Symptomatic and syndromal anxiety in chronic forms of major depression: Effect of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy, and their combination

Philip T. Ninan, A. John Rush, Paul Crits-Christoph, Susan G. Kornstein, Rachel Manber, Michael E. Thase, Madhukar H. Trivedi, Barbara O. Rothbaum, John Zajecka, Frances E. Borian, Martin B. Keller

Research output: Contribution to journalArticle

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Abstract

Background: Limited information is available on treatment response of anxiety symptoms in chronic forms of major depression. Concurrent anxiety disorders are prevalent in chronic depression, but the responsiveness of patients with such comorbidity to different treatments is largely unknown. This study investigated the comparative efficacy of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), and their combination in improving anxiety symptoms in patients with chronic forms of major depression, including those with a concurrent anxiety disorder. Method: 681 patients with chronic major depressive disorder (DSM-IV criteria) participated in a multicenter study of 12 weeks of acute treatment with nefazodone (N = 226), CBASP (N = 228), or the combination (N = 227). The Hamilton Rating Scale for Anxiety (HAM-A), the HAM-A psychic anxiety factor, and the anxiety/arousal subscale of the 30-item Inventory for Depressive Symptomatology-Self Report (IDS-SR-30) were used to assess anxiety symptoms. Results: In the full sample, without controlling for change in depressive symptoms, combination therapy was superior to both monotherapies on all 3 anxiety measures both in the rate of change and at endpoint. When change in depressive symptoms was controlled for, there were no treatment differences in rate of change from baseline to week 12 on any of the 3 anxiety measures. In those patients with a concurrent anxiety disorder, however, the combination was superior to CBASP on the HAM-A and the IDS-SR-30. Nefazodone alone and combination therapy were both superior to CBASP on the HAM-A psychic anxiety factor. Conclusion: For patients with chronic depression, combination therapy is superior to CBASP or nefazodone alone. Among patients with a concurrent anxiety disorder, nefazodone, either alone or in combination with CBASP, improves anxiety symptoms faster than CBASP alone, independent of depressive symptom reduction.

Original languageEnglish (US)
Pages (from-to)434-441
Number of pages8
JournalJournal of Clinical Psychiatry
Volume63
Issue number5
StatePublished - 2002

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Psychotherapy
Anxiety
Depression
Anxiety Disorders
Therapeutics
nefazodone
Neurobehavioral Manifestations
Major Depressive Disorder
Arousal
Diagnostic and Statistical Manual of Mental Disorders
Self Report
Multicenter Studies
Comorbidity
Equipment and Supplies

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

Ninan, P. T., John Rush, A., Crits-Christoph, P., Kornstein, S. G., Manber, R., Thase, M. E., ... Keller, M. B. (2002). Symptomatic and syndromal anxiety in chronic forms of major depression: Effect of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy, and their combination. Journal of Clinical Psychiatry, 63(5), 434-441.

Symptomatic and syndromal anxiety in chronic forms of major depression : Effect of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy, and their combination. / Ninan, Philip T.; John Rush, A.; Crits-Christoph, Paul; Kornstein, Susan G.; Manber, Rachel; Thase, Michael E.; Trivedi, Madhukar H.; Rothbaum, Barbara O.; Zajecka, John; Borian, Frances E.; Keller, Martin B.

In: Journal of Clinical Psychiatry, Vol. 63, No. 5, 2002, p. 434-441.

Research output: Contribution to journalArticle

Ninan, PT, John Rush, A, Crits-Christoph, P, Kornstein, SG, Manber, R, Thase, ME, Trivedi, MH, Rothbaum, BO, Zajecka, J, Borian, FE & Keller, MB 2002, 'Symptomatic and syndromal anxiety in chronic forms of major depression: Effect of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy, and their combination', Journal of Clinical Psychiatry, vol. 63, no. 5, pp. 434-441.
Ninan, Philip T. ; John Rush, A. ; Crits-Christoph, Paul ; Kornstein, Susan G. ; Manber, Rachel ; Thase, Michael E. ; Trivedi, Madhukar H. ; Rothbaum, Barbara O. ; Zajecka, John ; Borian, Frances E. ; Keller, Martin B. / Symptomatic and syndromal anxiety in chronic forms of major depression : Effect of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy, and their combination. In: Journal of Clinical Psychiatry. 2002 ; Vol. 63, No. 5. pp. 434-441.
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abstract = "Background: Limited information is available on treatment response of anxiety symptoms in chronic forms of major depression. Concurrent anxiety disorders are prevalent in chronic depression, but the responsiveness of patients with such comorbidity to different treatments is largely unknown. This study investigated the comparative efficacy of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), and their combination in improving anxiety symptoms in patients with chronic forms of major depression, including those with a concurrent anxiety disorder. Method: 681 patients with chronic major depressive disorder (DSM-IV criteria) participated in a multicenter study of 12 weeks of acute treatment with nefazodone (N = 226), CBASP (N = 228), or the combination (N = 227). The Hamilton Rating Scale for Anxiety (HAM-A), the HAM-A psychic anxiety factor, and the anxiety/arousal subscale of the 30-item Inventory for Depressive Symptomatology-Self Report (IDS-SR-30) were used to assess anxiety symptoms. Results: In the full sample, without controlling for change in depressive symptoms, combination therapy was superior to both monotherapies on all 3 anxiety measures both in the rate of change and at endpoint. When change in depressive symptoms was controlled for, there were no treatment differences in rate of change from baseline to week 12 on any of the 3 anxiety measures. In those patients with a concurrent anxiety disorder, however, the combination was superior to CBASP on the HAM-A and the IDS-SR-30. Nefazodone alone and combination therapy were both superior to CBASP on the HAM-A psychic anxiety factor. Conclusion: For patients with chronic depression, combination therapy is superior to CBASP or nefazodone alone. Among patients with a concurrent anxiety disorder, nefazodone, either alone or in combination with CBASP, improves anxiety symptoms faster than CBASP alone, independent of depressive symptom reduction.",
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T1 - Symptomatic and syndromal anxiety in chronic forms of major depression

T2 - Effect of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy, and their combination

AU - Ninan, Philip T.

AU - John Rush, A.

AU - Crits-Christoph, Paul

AU - Kornstein, Susan G.

AU - Manber, Rachel

AU - Thase, Michael E.

AU - Trivedi, Madhukar H.

AU - Rothbaum, Barbara O.

AU - Zajecka, John

AU - Borian, Frances E.

AU - Keller, Martin B.

PY - 2002

Y1 - 2002

N2 - Background: Limited information is available on treatment response of anxiety symptoms in chronic forms of major depression. Concurrent anxiety disorders are prevalent in chronic depression, but the responsiveness of patients with such comorbidity to different treatments is largely unknown. This study investigated the comparative efficacy of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), and their combination in improving anxiety symptoms in patients with chronic forms of major depression, including those with a concurrent anxiety disorder. Method: 681 patients with chronic major depressive disorder (DSM-IV criteria) participated in a multicenter study of 12 weeks of acute treatment with nefazodone (N = 226), CBASP (N = 228), or the combination (N = 227). The Hamilton Rating Scale for Anxiety (HAM-A), the HAM-A psychic anxiety factor, and the anxiety/arousal subscale of the 30-item Inventory for Depressive Symptomatology-Self Report (IDS-SR-30) were used to assess anxiety symptoms. Results: In the full sample, without controlling for change in depressive symptoms, combination therapy was superior to both monotherapies on all 3 anxiety measures both in the rate of change and at endpoint. When change in depressive symptoms was controlled for, there were no treatment differences in rate of change from baseline to week 12 on any of the 3 anxiety measures. In those patients with a concurrent anxiety disorder, however, the combination was superior to CBASP on the HAM-A and the IDS-SR-30. Nefazodone alone and combination therapy were both superior to CBASP on the HAM-A psychic anxiety factor. Conclusion: For patients with chronic depression, combination therapy is superior to CBASP or nefazodone alone. Among patients with a concurrent anxiety disorder, nefazodone, either alone or in combination with CBASP, improves anxiety symptoms faster than CBASP alone, independent of depressive symptom reduction.

AB - Background: Limited information is available on treatment response of anxiety symptoms in chronic forms of major depression. Concurrent anxiety disorders are prevalent in chronic depression, but the responsiveness of patients with such comorbidity to different treatments is largely unknown. This study investigated the comparative efficacy of nefazodone, Cognitive Behavioral Analysis System of Psychotherapy (CBASP), and their combination in improving anxiety symptoms in patients with chronic forms of major depression, including those with a concurrent anxiety disorder. Method: 681 patients with chronic major depressive disorder (DSM-IV criteria) participated in a multicenter study of 12 weeks of acute treatment with nefazodone (N = 226), CBASP (N = 228), or the combination (N = 227). The Hamilton Rating Scale for Anxiety (HAM-A), the HAM-A psychic anxiety factor, and the anxiety/arousal subscale of the 30-item Inventory for Depressive Symptomatology-Self Report (IDS-SR-30) were used to assess anxiety symptoms. Results: In the full sample, without controlling for change in depressive symptoms, combination therapy was superior to both monotherapies on all 3 anxiety measures both in the rate of change and at endpoint. When change in depressive symptoms was controlled for, there were no treatment differences in rate of change from baseline to week 12 on any of the 3 anxiety measures. In those patients with a concurrent anxiety disorder, however, the combination was superior to CBASP on the HAM-A and the IDS-SR-30. Nefazodone alone and combination therapy were both superior to CBASP on the HAM-A psychic anxiety factor. Conclusion: For patients with chronic depression, combination therapy is superior to CBASP or nefazodone alone. Among patients with a concurrent anxiety disorder, nefazodone, either alone or in combination with CBASP, improves anxiety symptoms faster than CBASP alone, independent of depressive symptom reduction.

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