Question:

Do mood disorders often coexist with anxiety disorders such as generalized anxiety, panic disorder and obsessive compulsive disorder (OCD)? What is the best way to treat both illnesses when they co-occur?

Answer:
Paula J. Clayton, M.D.
Professor in the Department of Psychiatry at University of New Mexico Medical School

Anxiety and depression frequently coexist. At least 85% of people with major depression also have significant anxiety symptoms. The most frequent symptoms are worry, inner tension or mental pain. About 33% of people with depression have panic attacks during their depressive episodes. Anxiety symptoms occur with equal frequency in men and women, whether they have major depression or bipolar depression.

With anxiety disorders like panic disorder or OCD, depressed mood occurs in most patients and full depressive episodes occur in about 75% of patients. With generalized anxiety disorder, the percentage of people who have major depression is even higher.

Having symptoms of anxiety and depression may mean a person needs to try different treatments in order to find one that treats all the symptoms. It is very important for doctors to treat the symptoms of both.

It is equally important for the patient to make sure the doctor recognizes and acknowledges the existence of both. Most antidepressants treat both depression and anxiety. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) work particularly well for both illnesses. In studies, these medications began to work in the early weeks of treatment.

If anxiety is severe and disabling, it may be helpful to supplement treatment with a short acting benzodiazepine at the beginning. Benzodiazepines should not be used exclusively, but as an addition to the chosen antidepressant. In people with a history of addiction, atypical antipsychotics in low doses can be prescribed instead. However, because of possible interactions between the two, some atypical antipsychotics should be used more cautiously when added to an antidepressant.

Monoamine oxidase inhibitors (MAOIs), the first generation antidepressants, are also useful in treating the combined symptoms. With these medications, a person must be on a strict diet, avoiding foods such as cheeses and processed meats that contain the chemical tyramine.

In people with depression, if anxiety is a long-term problem and not just a symptom, adding an anticonvulsant medication is sometimes recommended. Several newer anticonvulsant medications are being tested for treatment of panic and anxiety disorders. These may prove to be useful for people with both anxiety and depressive symptoms. Short term, focused psychotherapy can also be helpful for depression and anxiety symptoms.

Talk therapy can help a person cope with symptoms, triggers and crises, improve relationships and set goals for the future. A combination of medication, psychotherapy and support from people who understand is often the most helpful.

Information in “Ask the Doctors” is not meant to take the place of consultation with a qualified health care provider. A s

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