title: Cognitive therapy for anxious depression in STAR(*) D: what have we learned?
abstract: BACKGROUND
  Anxious depression, defined as MDD with high levels of anxiety symptoms, has been associated with lower rates of antidepressant response and remission as well as greater chronicity, suicidality and antidepressant side-effect burden. The primary aim of this study was to assess the effectiveness of cognitive therapy (CT) alone or in combination with medications for anxious versus non-anxious depression.
  
  
  METHODS
  We assessed the STAR(⁎)D study participants who were partial or non-responders to citalopram. Subjects were then either switched (n=696) to a new antidepressant or to CT alone, or they were kept on citalopram and augmented (n=577) with another antidepressant or CT. We compared response and remission rates, across treatment conditions, between those who met criteria for anxious depression and those who did not.
  
  
  RESULTS
  Those with anxious depression had significantly lower remission rates based on the QIDS, whether assigned to switch or augmentation, compared to those with non-anxious depression. Those with anxious depression, compared to those without, had significantly lower response rates based on the QIDS only in the switch group. There was no significant interaction between anxious depression and treatment assignment.
  
  
  CONCLUSIONS
  Limitations include the use of citalopram as the only Level 1 pharmacotherapy and medication augmentation option, the relatively small size of the CT arms, use of depression-focused CT rather than anxiety-focused CT, and focus on acute treatment outcomes.
  
  
  CONCLUSIONS
  Individuals with anxious depression appear to experience higher risk of poorer outcome following pharmacotherapy and/or CT after an initial course of citalopram and continued efforts to target this challenging form of depression are needed.
authors.affiliation: Depression Clinical and Research Program, Massachusetts General Hospital, United States. afarabaugh@partners.org
authors.forename: Amy
authors.initials: A
authors.lastname: Farabaugh
authors.forename: Jonathan
authors.initials: J
authors.lastname: Alpert
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Michael W
authors.initials: MW
authors.lastname: Otto
authors.forename: Maurizio
authors.initials: M
authors.lastname: Fava
authors.forename: Lee
authors.initials: L
authors.lastname: Baer
authors.forename: Roy
authors.initials: R
authors.lastname: Perlis
authors.forename: Ed
authors.initials: E
authors.lastname: Friedman
authors.forename: Maren
authors.initials: M
authors.lastname: Nyer
authors.forename: Stella
authors.initials: S
authors.lastname: Bitran
authors.forename: G K
authors.initials: GK
authors.lastname: Balasubramani
authors.forename: Aya
authors.initials: A
authors.lastname: Inamori
authors.forename: Madhukar
authors.initials: M
authors.lastname: Trivedi
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000453:epidemiology / Q000628:therapy*; D015283:Citalopram / Q000627:therapeutic use*; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012074:Remission Induction; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D015283:Citalopram