Boadie W. Dunlop Paula G. Davis
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Objective: To review the literature on the co-occurrence
of anxiety with depressive disorders and the rationale for and use of
combination treatment with benzodiazepines and selective serotonin
reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors (SSRIs/SNRIs)
for treating comorbid anxiety and depression.
Data Sources: PubMed and PsycINFO were searched using
terms identified as relevant based on existing practice guidelines. The
primary search terms were anxiety, anxiety disorders,
depression, depressive disorders, comorbidity,
epidemiology, benzodiazepines, antidepressants,
pharmacology, clinical trials, and pharmacotherapy.
Reference lists of identified articles were also reviewed to ensure
capture of relevant literature.
Study Selection: Publications were selected for inclusion
in the review if they applied to adult populations and specifically
addressed the comorbidity of anxiety and depression, their epidemiology,
or their management. Case reports and case series were not considered for
inclusion.
Data Extraction: Each author assessed the publications
independently for content related to the review topics. Findings
considered relevant to the clinical understanding and management of
comorbid anxiety and depression were incorporated into the review.
Data Synthesis: Comorbidity is very common among
patients with anxiety and depressive disorders, and, even when full
criteria for 2 separate disorders are not met, subsyndromal symptoms are
often present. Little controlled research has explored how benzodiazepines
and SSRIs/SNRIs may be usefully combined, yet their combination is
frequently employed in clinical practice. Patients with comorbidities are
likely to have poorer treatment outcomes and have greater utilization of
health care resources. Currently SSRIs/SNRIs are considered first-line
therapy and are effective in both anxiety and depressive states.
Nevertheless, many patients have only a partial response or have
difficulty tolerating efficacious doses of antidepressant monotherapy.
Benzodiazepines appear to improve treatment outcomes when an anxiety
disorder co-occurs with depression or for depression characterized by
anxious features. Specifically, they may provide benefits both in terms of
speed of response and overall response.
Conclusions: Long-term management plans for
anxiety disorder with or without comorbid depression should include
strategies for acute or short-term care, long-term maintenance, and
episodic or breakthrough symptoms. Combination therapy with
benzodiazepines and antidepressants in appropriate clinical settings may
improve outcomes over monotherapy in some patients.
Prim Care Companion J Clin Psychiatry 2008;10(3):222-228
https://doi.org/10.4088/PCC.v10n0307
© Copyright 2008 Physicians Postgraduate Press, Inc.