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V.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY

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The diagnosis and therapy of comorbid anxiety and depression disorders in clinical practice

https://doi.org/10.31363/2313-7053-2021-1-102-112

Abstract

Objective: to discuss problems of diagnostics and psychopharmacotherapy of associated depressive disorders and anxiety circle disorders.

Material and methods. The article is an analysis of a clinical case with the use of clinical and catamnestic method.

Results. Diagnostics of Generalized Anxiety Disorder, issues of its comorbidity with other mental disorders including anxiety and depressive disorders are discussed. The principles of panic disorder diagnosis are analyzed. Diagnostic criteria of associated anxiety and depression in ICD-10, DSM-5 and ICD-11 are considered. Modern approaches to the choice of therapeutic tactics in comorbidal anxiety and depression are given. The analysis of the patient’s treatment is carried out with the justification of the choice of drugs. The possibilities of combined therapy of associated anxiety and depression disorders using vortioxetine are demonstrated. Achievement of qualitative remission of mental disorder without residual symptomatology and full restoration of social functioning of the patient with associated depressive and anxious disorders is shown.

Conclusion. The clinical case demonstrates a characteristic chronic fluctuating course of GTR both in combination with different depths of depression and with other anxiety disorders (panic attacks). Diagnostic difficulties and therapeutic possibilities of a patient with double diagnosis: Generalized Anxiety Disorder and Depressive Episode have been analyzed.

About the Authors

N. N. Petrova
Saint-Petersburg University
Russian Federation


K. S. Savickaya
Peoples’ Friendship University of Russia
Russian Federation


References

1. Bekker RA, Bykov YU V. Alimemazin: application overview. Psihiatriya i psihofarmakoterapiya im.P.B.Gannushkina. 2016; 18 (6): 10-20. (In Russ.).

2. Zalutskaya NM. Generalized anxiety disorder: current theoretical models and approaches to diagnosis and therapy. Part3. Obozrenie Psihiatrii i Medicinskoj Psihologii im. V.M. Bekhtereva. 2015; 1:83–89 (In Russ.)

3. Kaluev AV, Natt DDzh. On the role of GABA in the pathogenesis of anxiety and depression. Eksperim. i klinich. farmakologiya. 2004; 67(4): 71-76. (In Russ.).

4. Karavaeva TA, Vasilyeva AV, Poltorak SV et al.. Diagnostic algorithm and criteria of generalized anxiety disorder. Obozrenie Psihiatrii i Medicinskoj Psihologii im. V.M. Bekhtereva. 2015; 3:124–130 (In Russ.)

5. Krasnov VN. Anxiety disorders: their place in modern systematics and therapy approaches. Social’naya i klinicheskaya psihiatriya. 2008; 3: 33-38. (In Russ.).

6. Mosolov SN. Trevozhnye i depressivnye rasstrojstva: komorbidnost’ i terapiya. M.: Artinfo; 2007: 63. (In Russ.).

7. Petrova NN. Optimization of antidepressant therapy. Obozrenie psihiatrii i medicinskoj psihologii im. V.M. Bekhtereva. 2013; 2: 83-97. (In Russ.).

8. Aboukhatwa M, Dosanjh L, Luo Y. Antidepressants are a rational complementary therapy for the treatment of Alzheimer’s disease. Mol Neurodegener. 2010; 5(10): 17.

9. Andrade LH, Wang Y-P. How global epidemiological evidence can inform the revision of ICD-10 classification of depression and anxiety disorders. World Psychiatry. 2012; 11(Suppl. 1):4-8.

10. Angst J, Gamma A, Baldwin DS et al. The generalized anxiety spectrum: prevalence, onset, course and outcome. Eur Arch Psychiatry ClinNeurosci. 2009; 259(1): 37-45.

11. Angst J, Gamma A, Bienvenu J et al. Varying temporal criteria for generalized anxiety disorder: prevalence and clinical characteristics in a young age cohort. Psychol Med. 2006; 36(9): 1283-1292.

12. Anxiety Disorders / D.Nutt, J.Ballenger (Еds.). Oxford: Blackwell Publishing. 2003; 286p.

13. Baldwin DS, Hansen Т, Florea I. Vortioxetine (Lu AA21004) in the long-term open-label treatment of major depressive disorder. Curr Med Res Opin. 2012; 28(10):1717-1724.

14. Batail JM, Palaric J, Guillery М et al. Personalized Medicine in Psychiatry. 2017. 7. https://doi.org/10.1016/j.pmip.2017.12.001clinical spec

15. Boulenger JP, Loft Н, Olsen СК. Efficacy and safety of vortioxetine (Lu AA21004), 15 and 20 mg/day: a randomized, double-blind, placebo-controlled, dNuttuloxetine-referenced study in the acute treatment of adult patients with major depressive disorder. Int Clin Psychopharmacol. 2014; 29:138-149.

16. Cameron ОG. Understanding Comorbid Depression and Anxiety. Psychiatric Times. 2007; 24(14):51-56.

17. Caspi А, Sugden К, Moffitt TE et al. Influence of Life Stress on Depression: Moderation by a Polymorphism in the 5-HTT Gene. Science. 2003; 301(5631):386-389. DOI: 10.1126/science.1083968.

18. Chen G, Lee R, Hojer AM, Buchbjerg JK, Serenko M, Zhao Z. Pharmacokinetic drug interactions involving vortioxetine (Lu AA21004), a multimodal antidepressant. Clin Drug Investig. 2013; 33(10):727-736.

19. Citrome L. Vortioxetine for major depressive disorder: a systematic review of the efficacy and safety profile for this newly approved antidepressant— what is the number needed to treat, number needed to harm and likelihood to be helped or harmed? Int J Clin Pract. 2014; 68(1):60–82.

20. Conradi HJ, Ormel J, de Jonge P. Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study. Psychol.Med. 2011; 41:1165–1174.

21. Demyttenaere К, Donneau A-F, Albert A et al. What is important in being cured from depression? Discordance between physicians and patients. Journal of Affective Disorders. 2015; 174:390–396.

22. Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization, 2017; Licence: CC BY-NC-SA 3 IGO.

23. Ebert DD, Zarski AC, Christensen H, Stikkelbroek Y, Cuijpers P, Berking M, Riper H. Internet and computer-based cognitive behavioral therapy for anxiety and depression in youth: a meta-analysis of randomized controlled outcome trials. PLoS ONE. 2015; 10 (3):129-132. DOI: 10.1146/annurev.psych.49.1.377

24. Fawcett J, Cameron RP, Schatzberg AF. Textbook of anxiety disorders, 2nd ed. Am J Psychiatry. 2010; 167(5):606-607. DOI: 10.1176/appi.ajp.2009.09121838

25. Hranov LG. Comorbid anxiety and depression: illumination of a controversy. Psychiatry Clin Pract. 2007; 11(3):89-171.

26. Judd LL, Kessler RC, Paulus MP et al. Comorbidity as a fundamental feature of generalized anxiety disorders: results from the National Comorbidity Study. Acta Psych. Scand. 1998; 98, Sup. 393:6-11.

27. Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, van Balkom AJ, Nolen WA, Zitman FG, Beekman AT, Penninx BW.Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry. 2011; 72(3):341-348. doi: 10.4088/JCP.10m06176blu. Epub 2011 Jan 25.

28. Lesch KP, Bengel, D, Heils A et al. Association of anxiety-related traits with a polymorphism in the serotonin transporter gene regulatory region. Science. 1996; 274: 1527–1531.

29. Mineka S, Watson D, Clark LA. Comorbidity of anxiety and unipolar mood disorders. Ann Rev Psychol. 1998; 49(1):377-412.

30. Moscati A, Flint J, Kendler KS. Classificaion of anxiety disorders comorbid with major depression: common or distinct influences on risk? Depress Anxiety. 2016; 33(2):120-127.

31. Paykel E, Andrade LH, Njenga F, Phillips MR.Changes needed in the classification of depressive disorders: options for ICD-11. World Psychiatry. 2012; 11(Supplement 1):37–42.

32. Rouillon F, Chignon JM. Psychiatric comorbidity of anxiety disorders in the year 2000: Controversies and perspectives / Costa-e-Silva J.A. (ed.). Proceeding of the meeting held in Paris 9, June. 1992:2634.

33. Salcedo B. The Comorbidity Of Anxiety And Depression. National Alliance on Mental Illness. 2018; 19:325-333.

34. Stein DJ. Anxiety symptoms in depression: clinical and conceptual considerations. Medicographia. 2013; 35(3):299–303.

35. van den Akker M, Buntinx F, Knottnerus JA. Comorbidity or multimorbidity. Eur J Gen Pract. 1996; 2:65-70. doi:10.3109/13814789609162146

36. van der Voort TY., Seldenrijk A., van Meijel B. et al. Functional versus syndromal recovery in patients with major depressive disorder and bipolar disorder//J Clin Psychiatry. 2015; 76(6):809-814. doi: 10.4088/JCP.14m09548.

37. Wittchen HU. Generalized anxiety disorder— a risk factor for depression? Int. J. Met. Psych. Res. 2006; 10(1):52-57.

38. Wittchen H-U, Lieb R, Schuster P et al. When is onset? Investigations into early developmental stages of anxiety and depressive disorders. Rapoport J.L. (ed.) Childhood Onset of “Adult” Psychopathology: Clinical and Research Advances.— Washington, DC: American Psychiatric Press. 1999: 259-302.

39. Zhou Y, Zh Cao, Yang M et al. Comorbid generalized anxiety disorder and its association with quality of life in patients with major depressive disorder. Scientific Reports. 2017; 18:40511. doi: 10.1038/srep40511.

40. Zimmerman M, McGlinchey J B, Posternak MA et al., How Should Remission From Depression Be Defined? The Depressed Patient’s Perspective. Am J Psychiatry. 2006; 163:148–150.

41. Zimmerman М, Martinez JA, Attiullah N et al. Why do some depressed outpatients who are in remission according to the Hamilton Depression Rating Scale not consider themselves to be in remission? J Clin psych. 2012; 73(6):790-795. DOI: 10.4088/JCP.11m07203


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For citations:


Petrova N.N., Savickaya K.S. The diagnosis and therapy of comorbid anxiety and depression disorders in clinical practice. V.M. BEKHTEREV REVIEW OF PSYCHIATRY AND MEDICAL PSYCHOLOGY. 2021;55(1):102-112. (In Russ.) https://doi.org/10.31363/2313-7053-2021-1-102-112

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