Treating comorbid depression and anxiety

Depression and anxiety disorders are distinct illnesses that often coexist. Patients suffering from both disorders have more psychological, physical, and social impairment than do patients suffering from either illness alone. Mixed anxiety-depression is gaining recognition as a separate diagnosis and has been included in the International Classification of Diseases, 10th edition, and in the appendix of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Current treatment recommendations for comorbid depression and anxiety are based on clinical experience with the treatment of anxiety and depressive disorders when they occur independently. Tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective for simultaneously occurring anxiety and depression, but the side-effect profiles of the MAOIs and TCAs limit their use for this condition. Benzodiazepines are useful for the acute treatment of anxiety symptoms and buspirone for chronic generalized anxiety, but neither agent is effective for the long-term treatment of depression. The recently available antidepressants nefazodone and venlafaxine may also be useful for this patient population. When possible, psychotherapy should be used in conjunction with pharmacotherapy to improve treatment outcomes.