High Rates Of Comorbid Depression Research Articles

Prevalence of diagnosable depression in patients awaiting orthopaedic specialist consultation: a cross-sectional analysis

BackgroundMusculoskeletal conditions, including osteoarthritis (OA), are a leading cause of disability and chronic pain, and are associated with high rates of comorbid depression. However, signs of depression are often masked by pain. The aim of this study was to determine the prevalence and severity of depression and pain in individuals awaiting specialist orthopaedic consultation. A secondary objective was to determine the relationship between pain and depression, irrespective of demographic factors and clinical diagnosis.MethodsCross-sectional analysis of individuals awaiting orthopaedic consultation at a public hospital in Melbourne, Australia. Relevant data were extracted from medical records and questionnaires. Descriptive statistics were used to summarise participant characteristics. The patient health questionnaire (PHQ-9) was used to assess depression and a numerical rating scale (NRS) was used to assess pain severity. Multiple linear regression analyses were used to establish the relationship between pain and depression.ResultsNine hundred and eighty-six adults (mean ± standard deviation, age = 54.1 ± 15.7 years, 53.2% women) participated in the study. OA was present in 56% of the population and 34% of the entire population had moderate depression or greater, 19% of which met the criteria for major depressive disorder. Moderate-to-severe pain was present in 79% of individuals with OA and 55% of individuals with other musculoskeletal complaints. Pain was significantly associated with depression scores (β = 0.84, adjusted R2 = 0.13, P < 0.001), and this relationship remained significant after accounting for gender, age, education and employment status, OA status, number of joints affected and waiting time (β = 0.91, adjusted R2 = 0.19, P < 0.001).ConclusionsDepression affects one-third of individuals on an orthopaedic waitlist. A strong link between pain and depression in patients awaiting specialist orthopaedic consultation exists, indicating a need for an integrated approach in addressing pain management and depression to manage this complex and comorbid presentation.

Depressive symptoms and weight change in inpatients with anorexia nervosa: A cross-lagged panel model

ObjectiveAnorexia nervosa (AN) is marked by a high rate of comorbid depression, which raises the question whether depressive symptoms may adversely affect treatment outcome. Thus, we examined whether depressive symptoms at admission would predict weight change from admission to discharge in a large sample of inpatients with AN. In addition, we also explored the reverse direction, that is, whether body mass index (BMI) at admission would predict changes in depressive symptoms. MethodsA sample of 3011 adolescents and adults with AN (4% male) who received inpatient treatment at four Schoen Clinics was analyzed. Depressive symptoms were measured with the Patient Health Questionnaire–9. ResultsBMI significantly increased and depressive symptoms significantly decreased from admission to discharge. BMI and depressive symptoms were unrelated at admission and discharge. Higher BMI at admission predicted smaller decreases in depressive symptoms and higher depressive symptoms at admission predicted larger weight gain. The latter effect, however, was mediated by longer length of stay. ConclusionResults indicate that depressive symptoms do not adversely affect weight gain during inpatient treatment in persons with AN. Instead, higher BMI at admission is predictive of smaller improvements in depressive symptoms but this effect seems to be negligible in terms of clinical relevance.

The prevalence and correlates of eating disorders in adult emergency department patients.

This study describes the prevalence of eating disorders among adult patients who present to the emergency department for medical care and examines the relationship between eating disorders, depression, and substance use disorders. Emergency department patients aged 21-65 years (n = 1,795) completed a computerized questionnaire that included validated screening tools for eating disorders, risky drinking behavior, other substance use, and depression. Analyses were conducted comparing individuals who screened positive for an eating disorder with those who did not based on demographics (gender, age, race, income, education), body mass index (BMI), risky drinking behavior, other substance use, and depression. Nearly 16% (15.9%) of all patients screened positive for an eating disorder regardless of their reason for presenting to the emergency department. Patients who screened positive for an eating disorder were significantly more likely to have a BMI > 30 (odds ratio [OR] = 2.68, confidence interval [CI] = 1.98, 3.62, p < .001), to also screen positive for depression (OR = 3.19, CI = 2.28, 4.47, p < .001) and to be female (OR = 2.37, CI = 1.76, 3.19, p < .001). No differences in the prevalence of positive screens for eating disorders were seen across age or racial groups, level of education or income, or for any of the included substance use variables. Eating disorders are common among adult emergency department patients and are associated with high rates of comorbid depression and higher BMI. Given the significant morbidity and mortality associated with eating disorders, targeted screening may be warranted in the emergency department setting.

Your inner midwife: hands on practical artistic creative workshop to make simple cloth dolls representing our midwife identity

Pregnant and parenting women who use substances report high rates of comorbid depression and anxiety. Due to the significant impact of this comorbidity on treatment adherence and maternal/child outcomes, effective psychosocial and behavioral interventions to address depression and anxiety in this population are necessary. A directed search of PubMed, PsycINFO, and CINAHL databases produced 22 articles from 20 distinct studies examining non-pharmacologic interventions with an effect on depression and anxiety among pregnant or parenting women using substances. Of the 20 studies reviewed, 8 were randomized controlled trials, 7 were quasi-experimental studies, and 5 were cohort studies. Results revealed a wide array of interventions targeting intrapersonal, interpersonal, and/or structural factors within these women's lives. Parenting therapy and psychosocially enhanced treatment programs had the strongest evidence for positive treatment effect in improving symptoms of depression and anxiety. The use of contingency-management, case-managed care, patient or wellness navigators, mindfulness-based therapy, maternal-child relationship-focused therapy, family therapy, peer support, and therapeutic community-based interventions show promise but warrant further experimental exploration. Comprehensive and gender-specific residential treatment was observationally associated with improvements in depression and anxiety; however, the specific modality of efficacy is unclear. Future research should focus on identifying which modalities are most cost-effective, feasible, and acceptable among this uniquely vulnerable population.

A Preliminary Investigation on the Effectiveness of Unified and Transdiagnostic Cognitive Behavior Therapy for Patients With Comorbid Depression and Anxiety

High rates of comorbid depression and anxiety often complicate psychological interventions. The current preliminary study was designed to examine the efficacy of a unified and transdiagnostic model based on emotion regulation skills for patients with comorbid depression and anxiety. Forty-three participants with a diagnosis of major depression and varying levels of comorbid anxiety symptoms were randomly assigned to either a unified and transdiagnostic treatment group (UP; n = 20) or a wait-list control group (n = 23). The treatment group received 14 weekly UP sessions. Scores on the Beck Depression Inventory-II, Beck Anxiety Inventory, and Emotion Regulation Questionnaire were used as outcome measures. Data provided preliminary evidence that UP can be effective in reducing depressive and anxiety symptoms and in improving the use of effective emotion regulation strategies up to 3 months. Present results support the implementation of UP as a beneficial group treatment for patients with comorbid depressive ...

Association between Healthcare Utilization and Depression in Korean Women with Cardiovascular Conditions.

ObjectiveThis study aimed to examine the associations between depression and both coronary artery disease (CAD) and cardiovascular risk factors (CVRs) in Korean women. Furthermore, this study sought to determine whether depression was associated with use of healthcare services in women with CAD or CVRs.MethodsThis cross-sectional study was conducted on 26,335 women who were aged 19 years or older, and who participated in the Korean National Health and Nutrition Examination Survey (2007–2014). Associations of prior diagnosis of depression with CAD and CVRs and with nonutilization of healthcare services were investigated.ResultsWomen with depression had a higher prevalence of CAD and CVRs including obesity, hypertension, dyslipidemia, and metabolic syndrome than those without depression. In addition, depression was significantly associated with nonutilization of healthcare services in women with most CVRs.ConclusionConsidering the high rate of comorbid depression with CAD or CVRs and the low lvels of health service utilization in depressed patients, screening for common CVRs, such as obesity, hypertension, and dyslipidemia, should be provided for patients with depression in mental health care settings.

QLIF-06. SEXUAL FUNCTION IN PATIENTS WITH PRIMARY BRAIN TUMORS (PBTs)

To determine if sexual function, defined by sexual drive, arousal, performance, and satisfaction, is compromised by PBTs and associated treatment. PBT patients are at risk of sexual dysfunction given direct effects on the hypothalamic-pituitary-gonadal axis, physical limitations, as well as high rates of comorbid depression and fatigue. Few data exist on this subject. One published study of 32 diffuse low-grade glioma patients undergoing surgical resection demonstrated that 53% of patients experienced a postoperative sexual change (Surbeck et al, 2015). This is an IRB-approved cross-sectional analysis of adults with PBTs who were approached to complete a voluntary, anonymous survey, based on the Arizona Sexual Experience Scale, to evaluate the impact of their PBT and treatment on sexual function. Implications for quality of life were assessed. 56 PBT patients were approached, 31 completed the survey (55%). The study included 17 men and 14 women, median age 49. There were 6 patients with low grade tumors and 25 with high grade tumors. Two patients reported pre-existing sexual dysfunction. All patients had received treatment: 27 underwent surgical resection, 26 received radiotherapy, and 28 received chemotherapy. As compared to their sexual function prior to PBT diagnosis, 55% of patients reported a decrease in sex drive, 35% reported more difficulty becoming aroused, 42% reported more difficulty achieving orgasm, and 39% reported less sexual satisfaction. Ten patients (32%) noted that sexual function plays an important role in their quality of life (QOL). Sixty-eight percent conveyed that they would not want to discuss sexual function with their clinical team, but the remaining patients noted that they were unsure or would welcome the opportunity to discuss such issues. Sexual function is likely compromised in PBT patients and this reduces QOL. This study is on-going and the full results will be reported at the meeting.

Design and protocol for the Dialysis Optimal Health Program (DOHP) randomised controlled trial.

BackgroundChronic kidney disease (CKD) and end-stage kidney disease (ESKD) are serious and growing health problems with enormous impact on psychological and social functioning. Despite high rates of comorbid depression and anxiety in these patient populations, and the adverse impact these have upon treatment adherence, quality of life, social connectedness and healthcare costs there has been little attention focused on the prevention or management of these problems. Thus, our aim was to evaluate the Dialysis Optimal Health Program (DOHP) that adopts a person-centred approach and engages collaborative therapy to educate and support those diagnosed with ESKD who are commencing dialysis.MethodsThe study design is a randomised controlled trial. Ninety-six adult patients initiating haemodialysis or peritoneal dialysis will be randomly allocated to either the intervention (DOHP) or usual care group. Participants receiving the intervention will receive nine (8 + 1 booster session) sequential sessions based on a structured information/workbook, psychosocial and educational supports and skills building. The primary outcome measures are depression and anxiety (assessed by the Hospital Anxiety and Depression Scale; HADS). Secondary outcomes include health-related quality of life (assessed by the Kidney Disease Quality of Life instrument; KDQOL), self-efficacy (assessed by General Self-Efficacy Scale) and clinical indices (e.g. albumin and haemoglobin levels). Cost-effectiveness analysis and process evaluation will also be performed to assess the economic value and efficacy of the DOHP. Primary and secondary measures will be collected at baseline and at 3-, 6-, and 12-month follow-up time points.DiscussionWe believe that this innovative trial will enhance knowledge of interventions aimed at supporting patients in the process of starting dialysis, and will broaden the focus from physical symptoms to include psychosocial factors such as depression, anxiety, self-efficacy, wellbeing and community support. The outcomes associated with this study are significant in terms of enhancing an at-risk population’s psychosocial health and reducing treatment-related costs and associated pressures on the healthcare system.Trial registrationANZCTR no. 12615000810516. Registered on 5 August 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1558-z) contains supplementary material, which is available to authorized users.

Expanding the efficacy of Project UPLIFT: Distance delivery of mindfulness-based depression prevention to people with epilepsy.

Depression affects about 16% of the U.S. population over a lifetime. People with chronic diseases have especially high rates of comorbid depression; 32% to 48% of people with epilepsy experience depression. This study evaluated the efficacy of a mindfulness-based cognitive therapy intervention for preventing major depressive disorder (MDD) episodes in people with epilepsy. Participants (n = 128) were adults from Georgia, Michigan, Texas, and Washington with epilepsy and mild/moderate depressive symptoms. The 8-session weekly Project UPLIFT intervention, based on mindfulness-based cognitive therapy, was group-delivered via Web or telephone. Using a randomized, controlled crossover design, participants were assigned to Project UPLIFT or a treatment-as-usual (TAU) waitlist and assessed at baseline, and after intervening in the intervention group (∼10 weeks) and in the TAU group (∼20 weeks). Assessments included valid self-report measures of depression and MDD, knowledge/skills, and satisfaction with life. The incidence of MDD episodes (new or relapse) from baseline to interim assessment was significantly lower in the intervention condition (0.0%) than in TAU (10.7%). Depressive symptoms decreased significantly more in the intervention condition than in TAU; Web and telephone did not differ. Change in knowledge/skills mediated the effect, which persisted over the 10 weeks of follow-up. Knowledge/skills and life satisfaction increased significantly more in the intervention condition than in TAU. Distance delivery of group mindfulness-based cognitive therapy can prevent episodes of MDD, reduce symptoms of depression, and increase life satisfaction in people with epilepsy. This intervention is easily modified for persons with other chronic diseases and other disparity populations. (PsycINFO Database Record

Sleep in Children and Adolescents with Obsessive-Compulsive Disorder.

Sleep problems are not a core feature of obsessive-compulsive disorder (OCD), but emerging empirical data indicate some form of sleep disruption to be highly common. Available research in both adult and child patients is limited in several important ways, including the use of subjective reports (particularly in children), high rates of comorbid depression, and concurrent use of psychotropic medication. The presence of sleep disruption in OCD patients may compound severity and impairment of the disorder. More research is needed to fully understand the nature and consequences of sleep-wake disruption in children with OCD.

Ten-year audit of clients presenting to a specialised service for young people experiencing or at increased risk for psychosis

BackgroundDespite strong research interest in psychosis risk identification and the potential for early intervention, few papers have sought to document the implementation and evaluation of specialised psychosis related services. Assessment of Ultra High Risk (UHR) has been given priority, but it is equally as important to identify appropriate comparison groups and other baseline differences. This largely descriptive service evaluation paper focuses on the ‘baseline characteristics’ of referred clients (i.e., previously assessed characteristics or those identified within the first two months following service presentation).MethodsData are reported from a 10-year layered service audit of all presentations to a ‘Psychological Assistance Service’ for young people (PAS, Newcastle, Australia). Baseline socio-demographic and clinical characteristics (N =1,997) are described (including clients’ psychosis and UHR status, previous service contacts, hospitalisation rates, and diagnostic and comorbidity profiles). Key groups are identified and comparisons made between clients who received ongoing treatment and those who were primarily assessed and referred elsewhere.ResultsClients averaged 19.2 (SD =4.5) years of age and 59% were male. One-tenth of clients (9.6%) were categorised as UHR, among whom there were relatively high rates of attenuated psychotic symptoms (69.1%), comorbid depression (62.3%), anxiety (42.9%), and attentional and related problems (67.5%). Overall, one-fifth (19.8%) experienced a recent psychotic episode, while a further 14.5% were categorised as having an existing psychosis (46.7% with a schizophrenia diagnosis), amongst whom there were relatively high rates of comorbid substance misuse (52.9%), psychosocial (70.2%) and physical health (37.7%) problems. The largest group presenting to PAS were those with non-psychotic disorders (43.7%), who provide a valuable comparison group against which to contrast the health trajectories of those with UHR and recent psychosis. Ongoing treatment by PAS was preferentially given to those experiencing or at risk for psychosis and those reporting greater current distress or dysfunction.ConclusionsWhether or not UHR clients transition to psychosis, they displayed high rates of comorbid depression and anxiety at service presentation, with half receiving ongoing treatment from PAS. Although international comparisons with similar services are difficult, the socio-demographic and comorbidity patterns observed here were viewed as largely consistent with those reported elsewhere.

Evaluating Risk Factors and Possible Mediation Effects in Posttraumatic Depression and Posttraumatic Stress Disorder Comorbidity

On September 11, 2001 (9/11), attacks on the World Trade Center (WTC) killed 341 Fire Department of the City of New York (FDNY) firefighters and injured hundreds more. Previous WTC-related studies reported high rates of comorbid depression and posttraumatic stress disorder (PTSD), identifying disability retirement, alcohol use, and early arrival at the WTC site as correlates. However, those studies did not evaluate risk factors that could have mediated the observed comorbidity. We identified unique risk factors for each condition in an effort to better understand comorbidity. We screened retired WTC-exposed firefighters using self-administered questionnaires including the Center for Epidemiologic Studies Depression Scale, the Post Traumatic Stress Disorder Checklist, and the Alcohol Use Disorders Identification Test. We performed regression analyses to compare independent predictors of elevated depression and PTSD risk, and also tested a mediation hypothesis. From December 2005 to July 2007, 23% and 22% of 1,915 retirees screened positive for elevated depression and PTSD risk, respectively, with comorbidity > 70%. Controlling for comorbidity, we identified unique risk factors for (1) depression: problem alcohol use and (2) PTSD: early arrival at the WTC site. Our data support the premise that PTSD and depression are different responses to trauma with unique risk factors. The data also suggest a hypothesis that PTSD mediates the relationship between early WTC arrival and depression, while depression mediates the relationship between alcohol use and PTSD, a more complex relationship than shown in previous studies. Clinicians should consider these factors when evaluating patients for depression and PTSD.

Response to Letter Regarding Article, “Efficacy and Safety of Varenicline for Smoking Cessation in Patients With Cardiovascular Disease: A Randomized Trial”

In their letter, Drs Smolderen and Pelle correctly point out that patients with cardiovascular disease (CVD) have a high rate of comorbid depression, that depressed patients have less success when they attempt to stop smoking, and that the exclusion of smokers with comorbid depression from our trial of varenicline in patients with CVD limits our ability to generalize the results of our study to all smokers with CVD, as we had noted in the original article.1 As they request, we clarify here why our trial excluded CVD patients with comorbid depression. According to standard methodology used in testing new drugs, medications not specifically intended for psychiatric indications are …

Review: A psychopharmacological treatment algorithm for generalised anxiety disorder (GAD)

Generalised anxiety disorder (GAD) is defined as excessive and uncontrollable worry and anxiety about everyday life situations. It is a chronic disorder, and is associated with substantial somatisation, high rates of comorbid depression and other anxiety disorders, and significant disability. The evidence base for pharmacotherapy and psychotherapy has continued to grow, and a wide range of drug choices for GAD now exists. Current guidelines for GAD generally restrict themselves to presentation of the evidence for various treatments, which, as a result, generally do not offer detailed discussion or recommendation of strategies beyond the first level of treatment, or take into account the individual circumstances of the patient. Thus, there is a lack of algorithm-based treatment guidelines for GAD. Our aim is, therefore, to present an algorithm for the psychopharmacologic management of GAD, intended for all clinicians who treat patients with GAD, where issues of pharmacotherapy are under consideration. We also hope that these GAD algorithms and other guidelines can help to identify high-priority areas that need further study. In this algorithm, we provide a sequenced approach to the pharmacotherapy of GAD, taking into account salient symptomatology and comorbidity, levels of evidence and extent of response. Special issues, including comorbidity, insomnia, suicidality, substance abuse, treatment adherence, pregnancy and lactation, cross-cultural issues, use of medication in the elderly, psychosocial treatment and dosing issues are also addressed.

Tobacco use and comorbidity in bulimia nervosa

To compare comorbid psychopathology and substance use among women with bulimia nervosa (BN) based on smoking status. Forty women diagnosed with BN (20 smokers, 20 nonsmokers) completed written self-report measures of depressive symptoms, substance use, and alcohol abuse. Smokers reported more symptoms of depression and alcohol abuse and were more likely to use alcohol than nonsmokers, whereas caffeine consumption did not significantly differ between the two groups. Smokers with BN may represent a distinct subtype characterized by high rates of comorbid depression and alcohol abuse.

Integrating Depression Care With Diabetes Care in Real-World Settings:Lessons From the Robert Wood Johnson Foundation Diabetes Initiative

Depression is a common comorbidity in diabetic patients and poses challenges for health care providers, patients, and health care systems. This article describes the implementation of unique models of care geared toward treating patients with both illnesses in a coordinated manner in primary care and community settings serving disadvantaged and ethnic minority populations.Nine community sites used the PHQ-9, a short version of the Patient Health Questionnaire, as a screening tool for depression in all diabetic patients enrolled in the Robert Wood Johnson Foundation Diabetes Initiative. The interventions and protocols developed independently at each Diabetes Initiative site are described. The authors then report aggregate screening data across the nine sites, describe models of treatment developed by the projects, and highlight key emergent themes.The proportion of diabetic patients in this population with moderate to severe depression ranged from 30 to 70%. The interventions and treatment protocols that emerged included enhancements of primary care, integrated mental health services, group therapy, and approaches emphasizing cultural traditions and mind-body focus.Patients with diabetes from underserved and ethnic minority populations have high rates of comorbid depression, and this may affect their ability to self-manage diabetes. Addressing depression is an essential part of diabetes care and can be accomplished in a coordinated manner in real-world settings.

Anxiety disorders: under-diagnosed and insufficiently treated

Anxiety disorders have a high prevalence, particularly specific phobia, social anxiety disorder (SAD), post-traumatic stress disorder (PTSD) and generalized anxiety disorder (GAD). The lifetime prevalence for any anxiety disorder is almost 30%. Also, many anxiety disorders have a high rate of comorbid depression, which is generally secondary to the anxiety. Despite high prevalence, anxiety disorders are under-diagnosed, misdiagnosed and inappropriately treated. There is a hierarchy in the lifetime probability of treatment contact, with panic and GAD being diagnosed and treated earlier – possibly as a result of these disorders being the most “visible”, unlike SAD, which is characteristically discreet. Under-diagnosis is linked with under-treatment: less than one in five patients with an anxiety disorder receive appropriate medication, which improves to almost one in three for subjects with comorbid depression. For the majority of people with undiagnosed or untreated anxiety disorder, there are many negative consequences, for both the individual and society. These include disability, reduced ability to work leading to loss of productivity, and a high risk of suicide. All of these factors contribute to a reduced quality of life. The economic costs associated with anxiety disorders are large – €48 billion over 28 European countries – and similar to those for dementia. Almost half of the costs are indirect, due to loss of productivity and earnings; the remainder being direct medical and non-medical costs. Current first-line therapies are the antidepressive selective serotonin reuptake inhibitors (SSRIs), with cognitive behavioural therapy a first- or second-line treatment. However, benzodiazepines continue to be prescribed more often than antidepressants. Recent studies have shown that a new type of SSRI, escitalopram (the S-enantiomer of the racemic citalopram), with a unique mode of action, is effective and offers potential as a new treatment for anxiety disorders.

Differentiation of depression and PTSD symptoms in combat veterans.

tudies have consistently shown that combat veteransevaluated for posttraumatic stress disorder (PTSD) ex-hibit a) extreme and diffuse levels of psychopathologyacross instruments (e.g., Mississippi Scale, Beck De-pression Inventory, Minnesota Multiphasic Personal-ity Inventory [MMPI]), measuring different domainsof mental illness, and b) extreme elevations on the va-lidity scales of the MMPI, which is suggestive of a ‘‘fakebad’’ response style [e.g., Fairbank et al., 1983; Hyer etal., 1986]. Thus, there is a well-documented over-reporting response style among veterans evaluated forPTSD, which hampers evaluation of individual veteransand colors our understanding of the disorder [see Fruehet al., in press, for a comprehensive review of the extantliterature related to this phenomenon].Our understanding of this over-reporting responsestyle among veterans remains undeveloped. For ex-ample, it is not clear to what extent veterans are ableto differentiate their reports of different symptoms(e.g., depression, anxiety) rather than responding witha single global distress factor (e.g., ‘‘negative affect’’).Although previous studies have examined the factorstructure of single PTSD measures [e.g., Engdahl etal., 1996; King and King, 1994; McFall et al., 1990],the distinctiveness of PTSD symptom reports fromother psychiatric symptom domains have not beenstudied in veteran populations.Examination of the psychometric distinctiveness ofdifferent constructs has been attempted with anxietyand depression in a variety of other clinical samples,with mixed results [e.g., Clark et al., 1994], although itappears that greater distinctiveness has been foundwhen homogenous clinical samples were used [e.g.,Cox et al., 1993; Morgan et al., 1998]. Because PTSDis classified as an anxiety disorder and is considered tohave high rates of comorbid depression [e.g., Keaneand Wolfe, 1990], comparison to the anxiety-depres-sion literature is pertinent.The present study was designed to evaluate the psy-chometric distinctiveness of symptom reports of de-pression and PTSD in combat veterans evaluated for

Comorbid depression and anxiety spectrum disorders.

The relationship between depression and anxiety disorders has long been a matter of controversy. The overlap of symptoms associated with these disorders makes diagnosis, research, and treatment particularly difficult. Recent evidence suggests genetic and neurobiologic similarities between depressive and anxiety disorders. Comorbid depression and anxiety are highly prevalent conditions. Patients with panic disorder, generalized anxiety disorder, social phobia, and other anxiety disorders are also frequently clinically depressed. Approximately 85% of patients with depression also experience significant symptoms of anxiety. Similarly, comorbid depression occurs in up to 90% of patients with anxiety disorders. Patients with comorbid disorders do not respond as well to therapy, have a more protracted course of illness, and experience less positive treatment outcomes. One key to successful treatment of patients with mixed depressive and anxiety disorders is early recognition of comorbid conditions. Antidepressant medications, including the selective serotonin reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase inhibitors, are highly effective in the management of comorbid depression and anxiety. The high rates of comorbid depression and anxiety argue for well-designed treatment studies in these populations.