TY - JOUR
T1 - Do comorbid social and other anxiety disorders predict outcomes during and after cognitive therapy for depression?
AU - Vittengl, Jeffrey R.
AU - Clark, Lee Anna
AU - Smits, Jasper A.J.
AU - Thase, Michael E.
AU - Jarrett, Robin B.
N1 - Funding Information:
Dr. Vittengl is a paid reviewer for UpToDate. Dr. Clark has no financial interest or conflict of interest in the research. Dr. Smits receives research funding from NIMH, NIDA and CPRIT. He has received compensation from Microtransponder, Inc. for consultation on research unrelated to the research described in this manuscript. He also receives royalties from various publishers for publications unrelated to the research described in this manuscript. Dr. Thase has no conflicts of interest pertaining to this paper, although he does report the following relationships with companies that develop treatment for depression or provide education pertaining to those treatments: Dr. Thase has consulted with and/or served on advisory boards for Alkermes, Allergan (includes Forest Laboratories), AstraZeneca, Cerecor, Johnson & Johnson (includes Janssen), Lundbeck, MedAvante, Merck, Moksha8, Otsuka, Pfizer Pharmaceuticals, Shire, Sunovion, and Takeda; he has received grant support from Alkermes, Allergan (includes Forest Laboratories), Assurerx, Johnson & Johnson, Takeda, the Agency for Healthcare Research and Quality, Patient Centered Outcomes Research Institute and the NIMH. He has equity holdings for MedAvante, Inc. and has received royalties from American Psychiatric Publishing, Inc. (APPI), Guilford Publications, Herald House, and W.W. Norton & Company, Inc. Dr. Thase’s spouse is an employee of Peloton Advantage, which does business with several pharmaceutical companies. Dr. Jarrett’s medical center collects the payments from the cognitive therapy she provides to patients. Dr. Jarrett is a paid consultant to the National Institutes of Health and is a paid reviewer for UpToDate.
Funding Information:
This report was supported by Grants Number K24 MH001571 , R01 MH58397 , R01 MH69619 (to Robin B. Jarrett, Ph.D.) and R01 MH58356 and R01 MH69618 (to Michael E. Thase, M.D.) from the National Institute of Mental Health (NIMH). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIMH or the National Institutes of Health.
Publisher Copyright:
© 2018
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Background: Cognitive therapy (CT) improves symptoms in adults with major depressive disorder (MDD) plus comorbid anxiety disorder, but the specific type of anxiety may influence outcomes. This study compared CT outcomes among adults with MDD plus social, other, or no comorbid anxiety disorders. Methods: Outpatients with recurrent MDD (N = 523, including 87 with social and 110 with other comorbid anxiety disorders) received acute-phase CT. Higher risk responders (n = 241 with partial or unstable response) were randomized to 8 months of continuation treatment (CT or clinical management plus fluoxetine or pill placebo), followed by 24 months of assessment. Lower risk responders (n = 49) were assessed for 32 months without additional research treatment. Depression, anxiety symptoms, and social avoidance were measured repeatedly. Results: Other (non-social), but not social, anxiety disorders predicted elevated depression and anxiety symptoms throughout and after acute-phase CT. Social, but not other, anxiety disorder predicted greater reduction in depressive symptoms during acute-phase CT and elevated social avoidance during and after acute-phase CT. Limitations: Anxiety disorders were assessed only before acute-phase treatment. The anxiety symptom measure was brief. Generalization to other patient populations and treatments is unknown. Conclusions: Non-social comorbid anxiety disorders may reduce the efficacy of acute-phase CT for MDD by diminishing both short- and longer term outcomes relative to depressed patients without comorbid anxiety disorders. Comorbid social anxiety disorder may increase relative reductions in depressive symptoms during acute-phase CT for MDD, but patients with comorbid social anxiety disorder may require specialized focus on social avoidance during CT.
AB - Background: Cognitive therapy (CT) improves symptoms in adults with major depressive disorder (MDD) plus comorbid anxiety disorder, but the specific type of anxiety may influence outcomes. This study compared CT outcomes among adults with MDD plus social, other, or no comorbid anxiety disorders. Methods: Outpatients with recurrent MDD (N = 523, including 87 with social and 110 with other comorbid anxiety disorders) received acute-phase CT. Higher risk responders (n = 241 with partial or unstable response) were randomized to 8 months of continuation treatment (CT or clinical management plus fluoxetine or pill placebo), followed by 24 months of assessment. Lower risk responders (n = 49) were assessed for 32 months without additional research treatment. Depression, anxiety symptoms, and social avoidance were measured repeatedly. Results: Other (non-social), but not social, anxiety disorders predicted elevated depression and anxiety symptoms throughout and after acute-phase CT. Social, but not other, anxiety disorder predicted greater reduction in depressive symptoms during acute-phase CT and elevated social avoidance during and after acute-phase CT. Limitations: Anxiety disorders were assessed only before acute-phase treatment. The anxiety symptom measure was brief. Generalization to other patient populations and treatments is unknown. Conclusions: Non-social comorbid anxiety disorders may reduce the efficacy of acute-phase CT for MDD by diminishing both short- and longer term outcomes relative to depressed patients without comorbid anxiety disorders. Comorbid social anxiety disorder may increase relative reductions in depressive symptoms during acute-phase CT for MDD, but patients with comorbid social anxiety disorder may require specialized focus on social avoidance during CT.
KW - Anxiety disorders
KW - Cognitive therapy
KW - Comorbidity
KW - Fluoxetine
KW - Major depressive disorder
KW - Social anxiety disorder
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U2 - 10.1016/j.jad.2018.08.053
DO - 10.1016/j.jad.2018.08.053
M3 - Article
C2 - 30176494
AN - SCOPUS:85054101998
SN - 0165-0327
VL - 242
SP - 150
EP - 158
JO - Journal of affective disorders
JF - Journal of affective disorders
ER -