The CANMAT task force recommendations for the management of patients with mood disorders and comorbid anxiety disorders.
BACKGROUND
Comorbid mood and anxiety disorders are commonly seen in clinical practice. The goal of this article is to review the available literature on the epidemiologic, etiologic, clinical, and management aspects of this comorbidity and formulate a set of evidence- and consensus-based recommendations. This article is part of a set of Canadian Network for Mood and Anxiety Treatments (CANMAT) Comorbidity Task Force papers.


METHODS
We conducted a PubMed search of all English-language articles published between January 1966 and November 2010. The search terms were bipolar disorder and major depressive disorder, cross-referenced with anxiety disorders/symptoms, panic disorder, agoraphobia, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. Levels of evidence for specific interventions were assigned based on a priori determined criteria, and recommendations were developed by integrating the level of evidence and clinical opinion of the authors.


RESULTS
Comorbid anxiety symptoms and disorders have a significant impact on the clinical presentation and treatment approach for patients with mood disorders. A set of recommendations are provided for the management of bipolar disorder (BD) with comorbid anxiety and major depressive disorder (MDD) with comorbid anxiety with a focus on comorbid posttraumatic stress disorder, use of cognitive-behavioral therapy across mood and anxiety disorders, and youth with mood and anxiety disorders.


CONCLUSIONS
Careful attention should be given to correctly identifying anxiety comorbidities in patients with BD or MDD. Consideration of evidence- or consensus-based treatment recommendations for the management of both mood and anxiety symptoms is warranted.
Mood and Anxiety Disorders Program, Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. ayal.schaffer@sunnybrook.ca
Ayal
A
Schaffer
Diane
D
McIntosh
Benjamin I
BI
Goldstein
Neil A
NA
Rector
Roger S
RS
McIntyre
Serge
S
Beaulieu
Richard
R
Swinson
Lakshmi N
LN
Yatham
D000293:Adolescent; D000328:Adult; D026683:Advisory Committees; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D001714:Bipolar Disorder / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D002170:Canada; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D006801:Humans; D019964:Mood Disorders / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D009771:Obsessive-Compulsive Disorder / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D016584:Panic Disorder / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D010698:Phobic Disorders / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000209:etiology / Q000628:therapy
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents