Differential impact of anxiety symptoms and anxiety disorders on treatment outcome for psychotic depression in the STOP-PD study

• Published in: Comprehensive psychiatry Vol. 55; no. 5; pp. 1069 - 1076
• Main Authors: Davies, Simon J.C, Mulsant, Benoit H, Flint, Alastair J, Rothschild, Anthony J, Whyte, Ellen M, Meyers, Barnett S
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2014; Elsevier; Elsevier Limited
• Subjects: Adult and adolescent clinical studies; Age; Antidepressive Agents - therapeutic use; Antipsychotic Agents - therapeutic use; Anxiety; Anxiety - diagnosis; Anxiety - drug therapy; Anxiety - psychology; Anxiety Disorders - diagnosis; Anxiety Disorders - drug therapy; Anxiety Disorders - psychology; Benzodiazepines - therapeutic use; Biological and medical sciences; Confidence intervals; Consent; Depression; Depressive Disorder, Major - drug therapy; Depressive Disorder, Major - psychology; Female; Gender; Humans; Logistic Models; Logistics; Male; Medical sciences; Middle Aged; Miscellaneous; Mood disorders; Panic attacks; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotic Disorders - drug therapy; Psychotic Disorders - psychology; Psychotropic drugs; Regression analysis; Serotonin Uptake Inhibitors - therapeutic use; Sertraline - therapeutic use; Studies; Treatment Outcome; Variables; Psychosis; Mood disorder; Affect affectivity; Symptomatology; Treatment efficiency; Psychotic depression; Anxiety disorder; Depression; Anxiety
• ISSN: 0010-440X; 1532-8384
• DOI: 10.1016/j.comppsych.2014.02.001

Abstract Background There are conflicting results on the impact of anxiety on depression outcomes. The impact of anxiety has not been studied in major depression with psychotic features (“psychotic depression”). Aims We assessed the impact of specific anxiety symptoms and disorders on the outcomes of psychotic depression. Methods We analyzed data from the Study of Pharmacotherapy for Psychotic Depression that randomized 259 younger and older participants to either olanzapine plus placebo or olanzapine plus sertraline. We assessed the impact of specific anxiety symptoms from the Brief Psychiatric Rating Scale (“tension”, “anxiety” and “somatic concerns” and a composite anxiety score) and diagnoses (panic disorder and GAD) on psychotic depression outcomes using linear or logistic regression. Age, gender, education and benzodiazepine use (at baseline and end) were included as covariates. Results Anxiety symptoms at baseline and anxiety disorder diagnoses differentially impacted outcomes. On adjusted linear regression there was an association between improvement in depressive symptoms and both baseline “tension” (coefficient = 0.784; 95% CI: 0.169–1.400; p = 0.013) and the composite anxiety score (regression coefficient = 0.348; 95% CI: 0.064–0.632; p = 0.017). There was an interaction between “tension” and treatment group, with better responses in those randomized to combination treatment if they had high baseline anxiety scores (coefficient = 1.309; 95% CI: 0.105–2.514; p = 0.033). In contrast, panic disorder was associated with worse clinical outcomes (coefficient = −3.858; 95% CI: –7.281 to −0.434; p = 0.027) regardless of treatment. Conclusions Our results suggest that analysis of the impact of anxiety on depression outcome needs to differentiate psychic and somatic symptoms.