Anxiety in Depression: Findings Questioned

The study “Difference in Treatment Outcome in Outpatients With Anxious Versus Nonanxious Depression: A STAR^*D Report” found that patients with anxious depression do not respond to treatment with newer-generation antidepressants as well as patients with nonanxious depression (see Original article: Anxiety Symptoms Complicate Depression Treatment). In an accompanying editorial, however, J. Craig Nelson, M.D., pointed out that earlier studies have not found such pronounced differences between depressed patients with anxiety and those without anxious symptoms.

The editorial and the study findings appear in the March American Journal of Psychiatry.

For instance, in a study by Gary Tollefson, M.D., Ph.D., and colleagues in the Journal of Clinical Psychiatry in 1994, 19 double-blind, randomized trials of fluoxetine including 1,183 patients with major depression were reviewed. Five of the trials were placebo controlled, and 12 compared fluoxetine and tricyclic antidepressants. Two of the trials compared tricyclics and placebo with fluoxetine.

Mean response rates for the fluoxetine trials were about the same for anxious and nonanxious patients, Nelson noted, but remission rates were slightly higher in anxious patients (38.3 percent compared with 29.5 percent).

Other meta-analyses showed similar response rates between patients with anxious and nonanxious depression who were treated with bupropion and SSRIs. Nelson noted that the SSRIs were slightly more effective in anxious patients, while bupropion was slightly less effective.

Nelson said in his editorial that there are differences between studies for a number of reasons, including whether patients have depression with comorbid anxiety disorders or depression with anxious symptoms.

“I suggest that the difference [between the earlier data] and STAR^*D is the high prevalence of comorbid anxiety disorders in STAR^*D, and this may explain the association of anxiety and response” in the new STAR^*D findings, Nelson wrote.