Anxious Depression

Anxious depression is not recognized in DSM-IV-TR (American Psychiatric Association 2000) as a subtype of depression; nevertheless, it has been frequently studied. Three of the tricyclic and tetracyclic compounds—doxepin, amoxapine, and maprotiline—have received FDA approval for use in patients with depression and symptoms of anxiety. For many years, clinical lore suggested that amitriptyline was most effective for anxious depression. Direct comparison studies, however, have found little indication that one of these compounds is better than another for treatment of anxious depression. Depressed patients who are anxious may respond less well than less anxious patients. This has been observed with amitriptyline (Kupfer and Spiker 1981), imipramine (Roose et al. 1986), and desipramine (Nelson et al. 1994). Yet these drugs are still more effective than placebo in anxious depressed patients, and it is not established that other classes of antidepressants are more effective in these patients.

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