The Differentiation of Anxiety and Depressive Syndromes

  • Richard P. Swinson
  • Marlene Kirby


Since Freud (1895) differentiated anxiety neurosis from the other neurotic disorders there has been debate about whether this particular entity exists separate from other nosological entities. Recent interest in the clear delineation of psychiatric states from each other has had impetus from a number of directions. These include the examination of the rates and criteria for the diagnosis of schizophrenia across countries (Carpenter, Strauss, & Bartko, 1973), the development of specific criteria for the diagnosis of psychiatric disorders (Feighner et al., 1972), and the introduction of diagnostic systems which rely on definite criteria (e.g., DSM-III, American Psychiatric Association, 1980). All of these developments force greater precision in psychiatric diagnosis and classification. They are relevant mainly because of changes in treatment techniques and the increasing ability of clinicians to be able to match specific treatments to specific clinical problems.


Depressive Symptom Anxiety Disorder Affective Disorder Panic Disorder Anxiety State 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Psychiatric Association (1980). Diagnostic and statistical manual of mental disorders (3rd edition). Washington, D.C. Author.Google Scholar
  2. Bowen, R.C., & Kohut, J. (1979). The relationship between agoraphobia and primary affective disorders. Canadian Journal of Psychiatry, 24, 317–321.Google Scholar
  3. Brier, A., Charney, D.S., & Heninger, G.R. (1984). Major depression in patients with agoraphobia and panic disorder. Archives of General Psychiatry, 41, 1129–1135.CrossRefGoogle Scholar
  4. Buglass, D., Clarke, J., Henderson, A.S., Kreitman, N., & Presley, A.S. (1977). A study of agoraphobic housewives. Psychological Medicine, 7, 73–86.PubMedCrossRefGoogle Scholar
  5. Carpenter, W.T., Strauss, S.J., & Bartko, J.J. (1973). Flexible system for the diagnosis of schizophrenia. Report from the W.H.O. International Pilot Study on Schizophrenia, 182, 57–63.Google Scholar
  6. Cassidy, W.L., Flanagan, N.B., & Spellman, M.N. (1957). Clinical observations in manic-depressive disease: A quantitative study of one hundred manic depressive patients and fifty medically sick controls. Journal of the American Medical Association, 164, 1535–1546.PubMedCrossRefGoogle Scholar
  7. Clancy, J., Noyes, R. Jr., Hoenk, P.R., & Slymen, D.J. (1978). Secondary depression in anxiety neurosis. Journal of Nervous and Mental Disorders, 166, 846–850.CrossRefGoogle Scholar
  8. Cleghorn, J. (1970). The anxiety-depression syndrome. Psychosomatics 11, 438–441.Google Scholar
  9. Curtis, G.C., Cameron, O.G., & Nesse, R.M. (1982). The dexamethasone suppression test in panic disorder and agoraphobia. American Journal of Psychiatry, 139, 1043–1046.PubMedGoogle Scholar
  10. Dealy, R.S., Ishiki, D.M., Avery, D.H., Wilson, L.G., & Dumes, D.L. (1981). Secondary depression in anxiety disorders. Comprehensive Psychiatry, 22, 612–618.PubMedCrossRefGoogle Scholar
  11. Delmas cited in Mapother, E. (1926). Discussion on manic-depressive psychosis. British Medical Journal, 1, 225–227.CrossRefGoogle Scholar
  12. Derogatis, L.R., Klerman, G.L., & Lipman, R.S. (1972). Anxiety states and depressive neuroses. The Journal of Nervous and Mental Disease, 155, 392–403.PubMedCrossRefGoogle Scholar
  13. Derogatis, L.R., Lipman, R.S., Covi, L., & Rickels, K. (1971). Neurotic symptom dimensions: As perceived by psychiatrists and patients of various social classes. Archives of General Psychiatry, 24, 454–464.PubMedCrossRefGoogle Scholar
  14. Dimes, D.L. (1981). Secondary depression in anxiety disorders. Comprehensive Psychiatry, 22, 612–618.CrossRefGoogle Scholar
  15. Feighner, J.P., Robins, E., Guze, S.B., Woodruff, R.A., Winokur, G., & Munoz, R. (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 57–63.PubMedCrossRefGoogle Scholar
  16. Finlay-Jones, R., & Brown, G.W. (1981). Types of stressful life event and the onset of anxiety and depressive disorders. Psychological Medicine, 11, 803–815.PubMedCrossRefGoogle Scholar
  17. Freud, S. (1895). The standard edition of the complete psychological works of Sigmund Freud. London: Hogarth.Google Scholar
  18. Gersh, F.S., & Fowles, D.C. (1979). Neurotic depression: The concept of anxious depression. In R.A. Depue (Ed.), The psychobiology of the depressive disorders: Implications for the effects of stress. New York: Academic Press.Google Scholar
  19. Goldberg, D.P., Rickeis, K., Downing, R., & Hesbacher, P. (1976). A comparison of two psychiatric screening tests. British Journal of Psychiatry, 129, 61–67.PubMedCrossRefGoogle Scholar
  20. Goldberg, D.P. (1982). Depressive reactions in adults. In G.F.M. Russell and L. Hersor (Eds.), Handbook of psychiatry: Vol. IV. Cambridge: Cambridge University Press.Google Scholar
  21. Gurney, C., Roth, M., Garside, R.F., Kerr, T.A., & Schapira, K. (1972). Studies in the classification of affective disorders. The relationship between anxiety states and depressive illnesses-II. British Journal of Psychiatry, 121, 162–166.PubMedCrossRefGoogle Scholar
  22. Hamilton, M. (1959). The assessment of anxiety states by rating. British Journal of Medical Psychology, 32, 50–55.PubMedCrossRefGoogle Scholar
  23. Hamilton, M. (1981). Depression and anxiety: A clinical viewpoint. In M. Hamilton and J.B. Bakker (Eds.). Psychiatry in the 80’s: Ideas, research, practice. Excerpta Medica.Google Scholar
  24. Hays, P. (1964). Modes of onset of psychotic symptoms. British Medical Journal, 2, 779–784.PubMedCrossRefGoogle Scholar
  25. Houshang, G., Zitrin, C.G., & Klein, D.F. (1984). Treatment of panic disorder with imipramine alone. American Journal of Psychiatry, 141, 446–448.Google Scholar
  26. Kerr, T.A., Schapira, K., & Roth, M. (1969). The relationship between premature death and affective disorders. British Journal of Psychiatry, 115, 1277–1282.PubMedCrossRefGoogle Scholar
  27. Klein, D.F. (1981). Anxiety reconceptualized. In D.F. Klein and J.G. Rabkin (Eds.), Anxiety: New research and changing concepts. New York: Raven Press.Google Scholar
  28. Leckman, J.F., Merikangas, K.R., Pauls, D.L., Prusoff, B.A., & Weissman, M.M. (1983). Anxiety disorders and depression: Contradictions between family study data and DSM-III conventions. American Journal of Psychiatry, 140, 880–882.PubMedGoogle Scholar
  29. Leckman, J.F., Weissman, M.M., Merikangas, K.R., Pauls, D.L., & Prusoff, B.A. (1983). Panic disorder and major depression. Archives of General Psychiatry, 40, 1055–1060.PubMedCrossRefGoogle Scholar
  30. Lewis, A.J. (1934). Melancholic — a clinical survey of depressive states. Journal of Mental Sciences, 80, 277–278.Google Scholar
  31. Mapother, E. (1926). Discussion on manic-depressive psychosis. British Medical Journal, 1, 225–227.CrossRefGoogle Scholar
  32. McNair, D.M., & Fisher, S. (1978). Separating anxiety from depression. In Lipton, DiMascio, and Kilman (Eds.), Psychopharmacology: A generation of progress. New York: Raven Press.Google Scholar
  33. Mendel, J.G.C., & Klein, D.F. (1969). Anxiety attacks with subsequent agoraphobia. Comprehensive Psychiatry, 10, 190–195.PubMedCrossRefGoogle Scholar
  34. Mountjoy, C.Q., Roth, M., Garside, R.F., & Leitcn, I.M. (1977). A clinical trial of phenelzine and anxiety depressive and phobic neurosis. British Journal of Psychiatry, 131, 486–492.PubMedCrossRefGoogle Scholar
  35. Myers, J.K., Weissman, M.M., Tischler, G.L., Holzer, C.E. III., Leaf, P.J., Anthony, J.C., Boyd, J.H., Burke, J.D. Jr., Kramer, M., & Stoltzman, R. (1984). Six month prevalence of psychiatric disorders in three communities. Archives of General Psychiatry, 41, 959–967.PubMedCrossRefGoogle Scholar
  36. Noyes, R., Clancy, J., Hoenk, P.R., & Slymen, D.J. (1980). The prognosis of anxiety neurosis. Archives of General Psychiatry, 37, 173–178.PubMedCrossRefGoogle Scholar
  37. Pitts, F.N., Jr., & McLure, J.N., Jr. (1967). Lactate metabolism in anxiety neurosis. New England Journal of Medicine, 277, 1329–1336.PubMedCrossRefGoogle Scholar
  38. Pollitt, J., & Young, J. (1971). Anxiety state or masked depression. British Journal of Psychiatry, 139, 1043–1046.Google Scholar
  39. Prusoff, B. & Klerman, G.L. (1974). Differentiating depressed from anxious neurotic outpatients: Use of discriminant function analysis for separation of neurotic affective states. Archives of General Psychiatry, 30, 302–309.PubMedCrossRefGoogle Scholar
  40. Rickeis, K., Downing, R.W., & Stein, M. (1979). The differentiation between neurotic depression and anxiety and drug treatment. In Saletu, Bruner, & Hollister (Eds.), Neuropsychopharmacology. New York: Permagon Press.Google Scholar
  41. Robins, L.N., Heizer, J.E., Croughan, J., & Ratcliff, K.S. (1981). National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics, and validity. Archives of General Psychiatry, 38, 381–389.PubMedCrossRefGoogle Scholar
  42. Robins, L.N., Heizer, J.E., Weissman, M.M., Orvaschel, H., Gruenberg, E., Burke, J.D., Jr. & Regier, D.A. (1984). Lifetime prevalence of specific psychiatric disorders in three sites. Archives of General Psychiatry, 41, 949–958.PubMedCrossRefGoogle Scholar
  43. Roth, M., Gurney, C., Garside, R.F., & Kerr, T.A. (1972). Studies in the classification of affective disorders. The relationship between anxiety states and depressive illness — I. British Journal of Psychiatry, 121, 147–161.PubMedCrossRefGoogle Scholar
  44. Roth, M., & Mountjoy, C.Q. (1982). The distinction between anxiety states and depressive disorders. In E.S. Paykel (Ed.), Handbook of Affective Disorders. New York: Guilford Press.Google Scholar
  45. Sheehan, D.V., Coleman, J.H., Greenblatt, D.J., Jones, K.J., Levine, P.H., Orsulak, P.J., Peterson, M., Schildkraut, J.J., Uzogara, E., & Watkins, D. (1984). Some biochemical correlates of panic attacks with agoraphobia and their response to a new treatment. Journal of Clinical Psychopharmacology, 4, 66–75.PubMedCrossRefGoogle Scholar
  46. Snaith, R.P., Bridge, G.W.K., & Hamilton, M. (1976). The Leeds scale for the self-assessment of anxiety and depression. The British Journal of Psychiatry, 128, 156–165.PubMedCrossRefGoogle Scholar
  47. Spitzer, R., & Williams, J. (1986). The classification of anxiety disorders. In B.F. Shaw, Z.V. Segal, T.M. Vallis, & F. Cashman (Eds.), Anxiety Disorders: Psychological and biological perspectives. New York: Plenum Press.Google Scholar
  48. Spitzer, R., & Williams, J. (1983). The structured clinical interview for DSM III (SCID). Biometrics Research Department, New York State Psychiatric Institute, New York, New York.Google Scholar
  49. Strian, F., & Klicpera, C. (1984). Anxiety and depression in affective disorders. Psychopathology, 17, 37–48.PubMedCrossRefGoogle Scholar
  50. Swinson, R.P., & McCormick, O.W. (1981). Diagnostic practice survey. Unpublished manuscript. University of Toronto.Google Scholar
  51. Weissman, M.M., Leckman, J.F., Merikangas, K.R., Gammon, G.D., & Prusoff, B.A. (1984). Depression and anxiety disorders in parents and children. Archives of General Psychiatry, 41, 845–852.PubMedCrossRefGoogle Scholar
  52. Wing, J.K., Nixon, J.M., Mann, S.A., & Leff, J.P. (1977). Reliability of the PSE (ninth edition) used in a population study. Psychological Medicine, 7, 505–516.PubMedCrossRefGoogle Scholar
  53. Woodruff, R.A., Guze, S.B., & Clayton, P.J. (1972). Anxiety neurosis among psychiatric outpatients. Comprehensive Psychiatry, 13, 165–170.PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1986

Authors and Affiliations

  • Richard P. Swinson
    • 1
  • Marlene Kirby
    • 1
  1. 1.University of TorontoCanada

Personalised recommendations