The comorbidity factor: establishing the primary diagnosis in patients with mixed symptoms of anxiety and depression.

Accurate diagnosis is the key to effective treatment and long-term management of anxiety and depressive disorders. Numerous studies, however, have established a high incidence of depressive symptoms among patients with anxiety disorders and likewise a significant incidence of anxiety symptoms among patients with unipolar or bipolar disorders. These patients with mixed symptoms will experience a more severe illness, with generally poorer outcome. Careful assessment of the patient's predominant mood, sleep patterns, psychomotor signs, age of onset, family history, pattern of substance use, response to exercise, and extent of psychosocial contact can assist the clinician in making an accurate primary diagnosis.