Anxiety State and Depressive Disorders: Separation in Terms of Symptom-Cluster, Patient-Groups and Personality Features

  • D. Caetano
  • M. Roth
  • C. Mountjoy


Since the recognition of anxiety as a syndrome in 1871 by Da-Costa1 there have been disagreements about the relationship between anxiety state and depressive illness. These disagreements are concerned with two viewpoints: one that brings anxiety along the same continuum with depression2–4, and another that states that there is a relevant difference between depressive and anxiety states5–7. The former approach represents a Unitarian view8,9, while the latter one postulates a categorical model10. With the development of computer technology sophisticated statistical techniques became feasible and have been applied to tackle the problem of classification of affective disorders. Although some of these investigations11–13 favor the unitarian view, the great majority, however, have consistently shown that anxiety and depressive state, despite some overlap, constitute two distinct syndromes10,14–20, However, there is still some confusion in the nomenclature used to nominate the affective disorder where anxiety and depressive symptoms are combined. This is exemplified by the current concept of “anxious depression” used by many psychiatrists.


Depressive Disorder Anxiety State Depressive State Depressive Illness Personality Measure 
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.


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  1. 1.
    J.C. Nemiah, Anxiety Neurosis, in: “Comprehensive Textbook of Psychiatry,” A.M. Friedman, H.I. Kaplan, B.J. Sadock, eds., Williams & Wilkins Company, USA (1976).Google Scholar
  2. 2.
    S. Freud, Inhibitions, Symptoms and Anxiety, in: “Complete Psychological Works, Vol. XX, Hogarth Press, London (1959).Google Scholar
  3. 3.
    H. Harris, Anxiety: its nature and treatment, J. Ment. Sci 80:482 (1934).Google Scholar
  4. 4.
    M.E.P. Seligman, “Helplessness on Depression, Development, and Death”. W.H. Freeman and Company, San Francisco (1975).Google Scholar
  5. 5.
    E. F. Buzzard, Discussion on manic-depressive psychosis, Brit. Med. J: 2:877 (1926).Google Scholar
  6. 6.
    T. A. Ross, The Cassel Hospital Seventh Annual Report. Cited in C. H. Rogerson, The differentiation of neuroses and psychoses with special reference to status of depression and anxiety, J. Ment. Sci: 86:632 (1940).Google Scholar
  7. 7.
    G. Germany, “Anxiety states”, Brit. Med. J. 1:943 (1956).CrossRefGoogle Scholar
  8. 8.
    E. Mapother, Opening paper of discussion of manic-depressive psychosis, Brit. Med. J. 2:872 (1926).CrossRefGoogle Scholar
  9. 9.
    A. J. Lewis, Melancholia: a clinical survey of depressive states, J. Ment. Sci 82:488 (1934).Google Scholar
  10. 10.
    M. Roth, C. Gurney, R. F. Garside, and T.A. Kerr, Studies in the classification of affective disorders: the relationship between anxiety states and depressive illnesses, Brit. J. Psychiat. 121: 147 (1972).PubMedCrossRefGoogle Scholar
  11. 11.
    H. J. Eysenck, Classification and the problem of diagnosis, in: “Handbook of Abnormal Psychology” H. J. Eysenck, ed., Pitman Medical Publishing Co., Ltd., London (1960).Google Scholar
  12. 12.
    J. Mendels, N. Weinstein, and C. Cochrane, The relationship between depression and anxiety, Arch. Gen. Psychiat. 27:649 (1972).PubMedCrossRefGoogle Scholar
  13. 13.
    R. C. Benfari, M. Beiser, A. H. Leighton, and C. Mertens, Some dimensions of psychoneurotic behavior in an urban sample, J. Nerv. Ment. Dis. 155:79 (1972).CrossRefGoogle Scholar
  14. 14.
    M. Hamilton, A rating scale for depression, J. Neurol. Neuros. Psychiat. 23:56 (1960).CrossRefGoogle Scholar
  15. 15.
    M. Lorr, and R.M. Hamlin, A multimethod factor analysis of behavioral and objective measures of psychopathology, J. Consult. Clin. Psychol. 36:136 (1972).Google Scholar
  16. 16.
    E. S. Paykel, Classification of depressed patients: a cluster analysis derived grouping, Brit. J. Psychiat. 118: 275 (1971).PubMedCrossRefGoogle Scholar
  17. 17.
    E. S. Paykel, Predictions of treatment response, in: “Psychopharmacology of Affective Disorders”, E.S. Paykel, H. Coppen, eds., Oxford University Press, Oxford (1979).Google Scholar
  18. 18.
    R. M. Mowbray, The Hamilton Rating Scale for Depression: a factor analysis, Psychol. Med. 2:272 (1972).PubMedCrossRefGoogle Scholar
  19. 19.
    L. R. Derogatis, R.S. Lipman, L. Covi, and K. Rickels, Factorial invariance of symptom dimensions in anxious and depressive neuroses, Arch. Gen. Psychiat. 27:659 (1972).PubMedCrossRefGoogle Scholar
  20. 20.
    C.Q. Mountjoy, M. Roth, Studies in the relationship between depressive disorders and anxiety states, Part 2 (Clinical items), J.Affect. Dis. 4:149 (1982).PubMedCrossRefGoogle Scholar
  21. 21.
    B. Prusoff, G. L. Klerman, Differentiating depressed from anxious neurotic out-patients, Arch. Gen. Psychiat. 30:302 (1974).PubMedCrossRefGoogle Scholar
  22. 22.
    M. Roth, The phobic anxiety-depersonalization syndrome, Proc. Roy. Soc. Med. 52:587 (1959).PubMedGoogle Scholar
  23. 23.
    C. Gurney, M. Roth, R. F. Garside, T.A. Kerr, K. Schapira, Studies in the classification of affective disorders: the relationship between anxiety states and depressive illnesses-II, Brit. J. Psychiat. 121:162 (1972).PubMedCrossRefGoogle Scholar
  24. 24.
    J. K. Wing, J. E. Cooper, N. Sartorius, “The Measurement and Classification of Psychiatric Symptoms”, Cambridge University Press, Cambridge (1974).Google Scholar
  25. 25.
    J. L. Fleiss, B. J. Gurland, J. E. Cooper, Some contribution to the measurement of psychopathology, Brit. J. Psychiat. 119:647 (1971).PubMedCrossRefGoogle Scholar
  26. 26.
    R. G. Mclnnes, Observations on heredity on neurosis, Proc. Roy. Soc. Med. 30:895 (1937).Google Scholar
  27. 27.
    F. W. Brown, Heredity in the psychoneuroses, Proc. Roy. Soc. Med. 35:785 (1942).PubMedGoogle Scholar
  28. 28.
    M. E. Cohen, D. M. Badal, A. Kilpratick, W. Reed, P.D. White, The high familial prevalence of neurocirculatory asthenia (Anxiety neurosis, Effort syndrome), Amer. J. Hum. Gen. 3:126 (1951).Google Scholar
  29. 29.
    P.L. Broadhurst, The biometrical analysis of behavioural inheritance, Sci. Prog. Oxf. 55:123 (1967).Google Scholar
  30. 30.
    E. Staler, V. Cowie, “The Genetics of Mental Disorders”, Oxford University Press, London (1971).Google Scholar
  31. 31.
    R. Jr. Noyes, J. Clancy, Anxiety neurosis: a 5-year follow-up. J. Nerv. Ment. Dis. 162:200 (1976).PubMedCrossRefGoogle Scholar
  32. 32.
    R. R. Crowe, D. L. Pauls, D. J. Slymen, R. Noyes, A family study of anxiety neurosis. Morbidity risk in families with and without mi tiral valve prolapse, Arch. Gen. Psychiat. 27:659 (1980).Google Scholar
  33. 33.
    C. Gurney, M. Roth, T.A. Kerr, K. Schapira, The bearing of treatment on the classification of the affective disorders, Brit. J. Psychiat. 117:251 (1970).PubMedCrossRefGoogle Scholar
  34. 34.
    R. Kuhn, The treatment of depressive states with G 22355 (imipramine hydrochloride), Am. J. Psychiatry. 115:459 (1958).PubMedGoogle Scholar
  35. 35.
    J. R. B. Ball, L.J. Kiloh, A controlled trial of imipramine in treatment of depressive states, Brit. J. Psychiat. 2:1052 (1959).Google Scholar
  36. 36.
    L. J. Kiloh, J. R. B. Ball, Depression treated with imipramine: a follow-up study, Brit. Med. J. 1:168 (1961).PubMedCrossRefGoogle Scholar
  37. 37.
    C.G. Burt, W. F. Gordon, N.F. Holt, A. Hordern, Amitriptyline in depressive states: a controlled trial, J. Ment. Sci: 108:711 (1962).PubMedGoogle Scholar
  38. 38.
    R. S. Master, Amitriptyline in depressive states, Brit. J. Psychiat. 109:826 (1963).PubMedCrossRefGoogle Scholar
  39. 39.
    M. E. Martin, A comparative trial of imipramine and phenelzine in the treatment of depression, Brit J. Psychiat. 109:279 (1963).CrossRefGoogle Scholar
  40. 40.
    A. Hordern, C. J. Burt, W. F. Gordon, N.F. Holt, Amitriptyline in depressive states: six-month treatment results, Brit. J. Psychiat. 110:641 (1964).PubMedCrossRefGoogle Scholar
  41. 41.
    Medical Research Council, Clinical trial of the treatment of depressive illness, Brit. J. Psychiat. 1:881 (1965).Google Scholar
  42. 42.
    J. E. Overall, L. E. Hollister, M. Johnson, V. Pennington, Nosology of depresssion and differential response to drugs, J. Am. Med. Assoc. 195:946 (1966).CrossRefGoogle Scholar
  43. 43.
    D. W. K. Kay, R.F. Garside, T. J. Fahy, A double-blind trial of phenelzine and amitriptyline in depressed out-patients. A possible differential effect of the drug on symptoms, Brit. J. Psychiat. 123:63 (1973).PubMedCrossRefGoogle Scholar
  44. 44.
    L. Covi, R.S. Lipman, L.R. Derogatis, J. E. Smith, J.H. Pattison, Drugs and groups psychotherapy in neurotic depression, Am. J. Psychiatry 131:191 (1974).PubMedGoogle Scholar
  45. 45.
    E. S. Paykel, Depressive typologies and response to amitriptyline, Brit. J. Psychiat. 120:147 (1972).PubMedCrossRefGoogle Scholar
  46. 46.
    E. S. Paykel, D. Haskell, H. Dimascio, Clinical response to amitriptyline among depressed women, J. Nerv. Ment. Dis. 156:149 (1973).PubMedCrossRefGoogle Scholar
  47. 47.
    D. V. Sheehan, J. Ballenger, G. Jacobsen, Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms, Arch. Gen. Psychiat. 37:51 (1980).PubMedCrossRefGoogle Scholar
  48. 48.
    E. D. West, P. J. Dally, Effects of iproniazid in depressive syndromes, Brit. J. Psychiat. 1:1491 (1959).Google Scholar
  49. 49.
    W. Sargant, P. Dally, Treatment of anxiety states by antidepressant drugs, Brit. Med. J. 1:6 (1962).PubMedCrossRefGoogle Scholar
  50. 50.
    D. Kelly, W. Guirguis, E. Frommer, N. Mitchel-Heggs, W. Sargant, Treatment of phobic states with antidepressants: a retrospective study of 246 patients, Brit. J. Psychiat. 116:387 (1970).PubMedCrossRefGoogle Scholar
  51. 51.
    L.E. Hollister, J.E. Overall, A.D. Pokorny, J. Shelton, Acetophenazine and diazepam in anxious depressions, Arch. Gen. Psychiat. 24:273 (1971).PubMedCrossRefGoogle Scholar
  52. 52.
    D.S. Robinson, A. Nies, L. Ravaris, K.R. Lamborn, The mono-amino oxidase inhibitor, phenelzine in the treatment of depression—anxiety states, Arch. Gen. Psychiat. 29:407 (1973).PubMedCrossRefGoogle Scholar
  53. 53.
    L. Solyom, G.F.D. Heseltine, D.J. McClure, C. Solyom, B. Ledwidge, G. Steinberg, Behaviour therapy versus drug therapy in the treatment of phobic neurosis, Can. Psychiat. Ass. J.: 18 (1973).Google Scholar
  54. 54.
    P. Typer, J. Candy, D. Kelly, Phenelzine in phobic anxiety: a controlled trial, Psychol. Med. 3:120 (1973).CrossRefGoogle Scholar
  55. 55.
    A. Raskin, J.G. Schulterbrandt, N. Reating, T.H. Crook, D.O. Rockville, Depresssion subtypes and response to phenelzine, diazepam, and a placebo: results of a nine hospital collaborative study, Arch. Gen. Psychiat. 30:66 (1974).PubMedCrossRefGoogle Scholar
  56. 56.
    J. A. Harris, A.A. Robin, A controlled trial of phenelzine in depressive reactions, J.Ment. Sci: 106:1432 (1960).PubMedGoogle Scholar
  57. 57.
    J.T. Hutchinson, D. Smedberg, Phenelzine (Nardil) in treatment of endogenous depression, J.Ment. Sci: 106:704 (1960).PubMedGoogle Scholar
  58. 58.
    E.H. Hare, J. Dominian, L. Sharpe, Phenelzine and dexamphetamine in depressive illness: a comparative trial, Brit. Med. J. 1:9 (1962).PubMedCrossRefGoogle Scholar
  59. 59.
    C. Mountjoy, M. Roth, A controlled trial of phenelzine in anxiety, depressive and phobic neuroses, in: “Excerpta Medica International Congress Series”, J. R. Boissier, H. Hippius, P. Pichot, eds. (1974).Google Scholar
  60. 60.
    A.F. Schatzberg, J.O. Cole, Benzodiazepines in depressive disorders, Arch. Gen. Psychiat. 35:1359 (1978).PubMedCrossRefGoogle Scholar
  61. 61.
    W.L. Neustatter, The results of fifty cases treated by psychotherapy, The Lancet 1:796 (1935).CrossRefGoogle Scholar
  62. 62.
    J.A. Harris, The prognosis of anxiety states, Brit. Med. J. 2:649 (1938).PubMedCrossRefGoogle Scholar
  63. 63.
    E. O. Wheeler, P.D. White, E.W. Reed, M.E. Cohen, Neurocirculatory asthenia (Anxiety neurosis, Effort Syndrome, Neurasthenia). A twenty-year follow-up study of one hundred and seventy-three patients, J. Am. Med. Assoc. 142:878 (1950).PubMedCrossRefGoogle Scholar
  64. 64.
    R. Blair, J.M. Gilroy, F. Pilkington, Some observations on out—patient psychoterapy with a follow-up of 235 cases, Brit. Med. J. 1:318 (1957).PubMedCrossRefGoogle Scholar
  65. 65.
    H.H.W. Miles, E.L. Barrabee, J. E. Finesinger, “Evaluation of psychotherapy with a follow-up of 62 cases of anxiety neurosis” Psychos. Med. 13:83 (1951).Google Scholar
  66. 66.
    L. Eitenger, “Studies in neuroses”, Acta Psychiat. Scand. Suppl. 101 (1955).Google Scholar
  67. 67.
    K. Ernst, “Die prognose der neurosen” Cited in Greer (1969) The prognosis of anxiety states, in “Studies of Anxiety”, M.H. Lader, ed., Brit. J. Psychiat. Special Publication No 3 (1969).Google Scholar
  68. 68.
    H.S. Greer, The prognosis of anxiety states, in: “Studies of Anxiety” M.H. Lader ed., Brit. J. Psychiat., Special Publication No 3 (1969).Google Scholar
  69. 69.
    H.S. Greer, R.H. Cawley, “Some observations on the natural history of neurotic illness”, Australian Medical Publishing company, Sydney (1966).Google Scholar
  70. 70.
    M. Raskin, J.W. Rondestnedt, G. Johnson, Anxiety in young adults: a prognostic study, J. Nerv. Ment. Dis. 154:229 (1972).PubMedCrossRefGoogle Scholar
  71. 71.
    T.H. Kerr, M. Roth, K. Schapira, C. Gurney, The assessment and prediction of outcome in affective disorders, Brit. J. Psychiat. 121:167 (1972).PubMedCrossRefGoogle Scholar
  72. 72.
    R. Jr. Noyes, J. Clancy, Anxiety neurosis: a 5-year follow-up. J. Nerv. Ment. Dis. 162:200 (1976).PubMedCrossRefGoogle Scholar
  73. 73.
    K. Schapira, M. Roth, T.A. Kerr, C. Gurney, The prognosis of affective disorders: the differentiation of anxiety states from depressive illnesses, Brit. J. Psychiat. 121:175 (1972).PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1985

Authors and Affiliations

  • D. Caetano
    • 1
  • M. Roth
    • 1
  • C. Mountjoy
    • 1
  1. 1.Department of PsychiatryClinical Medical School Cambridge UniversityCambridgeUK

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