title: What are the clinical implications of new onset or worsening anxiety during the first two weeks of SSRI treatment for depression?
abstract: OBJECTIVE
  To evaluate the prevalence of new onset or worsening of anxiety symptoms, as well as their clinical implications, during the first 2 weeks of Selective Serotonin Reuptake Inhibitor (SSRI) pharmacotherapy for depression.
  
  
  METHODS
  Adult outpatients with nonpsychotic major depressive disorder were enrolled in an 8-week acute phase SSRI treatment trial at 15 clinical sites across the United States. Worsening anxiety was defined as a greater than 2-point increase on the Beck Anxiety Inventory (BAI) between baseline and Week 2. New onset of anxiety symptoms was ascribed when the BAI baseline rating was 0 and the Week 2 value was greater or equal to 2 points on the BAI.
  
  
  RESULTS
  Overall, after 2 weeks of treatment, 48.8% (98 of 201 participants) reported improvement in anxiety symptoms, 36.3% (73 of 201) reported minimal symptom change, and 14.9% (30 of 201) reported worsening of anxiety symptoms. No association was found between change in anxiety symptoms within the first 2 weeks and change in depressive symptoms or remission at the end of 8 weeks of treatment. For participants with clinically meaningful anxiety symptoms at baseline, however, worsening of anxiety during the first 2 weeks of treatment was associated with worsening depressive symptoms by 8 weeks (P = .054).
  
  
  CONCLUSIONS
  The trajectory of anxiety symptom change early in SSRI treatment is an important indicator of eventual outcome for outpatients with major depression and baseline anxiety symptoms.
authors.affiliation: Asher Center for the Study and Treatment of Depressive Disorders, Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, Illinois 60611, USA. j-gollan@northwestern.edu
authors.forename: Jackie K
authors.initials: JK
authors.lastname: Gollan
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: Benji
authors.initials: B
authors.lastname: Kurian
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: A John
authors.initials: AJ
authors.lastname: Rush
authors.forename: Ella
authors.initials: E
authors.lastname: Daly
authors.forename: Sachiko
authors.initials: S
authors.lastname: Miyahara
authors.forename: Madhukar H
authors.initials: MH
authors.lastname: Trivedi
mesh_terms: D000328:Adult; D000368:Aged; D003865:Major Depressive Disorder / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors