Depression and anxiety a dangerous combination

Suicide risk runs high among patients suffering from both conditions

Depression is a common health problem that causes serious disability worldwide. Indeed, studies show significant levels of functional impairment caused by depressive symptoms. This makes it very important for clinicians to target the early identification of depressive symptoms as the first step toward the prediction and prevention of major depression while also taking into account possible risk factors. Gender, marital status, age, and prior history of other psychiatric disorder or depressive symptoms are associated with rates of major depression.

    Depression may occur as pure depression with another psychiatric disorder. Studies of diagnostic patterns show that depression, anxiety, and other psychiatric disorders can occur with each other at the same time.

    The Cross-National Collaborative Group studied the coexistence of major depression with other psychiatric disorders, and showed increased odds ratios in subjects with major depression for lifetime comorbidity with alcohol and drug abuse or dependence, panic disorder, and obsessive-complusive disorder. A United States National Comorbidity Survey also showed at least one diagnosis of anxiety disorder recognized in subjects with a lifetime major depressive disorder.

    A basic pattern of bivariate comorbidity between major depression disorder and anxiety disorders showed that respondents with lifetime depression also had a lifetime anxiety disorder and those with a lifetime anxiety disorder had lifetime major depression disorder. This was shown in a 12-month comorbidity study, with major depressive disorder and anxiety cooccurring at the same time.

    Comorbidity is also associated with illness severity. There are types of anxiety considered to be a significant predictor of role impairment due to depression, and depression significantly predicts serious role impairment associated with generalized anxiety disorder and social phobia.

    Comorbid depression has a more consistent association with suicide attempts in those with a history of simple phobia, social phobia, panic disorder, and posttraumatic-stress disorder. Anxiety-depression comorbidity is more persistent than either pure anxiety or pure depression. Over time, anxiety and depression covary, and tend to be recurrent.

    All these point to a significant decline in a patient's quality of life. It has great impact on the outcome of physical disorders, lost productivity, and daily function. They pose a challenge on unlocking the nature, etiology, changing character, and interactions of depression and anxiety disorders, as well as understanding the biological and psychosocial variables in the etiology of comorbidities. Further, there is also the challenge of ascertaining precipitating life experiences and stressors including primary psychiatric disorders that promote secondary depression or comorbidity.

    Besides psychosocial and environmental factors, there is some evidence pointing to genetic influences that may bring about the cause of some forms of comorbidity between depression and anxiety. A case of comorbidity between depression and generalized anxiety disorder suggests that the genes for these two disorders are identical and may interact with stressful environmental experiences, the result of which could manifest either as depression, anxiety, or depression-anxiety.

    Continuing investigations into comorbidities are important especially because studies show that comorbid depression-anxiety is prevalent in the general population and is often underdiagnosed and undertreated, and patients with comorbidity have a poorer diagnosis than those with pure disorders.

    Treatmentwise, however, there have been massive improvements. Modern medications are equally effective in treating pure depression or depression cooccurring with anxiety. Likewise, treatment for anxiety disorders are equally effective whether or not there is depression.

    However, adjunct to the treatment of depression and comorbidities should be the prevention of the same. Kessler (1993) said that if primary disorders are causal or in a causal pathway linked to risk of the secondary disorders, early interventions aimed at treatment of primary disorders could be effective in preventing secondary disorders.

    Furthermore, if primary disorders are early warnings of risk that are amenable to environmental intervention, then early interventions aimed at preventing secondary disorders among people with current primary disorders might likewise be effective. However, if depression and anxiety are manifestations of a common genetic vulnerability, successful treatment of primary anxiety may not prevent the onset of secondary depression. A. Cababa