Symptomatic and Syndromal Anxiety in Chronic Forms of Major Depression: Effect of Nefazodone, Cognitive Behavioral Analysis System of Psychotherapy, and Their Combination
J Clin Psychiatry 2002;63(5):434-441
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Limited information is available
on treatment response of anxiety symptoms in
chronic forms of major depression. Concurrent anxiety
disorders are prevalent in chronic depression, but the
responsiveness of patients with such comorbidity to
different treatments is largely unknown. This
study investigated the comparative efficacy of
nefazodone, Cognitive Behavioral Analysis System of
Psychotherapy (CBASP), and their combination in
improving anxiety symptoms in patients with chronic forms
of major depression, including those with a
concurrent anxiety disorder.
Method: 681 patients with chronic major
depressive disorder (DSM-IV criteria) participated in
a multicenter study of 12 weeks of acute treatment
with nefazodone (N=226), CBASP (N=228), or the combination (N=227). The Hamilton Rating Scale
for Anxiety (HAM-A), the HAM-A psychic anxiety factor, and the anxiety/arousal subscale of the
30-item Inventory for Depressive Symptomatology-Self
Report (IDS-SR-30) were used to assess anxiety symptoms.
Results: In the full sample, without controlling
for change in depressive symptoms, combination
therapy was superior to both monotherapies on all 3
anxiety measures both in the rate of change and at
endpoint. When change in depressive symptoms was
controlled for, there were no treatment differences in rate
of change from baseline to week 12 on any of the 3
anxiety measures. In those patients with a concurrent
anxiety disorder, however, the combination was superior
to CBASP on the HAM-A and the IDS-SR-30. Nefazodone alone and combination therapy were both
superior to CBASP on the HAM-A psychic anxiety factor.
Conclusion: For patients with chronic
depression, combination therapy is superior to CBASP or
nefazodone alone. Among patients with a concurrent
anxiety disorder, nefazodone, either alone or in
combination with CBASP, improves anxiety symptoms faster
than CBASP alone, independent of depressive