Medical Psychiatry

Handbook of Depression and Anxiety Second Edition, Revised and Expanded edited by Siegfried Kasper University of Vienna Vienna, Austria Johan A. den Boer Academic Hospital Groningen Groningen, The Netherlands J. M. Ad Sitsen Academic Hospital Utrecht Utrecht, The Netherlands MARCEL MARCEL DEKKER, INC. NEW YORK • BASEL D E K K E R The first edition was published as Handbook of Depression and Anxiety: A Biological Approach, edited by Johan A. den Boer and J. M. Ad Sitsen (Marcel Dekker, 1994). Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress. ISBN: 0-8247-0872-5 This book is printed on acid-free paper. Headquarters Marcel Dekker, Inc. 270 Madison Avenue, New York, NY 10016 tel: 212-696-9000; fax: 212-685-4540 Eastern Hemisphere Distribution Marcel Dekker AG Hutgasse 4, Postfach 812, CH-4001 Basel, Switzerland tel: 41-61-260-6300; fax: 41-61-260-6333 World Wide Web http://www.dekker.com The publisher offers discounts on this book when ordered in bulk quantities. For more information, write to Special Sales/Professional Marketing at the headquarters address above. Copyright 2003 by Marcel Dekker, Inc. All Rights Reserved. Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher. Current printing (last digit): 10987654321 PRINTED IN THE UNITED STATES OF AMERICA Medical Psychiatry Series Editor Emeritus William A. Frosch, M.D. Weill Medical College of Cornell University New York, New York, USA Advisory Board Jonathan E. Alpert, M.D., Ph.D. Siegfried Kasper, M.D. Massachusetts General Hospital and University Hospital for Psychiatry Harvard University School of Medicine and University of Vienna Boston Massachusetts, U S A Vienna, Austria Bennett Leventhal, M.D. Mark H. Rapaport, M.D. University of Chicago School of Medicine Cedars-Sinai Medical Center Chicago Illinois, USA Los Angeles California, USA 1 Handbook of Depression and Anxiety A Biological Approach, edited by Johan A. den Boer and J M Ad Sitsen 2 Anticonvulsants in Mood Disorders, edited by Russell T Joffe and Joseph R Calabrese 3 Serotonin in Antipsychotic Treatment Mechanisms and Clinical Practice, edited by John M Kane, H -J Moller, and Frans Awou- ters 4 Handbook of Functional Gastrointestinal Disorders, edited by Kevin W Olden 5 Clinical Management of Anxiety, edited by Johan A den Boer 6 Obsessive-Compulsive Disorders Diagnosis • Etiology • Treat- ment, edited by Eric Hollander and Dan J Stem 7 Bipolar Disorder Biological Models and Their Clinical Application, edited by L Trevor Young and Russell T Joffe 8 Dual Diagnosis and Treatment Substance Abuse and Comorbid Medical and Psychiatric Disorders, edited by Henry R Kranzlerand Bruce J Rounsaville 9 Geriatric Psychopharmacology, edited by J Craig Nelson 10 Panic Disorder and Its Treatment, edited by Jerrold F Rosenbaum and Mark H Pollack 11 Comorbidity in Affective Disorders, edited by Mauncio Tohen 12 Practical Management of the Side Effects of Psychotropic Drugs, edited by Richard Baton 13. Psychiatric Treatment of the Medically Hi, edited by Robert G. Robinson and William R. Yates 14. Medical Management of the Violent Patient' Clinical Assessment and Therapy, edited by Kenneth Tardiff 15 Bipolar Disorders. Basic Mechanisms and Therapeutic Implica- tions, edited by Jair C. Scares and Samuel Gershon 16 Schizophrenia A New Guide for Clinicians, edited by John G. Csernansky 17 Polypharmacy in Psychiatry, edited by S. Nassir Ghaemi 18 Pharmacotherapy for Child and Adolescent Psychiatric Disorders- Second Edition, Revised and Expanded, David R. Rosenberg, Pablo A Davanzo, and Samuel Gershon 19 Brain Imaging In Affective Disorders, edited by Jair C. Scares 20 Handbook of Medical Psychiatry, edited by Jair C. Soares and Samuel Gershon 21 Handbook of Depression and Anxiety: Second Edition, Revised and Expanded, edited by Siegfried Kasper, Johan A. den Boer, and J. M. Ad Sitsen ADDITIONAL VOLUMES IN PREPARATION Aggression- Psychiatric Assessment and Treatment, edited by Emil F. Coccaro Autism Spectrum Disorders, edited by Eric Hollander Depression in Later Life: A Multidisciplinary Approach, edited by James Ellison and Sumer Verma Handbook of Chronic Depression: Diagnosis and Therapeutic Man- agement, edited by Maurizio Fava and Jonathan Alpert Series Introduction Depression and anxiety, both externally experienced and internally perceived, are part of the normal human repertoire of response to stress. In my opinion, those who never experi- ence such feelings are seriously ill, unable to recognize or respond appropriately to the importance of danger and loss. On the other hand, the capacity to tolerate a “normal expectable” level of each is a sign of mental health. Unfortunately, however, many of us are unable to withstand the impact of the usual vicissitudes of life and are overwhelmed by excessive stress or chronic strain. The stressors may be as sudden as the events of 9/11, the diagnosis of a life-threatening disease, or the loss of someone we love, or they may be an accumulation of the ordinary stresses of life at work and at home, with family and friends. Symptoms of depression and/or anxiety may develop, sometimes assorted into identifiable syndromes and, at times, representing specific disease states. The chapters of this volume provide us with background information, such as the conceptual history of our understanding of anxiety and depression, their epidemiology and genetics. They also provide insight into our current knowledge of the physiology and pathology of both anxiety and depression, and information about up-to-date treatment approaches for both acute and chronic presentations. This volume should be kept on our desks, readily accessible for consultation when we need help with understanding the difficult issues that bring people to us in search of relief. It is a “vade-mecum”—a useful manual of what we now know about the biological and pharmacological treatments of depression and anxiety, and an invaluable resource for all who care for the afflicted, important for general practitioners as well as for psychiatrists and others in the mental health fields. The internationally renowned group of contributors illustrate a growing consensus that anxiety and depression are both symptom and syndrome, and, in some instances, disease. It is time to apply this understanding to the practice of medicine. William A. Frosch, M.D. Weill Medical College of Cornell University New York, New York iii Preface Anxiety and depression are complex emotional states in which cognitive evaluations and affective and physiological responses are involved. Considering the complexity of these emotions, which can be described in several scientific languages at different levels of analysis, there is no doubt that multiple neuronal systems in the brain are implicated in the pathophysiology of these closely related disorders. On a phenomenological level, there is a high degree of overlap between symptoms of anxiety and depression as well as a high degree of comorbidity. This does not imply, however, that both syndromes are merely different phenotypical expressions of a geneti- cally based constitution sharing similar biological underpinnings. The question of whether anxiety and depression result from similar or different biological abnormalities cannot be answered using one research strategy. On the one hand, psychophysiological research provides evidence suggesting that anxiety and depression are clearly distinct disorders; on the other hand, some anxiety disorders and depressive syndromes respond to similar pharmacological interventions. Thus, these conflicting findings from different biomedical fields of research present a challenge to all of us involved in the study of these very common and often debilitating psychiatric illnesses. Some investigators argue that distinguishing different subtypes among depressive syndromes and anxiety disorders is a somewhat artificial practice. They reason that a syndrome exists based upon a common underlying propensity toward ‘‘nervousness.’’ This (dimensional) viewpoint implies that the different diagnostic categories could be merely phenotypical manifestations of an underlying vulnerability to anxiety or depression. Over the last decade, our knowledge about the biological underpinnings of depression and anxiety disorders has increased substantially, particularly for anxiety disorders, and new insights are continually emerging from widely disparate fields, such as epidemiology, genetics, immunology, psychophysiology, and psychopharmacology. This volume brings together these different disciplines and reviews the state of the art in research on anxiety and depression and their interrelatedness. We consider ourselves fortunate to have succeeded in getting so many internationally renowned contributors, who lend to this volume their knowledge and expertise in v vi Preface these disciplines. We hope that scientists and clinicians from many fields will be inspired by the exciting findings presented in this book. Siegfried Kasper Johan A. den Boer J. M. Ad Sitsen Contents Preface iii Contributors xi 1. A Conceptual History of Anxiety and Depression 1 Gerrit Glas 2. Epidemiology of Depression and Anxiety 49 Borwin Bandelow 3. Comorbidity of Depression and Anxiety 69 Giovanni B. Cassano, Nicolo` B. Rossi, and Stefano Pini 4. Anxiety,

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