Management of mixed affective symptoms in primary care: a critical experiment

The treatment of mixed anxiety/depression in general practice remains a problem. Non-psychiatrists find diagnosis difficult to make in these patients. A double-blind study was set up to explore this area and to investigate the efficacy of a tetracyclic antidepressant (mianserin) in the treatment of anxiety with or without mild and moderate depressive symptoms. The comparative drug used was diazepam. Benzodiazepines are used to treat patients with this presentation, often inappropriately. Forty-seven patients were treated for up to 8 weeks, 24 received diazepam 5-10 mg daily and 23 mianserin 30-60 mg daily. Symptoms of anxiety and depression were measured using computer-delivered rating scales. Mianserin was shown to be more effective than diazepam in treating symptoms of both depression and anxiety, with significantly more patients in the mianserin group reaching resolution of symptoms in the time period studied. Resolution occurred sooner with the antidepressant than with diazepam.