Treatment of comorbid anxiety disorders and depression

The close relationship between anxiety and depression has been a long-standing clinical observation. It may be practically advantageous to view anxiety and depression as two symptomatic stages of the same affective disorder, with the ratio of anxious and depressive symptoms varying over time, so that assessment and treatment depend on when, in the course of affective illness, the observation is made and on comprehensive evaluation of all clinical variables that may be subsumed under the rubric of clinical judgment. Selection of treatment according to evidence-based medicine and treatment guidelines relies primarily on randomized controlled trials and meta-analyses. This chapter first discusses the assessment of comorbidity and the differential diagnosis of depressive symptoms in the setting of anxiety disorders. It then refers to the main treatment options when a major depressive disorder is diagnosed and how they can be applied according to clinical presentations in the adult population.