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Am J Psychiatry 1991; 148:1512-1517
Copyright © 1991 by American Psychiatric Association
Follow-up and family study of anxious depression
PJ Clayton, WM Grove, W Coryell, M Keller, R Hirschfeld and J Fawcett
NIMH Collaborative Program on the Psychobiology of Depression-Clinical Studies, Minneapolis, MN.
OBJECTIVE: The failure of the concept of anxious depression to find its way
into DSM-III-R led the authors to conclude that a further report on the
occurrence of anxiety symptoms in depressed subjects is indicated. METHOD:
The subjects were 327 consecutively evaluated inpatients and outpatients
with primary unipolar depressive disorder at five university medical
centers participating in the National Institute of Mental Health
Collaborative Program on the Psychobiology of Depression-- Clinical
Studies. The authors restricted their sample selection to patients with
primary depressive disorder so that patients with other preexisting
psychiatric disorders, especially anxiety disorders, would not contaminate
the symptom picture, family studies, or follow-up. The examined six anxiety
symptoms and derived a new anxiety summary score to show the effect of
anxiety in depression on family data and 5-year outcome. RESULTS: Depressed
subjects with higher ratings for anxiety took longer to recover. There was
also a significant relationship between anxiety in depressed probands and
the risk for primary unipolar depressive disorder, but not anxiety
disorders or alcoholism, among 832 blindly interviewed first-degree
relatives. CONCLUSIONS: These data confirm the usefulness of subdividing
depressed patients according to anxiety symptoms: psychic and somatic
symptoms of anxiety, taken together, significantly predict family illness
and course. The data also emphasize the wisdom of requiring that
generalized anxiety disorder not be diagnosed in the presence of a mood
disorder. Clearly, symptoms of anxiety coexist with depression and need to
be recognized for the effective treatment of the underlying depressive
disorder.
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