Marks Psychiatry

A symptom of depression can be anxiety, but a person can also have a co-morbid (meaning simultaneously occurring) anxiety disorder that is a separate entity from their depression. Some anxiety disorders that can occur with depression are Panic Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Social Phobia and Post-Traumatic Stress Disorder. It is not uncommon for the anxiety to present prior to the depression. In fact, according to an article in the Journal of Psychiatric Research (2003;37:187-92), the prevalence of generalized anxiety occurring with major depression is close to 70%. This is a high percentage.

Other studies show that 28% - 38% of those with bipolar disorder have a separate anxiety disorder. One study in the American Journal of Psychiatry (2004;161:2222-9) showed that an anxiety disorder occurring with bipolar disorder was associated with an earlier age of onset. The authors noted that teenagers developing bipolar disorder at an earlier age likely began with anxiety problems as a prelude to developing the mood symptoms.

Why is this important? Unfortunately we have seen that anxiety disorders can worsen the course of depression or bipolar disorder, making it harder to achieve remission of symptoms. The untreated symptoms can lead to substance abuse as a way to self-medicate. If a person is in the throws of serious mood episode (depression or mania), it can be easy for all those involved to overlook the anxiety disorder or not aggressively manage the anxiety because of the attention to the mood symptoms. So these findings emphasize the importance of diagnosing and managing comorbid anxiety disorders in individuals with major depression or bipolar disorder.

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