Depression and Generalized Anxiety Disorder

Abstract

Context:The close association between generalized anxiety disorder (GAD) and major depressive disorder (MDD) prompts questions about how to characterize this association in future diagnostic systems. Most information about GAD-MDD comorbidity comes from patient samples and retrospective surveys.Objective: To revisit the sequential and cumulative comorbidity between GAD and MDD using data from a prospective longitudinal cohort.Design: Prospective longitudinal cohort study.Setting: New Zealand.Participants: The representative 1972The representative -1973 Dunedin birth cohort of 1037 members was followed up to age 32 years with 96% retention. Main Outcome Measures:Research diagnoses of anxiety and depression were made at ages 11,13,15,18,21,26, and 32 years. Mental health services were reported on a life history calendar.Results: Sequentially, anxiety began before or concurrently in 37% of depression cases, but depression began before or concurrently in 32% of anxiety cases. Cumulatively, 72% of lifetime anxiety cases had a history of depression, but 48% of lifetime depression cases had anxiety. During adulthood, 12% of the cohort had comorbid GADϩ MDD, of whom 66% had recurrent MDD, 47% had recurrent GAD, 64% reported using mental health services, 47% took psychiatric medication, 8% were hospitalized, and 11% attempted suicide. In this comorbid group, depression onset occurred first in one third of the participants, anxiety onset occurred first in one third, and depression and anxiety onset began concurrently in one third. Conclusions:Challenging the prevailing notion that generalized anxiety usually precedes depression and eventually develops into depression, these findings show that the reverse pattern occurs almost as often. The GAD-MDD relation is strong, suggesting that the disorders could be classified in 1 category of distress disorders. Their developmental relation seems more symmetrical than heretofore presumed, suggesting that MDD is not necessarily primary over GAD in diagnostic hierarchy. This prospective study suggests that the lifetime prevalence of GAD and MDD may be underestimated by retrospective surveys and that comorbid GAD ϩ MDD constitutes a greater mental health burden than previously thought. Psychiatry. 2007;64:651-660 T HIS ARTICLE WAS PREPARED in response to a call for research to inform how generalized anxiety disorder (GAD) should be characterized in relation to major depressive disorder (MDD) in forthcoming diagnostic systems. Arch Gen1 Because the 2 disorders are closely related, key nosologic questions concern whether they ought to be classified together and whether GAD ought to be considered a subsyndrome of MDD vs an independent disorder. Substantial literature suggests that GAD ought not be viewed as independent from MDD, pointing to evidence that generalized anxiety generally precedes MDD in sequential order and that most individuals with GAD eventually develop MDD. The present article revisits the sequential and cumulative comorbidity between GAD and MDD using data from a pr...

Effects of Traditional Thai Massage on Heart Rate, Blood Pressure, and Anxiety in Depression Patients: A Pilot Study

“…The result of this study has suggested that TTM may have calming effect for this patient population since it had reducedheart rate, and anxiety.The findings of this study are in line with the previous two studies [8], [9]. Although the psychiatric symptoms vary from patient to patient and depend upon the severity and complexity of the disease, the anxiety level of all the patients with depression has been reduced immediately after having TTM.…”

“…Interestingly, the onset of anxiety generally precedes depression, whereas anxiety disorders were strongly related to major depressive disorder (MDD) regardless of the time frame [7].However, a recent study has suggested that the pattern generalized anxiety has usually developed into depression or vice versa [8].…”

Relationship between Symptoms of Anxiety and Depression in a Sample of Arab College Students Using the Hopkins Symptom Checklist 25

“…The controversy over the relationship between clinical anxiety and depression, arising from the widely reported high frequency of comorbidity, is an enduring issue in psychiatry [1,2]. Among other reasons, this issue is important because it can contribute to the current debate on the nosology of anxiety and depression in the planned DSM-V and ICD-11 [3,4].…”

“…The first issue is whether some of the disorders (e.g. major depressive disorder and generalized anxiety disorder, GAD) should be classified as one disorder (vs. different categories) [2,3,4,5]. The second issue is whether anxiety and depressive disorders should be classified as belonging to the same group of an ‘overarching superclass’ or ‘metastructure’ of emotional disorders (vs. different groups of mood and anxiety disorders as in the DSM-IV) [6,7].…”

Repeated mild traumatic brain injuries is not associated with volumetric differences in former high school football players

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