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Am J Psychiatry 1996; 153:1293-1300
Copyright © 1996 by American Psychiatric Association
Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders
C Brown, HC Schulberg, MJ Madonia, MK Shear and PR Houck
Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213, USA.
OBJECTIVE: Major depression occurs with generalized anxiety disorder and
panic disorder in up to 60% of psychiatric and primary care patients. This
comorbidity has been associated with greater severity of depression, poorer
psychosocial functioning, and poorer treatment outcomes in psychiatric
samples. This study examined the clinical outcomes for depressed primary
care patients with and without a lifetime anxiety disorder. METHOD: A total
of 157 primary care patients who met criteria for major depression were
randomly assigned to standardized interpersonal psychotherapy or
pharmacotherapy with nortriptyline and were assessed at baseline and at 4
and 8 months on severity of depression, psychosocial functioning, and
health-related functioning. RESULTS: Depressed patients with a comorbid
anxiety disorder presented with significantly more psychopathology and
tended to prematurely terminate treatment more frequently than patients
with major depression alone. Both standardized depression-specific
treatments were effective for depressed patients with and without a
comorbid generalized anxiety disorder, although time to recovery was longer
for the former. Patients with lifetime panic disorder showed poor recovery
in response to psychotherapy or pharmacotherapy. CONCLUSIONS: Standardized
psychotherapy and pharmacotherapy are effective for patients with major
depression with and without a generalized anxiety disorder. However, the
longer time to recovery for the former group and lack of response to these
treatments by patients with lifetime panic disorder suggest that primary
care physicians should carefully assess history of anxiety disorder among
depressed patients so as to select a proper intervention.
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