Comorbidity Of Depression And Anxiety

The National Comorbidity Survey (NCS) showed dramatically higher rates of panic disorder in individuals with a history of depression (Kessler et al., 1998). Chronologically, primary depression predicted the first onset of subsequent panic attacks but not of panic disorder. Chronologically, primary panic attacks, with or without panic disorder, predicted a first onset of subsequent major depression. Data from the NCS also indicate increased clini-

cal severity when depression and panic disorder co-occur. Comorbid depression and panic disorder was associated with greater symptom severity, persistence, role impairment, suicidality, and help seeking (Roy-Byrne et al., 2000). Findings did not differ according to which disorder was chronologically primary.

There is also strong evidence for a high co-occurrence of major depression and social phobia (Magee et al., 1996; Rush et al., 2005), with even greater rates of depression among individuals with more social fears and among individuals seeking treatment (Kessler, Stang, Wittchen, Stein, & Walters, 1999). For example, in a sample of 449 outpatients with a lifetime diagnosis of social phobia, Brown and colleagues (2001) found a 60% rate of lifetime major depression and a 20% rate of lifetime dysthymia. The onset of social phobia typically occurs prior to the onset of depression (e.g., Brown et al., 2001; van Ameringen, Mancini, Styan, & Donison, 1991), and evidence suggests that social phobia increases the risk of subsequent depression (e.g., Stein et al., 2001).

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