selective serotonin reuptake inhibitors (SSRIs). However, it is also clear that much more research needs to be undertaken in this important patient group so that we can better understand its prevalence, clinical features, and treatment.