Difference in Treatment Outcome in Outpatients With Anxious Versus Nonanxious Depression: A STAR*D Report

Fava, Maurizio; Rush, A. John; Alpert, Jonathan E.; Balasubramani, G.K.; Wisniewski, Stephen R.; Carmin, Cheryl N.; Biggs, Melanie M.; Zisook, Sidney; Leuchter, Andrew F.; Howland, Robert H; Warden, Diane; Trivedi, Madhukar H.

doi:10.1176/appi.ajp.2007.06111868

Cited by 754 publications

(679 citation statements)

References 35 publications

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“…Previous antidepressant studies conducted in MDD patients with high anxiety symptoms suggest that these patients are often difficult to treat, exhibiting a slower or less robust response, with a higher risk of adverse events and suicidal ideation (Andreescu et al., 2007; Fava et al., 2008). …”

Section: Discussionmentioning

confidence: 99%

The effect of vortioxetine on overall patient functioning in patients with major depressive disorder

et al. 2017

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BackgroundThe objectives of this meta‐analysis of data from randomized, placebo‐controlled studies were to assess the effect of vortioxetine on overall functioning (primary) and functional remission (secondary) using the Sheehan Disability Scale (SDS) in adults with major depressive disorder (MDD).MethodsData from nine short‐term (6/8 weeks) pivotal studies that included patient functioning assessments were included in this random‐effects meta‐analysis, which used aggregated study‐level data for all therapeutic vortioxetine doses and a mixed‐effect model for repeated measures using the full analysis set.ResultsA total of 4,216 patients received ≥1 dose of study treatment (1,522 placebo, 2,694 vortioxetine 5–20 mg/day). At study end, the meta‐analysis showed improvement for vortioxetine versus placebo (n = 911) in SDS total score (vortioxetine 5 mg, n = 564, change from baseline versus placebo [Δ] −0.24, p = NS; 10 mg, n = 445, Δ −1.68, p ≤ .001; 15 mg, n = 204, Δ −0.91, p = NS; 20 mg, n = 340, Δ −1.94, p ≤ .01). Functional remission (SDS total score ≤6) was observed with vortioxetine 10 mg (n = 170/573; odds ratio [OR] relative to placebo 1.7, p < .001) and 20 mg (n = 144/447; OR 1.6, p < .05), but not 5 mg (n = 207/757; OR 1.1, p = NS) or 15 mg (n = 92/295; OR 1.3, p = NS).ConclusionVortioxetine 5–20 mg for 6/8 weeks improved overall patient functioning in patients with MDD. Relative to placebo, vortioxetine 10 and 20 mg demonstrated significant improvement in SDS total score and functional remission.

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Section: Discussionmentioning

confidence: 99%

The effect of vortioxetine on overall patient functioning in patients with major depressive disorder

et al. 2017

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“…Anxious depression is recognized as a recalcitrant subtype of depression, which is associated with poorer remission rate even with antidepressant treatment. [61,62] In response to antidepressant treatment, patients with anxious depression either take longer to achieve a response or lack a response to the treatment. The patients with MDD having lifetime general anxiety disorder, compared with patients having uncomplicated MDD, usually have worse symptom severity.…”

Section: Hyporeactivity Of the Central Ne System In Chronic Anxious Dmentioning

confidence: 99%

Current perspectives of the roles of the central norepinephrine system in anxiety and depression

et al. 2010

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Norepinephrine (NE) is a major monoamine neurotransmitter that has widespread effects across multiple brain areas to regulate arousal and stress responses. The underlying function of the NE cortical system is to balance vigilance/scanning behavior with focused attention on novel environmental stimuli and the state of arousal. The central NE system is involved intrinsically with the stress response system, and dysregulation within the NE system has been implicated in the pathogenesis of anxiety and depressive disorders. Central NE activity paradoxically has either anxiogenic or anxiolytic effects, depending on whether the time course of the stress is acute or chronic, whether the stress is predictable or unpredictable, and which underlying brain regions are affected. Under conditions of chronic stress, NE system activity dysregulation of the hypothalamic-pituitary-adrenal system may turn a homeostatic stress response into a pathological stress response. Data suggest that the NE interplay with the serotonin system may exert neurobiological normalization of the pathophysiological state of anxious depression. Accordingly, pharmacological interventions targeting the NE system can result in anxiolytic, rather than anxiogenic, outcomes when used to treat patients with anxiety and depression. Depression and Anxiety 27:339-350, 2010. r r

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“…Some research suggests that antidepressant medications are less effective for depression with comorbid anxiety. [16] In contrast, the evidence that comorbid depression adversely affects medication response with various anxiety disorders is less consistent. [17] Studies of CBT in various anxiety disorders have generally not found that depressive comorbidity adversely impacts effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Relative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression, and CBT somewhat better for anxiety?

et al. 2011

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Background: Little is known about whether cognitive behavioral therapy (CBT) or pharmacotherapy is relatively more advantageous for depressive versus anxiety disorders. Methods: We conducted a meta-analysis wherein we searched electronic databases and references to select randomized controlled studies comparing CBT and pharmacotherapy, with or without placebo, in adults with major depressive or anxiety disorders. The primary effect size was calculated from disorder-specific outcome measures as the difference between CBT and pharmacotherapy outcomes (i.e., positive effect size favors CBT; negative effect size favors pharmacotherapy). Results: Twenty-one anxiety (N 5 1,266) and twenty-one depression (N 5 2,027) studies comparing medication to CBT were included. Including all anxiety disorders, the overall effect size was .25 (95% CI: À0.02, 0.55, P 5.07). Effects for panic disorder significantly favored CBT over medications (.50, 95% CI: 0.02, 0.98). Obsessive-compulsive disorder showed similar effects-sizes, though not statistically significant (.49, 95% CI: À0.11, 1.09). Medications showed a nonsignificant advantage for social anxiety disorder (À.22, 95% CI: À0.50, 0.06). The overall effect size for depression studies was .05 (95% CI: À0.09, 0.19), with no advantage for medications or CBT. Pooling anxiety disorder and depression studies, the omnibus comparison of the relative difference between anxiety and depression in effectiveness for CBT versus pharmacotherapy pointed to a nonsignificant advantage for CBT in anxiety versus depression (B 5 .14, 95% CI: À0.14, 0.43). Conclusions: On balance, the evidence presented here indicates that there are at most very modest differences in effects of CBT versus pharmacotherapy in the treatment of anxiety versus depressive disorders. There seems to be larger differences between the anxiety disorders in terms of their relative responsiveness to pharmacotherapy versus CBT. Depression and Anxiety 28:560-567, 2011.

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Difference in Treatment Outcome in Outpatients With Anxious Versus Nonanxious Depression: A STAR*D Report

Abstract: Anxious depression is associated with poorer acute outcomes than nonanxious depression following antidepressant treatment.

Cited by 754 publications

References 35 publications

The effect of vortioxetine on overall patient functioning in patients with major depressive disorder

The effect of vortioxetine on overall patient functioning in patients with major depressive disorder

Current perspectives of the roles of the central norepinephrine system in anxiety and depression

Relative effects of CBT and pharmacotherapy in depression versus anxiety: is medication somewhat better for depression, and CBT somewhat better for anxiety?

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