The anxiety factor in depression.
Anxiety symptoms are commonly associated with depression, and contribute to a poorer patient prognosis. An increase in serotonergic function is implicated in the pathogenesis of anxiety and there is good evidence that the selective serotonin re-uptake inhibitors (SSRIs) may be useful in clinical management. Sertraline, a novel SSRI, has been shown to be effective in the treatment of anxiety symptoms in both pure and mixed anxiety disorders. Studies have also shown sertraline to be effective in obsessive-compulsive disorder. A recent study (Moon  et al. , 1994) shows sertraline to have comparative therapeutic efficacy with that of clomipramine with respect to reduction of anxiety symptoms in depression. However, it also highlights important differences in side-effect profiles, with a high incidence of cardiovascular effects and subsequent dropouts reported in the clomipramine group. Limited comparative data with other SSRIs suggest there is no evidence of any aggravation of anxiety symptoms during treatment with sertraline, as has been reported with fluoxetine. Sertraline has been shown to have a normalising effect on sleep disturbance in depression without evidence of daytime sedation. Therefore, given the high prevalence of anxiety symptoms in depression, sertraline would be a useful therapeutic option in clinical management.
Director, Psychopharmacology Unit, University of Bristol, Bristol, UK.
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