No Links Between Comorbid Anxiety and Venlafaxine Response in Depression

Elderly man sitting on bed looking serious – Indoors
Comorbid anxiety worsened depressive symptom severity in general and was linked to suicidality.

Comorbid anxiety symptoms did not influence venlafaxine treatment response in older patients with major depressive disorder (MDD), according to results from a study published in Depression and Anxiety. However, comorbid anxiety did worsen depressive symptom severity in general, and was linked to suicidality.

Yasmina Saade, MD, from the department of psychiatry, Washington University in St. Louis, Missouri, and colleagues conducted an open-label multicenter study of 468 adults with MDD aged 60 years or older between July 2009 and January 2014. Subjects with a comorbid anxiety disorder were also included. Study patients received extended-release venlafaxine for a total of 12 to 14 weeks, which was initiated at 37.5 mg daily and titrated to a maximum of 300 mg daily based on efficacy and tolerability. Some patients continued benzodiazepine treatment during the study.

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Anxiety symptoms were assessed during pretreatment with the Brief Symptom Inventory (BSI), Anxiety Sensitivity Index (ASI), and Penn State Worry Questionnaire (PSWQ). During the study, depressive symptoms and suicidality were evaluated every 1 to 2 weeks. Both survival analysis and logistic regression were used to measure associations between anxiety symptoms and treatment response.

The researchers found that the presence of anxiety symptoms at baseline did not predict depression remission on venlafaxine therapy (ASI: odds ratio, 0.85 [95% CI, 0.69-1.04; P =.11]; BSI OR, 0.82 [95% CI, 0.67-1.01; P =.06]; PSWQ OR, 0.90 [95% CI, 0.73-1.10; P =.31]). These results remained stable when controlling for covariates, including demographic factors and benzodiazepine use, and for analyses of time to remission.

Suicidality at baseline was associated with elevated anxiety, particularly worry, fear, and panic, (ASI [t(460), −2.01; P =.05]; BSI [t(460), −2.89; P =.004]; PSWQ [t(460), −2.49; P =.01]) and greater depressive symptom severity (t(460), -4.26; P <.001).

Limitations of the study included its open-label approach and some patients’ continued treatment with benzodiazepines.

“[T]hese results suggest that, while anxiety symptoms in the setting of depression may be associated with more severe psychopathology, it does not negatively impact outcome to protocolized antidepressant treatment in older adults,” the researchers wrote.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Saade YM, Nicol G, Lenze EJ, et al. Comorbid anxiety in late-life depression: Relationship with remission and suicidal ideation on venlafaxine treatment [published online November 4, 2019]. Depress Anxiety. doi:10.1002/da.22964