Interaction of Depression and Anxiety

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Major depression and anxiety are often found together, and each illness complicates the course and outcome of the other. Studies have consistently shown that anxiety disorders are the most frequently occurring comorbid disorder with major depression, with 50% to 60% of major depressed patients with both illnesses (Zimmerman et al., 2002). Anxiety can lead to depression in almost 60% of patients, whereas depression leads to anxiety in only 15% of patients (Mineka et al., 1998). Not surprisingly, the more severe anxiety disorders are more likely to lead to subsequent depression; that is, panic disorder, agoraphobia, OCD, PTSD and GAD more frequently lead to depression compared to either social phobia or simple phobia. In addition, patients with both illnesses often have increased severity of symptoms, increased frequency of episodes (either mood or anxiety episodes), poorer response to treatment, higher suicide rates, a more chronic course, and overall poorer prognosis.

Treatment is complicated by the fewer studies on coexisting depression and anxiety, providing clinicians with a smaller evidence-base for treatment decisions. Patients with comorbid major depressive disorders are half as likely subsequently to recover from panic disorder with agoraphobia or GAD, and comorbid major depression almost doubles the likelihood of recurrence of panic disorder with agoraphobia (Bruce et al., 2005). In addition, children and adolescents with anxiety disorders are at eight times the risk of additional depression (Angold et al., 1999). Practitioners must therefore be aggressive in screening for anxiety disorders in patients reporting depressive symptoms, as well as screening for depression in patients reporting anxiety symptoms.

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