Skip to main content
SpringerLink
Log in

Treatment of Comorbid Depression

  • Chapter
  • First Online:
Handbook of Treating Variants and Complications in Anxiety Disorders

Abstract

Anxiety disorders are frequently accompanied by depression which can attenuate anxiety treatment outcomes. As such, this chapter outlines the clinical characteristics of patients presenting with anxiety and depression and describes a treatment approach that is able to adapt to these patients. A case example is given to represent the clinical characteristics and treatment approach.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 329.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Abramowitz, J. A., & Foa, E. B. (2000). Does comorbid major depressive disorder influence outcome or exposure and response prevention for OCD? Behavior Therapy, 31, 795–800.

    Google Scholar 

  • Abramowitz, J. S., Franklin, M. E., Street, G., Kozak, M., & Foa, E. B. (2000). Effects of comorbid depression in response to treatment for obsessive-compulsive disorder. Behavior Therapy, 31, 517–528.

    Google Scholar 

  • Abramowitz, J. S., Deacon, B. J., & Whiteside, S. P. (2011). Exposure therapy for anxiety: Principles and practice. New York: Guilford.

    Google Scholar 

  • Alloy, L. B., Kelly, K. A., Mineka, S., & Clements, C. M. (1990). Comorbidity of anxiety and depressive disorders: A helplessness-hopelessness perspective. In J. D. Maser, C. Cloninger, J. D. Maser, & C. Cloninger (Eds.), Comorbidity of mood and anxiety disorders (pp. 499–543). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, Fourth Ed., Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  • Angst, J., & Dobler-Mikola, A. (1985). The Zurich Study, anxiety and phobia in young adults. European Archives of Psychiatry and Neurological Science, 235, 171–178.

    Article  Google Scholar 

  • Antony, M., Downie, F., & Swinson, R. (1998). Diagnostic issues and epidemiology in obsessive–compulsive disorder Obsessive-compulsive disorder: Theory, research, and treatment. New York: Guilford Press.

    Google Scholar 

  • Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84, 191–215.

    Article  PubMed  Google Scholar 

  • Beck, A. T., & Emery, G. (1985). Anxiety disorders and phobias: A cognitive perspective. Cambridge, MA: Basic Books.

    Google Scholar 

  • Bellodi, L., Scioto, G., Diaferia, G., Ronchi, P., & Smiraldi, E. (1992). Psychiatric disorders in families of patients with obsessive-compulsive disorder. Psychiatry Research, 42, 111–120.

    Article  PubMed  Google Scholar 

  • Belzer, K., & Schneier, F. R. (2004). Comorbidity of anxiety and depressive disorders: Issues in conceptualization, assessment, and treatment. Journal of Psychiatric Practice, 10, 296–306.

    Article  PubMed  Google Scholar 

  • Bremner, J. D., & Charney, D. S. (2010). Neural circuits in fear and anxiety. In D. J. Stein, E. Hollander, & B. O. Rothbaum (Eds.), Textbook of anxiety disorders (2nd ed., pp. 55–71). Washington, DC: American psychiatric Press.

    Google Scholar 

  • Bruce, S. E., Machan, J. T., Dyck, I., & Keller, M. B. (2001). Infrequency of “pure” GAD: Impact of psychiatric comorbidity on clinical course. Depression and Anxiety, 14, 219–225.

    Article  PubMed  Google Scholar 

  • Bruce, S. E., Yonkers, K. A., Otto, M. W., Eisen, J. L., Weisberg, R. B., Pagano, M., et al. (2005). Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: A 12-year prospective study. The American Journal of Psychiatry, 162(6), 1179–1187.

    Article  PubMed  Google Scholar 

  • Bystritsky, A., Kerwin, L., Niv, N., Natoli, J. L., Abrahami, N., Klap, R., et al. (2010). Clinical and subthreshold panic disorder. Depression and Anxiety, 27(4), 381–389.

    Article  PubMed  Google Scholar 

  • Chou, K. (2009). Social anxiety disorder in older adults: Evidence from the National Epidemiologic Survey on alcohol and related conditions. Journal of Affective Disorders, 119(1–3), 76–83.

    Article  PubMed  Google Scholar 

  • Craighead, W., Evans, D., & Robins, C. (1992). Unipolar depression. In S. M. Turner, K. S. Calhoun, & H. Adams (Eds.), Handbook of clinical behavior therapy (2nd ed., pp. 99–116). New York: Wiley.

    Google Scholar 

  • Davis, L., Barlow, D. H., & Smith, L. (2010). Comorbidity and the treatment of principal anxiety disorders in a naturalistic sample. Behavior Therapy, 41(3), 296–305.

    Article  PubMed  Google Scholar 

  • de Graaf, R., Bijl, R. V., ten Have, M., Beekman, A. F., & Vollebergh, W. M. (2004). Pathways to comorbidity: The transition of pure mood, anxiety and substance use disorders into comorbid conditions in a longitudinal population-based study. Journal of Affective Disorders, 82(3), 461–467.

    Article  PubMed  Google Scholar 

  • Demal, U., Lenz, G., Mayrhofer, A., Zapotoczky, H.-G., & Zitterl, W. (1993). Obsessive-compulsive disorder and depression. A retrospective study on course and interaction. Psychopathology, 26, 145–150.

    Article  PubMed  Google Scholar 

  • Dobson, K. D. (1989). A meta-analysis of the efficacy of cognitive therapy for depression. Journal of Consulting and Clinical Psychology, 57, 414–419.

    Article  PubMed  Google Scholar 

  • Eison, M. (1990). Serotonin: A common neurobiologic substrate in anxiety and depression. Journal of Clinical Psychopharmacology, 10(Suppl), 26S–30S.

    Article  PubMed  Google Scholar 

  • Elkin, I., Shea, M., Watkins, J. T., Imber, S., Sotsky, S., Cllins, J., et al. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research program: General effectiveness of treatments. Archives of General Psychiatry, 46, 971–982.

    Article  PubMed  Google Scholar 

  • Foa, E. B., Kozak, M. J., Steketee, G., & McCarthy, P. (1992). Treatment of depressive and obsessive-compulsive symptoms in OCD by imipramine and behavior therapy. British Journal of Clinical Psychology, 31, 279–292.

    Article  PubMed  Google Scholar 

  • Foa, E. B., Liebowitz, M. R., Kozak, M. J., Davies, S., Campeas, R., Franklin, M. E., et al. (2005). Randomized, placebo-controlled trial of exposure and ritual prevention, clomipramine, and their combination in the treatment of obsessive-compulsive disorder. The American Journal of Psychiatry, 162, 151–161.

    Article  PubMed  Google Scholar 

  • Frayne, S. M., Seaver, M. R., Loveland, S., Christansen, C., Spiro, A., Parker, V. A., et al. (2005). Burden of medical illness in women with depression and posttraumatic stress disorder. Archives of Internal Medicine, 164, 1306–1312.

    Article  Google Scholar 

  • Ginzburg, K. (2007). Comorbidity of PTSD and depression following myocardial infarction. Journal of Affective Disorders, 94, 135–143.

    Article  Google Scholar 

  • Goldenberg, K., White, K., Yonkers, J., Reich, M. G., Warshaw, R. M., & Goisman. (1996). The infrequency of “pure culture” diagnoses among the anxiety disorders. The Journal of Clinical Psychiatry, 57, 528–533.

    Article  PubMed  Google Scholar 

  • Goodman, W. K., Price, L. H., Rasmussen, S. A., Masure, C., Fleishman, C., Hill, C., et al. (1989a). The Yale-Brown obsessive compulsive scale (Y-BOCS), I: Development, use and reliability. Archives of General Psychiatry, 46, 1006–1011.

    Article  PubMed  Google Scholar 

  • Goodman, W. K., Price, L. H., Rasmussen, S. A., Masure, C., Fleishman, C., Hill, C., et al. (1989b). The Yale-Brown obsessive compulsive scale (Y-BOCS), II: Validity. Archives of General Psychiatry, 46, 1012–1016.

    Article  PubMed  Google Scholar 

  • Gorman, J. M. (1996). Comorbid depression and anxiety spectrum disorders. Depression and Anxiety, 4, 160–168.

    Article  PubMed  Google Scholar 

  • Greenberger, D., & Padesky, C. A. (1995). Mind over mood: Change how you feel by changing the way you think. New York: Guilford.

    Google Scholar 

  • Hassler, G., LaSalle-Ricci, V., Ronquillo, J., Crawley, S., Cochran, L., Kazuba, D., Greenberg, B., & Murphy, D. (2005). Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity. Psychiatry Research, 135, 121–132.

    Article  PubMed  Google Scholar 

  • Hecht, H., Von Zerssen, D., & Wittchen, H.-U. (1990). Anxiety and depression in a community sample: The influence of comorbidity on social functioning. Journal of Affective Disorders, 18, 137–144.

    Article  PubMed  Google Scholar 

  • Hirschfeld, R. (2001). The comorbidity of major depression and anxiety disorders: Recognition and management in primary care. Primary care companion. Journal of Clinical Psychiatry, 2, 244–254.

    Google Scholar 

  • Hranov, L. G. (2007). Comorbid anxiety and depression: Illumination of a controversy. International Journal of Psychiatry in Clinical Practice, 11(3), 171–189.

    Article  Google Scholar 

  • Huppert, J. D., Simpson, H., Nissenson, K. J., Liebowitz, M. R., & Foa, E. B. (2009). Quality of life and functional impairment in obsessive-compulsive disorder: A comparison of patients with and without comorbidity, patients in remission, and healthy controls. Depression and Anxiety, 26(1), 39–45.

    Article  PubMed  Google Scholar 

  • Lepine, J. P., Wittchen, H. U., & Essau, C. A. (1993). Lifetime and current comorbidity of anxiety and affective disorders: Results from the International WHO/ADAMHA CIDI field trials. International Journal of Methods Psychiatry, 3, 67–77.

    Google Scholar 

  • Marks, I., Stern, R., Mawson, D., Cobb, J., & McDonald, R. (1980). Clomipramine and exposure for obsessive-compulsive rituals. British Journal of Psychiatry, 136, 1–25.

    Article  PubMed  Google Scholar 

  • Marom, S., Gilboa-Schechtman, E., Aderka, I. M., Weizman, A., & Hermesh, H. (2009). Impact of depression on treatment effectiveness and gains maintenance in social phobia: A naturalistic study of cognitive behavior group therapy. Depression and Anxiety, 26(3), 289–300.

    Article  PubMed  Google Scholar 

  • Mineka, S., Watson, D., & Clark, L. (1998). Comorbidity of anxiety and unipolar mood disorders. Annual Review of Psychology, 49, 377–412.

    Article  PubMed  Google Scholar 

  • Moitra, E., Herbert, J. D., & Forman, E. M. (2008). Behavioral avoidance mediates the relationship between anxiety and depressive symptoms among social anxiety disorder patients. Journal of Anxiety Disorders, 22(7), 1205–1213.

    Article  PubMed  Google Scholar 

  • Mollica, R. F., McInnes, K., Sarajlić, N., Lavelle, J., Sarajlić, I., & Massagli, M. P. (1999). Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. Journal of the American Medical Association, 282(5), 433–439.

    Article  PubMed  Google Scholar 

  • Nestadt, G., Samuels, J., Riddle, M. A., Liang, K. Y., Bienvenu, O. J., Hoehn-Saric, R., et al. (2001). Relationship between obsessive-compulsive disorder and anxiety and affective disorders: Results from the Johns Hopkins OCD Family Study. Psychological Medicine, 31, 481–487.

    Article  PubMed  Google Scholar 

  • Newman, M. G., Przeworski, A., Fisher, A. J., & Borkovec, T. D. (2010). Diagnostic comorbidity in adults with generalized anxiety disorder: Impact of comorbidity on psychotherapy outcome and impact of psychotherapy on comorbid diagnoses. Behavior Therapy, 41(1), 59–72.

    Article  PubMed  Google Scholar 

  • Ohayon, M. M., & Schatzberg, A. F. (2010). Social phobia and depression: Prevalence and comorbidity. Journal of Psychosomatic Research, 68(3), 235–243.

    Article  PubMed  Google Scholar 

  • Roy-Byrne, P. P. (2000). Lifetime panic-depression comorbidity in the National Comorbidity Survey. Association with symptoms, impairment, course and help-seeking. The British Journal of Psychiatry, 176, 229–235.

    Article  PubMed  Google Scholar 

  • Ricciardi, J. & McNally, R. J. (1995). Depressed mood is related to obsessions but not compulsions in obsessive-compulsive disorder. Journal of Anxiety Disorders, 9, 249–256.

    Article  PubMed  Google Scholar 

  • Salcioglu, E., Basoglu, M., & Livanou, M. (2003). Long-term psychological outcome for non-treatment-seeking earthquake survivors in Turkey. The Journal of Nervous and Mental Disease, 191, 154–160.

    PubMed  Google Scholar 

  • Schneier, F. R., Johnson, J., Hornig, C. D., & Liebowitz, M. R. (1992). Social phobia: Comorbidity and morbidity in an epidemiologic sample. Archives of General Psychiatry, 49(4), 282–288.

    Article  PubMed  Google Scholar 

  • Seligman, M. E. P. (1975). Helplessness. San Francisco: Freeman.

    Google Scholar 

  • Stavrakaki, C., & Vargo, B. (1986). The relationship of anxiety and depression: A review of the literature. The British Journal of Psychiatry, 149, 7–16.

    Article  PubMed  Google Scholar 

  • Steketee, G., Chambless, D. L., & Tran, G. Q. (2001). Effects of Axis I and II comorbidity on behavior therapy outcome for obsessive-compulsive disorder and agoraphobia. Comprehensive Psychiatry, 42, 76–86.

    Article  PubMed  Google Scholar 

  • Sundquist, K., Johansson, L., DeMarinis, V., & Johansson, J. (2005). Posttraumatic stress disorder and psychiatric co-morbidity: Symptoms in a random sample of female Bosnian refugees. European Psychiatry, 20, 158–164.

    Article  PubMed  Google Scholar 

  • Weissman, M. M., Bland, R. C., & Canino, G. J. (1997). The cross-national epidemiology of panic disorder. Archives of General Psychiatry, 54, 305–309.

    Article  PubMed  Google Scholar 

  • Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. West Sussex: Wiley.

    Google Scholar 

  • Yaryuba-Tobias, J., Todaro, J., Gunes, M., McKay, D., Stockman, R., & Neziroglu, F. (1996). Comorbidity versus continuum of Axis I disorders in OCD. Paper presented at meeting of Association for Advancement of Behavior Therapy, New York, NY.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, University of North Carolina at Chapel Hill, 3270, Chapel Hill, NC, 27599, USA

    Jonathan S. Abramowitz Ph.D.

  2. Department of Psychology, University of Colorado at Boulder, 345 UCB Muenzinger, Boulder, CO, 80309-0345, USA

    Lauren Landy B.A.

Authors
  1. Jonathan S. Abramowitz Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lauren Landy B.A.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan S. Abramowitz Ph.D. .

Editor information

Editors and Affiliations

  1. , Departments of Pediatrics, Psychiatry, a, University of South Florida, Tampa, 33612, Florida, USA

    Eric A. Storch

  2. , Department of Psychology, Fordham University, East Fordham Road 441, Bronx, 10458, New York, USA

    Dean McKay

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Abramowitz, J.S., Landy, L. (2013). Treatment of Comorbid Depression. In: Storch, E., McKay, D. (eds) Handbook of Treating Variants and Complications in Anxiety Disorders. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6458-7_16

Download citation

Publish with us

Policies and ethics

Search

Navigation