Skip to main content Accessibility help
×
Home

Anxious and non-anxious forms of major depression: familial, personality and symptom characteristics

  • D. P. Goldberg (a1), H.-U. Wittchen (a2), P. Zimmermann (a3), H. Pfister (a3) and K. Beesdo-Baum (a2)...

Abstract

Background

Earlier clinical studies have suggested consistent differences between anxious and non-anxious depression. The aim of this study was to compare parental pathology, personality and symptom characteristics in three groups of probands from the general population: depression with and without generalized anxiety disorder (GAD) and with other anxiety disorders. Because patients without GAD may have experienced anxious symptoms for up to 5 months, we also considered GAD with a duration of only 1 month to produce a group of depressions largely unaffected by anxiety.

Method

Depressive and anxiety disorders were assessed in a 10-year prospective longitudinal community and family study using the DSM-IV/M-CIDI. Regression analyses were used to reveal associations between these variables and with personality using two durations of GAD: 6 months (GAD-6) and 1 month (GAD-1).

Results

Non-anxious depressives had fewer and less severe depressive symptoms, and higher odds for parents with depression alone, whereas those with anxious depression were associated with higher harm avoidance and had parents with a wider range of disorders, including mania.

Conclusions

Anxious depression is a more severe form of depression than the non-anxious form; this is true even when the symptoms required for an anxiety diagnosis are ignored. Patients with non-anxious depression are different from those with anxious depression in terms of illness severity, family pathology and personality. The association between major depression and bipolar disorder is seen only in anxious forms of depression. Improved knowledge on different forms of depression may provide clues to their differential aetiology, and guide research into the types of treatment that are best suited to each form.

Copyright

Corresponding author

* Address for correspondence: D. P. Goldberg, Professor Emeritus, Health Service & Population Research, Institute of Psychiatry, de Crespigny Park, London SE5 8AF, UK. (Email: davidpgoldberg@yahoo.com)

References

Hide All
Andreescu, C, Butters, M, Lenze, EJ, Venkatraman, VK, Nable, M, Reynolds, CF 3rd, Aizenstein, HJ (2009). fMRI activation in late-life anxious depression: a potential biomarker. International Journal of Geriatric Psychiatry 24, 820828.
Andreescu, C, Wu, M, Butters, MA, Figurski, J, Reynolds, CF 3rd, Aizenstein, HJ (2011). The default mode network in late-life anxious depression. American Journal of Geriatric Psychiatry 19, 980983.
Beesdo-Baum, K, Bittner, A, Pine, DS, Stein, MB, Höfler, M, Lieb, R, Wittchen, H-U (2007). Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Archives of General Psychiatry 64, 903912.
Beesdo-Baum, K, Höfler, M, Gloster, AT, Klotsche, J, Lieb, R, Beauducel, A, Bühner, M, Kessler, RC, Wittchen, H-U (2009). The structure of common mental disorders: a replication study in a community sample of adolescents and young adults. International Journal of Methods in Psychiatric Research 18, 204220.
Beesdo-Baum, K, Pine, DS, Lieb, R, Wittchen, H-U (2010). Incidence and risk patterns of anxiety and depressive disorders and categorization of generalized anxiety disorder. Archives of General Psychiatry 67, 4757.
Beesdo-Baum, K, Winkel, S, Pine, DS, Hoyer, J, Höfler, M, Lieb, R, Wittchen, H-U (2011). The diagnostic threshold of generalized anxiety disorder in the community: a developmental perspective. Journal of Psychiatric Research 45, 962972.
Bittner, A, Egger, HL, Erkanli, A, Costello, EJ, Foley, DL, Angold, A (2007). What do childhood anxiety disorders predict? Journal of Child Psychology and Psychiatry 48, 11741183.
Bruder, GE, Wexler, BE, Stewart, JW, Price, LH, Quitkin, FM (1999). Perceptual asymmetry differences between major depression with or without a comorbid anxiety disorder: a dichotic listening study. Journal of Abnormal Psychology 108, 233239.
Clayton, PJ, Grove, WM, Coryell, W, Keller, M, Hirschfeld, R, Fawcett, J (1991). Follow-up and family study of anxious depression. American Journal of Psychiatry 148, 15121519.
Cloninger, CR (1987). A systematic method for clinical description and classification of personality variants: a proposal. Archives of General Psychiatry 44, 573588.
Coryell, W, Endicott, J, Winokur, G (1992). Anxiety syndromes as epiphenomena of primary major depression: outcome and familial psychopathology. American Journal of Psychiatry 149, 100107.
Fava, M, Alpert, JE, Carmin, CN, Wisniewski, SR, Trivedi, MH, Biggs, MM, Shores-Wilson, K, Schwartz, T, Balasubramani, GK, Rush, AJ (2004). Clinical correlates and symptom patterns of anxious depression among patients with major depression in STAR*D. Psychological Medicine 34, 12991308.
Fava, M, Rankin, MA, Wright, EC, Alpert, JE, Nierenberg, AA, Pava, J, Rosenbaum, JF (2000). Anxiety disorders in major depression. Comprehensive Psychiatry 41, 97102.
Fava, M, Rush, AJ, Alpert, JE (2008). Difference in treatment outcome in patients with anxious versus non-anxious depression: a STAR*D report. American Journal of Psychiatry 165, 342351.
Fava, M, Rush, AJ, Trivedi, MH, Nierenberg, AA, Thase, ME, Sackeim, HA, Quitkin, FM, Wisniewski, S, Lavori, PW, Rosenbaum, JF, Kupfer, DJ (2003). Background and rationale for the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Psychiatric Clinics of North America 2, 457494.
Fawcett, J, Kravitz, HM (1983). Anxiety syndromes and their relationship to depressive illness. Journal of Clinical Psychiatry 44, 811.
Fergusson, DM, Horwood, LJ (2001). The Christchurch Health and Development Study: review of findings on child and adolescent mental health. Australian and New Zealand Journal of Psychiatry 35, 287296.
Goldberg, DP, Fawcett, J (2012). The importance of anxiety in both major depression and bipolar disorder. Depression and Anxiety 29, 471478.
Goldberg, DP, Krueger, RF, Andrews, G, Hobbs, M (2009). Emotional disorders: cluster 4 of the proposed meta-structure for DSM-V and ICD-11. Psychological Medicine 39, 20432059.
Goldberg, DP, Simms, LJ, Gater, R, Krueger, RF (2011). Integration of dimensional spectra for depression and anxiety into categorical diagnoses for general medical practice. In The Conceptual Evolution of DSM-5 (ed. Regier, D., Narrow, W. E., Kuhl, E. A. and Kupfer, D. J.), pp. 1936. American Psychiatric Publishing: Washington, DC.
Hettema, J (2008). The nosologic relationship between generalized anxiety disorder and major depression. In Diagnostic Issues in Depression and Generalized Anxiety Disorder: Refining the Research Agenda for DSM-V (ed. Goldberg, D., Kendler, K. S., Sirovatka, P. and , D. A. , Regier), pp. 1540. American Psychiatric Association: Arlington, VA.
Inkster, B, Rao, AW, Ridler, K, Nichols, TE, Saemann, PG, Auer, DP, Holsboer, F, Tozzi, F, Muglia, P, Merlo-Pich, E, Matthews, PM (2011). Structural brain changes in patients with recurrent major depressive disorder presenting with anxiety symptoms. Journal of Neuroimaging 21, 375382.
Kendler, KS, Neale, MC, Kessler, RC, Heath, AC, Eaves, LJ (1992). Major depression and generalized anxiety disorder. Same genes, (partly) different environments? Archives of General Psychiatry 49, 716722.
Kessler, RC, Brandenburg, N, Lane, M, Roy-Byrne, P, Stang, PD, Stein, DJ, Wittchen, H-U (2005). Rethinking the duration requirement for generalized anxiety disorder: evidence from the National Co-morbidity Survey Replication. Psychological Medicine 35, 10731082.
Krueger, RF (1999). The structure of common mental disorders. Archives of General Psychiatry 56, 921926.
Lieb, R, Isensee, B, Höfler, M, Wittchen, H-U (2002). Parental depression and depression in offspring: evidence for familial characteristics and subtypes? Journal of Psychiatric Research 36, 237246.
Meller, WH, Kathol, RG, Samuelson, SD, Gehris, TL, Carroll, BT, Pitts, AF, Clayton, PJ (1995). CRH challenge test in anxious depression. Biological Psychiatry 37, 376382.
Merikangas, KR, Mehta, RL, Molnar, BE, Walters, EE, Swendsen, JD, Aguilar-Gaziola, S, Bijl, R, Borges, G, Caraveo-Anduaga, JJ, Dewit, DJ, Kolody, B, Vega, WA, Wittchen, H-U, Kessler, RC (1998). Comorbidity of substance use disorders with mood and anxiety disorders: results of the international consortium in psychiatric epidemiology. Addictive Behaviors 23, 893907.
Moffitt, TE, Caspi, A, Harrington, H, Milne, BJ, Melchior, M, Goldberg, D, Poulton, R (2007 a). Generalized anxiety disorder and depression: childhood risk factors in a birth cohort followed to age 32. Psychological Medicine 37, 441452.
Moffitt, TE, Harrington, H, Caspi, A, Kim-Cohen, J, Goldberg, D, Gregory, AM, Poulton, R (2007 b). Depression and generalized anxiety disorder: cumulative and sequential comorbidity in a birth cohort followed prospectively to age 32 years. Archives of General Psychiatry 64, 651660.
Nelson, BD, Sarapas, C, Robison-Andrew, EJ, Altman, SE, Campbell, ML, Shankman, SA (2012). Frontal brain asymmetry in depression with comorbid anxiety: a neuropsychological investigation. Journal of Abnormal Psychology 121, 579591.
Rao, ML, Vartzopoulos, D, Fels, K (1989). Thyroid function in anxious and depressed patients. Pharmacopsychiatry 22, 6670.
Raskin, A, Schulterbrandt, JG, Reatig, N, Crook, TH, Odle, D (1974). Depression subtypes and response to phenelzine, diazepam, and a placebo. Results of a nine hospital collaborative study. Archives of General Psychiatry 30, 6675.
Reed, V, Gander, F, Pfister, H, Steiger, A, Sonntag, H, Trenkwalder, C, Sonntag, A, Hundt, W, Wittchen, H-U (1998). To what degree the Composite International Diagnostic Interview (CIDI) correctly identifies DSM-IV disorders? Testing validity issues in a clinical sample. International Journal of Methods in Psychiatric Research 7, 142155.
Reich, J (1993). Distinguishing mixed anxiety/depression from anxiety and depressive groups using the family history method. Comprehensive Psychiatry 35, 285290.
Ruscio, AM, Chiu, WT, Roy-Byrne, P, Stang, PE, Stein, DJ, Wittchen, HU, Kessler, RC (2007). Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication. Journal of Anxiety Disorders 21, 662676.
Slade, T, Watson, D (2006). The structure of common DSM-IV and ICD-10 mental disorders in the Australian general population. Psychological Medicine 36, 15931600.
StataCorp (2012). Stata Statistical Software: Release 12.1. Stata Corporation: College Station, TX.
Taylor-Clift, A, Morris, BH, Rottenberg, J, Kovacs, M (2011). Emotion-modulated startle in anxiety disorders is blunted by co-morbid depressive episodes. Psychological Medicine 41, 129139.
Vollebergh, WA, Iedema, J, Bijl, RV, de Graaf, R, Smit, F, Ormel, J (2001). The structure and stability of common mental disorders: the NEMESIS study. Archives of General Psychiatry 58, 597603.
Weyers, P, Krebs, J, Janke, W (1995). Reliability and construct validity of the German version of Cloninger's Tridimensional Personality Questionnaire. Personality and Individual Differences 9, 853861.
Wittchen, H-U, Höfler, M, Gloster, AT, Craske, MG, Beesdo, K (2010). Options and dilemmas of dimensional measures for DSM-V: which types of measures fare best in predicting course and outcome? In The Conceptual Evolution of DSM-5 (ed. Regier, D. A., Narrow, W. E., Kuhl, E. A. and Kupfer, D. J.), pp. 119143. American Psychiatric Publishing: Washington, DC.
Wittchen, H-U, Kessler, RC, Pfister, H, Lieb, R (2000). Why do people with anxiety disorders become depressed? A prospective-longitudinal community study. Acta Psychiatrica Scandinavica 102 (Suppl. 406), 1423.
Wittchen, H-U, Lachner, G, Wunderlich, U, Pfister, H (1998 a). Test-retest reliability of the computerized DSM-IV version of the Munich-Composite International Diagnostic Interview (M-CIDI). Social Psychiatry and Psychiatric Epidemiology 33, 568578.
Wittchen, H-U, Lieb, R, Schuster, P, Oldehinkel, AJ (1999). When is onset? Investigations into early developmental stages of anxiety and depressive disorders. In Childhood Onset of ‘Adult’ Psychopathology: Clinical and Research Advances (ed. Rapoport, J. L.), pp. 259302. American Psychiatric Publishing: Washington, DC.
Wittchen, H-U, Nelson, CB, Lachner, G (1998 b). Prevalence of mental disorders and psychosocial impairments in adolescents and young adults. Psychological Medicine 28, 109126.
Wittchen, H-U, Perkonigg, A, Lachner, G, Nelson, CB (1998 c). Early Developmental Stages of Psychopathology Study (EDSP): objectives and design. European Addiction Research 4, 1827.
Wittchen, H-U, Pfister, H (1997). DIA-X Interviews; Manual für Screening-Verfahren und Interview; Interviewheft Längsschnittuntersuchung (DIA-X-Lifetime); Ergänzungsheft (DIA-X-Lifetime); Interviewheft Querschnittuntersuchung (DIA-X-12 Monate); Ergänzungsheft (DIA-X-12 Monate); PC-Programm zur Durchführung des Interviews (Längs- und Querschnittuntersuchung); Auswertungsprogramm. Swets & Zeitlinger: Frankfurt, Germany.
Zimmermann, P, Brückl, T, Nocon, A, Pfister, H, Lieb, R, Wittchen, HU, Holsboer, F, Angst, J (2009). Heterogeneity of DSM-IV major depressive disorder as a consequence of sub-threshold bipolarity. Archives of General Psychiatry 66, 13411352.

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed