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Anxious Depression Predicts Poorer Treatment Results

Blue womanA new study examining the results of the STAR*D data has found that people who have “anxious depression” have a more difficult time in treatment than those without. A person with anxious depression experiences a major depressive episode and clinically meaningful levels of anxiety as well.

The research examined 2,876 adults who were in treatment for depression in 41 different treatment centers across the U.S. In the first phase of treatment, patients received the antidepressant Celexa (citalopram) to treat their depression.

In the second phase of the study, 1,292 of the patients who didn’t feel significantly less depressed after taking Celexa for up to 14 weeks were then randomly assigned to try a different antidepressant, or to try Celexa combined with another antidepressant.

Anxious depression was assessed through the Hamilton Depression Rating Scale’s anxiety/somatization score. The Hamilton Depression Rating Scale is administered by a healthcare professional to assess a person’s level of depression, as well as other symptoms commonly associated with depression.

The researchers found that approximately 53% of people in the STAR*D study had “anxious depression” and that, for these patients, “Remission [of depression symptoms] was significantly less likely and took longer to occur in these patients than in those with nonanxious depression.”

“Ratings of side effect frequency, intensity, and burden, as well as the number of serious adverse events, were significantly greater in the anxious depression group.”

Changing antidepressant medications, or augmenting Celexa with another antidepressant, also didn’t help people with anxious depression nearly as much as those with nonanxious depression. Patients with anxious depression fared significantly worse in the second phase of the study.

The findings from this research suggest that it is important for healthcare professionals to assess anxiety during the initial diagnosis of major depression. Such co-existing anxiety has the potential to significantly negatively affect treatment outcomes if it is not taken into consideration and treated as well.

The STAR*D was a ground-breaking, large-scale, real-world study conducted on over 4,000 adults with treatment-resistant depression at 41 clinical locations. You can learn more about STAR*D here.

The study was published in the January 2 issue of the American Journal of Psychiatry.


Maurizio Fava, A. John Rush, Jonathan E. Alpert, G.K. Balasubramani, Stephen R. Wisniewski, Cheryl N. Carmin, Melanie M. Biggs, Sidney Zisook, Andrew Leuchter, Robert Howland, Diane Warden, and Madhukar H. Trivedi. (2008). Difference in Treatment Outcome in Outpatients With Anxious Versus Nonanxious Depression: A STAR*D Report. Am J Psychiatry, 10, 1176.

Anxious Depression Predicts Poorer Treatment Results

John M. Grohol, Psy.D.

John Grohol, PsyDDr. John Grohol is the founder & CEO of Psych Central. He is an author, researcher and expert in mental health online, and has been writing about online behavior, mental health and psychology issues -- as well as the intersection of technology and human behavior -- since 1992. Dr. Grohol sits on the editorial board of the journal Cyberpsychology, Behavior and Social Networking and is a founding board member and treasurer of the Society for Participatory Medicine. You can read his full bio here.

APA Reference
Grohol, J. (2018). Anxious Depression Predicts Poorer Treatment Results. Psych Central. Retrieved on February 22, 2019, from
Scientifically Reviewed
Last updated: 8 Aug 2018
Last reviewed: By a member of our scientific advisory board on 8 Aug 2018
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