[Comorbid anxiety and depression: Diagnostic issues and treatment management]

Epidemiological data show that besides the high prevalence of anxiety and depressive disorders in the general population, comorbidity between the two is a very frequent phenomenon. There is a variety in the clinical presentation of comorbidity. Comorbidity may be present as the full clinical picture of the two syndromes or as limited symptoms from both two syndromes. Anxiety disorders usually are the first manifestation. The impact of comorbidity is reflected in the severity of the disorder, the chronicity and persistency of its course, the more functional impairment and the worse quality of patient's life. There is interplay between several genetic, neurobiological and environmental risk factors leading to comorbidity. Disturbances of the serotoninergic and noradrenergic systems, as well as of the hypothalamic-pituitary-adrenal axis have been implicated in the pathophysiology of comorbidity. Treatment with novel antidepressants and anxiolytics, as well as psychotherapeutic approaches has proven to be effective for the management of comorbid anxiety and depression.