Impact of depressive symptoms on the treatment of generalized social anxiety disorder

Abstract

Patients with depression are often excluded from studies on the treatment of social anxiety disorder (SAD), leaving gaps in our knowledge about the impact of depressive affect on treatment for SAD. Patients participated in a randomized, placebo-controlled study of treatment for SAD. As in previous studies, patients were excluded from the study if they met criteria for major depressive disorder in the past 6 months. This exclusion notwithstanding, patients who enrolled in the study exhibited a range of depressive symptoms, permitting an examination of the impact of depressive symptoms on treatment outcome for SAD. Assessment measures included the Clinical Global Impression Scale, Hamilton Rating Scale for Depression, Brief Social Phobia Scale, and Beck Depression Inventory. Higher levels of depressive symptoms were related to more severe social anxiety overall, and to less change in social anxiety symptoms over the course of the study. Patients who were deemed nonresponders to treatment had higher levels of depressive symptoms at pretreatment than those who responded. In addition, patients who dropped out of the study had higher levels of depressive symptoms at pretreatment than those who completed the study. These results suggest that modifications should be made to existing treatments to improve outcomes and decrease attrition in the substantial proportion of patients with SAD who also evidence depressive symptoms. Such modifications are likely to be more important when treating patients with SAD and comorbid major depressive disorder.

Social Anxiety in Online and Real-Life Interaction and Their Associated Factors

“…4 In subjects with social anxiety, comorbid depression has a mutually deteriorating course 4,14,15 Thus, intervention programs for social anxiety should also consider comorbid depression. The Internet is now recognized as an alternative medium to deliver treatment for depression.…”

Selected abstracts of the 26th Annual Conference of the Anxiety Disorders Association of America, March 23–26, 2006, Miami, Florida

“…Although comorbidity rates of SAD and depression have been studied extensively (Essau et al, 1999), little research has been conducted to analyze the development of depressive symptoms among people with SAD. This phenomenon has clinical importance because comorbid depressive symptoms are correlated with therapeutic impediments such as increased severity in SAD symptoms and treatment drop-out (Ledley et al, 2005) and we hypothesized it was mediated by behavioral avoidance, an important risk factor for depressive symptoms (Beck, 1997). The current investigation examined the mediational role of behavioral avoidance secondary to SAD at baseline and over the course of treatment among a sample of adults presenting to treatment for SAD.…”

Issues and controversies surrounding the diagnosis and treatment of social anxiety disorder

“…For example, a study by Ledley et al found that depression symptoms were associated with more severe SAD symptoms overall, less change in symptoms over the course of CBT for SAD and nonresponse to treatment [140]. However, one limitation is that they excluded patients who met full criteria for major depressive disorder (MDD).…”