The British Journal of Psychiatry (2007) 190: 344-349. doi: 10.1192/bjp.bp.106.027169
© 2007 The Royal College of Psychiatrists
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Effect of comorbid anxiety on treatment response and relapse risk in late-life depression: controlled study

Carmen Andreescu, MD, Eric J. Lenze, MD, Mary Amanda Dew, PhD and Amy E. Begley, MA

Advanced Center for Interventions and Services Research for Late-life Mood Disorders and the John A. Hartford Center of Excellence in Geriatric Psychiatry, Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA

Benoit H. Mulsant, MD

Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA, and Center for Addiction and Mental Health, University of Toronto, Canada

Alexandre Y. Dombrovski, MD

Advanced Center for Interventions and Services Research for Late-Life Mood Disorders and the John A. Hartford Center of Excellence in Geriatric Psychiatry, Departmentof Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA

Bruce G. Pollock, MD, PhD

Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA, and Rotman Research Institute, Baycrest Center for Geriatric Care, University of Toronto, Canada

Jacqueline Stack, MSN, Mark D. Miller, MD and Charles F. Reynolds, MD

Advanced Center for Interventions and Services Research for Late-life Mood Disorders and the John A. Hartford Center of Excellence in Geriatric Psychiatry, Department of Psychiatry, University of Pittsburgh School of Medicine, Pennsylvania, USA

Correspondence: Dr Eric Lenze, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Room E 823, Pittsburgh, PA15213, USA. Tel: +1 412 246 6007; fax: +1 412 246 6260; email: Lenzee{at}upmc.edu

Declaration of interest E.J.L., B.H.M., B.G.P., M.D.M. and C.F.R. have received support and/or consult for (one or more of): Forest Laboratories, Pfizer Inc., Johnson & Johnson Co., Bristol-Myers Squibb, Eli Lilly, GlaxoSmith Kline, Lundbeck, Janssen Pharmaceutica, and Sepracor (detailsin Acknowledgements).

Background Comorbid anxiety is common in depressive disorders in both middle and late life, and it affects response to antidepressant treatment.

Aims To examine whether anxiety symptoms predict acute and maintenance (2 years) treatment response in late-life depression.

Method Data were drawn from a randomised double-blind study of pharmacotherapy and interpersonal psychotherapy for patients age 70 years and over with major depression. Anxiety symptoms were measured using the Brief Symptom Inventory. Survival analysis tested the effect of pre-treatment anxiety on response and recurrence.

Results Patients with greater pretreatment anxiety took longer to respond to treatment and had higher rates of recurrence. Actuarial recurrence rates were 29% (pharmacotherapy, lower anxiety), 58% (pharmacotherapy, higher anxiety), 54% (placebo, lower anxiety) and 81% (placebo, higher anxiety).

Conclusions Improved identification and management of anxiety in late-life depression are needed to achieve response and stabilise recovery.


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depression severity is a confounder in the relation between anxiety and treatment response
Rob M. Kok, et al.
BJP Online, 29 May 2007 [Full text]