The treatment of generalized anxiety disorder in patients with depressive symptomatology

Concomitant depressive symptoms occur in at least 50% of patients with a primary diagnosis of generalized anxiety disorder (GAD). The authors review the treatment implications of the presence of concomitant depressive symptoms. First considered is the extent to which traditional benzodiazepines, because of their suggested depressogenic liability, are indicated or contraindicated for such patients and the possible differential therapeutic advantage of triazolobenzodiazepines, which have shown preliminary antidepressant effect. Second, the role of tricyclic antidepressants in the treatment of GAD is reviewed. A large body of literature, mostly from the 1970s, has found benefit for the tricyclics in mixed anxiety-depression. Two studies published in the 1980s found that patients suffering from a primary anxiety diagnosis but with subsyndromic levels of depression benefited from treatment with tricyclic antidepressants. The authors also review the role of the azapirones, most notably buspirone, in the treatment of GAD complicated by depressive symptoms. Evidence for its efficacy in this population comes from both retrospective analysis of previous GAD treatment studies, as well as a recent prospective study of depression with concomitant GAD.