For about half of patients with major depressive disorder, clinically significant anxiety accompanies their depression, and treatment for these individuals may be more difficult due to the coexisting anxiety. Antidepressant medication, which can be so helpful to many, is less likely to benefit these patients.


In January 2008, a study from the American Journal of Psychiatry compared the treatment outcomes of patients with what they termed “anxious depression” to that of patients with depression only. Of the 2,876 study participants, 52% had significant symptoms of anxiety in addition to depression. After 14 weeks of treatment with the antidepressant citalopram (Celexa), 42% of these patients had seen improvement in their symptoms, and 22% had reached remission. For patients with depression only, however, 53% had improved from taking the medication and 33% reached remission. Not only was remission less likely for those with anxious depression, it also took longer for symptoms to subside in those who did remit. After treatment with Celexa, those who did not remit were randomly selected to either add a second antidepressant to their treatment or switch antidepressants altogether. Again, the combination of depression and anxiety was associated with poorer treatment outcomes, regardless of whether the participant had switched to another antidepressant or added a second to augment the first.

Patients with anxiety in addition to depression often have other related difficulties; they are more likely to be unemployed, have less education, have lower socioeconomic standing, be suicidal, have more severe depression, and to have more concurrent disorders. In the 2008 study, patients with anxious depression also experienced more adverse side effects from their medication and were more likely to be hospitalized. Cause and effect is a complex issue, and any of these problems could contribute to anxiety and depression, or stem from them. Stress caused by these difficulties may be partially responsible for the poor treatment outcomes associated with anxious depression, and there could be other, more subtle factors at play as well.

The gap in treatment outcomes between those with depression and anxiety and those with depression only is troubling, and illustrates why it is important that individuals with both conditions find a form of treatment that works for them. Identifying those most likely to have difficulties during treatment may be an important factor in effectively treating both depression and anxiety.