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Psychotherapy and Psychosomatics 2021Depressive and anxiety disorders are frequently associated. Depression may be a complication of anxiety and anxiety can complicate depression. The nature of their... (Review)
Review
Depressive and anxiety disorders are frequently associated. Depression may be a complication of anxiety and anxiety can complicate depression. The nature of their relationship has been a source of controversy. Reviews generally base their conclusions on randomized controlled trials and meta-analyses that refer to the average patient and often clash with the variety of clinical presentations that may occur when anxiety and depression coexist. The aim of this review was to examine the literature according to profiling of subgroups of patients based on clinimetric criteria, in line with the recently developed concept of medicine-based evidence. We critically reviewed the literature pertaining to the specific presentations of anxiety and depression, outlining the advantages and disadvantages of each treatment approach. The following prototypic cases were presented: depression secondary to an active anxiety disorder, depression in patients with anxiety disorders under treatment, anxious depression, anxiety as a residual component of depression, and demoralization secondary to anxiety disorder. We argue that the selection of treatment when anxiety and depression coexist should take into account the modalities of presentation and be filtered by clinical judgment. Very different indications may ensue when the literature is examined according to this perspective.
Topics: Anxiety; Anxiety Disorders; Cognitive Behavioral Therapy; Depression; Diagnosis, Differential; Humans
PubMed: 34344013
DOI: 10.1159/000517518 -
Journal of Affective Disorders Jun 2022Perinatal anxiety is associated with adverse outcomes for women and their infants. Women in low- and middle-income countries (LMIC) may be at higher risk of perinatal... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Perinatal anxiety is associated with adverse outcomes for women and their infants. Women in low- and middle-income countries (LMIC) may be at higher risk of perinatal anxiety. We aimed to systematically review and synthesise the evidence on prevalence of perinatal anxiety in LMIC.
METHOD
We searched MEDLINE, Embase, PscyhINFO, Global Health and Web of Science to identify studies assessing prevalence of perinatal anxiety in LMIC. Studies published since January 2016 were included. Screening and data extraction was conducted independently by two reviewers. Pooled prevalence estimates were calculated using random-effect meta-analyses and sources of heterogeneity explored through subgroup analyses and meta-regression.
RESULTS
We screened 9494 titles and abstracts, reviewed 700 full-texts and included 54 studies in the systematic review and meta-analysis. The pooled prevalence of self-reported anxiety symptoms was 29.2% (95%CI 24.5-34.2; I 98.7%; 36 studies; n = 28,755) antenatally and 24.4% (95%CI 16.2-33.7; I 98.5%; 15 studies; n = 6370) postnatally. The prevalence of clinically-diagnosed anxiety disorder was 8.1% (95%CI 4.4-12.8; I 88.1% 5 studies; n = 1659) antenatally and 16.0% (95% CI 13.5-18.9; n = 113) postnatally.
LIMITATIONS
Our search was limited to studies published since January 2016 in order to update a previous review on this topic.
CONCLUSION
Perinatal anxiety represents a significant burden in LMIC, with one in four women experiencing symptoms during pregnancy or postpartum. Research remains lacking in a significant proportion of LMIC, particularly in the lowest income countries. Further research should guide application of screening tools in clinical settings to identify women with anxiety disorders in order to provide appropriate treatment.
Topics: Anxiety; Anxiety Disorders; Developing Countries; Female; Humans; Infant; Poverty; Pregnancy; Prevalence
PubMed: 35306121
DOI: 10.1016/j.jad.2022.03.032 -
BMC Psychiatry Jun 2023Depression and anxiety are common symptoms associated with significant morbidity in adolescents. Few studies have explored the relationship between latent profiles of...
BACKGROUND
Depression and anxiety are common symptoms associated with significant morbidity in adolescents. Few studies have explored the relationship between latent profiles of adolescent depression-anxiety symptoms and executive function (EF), which is also a major pediatric public health concern.
METHODS
The sample included 1,306 participants who were recruited from two schools in Ningxia. The Depression Self-Rating Scale for Children (DSRSC) and the Screen for Child Anxiety Related Emotional Disorders (SCARED) were used to assess the level of depression-anxiety symptoms in adolescents, and their executive function state was assessed using the Behavior Rating Inventory of Executive Function-Self-Report version (BRIEF-SR). Latent profile analysis (LPA) was carried out using Mplus 7.0 to explore the most likely number of profiles based on the subscales of DSRSC and SCARED. The relationship between adolescents' executive function and depression-anxiety symptoms were analyzed by multivariable logistic regression, and the odds ratio were used to test the impact of this relationship.
RESULTS
The LPA results show that the three-profile model was the best-fitting model for adolescent depression and anxiety symptoms. The proportions of Profile-1 ("Healthy Group"), Profile-2 ("Anxiety Disorder Group"), and Profile-3 ("Depression-Anxiety Disorder Group") were 61.4%, 23.9%, and 14.7%, respectively. Additional analyses using multivariable logistic regression suggested that poor shifting capacity and emotional control were significantly more likely to be classified into the depression and/or anxiety groups, and worse working memory, task completion, and better inhibition were significantly more likely to be classified into the anxiety group.
CONCLUSIONS
The findings contribute to our understanding of the heterogeneity of adolescents' depression-anxiety symptoms and highlight the important role of executive function in influencing mental health outcomes. These findings will guide the improvement and delivery of interventions for the treatment of anxiety and depression in adolescents, mitigating functional impairments in patients and reducing disease risk.
Topics: Adolescent; Humans; Anxiety; Anxiety Disorders; Depression; East Asian People; Executive Function
PubMed: 37286986
DOI: 10.1186/s12888-023-04810-z -
Canadian Journal of Psychiatry. Revue... Jun 2022Despite increasing rates of legalization of medical cannabis worldwide, the current evidence available on its effect on mental health outcomes including anxiety is of... (Observational Study)
Observational Study
OBJECTIVES
Despite increasing rates of legalization of medical cannabis worldwide, the current evidence available on its effect on mental health outcomes including anxiety is of mixed results. This study assesses the effect of medical cannabis on generalized anxiety disorder 7-item (GAD-7) scores in adult patients between 2014 and 2019 in Ontario and Alberta, Canada.
METHODS
An observational cohort study of adults authorized to use medical cannabis. The GAD-7 was administered at the time of the first visit to the clinic and subsequently over the follow-up time period of up to 3.2 years. Overall changes in GAD-7 scores were computed (mean change) and categorized as: no change (<1 point); improvement; or worsening-over time.
RESULTS
A total of 37,303 patients had initial GAD-7 scores recorded and 5,075 (13.6%) patients had subsequent GAD-7 follow-up scores. The average age was 54.2 years (SD 15.7 years), 46.0% were male, and 45.6% noted anxiety symptoms at the baseline. Average GAD-7 scores were 9.11 (SD 6.6) at the baseline and after an average of 282 days of follow-up (SD 264) the average final GAD-7 score recorded was 9.04 (SD 6.6): mean change -0.23 (95% CI, -0.28 to -0.17, [5,074]: -8.19, -value <0.001). A total of 4,607 patients (90.8%) had no change in GAD-7 score from their initial to final follow-up, 188 (3.7%) had a clinically significant decrease, and 64 (1.3%) noted a clinically significant increase in their GAD-7 scores.
CONCLUSIONS
Overall, there was a statistically significant decrease in GAD-7 scores over time (in particular, in the 6-12-month period). However, this change did not meet the threshold to be considered clinically significant. Thus, we did not detect clinical improvements or detriment in GAD-7 scores in medically authorized cannabis patients. However, future well-controlled clinical trials are needed to fully examine risks or benefits associated with using medical cannabis to treat anxiety conditions.
Topics: Adult; Alberta; Anxiety Disorders; Cannabis; Female; Humans; Male; Medical Marijuana; Middle Aged; Ontario; Patient Health Questionnaire
PubMed: 34520280
DOI: 10.1177/07067437211043393 -
Neuropsychopharmacology Reports Sep 2023Previous behavioral pharmacology studies involving rodents suggested riluzole had potential to be an ideal psychotropic drug for psychiatric disorders with anxiety or... (Review)
Review
AIM
Previous behavioral pharmacology studies involving rodents suggested riluzole had potential to be an ideal psychotropic drug for psychiatric disorders with anxiety or fear as primary symptoms. Several clinical studies have recently been conducted. The purpose of this study was to gather information about the efficacy and tolerability of riluzole for patients with those symptoms.
METHODS
We searched PubMed, PsycINFO, CINAHL, EMBASE, and the Cochrane database from inception until April 2021, and performed manual searches for additional relevant articles. This review included: (1) studies involving participants that were patients with generalized anxiety disorder (GAD), social anxiety disorder, panic disorder, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), acute stress disorder, or phobias; and (2) randomized controlled trials (RCTs) or intervention studies (e.g., single arm trials) examining the effects and safety of riluzole.
RESULTS
Of the 795 identified articles, four RCTs, one RCT subgroup-analysis, and three open-label trials without control groups met the inclusion criteria. Most trials evaluated the efficacy of riluzole as an augmentation therapy with selective serotonin reuptake inhibitors and other antidepressants for PTSD, OCD, or GAD. However, there was insufficient evidence to confirm the effects of riluzole for patients with these psychiatric disorders. Most trials demonstrated adequate study quality.
CONCLUSIONS
This review found insufficient evidence to confirm the effects of riluzole for psychiatric disorders with anxiety or fear as primary symptoms. It would be worthwhile to conduct studies that incorporate novel perspectives, such as examining the efficacy of riluzole as a concomitant medication for psychotherapy.
Topics: Humans; Riluzole; Anxiety Disorders; Anxiety; Obsessive-Compulsive Disorder; Fear
PubMed: 37463744
DOI: 10.1002/npr2.12364 -
Ugeskrift For Laeger May 2021Up to half of all patients with bipolar affective disorder (BP), develop a comorbid anxiety disorder during their lifetime. The consequences of comorbid anxiety in BP... (Review)
Review
Up to half of all patients with bipolar affective disorder (BP), develop a comorbid anxiety disorder during their lifetime. The consequences of comorbid anxiety in BP compared to BP without comorbid anxiety are serious, including more frequent and severe depressions and twice the risk of substance abuse and suicide attempts. In this review we argue, that due to the poorer prognosis of these conditions, it is important to diagnose comorbid anxiety when present, and to ensure proper treatment, which should be performed by a psychiatrist preferably specialised in affective disorders.
Topics: Anxiety; Anxiety Disorders; Bipolar Disorder; Comorbidity; Humans; Mood Disorders
PubMed: 34060453
DOI: No ID Found -
East Asian Archives of Psychiatry :... Mar 2022This study aims to examine the rates of anxiety, depression, and posttraumatic stress disorder (PTSD) after hospital discharge among COVID-19 survivors and to determine...
OBJECTIVES
This study aims to examine the rates of anxiety, depression, and posttraumatic stress disorder (PTSD) after hospital discharge among COVID-19 survivors and to determine the associated risk factors.
METHODS
Adult COVID-19 survivors discharged from hospitals between March 2020 and March 2021 were asked to complete a questionnaire at 4 weeks after discharge. The Chinese version of the 22-item Impact of Event Scale - Revised (IES-R) was used to measure symptoms of PTSD. The 9-item Patient Health Questionnaire (PHQ-9) was used to assess symptoms of major depressive disorder. The 7-item Generalised Anxiety Disorder Scale (GAD-7) was used to measure symptoms of generalised anxiety disorder. The rates of anxiety, depression, and PTSD among discharged patients were determined, as were associations between psychosocial factors and outcome measures and predictors for moderate-tosevere symptoms of anxiety, depression, and PTSD.
RESULTS
96 men and 103 women aged 18 to 81 years returned the completed questionnaire. 12.1% to 20.1% of them reported symptoms of PTSD, anxiety, or depression. Higher symptom severity was associated with higher perceived life threat, lower emotional support, lower disease severity upon admission, and longer hospital stay. Women had more PTSD symptoms than men, particularly when knowing someone under quarantine.
CONCLUSION
COVID-19 survivors with higher perceived life threat, lower emotional support, lower disease severity upon admission, and longer hospital stay were associated with higher severity of symptoms of PTSD, anxiety, and depression. Timely intervention should provide to at-risk survivors.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anxiety; Anxiety Disorders; COVID-19; Depression; Depressive Disorder, Major; Female; Humans; Male; Middle Aged; Stress Disorders, Post-Traumatic; Survivors; Young Adult
PubMed: 35332104
DOI: 10.12809/eaap2176 -
Behavioral Sleep Medicine 2021: Few studies have examined the relationship between insomnia and anxiety treatment outcomes in naturalistic settings. Furthermore, prior studies typically examine...
: Few studies have examined the relationship between insomnia and anxiety treatment outcomes in naturalistic settings. Furthermore, prior studies typically examine insomnia within a single anxiety diagnosis without accounting for the high overlap between disorders. Here we investigate the association between insomnia and multiple anxiety disorders over a course of cognitive behavioral treatment (CBT) in a naturalistic treatment setting. : Insomnia was assessed in 326 patients seeking treatment at a clinic specializing in CBT for anxiety. : Multilevel modeling was used to investigate whether insomnia moderated reductions in anxiety symptoms. A cross-lagged analysis tested for bidirectional effects between insomnia and anxiety. Multiple regression was used to investigate the relationship between insomnia and anxiety while controlling for the other anxiety disorders and depression. : While there was a significant reduction in insomnia during treatment in all anxiety disorders, the majority of the most severe patients remained in the clinical range at post-treatment. Baseline insomnia did not significantly moderate anxiety outcomes, suggesting that patients with high or low levels of insomnia will do equally well in CBT for anxiety. The bidirectional effect between insomnia and anxiety did not reach significance. Additionally, posttraumatic stress disorder, generalized anxiety disorder, and panic disorder were associated with the greatest endorsement of insomnia, after controlling for the overlap between disorders. : Sleep problems may persist after anxiety treatment, suggesting that CBT for insomnia may be warranted during or after a course of CBT for anxiety. Importantly, baseline insomnia does not impede anxiety reduction during CBT.
Topics: Adult; Anxiety Disorders; Cognitive Behavioral Therapy; Female; Humans; Male; Sleep Initiation and Maintenance Disorders; Treatment Outcome
PubMed: 31955594
DOI: 10.1080/15402002.2020.1714624 -
Journal of Affective Disorders Apr 2021Comorbidity of depressive and anxiety disorders is common and remains incompletely comprehended. This paper summarizes findings from the Netherlands Study of Depression... (Review)
Review
BACKGROUND
Comorbidity of depressive and anxiety disorders is common and remains incompletely comprehended. This paper summarizes findings from the Netherlands Study of Depression and Anxiety (NESDA) regarding prevalence, temporal sequence, course and longitudinal patterns; sociodemographic, vulnerability and neurobiological indicators; and functional, somatic and mental health indicators of comorbidity.
METHODS
Narrative synthesis of earlier NESDA based papers on comorbidity (n=76).
RESULTS
Comorbidity was the rule in over three-quarter of subjects with depressive and/or anxiety disorders, most often preceded by an anxiety disorder. Higher severity and chronicity characterized a poorer comorbidity course. Over time, transitions between depressive and anxiety disorders were common. Consistent comorbidity risk indicators in subjects with depressive and anxiety disorders were childhood trauma, neuroticism and early age of onset. Psychological vulnerabilities, such as trait avoidance tendencies, were more pronounced in comorbid than in single disorders. In general, there were few differences in biological markers and neuroimaging findings between persons with comorbid versus single disorders. Most functional, somatic, and other mental health indicators, ranging from disability to cardiovascular and psychiatric multimorbidity, were highest in comorbid disorders.
LIMITATIONS
The observational design of NESDA limits causal inference. Attrition was higher in comorbid relative to single disorders.
CONCLUSIONS
As compared to single disorders, persons with comorbid depressive and anxiety disorders were characterized by more psychosocial risk determinants, more somatic and other psychiatric morbidities, more functional impairments, and poorer outcome. These results justify specific attention for comorbidity of depressive and anxiety disorders, particularly in treatment settings.
Topics: Anxiety Disorders; Child; Comorbidity; Depressive Disorder; Humans; Netherlands; Prevalence
PubMed: 33588240
DOI: 10.1016/j.jad.2021.02.004 -
European Archives of Psychiatry and... Oct 2023We report on a meta-analysis of Silexan, a proprietary active substance produced from Lavandula angustifolia, in subthreshold anxiety, mixed anxiety and depressive... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
We report on a meta-analysis of Silexan, a proprietary active substance produced from Lavandula angustifolia, in subthreshold anxiety, mixed anxiety and depressive disorder (MADD), and generalized anxiety disorder (GAD).
METHODS
The present analyses are based on all currently completed 5 double-blind, randomized, placebo-controlled trials investigating Silexan in adult out-patients who received Silexan 1 × 80 mg/day or placebo for ten weeks according to random assignment (n = 1213). Efficacy was assessed based on the Hamilton Anxiety Rating Scale (HAMA), several anxiety self-rating scales, the Clinical Global Impression (CGI) scale, and the Short Form-36 (SF-36) health status questionnaire.
RESULTS
After ten weeks' treatment, Silexan was significantly superior to placebo in reducing the HAMA total score (including the psychic and somatic anxiety sub-scores) and self-rated anxiety. Based on a ≥ 50% HAMA total score reduction, the responder rate ratio was 1.34 favoring Silexan, and the rate ratio of subjects much or very much improved according to the CGI was 1.51. Silexan was also significantly superior in improving the physical and mental health summary scores of the SF-36. There were no significant between-group differences concerning the occurrence of adverse events (AEs), serious AEs, and premature withdrawal due to AEs.
CONCLUSIONS
This meta-analysis demonstrates that Silexan exerts significant anxiolytic effects in subthreshold anxiety, GAD and MADD that were consistently reflected in investigator ratings and patient-reported outcomes, including improvement of health-related life-quality, while showing favorable tolerability and safety.
Topics: Adult; Humans; Plant Oils; Oils, Volatile; Anxiety Disorders; Lavandula; Anti-Anxiety Agents; Double-Blind Method; Treatment Outcome; Randomized Controlled Trials as Topic
PubMed: 36717399
DOI: 10.1007/s00406-022-01547-w