title: [Difficulties in the diagnosis and treatment of major depressive disorder with comorbid anxiety symptoms].
abstract: Major depressive disorder (MDD) is a common and costly disorder. MDD often occurs with comorbid symptoms of anxiety. While symptoms of anxiety are not part of the diagnosis criteria of MDD, it has been recognized for many years that anxiety may play a critical role in depressive illness. The presence of anxiety has been associated with greater severity of depression and functional impairment, as well as increased suicide risk. Moreover, anxiety symptoms have been associated with reduced antidepressant response, in addition to greater risk of relapse and chronicity. Recently, emphasis has been placed on remission as the goal in the treatment of MDD. Patients who achieve remission have more favorable long-term outcomes than those who have appreciable improvement, but still have residual symptoms. Given the burden of illness caused by MDD, and given that anxiety is a common component of MDD and that full symptom resolution should be the goal of antidepressant therapy, efficacy in treating the symptoms of anxiety associated with depression may be an important component of the overall treatment of depression. Treatment of anxious depression presents unique challenges, optimally involving pharmacological agents that are effective for both depression and anxiety. The likely role of abnormal serotonergic neurotransmission in anxiety is widely supported, while the role of norepinephrine is less clear. A large body of evidence supports the hypothesis that a perturbation in norepinephrine neurotransmission contributes to the symptoms of anxiety. It has been suggested that agents with dual reuptake inhibition of 5-HT and norepinephrine may be particularly effective in treating anxiety.
authors.affiliation: Uludağ U Tip Fak., Psikiyatri A D., Bursa. cakkaya@uludag.edu.tr
authors.forename: Cengiz
authors.initials: C
authors.lastname: Akkaya
mesh_terms: D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000150:complications*; D003865:Major Depressive Disorder / Q000150:complications* / Q000188:drug therapy*; D006801:Humans
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents