title: Effects of co-occurring depression on treatment for anxiety disorders: analysis of outcomes from a large primary care effectiveness trial.
abstract: OBJECTIVE
  Co-occurring depression is common in patients seeking treatment for anxiety; however, the literature on the effects of depression on anxiety treatment outcomes is inconclusive. The current study evaluated prescriptive and prognostic effects of depression on anxiety treatment outcomes in a large primary care sample.
  
  
  METHODS
  Data were analyzed from a randomized controlled effectiveness trial that compared coordinated anxiety learning and management (CALM) to usual care. The study enrolled 1,004 patients between June 2006 and April 2008. Patients were referred by their primary care provider and met DSM-IV criteria for generalized anxiety disorder, panic disorder, posttraumatic stress disorder, and/or social anxiety disorder. They were treated for approximately 3 to 12 months with CALM (computer-assisted cognitive-behavioral therapy, medication management, or their combination) or usual care. Outcomes were evaluated by blinded assessment at 6, 12, and 18 months. Effects of baseline major depressive disorder (MDD) on anxiety symptoms, anxiety-related disability, and response/remission rates were evaluated using statistical models accounting for baseline anxiety and patient demographics.
  
  
  RESULTS
  MDD did not moderate the effects of CALM (relative to usual care) on anxiety symptoms, anxiety-related disability, or response/remission rates. Greater improvements in anxiety symptoms and anxiety-related disability were observed in depressed patients, regardless of treatment assignment (P values < .005). However, cross-sectionally depressed patients displayed higher anxiety symptom and anxiety-related disability scores at baseline and all subsequent assessments (P values < .001). Depressed patients also displayed lower remission rates at each follow-up (P values < .001).
  
  
  CONCLUSIONS
  CALM had comparable advantages over usual care for patients with and without MDD. Depressed patients displayed more severe anxiety symptoms and anxiety-related disability at baseline, but their clinical improvement was substantial and larger in magnitude than that observed in the nondepressed patients. Results support the use of empirically supported interventions for anxiety disorders in patients with co-occurring depression.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT00347269.
authors.affiliation: Department of Psychiatry, University of California, San Diego, La Jolla, CA 92037, USA. campbell-sills@ucsd.edu
authors.forename: Laura
authors.initials: L
authors.lastname: Campbell-Sills
authors.forename: Cathy D
authors.initials: CD
authors.lastname: Sherbourne
authors.forename: Peter
authors.initials: P
authors.lastname: Roy-Byrne
authors.forename: Michelle G
authors.initials: MG
authors.lastname: Craske
authors.forename: Greer
authors.initials: G
authors.lastname: Sullivan
authors.forename: Alexander
authors.initials: A
authors.lastname: Bystritsky
authors.forename: Ariel J
authors.initials: AJ
authors.lastname: Lang
authors.forename: Denise A
authors.initials: DA
authors.lastname: Chavira
authors.forename: Raphael D
authors.initials: RD
authors.lastname: Rose
authors.forename: Stacy
authors.initials: S
authors.lastname: Shaw Welch
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
mesh_terms: D000328:Adult; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D010698:Phobic Disorders / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D011320:Primary Health Care; D016032:Randomized Controlled Trials as Topic; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D013813:Therapy, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014481:United States
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents