Suzanne C van Bronswijk1, Lotte H J M Lemmens2, Marcus J H Huibers3, Arnoud Arntz4, Frenk P M L Peeters5. 1. Department of Psychiatry and Psychology, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. Electronic address: suzanne.vanbronswijk@maastrichtuniversity.nl. 2. Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands. 3. Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands; Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. 4. Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands. 5. Department of Psychiatry and Psychology, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands; School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Abstract
BACKGROUND:Anxious depression is an important subtype of Major Depressive Disorder (MDD) defined by both syndromal (anxiety disorders) and dimensional (anxiety symptoms) criteria. A debated question is how anxiety affects MDD treatment. This study examined the impact of comorbid anxiety disorders and symptoms on the effectiveness of and dropout during Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for MDD. METHODS: Depressed individuals were randomized to CT (n = 76) or IPT (n = 75). Outcome was depression severity measured with the Beck Depression Inventory-II (BDI-II) at the start of each therapy session, post treatment, and monthly up to five months follow-up. Anxiety disorders were assessed with the Structured Clinical Interview for DSM-IV Axis I disorders, (phobic) anxiety symptoms were assessed with Brief Symptom Inventory subscales. RESULTS: Approximately one third of participants had a comorbid anxiety disorder. Comorbid anxiety disorders and anxiety symptoms were associated with less favorable depression change during IPT as compared to CT in the treatment phase, but not in the trial follow-up phase. Individuals with a comorbid anxiety disorder had significantly higher treatment dropout during both treatments. LIMITATIONS: Not all therapists and participants were blind to the assessment of comorbid anxiety disorders and the assessments were performed by one rater. CONCLUSIONS: A preference for CT over IPT for MDD is justifiable when comorbid anxiety is present, although long-term differences are not established and replication of this finding is needed. Clinicians should be aware of the risk of dropout for depressed individuals with an anxiety disorder.
RCT Entities:
BACKGROUND:Anxious depression is an important subtype of Major Depressive Disorder (MDD) defined by both syndromal (anxiety disorders) and dimensional (anxiety symptoms) criteria. A debated question is how anxiety affects MDD treatment. This study examined the impact of comorbid anxiety disorders and symptoms on the effectiveness of and dropout during Cognitive Therapy (CT) and Interpersonal Psychotherapy (IPT) for MDD. METHODS:Depressed individuals were randomized to CT (n = 76) or IPT (n = 75). Outcome was depression severity measured with the Beck Depression Inventory-II (BDI-II) at the start of each therapy session, post treatment, and monthly up to five months follow-up. Anxiety disorders were assessed with the Structured Clinical Interview for DSM-IV Axis I disorders, (phobic) anxiety symptoms were assessed with Brief Symptom Inventory subscales. RESULTS: Approximately one third of participants had a comorbid anxiety disorder. Comorbid anxiety disorders and anxiety symptoms were associated with less favorable depression change during IPT as compared to CT in the treatment phase, but not in the trial follow-up phase. Individuals with a comorbid anxiety disorder had significantly higher treatment dropout during both treatments. LIMITATIONS: Not all therapists and participants were blind to the assessment of comorbid anxiety disorders and the assessments were performed by one rater. CONCLUSIONS: A preference for CT over IPT for MDD is justifiable when comorbid anxiety is present, although long-term differences are not established and replication of this finding is needed. Clinicians should be aware of the risk of dropout for depressed individuals with an anxiety disorder.
Authors: Jeffrey R Vittengl; Lee Anna Clark; Jasper A J Smits; Michael E Thase; Robin B Jarrett Journal: J Affect Disord Date: 2018-08-25 Impact factor: 4.839
Authors: D A van Dijk; M L Deen; Th M van den Boogaard; H G Ruhé; J Spijker; F P M L Peeters Journal: Eur Arch Psychiatry Clin Neurosci Date: 2022-10-17 Impact factor: 5.760