The patient with comorbid depression and anxiety: the unmet need

Major depression and anxiety occur concomitantly in general practice, occur in more patients than either depression or anxiety alone, and are associated with significant morbidity. When depression and anxiety occur together, they are associated with more severe symptoms, increased impairment, a more chronic course and poorer outcome, and a higher incidence of suicide. As many as 80% of patients with generalized anxiety disorder (GAD) have symptoms of depression. Patients with depression and comorbid anxiety present special treatment challenges with selection of drugs that have demonstrated efficacy for both depression and anxiety. A range of effective pharmacotherapeutic strategies are available, including tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors, the 5-HT2 blocker nefazodone, and the serotonin-norepinephrine reuptake inhibitor venlafaxine. Venlafaxine has been extensively evaluated for the treatment of depression and symptoms of anxiety in post hoc analyses. The efficacy of venlafaxine extended release (XR) has been demonstrated in patients with depression and concomitant anxiety. Further, venlafaxine XR is the first antidepressant that has demonstrated significant pure anxiolytic effects in prospective clinical trials of patients with GAD. The spectrum of pure depression, comorbid depression and anxiety disorders, and pure anxiety presents a treatment challenge. Venlafaxine offers a unique pharmacologic approach for the entire spectrum of these disorders.