Institute of Psychiatry, University of Milan, School of Medicine, 20122 Milan, Italy
In 1894 Freud (21) proposed the separation of anxiety neurosis from neuras­thenia. Since then, there has been intensive theoretical and extensive experimental work on the relationship between anxiety and depression. Nonetheless, we still cannot firmly conclude whether anxiety and depressive disorders are distinct entities. Our clinical experience, however, has unquestionably demonstrated that symptoms of anxiety very frequently color the picture of depressive disorders, so much that the label "anxious depression" is widely used in spite of the fact that it is not a category recognized by most of the latest diagnostic systems. The presence of symptoms of both anxiety and depression in clinically de­pressed patients definitely does not appear to be confined exclusively to depressive neurosis or to other minor types of depression. Anxiety is also present in patients that are readily diagnosed as having either some of the traditionally defined disorders, such as manic-depressive psychosis or endogenous depression, or the operationally defined major affective disorders. A few examples will suffice to confirm the presence of anxiety in major depres­sion. Factor analysis (12) has shown that, at the very least, the anxiety and depressive factors loaded equally in over 65% of the cases of a sample of patients with endogenous depression. Similarly, a recent study (2) demonstrated that as many as 25% of the patients with major depression and 10% of those with brief recurrent depressions had an overlapping anxiety disorder as well. On the other hand, an ever-increasing body of data from genetics, biochemistry, neuroendocrinology, neuromorphology, and clinical psychopharmacology (8,25,31,43,46,47,53,55) indicates that major depression is not a homogeneous disorder, but subsumes a number of biologically and, perhaps, etiopathogenetic distinct subforms. In order to understand the presence of anxious symptomatology in major depressives it seems particularly important to look at this problem in the light of the inherent biological heterogeneity of major depression. Although prelim­inary, recent reports (6,54) of different familial incidence of major depression among the first-degree relatives of depressive patients with and without associated panic attacks or agoraphobia suggest that specific anxious symptoms are pref­erentially clustered in distinct subtypes of major depression. In order to explore this hypothesis, we undertook a series of exploratory anal­yses specifically designed to test whether some biochemical, pharmacological, and clinical variables, usually singled out as putative markers of the heterogeneity of major affective disorders, could be useful in screening major depressive patients who would consistently present anxiety symptoms. This chapter summarizes the findings from these preliminary studies, soma of which are still underway.

This entry was posted on Tuesday, March 31st, 2009 at 4:21 am and is filed under Major Affective Disorder. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.