COMMENTARY

Anxiety Symptoms and Treating Depression

Michael R. Liebowitz, MD

Disclosures

March 25, 2004

In This Article

Introduction and Clinical Tools

Over the past 10-15 years, the pharmacologic treatment of depression has been greatly advanced, with the introduction of many new medications that have achieved much wider use. However, a variety of problems continue to exist. Many patients do not respond to first-choice treatments, which are usually selective serotonin reuptake inhibitors (SSRIs), and there are no clear guidelines as to what to do next for such patients. Further, substantial portions of the patients who do benefit from the SSRIs do not achieve full remission, and here also guidelines are lacking as to what to do next. Finally, many depressed patients manifest substantial anxiety symptoms as well; here again, guidelines are lacking as to how these anxiety features should influence treatment selection.

Unfortunately, at present, psychiatry lacks many of the diagnostic techniques that have advanced the precision of treatment selection in other fields of medicine, such as blood tests, x-rays and other imaging techniques, biopsies, and cultures. Instead, we must rely on clinical presentation and histories of the patient's illness, their prior treatment response, and family illness and treatment response to guide medication selection. While this approach is far from perfect even in the most expert of hands, there are a number of clinical markers that can enhance treatment selection that are not yet widely employed.

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