Simon J C Davies1, Benoit H Mulsant2, Alastair J Flint3, Anthony J Rothschild4, Ellen M Whyte5, Barnett S Meyers6. 1. Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Academic Unit of Psychiatry, University of Bristol, Bristol, UK. 2. Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada. Electronic address: benoit.mulsant@camh.ca. 3. Department of Psychiatry, University of Toronto, Toronto, Canada; University Health Network, Toronto, Canada. 4. University of Massachusetts Medical School and University of Massachusetts, Worcester, MA, USA. 5. Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 6. Weill Medical College of Cornell University and New York Presbyterian Hospital, New York, NY, USA.
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 eitherolanzapine 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.
RCT Entities:
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.