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PANIC DISORDER AND SOCIAL PHOBIA

Michael W. Otto Mark B. Powers Georgia Stathopoulou Stefan G. Hofmann

Given the chronic avoidance, social isolation, role impairment, and disrupted quality of life associated with the anxiety disorders (e.g., Rubin et al., 2000; Schneier, Johnson, Hornig, Liebowitz, & Weissman, 1992), it is not surprising that anxiety comorbidity exacts a toll on the treatment of major depression. For example, a prospective study of 85 primary care patients showed that anxiety predicts persistence of depression 1 year later (Gaynes et al., 1999), with an 82% rate of depression at 1-year follow-up in the comorbid group compared to 57% in the noncomorbid group. Moreover, although at baseline the two groups did not differ in the severity of depressive symptoms, by 3-month follow-up the comorbid group exhibited greater depressive severity, indicated by an average 54.9 annual disability days over the follow-up period compared with an average of 19.8 days for the noncomorbid group (see also Fava et al., 2004; Frank et al., 2000). These results extend to psychosocial treatment. For example, Brown, Schulberg, Madonia,

Shear, and Houck (1996) found that although patients with a history of anxiety disorders made significant gains in psychotherapy, they were less likely to complete the treatment study and showed less improvement overall than patients with major depression only.

The negative effects of anxiety comorbidity appear to extend to bipolar disorder as well. In a large, prospective study, Otto and associates (2006) found that anxiety comorbidity predicted a worse course of bipolar disorder, with fewer days of relative euthymia over a year of study, poorer quality of life and role functioning, greater risk of relapse for those patients starting the study period in relative euthymia, and a slower rate of recovery for patients already depressed. Greater anxiety comorbidity (two or more disorders) predicted an intensification of these negative outcomes, and among individual anxiety disorders, social phobia and posttraumatic stress disorder had prominent influences. These findings and data from other studies indicated a worse course, poorer response to treatment, greater role dysfunction, greater substance use disorder comorbidity, and greater suicidality for patients with bipolar disorder with comorbid anxiety and panic spectrum disorders (McElroy et al., 2001; Simon et al., 2004).

Our purpose in this chapter is to provide a broader account of the rates and nature of the co-occurrence between anxiety disorders and major depression. In particular, we examine the influence of anxiety comorbidity on the nature and outcome of depression, with a focus on panic disorder and social phobia. Given this information, we then discuss treatment considerations that evolve from the partial guidance offered by the empirical literature. Although anxiety comorbidity is high in bipolar disorder, linked to a poorer course, and targeted in cognitive-behavioral therapy (CBT) protocols for bipolar disorder (Henin, Otto, & Reilly-Harrington, 2001), currently there is an absence of published treatment outcome studies of anxiety comorbidity in these samples. Accordingly, our chapter focuses only on treatment issues concerning the co-occurrence of anxiety and unipolar depression.

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BiPolar Explained

Bipolar is a condition that wreaks havoc on those that it affects. If you suffer from Bipolar, chances are that your family suffers right with you. No matter if you are that family member trying to learn to cope or you are the person that has been diagnosed, there is hope out there.

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