Anxiety Symptoms in Patients with Major Depressive Disorder: Commentary on Prevalence and Clinical Implications

The prevalence of major depressive disorder (MDD) has been increasing, and MDD is now a leading cause of global disability. Depression often coexists with anxiety, and the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced the 'anxious distress' specifier to identify those patients within the MDD category who have anxiety as well. The prevalence of anxious depression is high, with studies suggesting that 50-75% of patients with MDD meet the DSM-5 criteria for anxious depression. However, it can be difficult to discern whether a patient has MDD with anxiety or an anxiety disorder that has triggered an episode of depression. In fact, approximately 60-70% of patients with comorbid anxiety and depression experience anxiety first, but it is often depression that leads the patient to seek treatment. Patients with MDD who also have anxiety have significantly worse psychosocial functioning and poorer quality of life compared with patients with MDD without anxiety. In addition, patients with MDD and anxiety take significantly longer to achieve remission, and are less likely to achieve remission, than patients with MDD without anxiety. Therefore, it is essential that physicians have a high index of suspicion for comorbid anxiety in patients with depression, and that anxiety symptoms in patients with MDD are effectively treated. This commentary is based on a virtual symposium presented at the 33rd International College of Neuropsychopharmacology (CINP) World Congress, Taipei, Taiwan, in June 2022.