Characteristics of Anxious Distress Specifier in Patients With a Major Depressive Episode-Influence of Overlapping...

To examine the characteristics of major depressive episodes (MDEs) with underlying anxious distress (ANXD), specifically whether these characteristics are influenced by the presence of Benazzi's depressive mixed state (DMX) or are unique to ANXD.

Sociodemographic and clinical characteristics of patients with or without ANXD and of patients with ANXD with or without Benazzi's DMX were retrospectively examined in 160 patients with MDEs.

Overall, 45.6% of patients met the criteria for ANXD. The mean Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR) total score and frequencies of Benazzi's DMX, psychotic features, and psychiatric adverse events associated with antidepressants were significantly higher in patients with ANXD than in those without ANXD. Benazzi's DMX and male sex were independently associated with ANXD (odds ratio, 95% confidence interval: 4.95 [2.45-10.04], p < 0.001 and 2.11 [1.04-4.27], p < 0.038, respectively), regardless of depressive symptom severity or bipolar disorder diagnosis. In patients with ANXD with Benazzi's DMX, the rate of bipolar disorder diagnosis, QIDS-SR suicidal ideation score, and number of MDEs were significantly higher. The frequency of psychiatric adverse events associated with antidepressants and sociodemographic disadvantages in education and marital status were also numerically higher compared with patients with ANXD only.

Although ANXD itself is not a defining feature of bipolarity, its coexistence with Benazzi's DMX suggests an underlying bipolar disorder. Furthermore, high suicidality, high frequency of psychiatric adverse events associated with antidepressants, and sociodemographic disadvantages may be influenced by Benazzi's DMX. Further studies are required to validate these findings.