Mixed Anxiety and Depression : Diagnosis and Treatment Options

Symptoms of anxiety and depression often appear together in patients, either as 2 discrete disorders, such as major depressive disorder and panic disorder, or as a combination of symptoms not meeting criteria for specific disorders. The social, economic, occupational and medical costs of such comorbid anxiety and depression can be enormous, affecting both the individual and society.The clinician must be creative when treating patients with mixed anxiety and depressive symptoms; psychopharmacological treatment can involve the use of a variety of mono- and polytherapies. Benzodiazepines can be effective in treating anxiety symptoms, but unwanted adverse effects limit their use to the short term. Tricyclic antidepressants, although proven to be effective in treating both anxiety and depressive symptoms, have numerous adverse effects, making them a second-choice therapy. Traditional monoamine oxidase inhibitors have proven efficacy in atypical depression, and the newer reversible and selective inhibitors of monoamine oxidase-A may prove to be very effective in treating both sets of symptoms. Of particular importance in the treatment of patients with anxiety and depressive symptoms are the selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors, nefazodone and the azapirones (including buspirone).