Overview

Key Points

• Depression and anxiety increase medical morbidity and mortality.

• Mood disorders comprise unipolar and bipolar disorder.

• Anxiety disorders comprise eight disorders, of which generalized anxiety disorder and panic disorder are frequently encountered in primary care settings.

• Treatment of depression and anxiety improves overall health outcomes.

• The majority of mood and anxiety disorders are treated in primary care settings.

Major depression and anxiety disorders are the two most common psychiatric illnesses in the United States and are particularly prevalent in primary care settings. Despite the relative availability of specialty psychiatric care in the United States, most patients with depression or anxiety disorder continue to receive their treatment from primary care physicians. Moreover, patients with both medical illness and comorbid mood or anxiety disorder frequently have poorer outcomes, experience more prolonged and difficult treatment, and have greater morbidity and mortality than patients without psychiatric illness (Katon, 2003). Conversely, treating underlying depressive and anxiety disorders not only improves the emotional well-being of patients, but also improves overall health outcomes and lowers health care costs. Given their frequency, severity, prevalence, morbidity, and mortality, depression and anxiety disorders remain important illnesses for primary care physicians to identify and treat.

The broader categories of mood and anxiety disorders comprise a large number of specific illnesses. Mood disorders include major depression (also called unipolar depression), bipolar disorder (which includes bipolar I and bipolar II disorder), cyclothymia, and dysthymia. The category of anxiety disorders includes generalized anxiety disorder (GAD), panic disorder with and without agoraphobia, agoraphobia without a history of panic disorder, specific phobia (e.g., fear of heights), social phobia (social anxiety disorder), obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and acute stress disorder. Describing the specific symptoms, epidemiology, assessment, and treatment of each illness is beyond the scope of this chapter; rather, we examine the illnesses that primary care physicians are most likely to encounter in clinical settings, and provide the most common strategies used in assessment, diagnosis, and treatment.

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