Systematic review of the outcome of anxiety and depressive disorders

Abstract

Background Although there have been many changes in the diagnosis of anxiety and depressive disorders in the past 20 years there have been few comparative enquiries into the clinical outcome of greater diagnostic categories. We therefore compared the outcome of all studies which compared the outcome of specific anxiety and depressive disorders using the standard procedures of systematic review.Method A Medline search was carried out of all studies comparing the outcome of anxiety and depressive disorders or mixed anxiety-depressive disorders in which information was available separately for each disorder.Results Eight studies satisfied the search criteria (all involving a period of observation of two years or greater); only one of these included randomisation of treatment and comparison between specific anxiety disorder outcome. There was a somewhat better outcome in patients with depressive disorders compared with anxiety ones, and strong evidence that both anxiety and depressive disorders singly had better outcomes than comorbid mixed disorders.Conclusion Comorbid anxiety-depressive disorders have a poor outcome compared with single anxiety and depressive disorders, and there is some evidence that anxiety disorders have a worse outcome than depressive ones.

Long-term outcome of cognitive behaviour therapy clinical trials in central Scotland

“…4,5 We know also that where anxiety and depressive symptoms coexist, which is probably in the majority of cases referred for psychological therapy in the NHS, there is a heightened probability of a chronic and relapsing course. 6 The claim, therefore, that CBT leads to a sustained improvement, and confers a long-term advantage relative to other types of treatment, is an ambitious one. A very powerful treatment technology would be required to influence the overall course of a potentially chronic disorder on the basis of a limited number of hours of personal therapy and it would be unwise to assume sustained benefit in the absence of evidence.…”

Prospective studies of cothymia (mixed anxiety-depression): how do they inform clinical practice?

“…A single contrast comparing the cothymia group with the mean of the other two was extracted. The data from this study were combined with those from a recent systematic review (Emmanuel et al 1998) in which mixed anxiety and depressive diagnoses were compared with those of anxiety alone, in which separation of patients was into those who had shown no improvement versus the remainder.…”

“…4 Details of studies included in systematic review of outcome of anxiety disorders alone and mixed anxiety and depression (cothymia) Table 5) and GAD] of 4 or greater) of drug treat-(%with NDOS (15) ment, cognitive of 4 or greater) behaviour (31) therapy and self-help than with a single diagnosis alone (Table 5) and this was a consistent funding in all but one of the seven studies ( Fig. 1) The results show that, at least with regard to long-term outcome, that the diagnosis of cothymia is highly relevant to the clinician who wishes to have a guide to outcome when assessing a patient with anxiety and depression.…”

The Roles of Exercise and Yoga in Ameliorating Depression as a Risk Factor for Cognitive Decline

“…moderate the potential benefits of exercise and/or yoga? For example, depression and anxiety are highly comorbid [116–120], which negatively affects treatment and recovery, quality of life, and global functioning, over and above the effects of either disorder independently [121–123], suggesting comorbid depression/anxiety may be quantitatively or qualitatively different than either disorder alone. Studies have also demonstrated that anxiety negatively affects cognition [2, 3, 124, 125] and that exercise [26, 46] and yoga [46, 126] may help to ameliorate these associated cognitive deficits.…”