Treating Anxiety, Mood Disorders Takes Time

Article excerpt

SANTA FE, N.M. -- Anxiety disorders are a common comorbidity that lead to worse outcomes for patients with major depressive and bipolar disorders, speakers warned at a psychiatric symposium sponsored by the University of Arizona.

Dr. A. John Rush reported that more than half, 53.2%, of 2,876 depressed patients in the first phase of the STAR*D trial had anxious depression (Am. J. Psychiatry 2006;163:28-40).

Anxious patients were significantly less likely to achieve remission on their first medication for depression (odds ratio 0.77), according to Dr. Rush, principal investigator of the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial.

Each of the comorbid anxiety disorders was associated with a lower remission rate. Posttraumatic stress disorder (PTSD) had the most negative effect (odds ratio 0.6). Only social phobia did not have a significant impact, though it also reduced the odds of remission (odds ratio 0.87).

"A person coming in with anxiety disorder takes longer and is less likely to remit," said Dr. Rush, a distinguished professor in mental health at the University of Texas Southwestern Medical Center in Dallas.

About half of bipolar depression patients also had an anxiety disorder, according to an analysis of the first 500 patients in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) trial, another large multi-center study supported by the National Institute of Mental Health. Lifetime prevalence was 51.2%, and 30.5% had a current anxiety disorder when they entered the study.

"If you have a history of anxiety disorder, you are not the same as a patient who does not have that," Dr. Gary Sachs said at the meeting, which also was sponsored by the University of Texas Southwestern Medical Center at Dallas and the University of New Mexico.

Bipolar patients with comorbid anxiety were significantly more likely to have a history of suicide attempts, said Dr. Sachs, principal investigator of STEP-BD and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital in Boston.

The rate of suicide attempts was 52.1% in patients with lifetime anxiety disorder vs. 22.1% in patients who did not have a history of anxiety disorder. The highest rate, 65.4%, was in patients with a history of posttraumatic stress disorder (Am. J. Psychiatry 2004;161:2222-9).

Bipolar patients with lifetime anxiety disorders also had an earlier age of bipolar onset, 15.6 years vs. 19.4 years in patients who did not have a history of anxiety disorder, Dr. Sachs said.

Length of recovery was shorter as well in patients with a history of anxiety disorder. …