title: Differential impact of anxiety symptoms and anxiety disorders on treatment outcome for psychotic depression in the STOP-PD study.
abstract: BACKGROUND
  There are conflicting results on the impact of anxiety on depression outcomes. The impact of anxiety has not been studied in major depression with psychotic features ("psychotic depression").
  
  
  OBJECTIVE
  We assessed the impact of specific anxiety symptoms and disorders on the outcomes of psychotic depression.
  
  
  METHODS
  We analyzed data from the Study of Pharmacotherapy for Psychotic Depression that randomized 259 younger and older participants to either olanzapine plus placebo or olanzapine plus sertraline. We assessed the impact of specific anxiety symptoms from the Brief Psychiatric Rating Scale ("tension", "anxiety" and "somatic concerns" and a composite anxiety score) and diagnoses (panic disorder and GAD) on psychotic depression outcomes using linear or logistic regression. Age, gender, education and benzodiazepine use (at baseline and end) were included as covariates.
  
  
  RESULTS
  Anxiety symptoms at baseline and anxiety disorder diagnoses differentially impacted outcomes. On adjusted linear regression there was an association between improvement in depressive symptoms and both baseline "tension" (coefficient=0.784; 95% CI: 0.169-1.400; p=0.013) and the composite anxiety score (regression coefficient = 0.348; 95% CI: 0.064-0.632; p=0.017). There was an interaction between "tension" and treatment group, with better responses in those randomized to combination treatment if they had high baseline anxiety scores (coefficient=1.309; 95% CI: 0.105-2.514; p=0.033). In contrast, panic disorder was associated with worse clinical outcomes (coefficient=-3.858; 95% CI: -7.281 to -0.434; p=0.027) regardless of treatment.
  
  
  CONCLUSIONS
  Our results suggest that analysis of the impact of anxiety on depression outcome needs to differentiate psychic and somatic symptoms.
authors.affiliation: Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Academic Unit of Psychiatry, University of Bristol, Bristol, UK.
authors.forename: Simon J C
authors.initials: SJ
authors.lastname: Davies
authors.affiliation: Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada. Electronic address: benoit.mulsant@camh.ca.
authors.forename: Benoit H
authors.initials: BH
authors.lastname: Mulsant
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Canada; University Health Network, Toronto, Canada.
authors.forename: Alastair J
authors.initials: AJ
authors.lastname: Flint
authors.affiliation: University of Massachusetts Medical School and University of Massachusetts, Worcester, MA, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Rothschild
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Whyte
authors.affiliation: Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Barnett S
authors.initials: BS
authors.lastname: Meyers
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001007:Anxiety / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology*; D001569:Benzodiazepines / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D000077152:Olanzapine; D011618:Psychotic Disorders / Q000188:drug therapy* / Q000523:psychology*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D020280:Sertraline / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D001569:Benzodiazepines; D000077152:Olanzapine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline