Comorbid Anxiety Affects Therapy Efficacy, Dropout Rate in Depression
Comorbid anxiety disorders should be considered by clinicians when considering psychotherapy regimens for patients with major depressive disorder.
For patients with major depressive disorder and comorbid anxiety, cognitive therapy may be more effective than interpersonal psychotherapy, according to results published in the Journal of Affective Disorders. Clinicians should be aware of the significant dropout risk for patients with major depressive disorder and comorbid anxiety.
The study included 182 participants with depression who were randomly assigned to cognitive therapy (n=76), interpersonal psychotherapy (n=75), or a 2-month waiting-list control group followed by treatment of choice (n=31). The primary outcome was depression severity measured with the Beck Depression Inventory-II at the start of each therapy session, posttreatment, and monthly for 5 months of follow-up. The researchers used the Structured Clinical Interview for DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) Axis I disorders to assess anxiety disorders and the Brief Symptom Inventory subscales to assess phobic anxiety symptoms.
Of the 151 participants who completed the study, 43 were diagnosed with 1 (n=35) or 2 anxiety disorders (n=8). The most prevalent anxiety disorder was panic disorder (n=18), followed by social phobia (n=16), specific phobia (n=7), posttraumatic stress disorder (n=6), generalized anxiety disorder (n=2), agoraphobia without panic disorder (n=1), obsessive compulsive disorder (n=1), and anxiety disorder not otherwise specified (n=1).
Participants with a comorbid anxiety disorder were significantly more likely to drop out of treatment (n=17, 39.5%) compared with participants without a comorbid anxiety disorder (n=19, 17.6%).
The researchers found that comorbid anxiety disorders and anxiety symptoms were associated with less favorable depression change during interpersonal psychotherapy as compared with cognitive therapy in the treatment phase, but not in the trial follow-up phase.
"[T]he presence of anxiety disorders and anxiety symptoms should be considered when selecting an effective psychotherapy for a depressed individual. Based on these results, a preference to [cognitive] over [interpersonal psychotherapy] is justifiable," concluded the study authors.
van Bronswijk, SC, Lemmens LHJM, Huibers MJH, Arntz A, Peeters FPML. The influence of comorbid anxiety on the effectiveness of cognitive therapy and interpersonal psychotherapy for major depressive disorder. J Affect Disord. 2018;232:52-60.