The Comorbidity of Major Depression and Anxiety Disorders: Recognition and Management in Primary Care
Primary Care Companion J Clin Psychiatry 2001;3(6):244-254
© Copyright 2017 Physicians Postgraduate Press, Inc.
Background: Depressive and anxiety
disorders commonly occur together in patients presenting
in the primary care setting. Although recognition
of individual depressive and anxiety disorders has increased substantially in the past decade,
recognition of comorbidity still lags. The current
report reviews the epidemiology, clinical
implications, and management of comorbidity in the
primary care setting.
Method: Literature was reviewed by 2
methods: (1) a MEDLINE search (1980-2001) using the
key words depression, depressive disorders, and anxiety disorders; comorbidity was also searched with
individual anxiety diagnoses; and (2) direct search
of psychiatry, primary care, and internal medicine journals over the past 5 years.
Results: Between 10% and 20% of adults in
any given 12-month period will visit their primary
care physician during an anxiety or depressive
disorder episode (although typically for a
nonpsychiatric complaint); more than 50% of these patients
suffer from a comorbid second depressive or anxiety
disorder. The presence of depressive/anxiety comorbidity substantially increases medical
utilization and is associated with greater chronicity,
slower recovery, increased rates of recurrence, and
greater psychosocial disability. Typically, long-term
treatment is indicated, although far less research
is available to guide treatment decisions.
Selective serotonin reuptake inhibitor antidepressants are
the preferred treatment based on efficacy, safety,
and tolerability criteria. Knowledge of their
differential clinical and pharmacokinetic profiles can assist
in optimizing treatment.
Conclusion: Increased recognition of the
high prevalence and negative psychosocial impact
of depression and anxiety disorder comorbidity
will lead to more effective treatment. While it is
hoped that early and effective intervention will yield
long-term benefits, research is needed to confirm this.