Anxious depression as a clinically relevant subtype of pediatric major depressive disorder
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In adults, anxious depression has been identified as a more severe form of major depressive disorder (MDD), associated with higher depression severity, more suicidal ideation and worse treatment outcome. Research in pediatric depression, however, has been sparse. 126 children and adolescents aged 8–18 years with a primary diagnosis of MDD were categorized into a MDD-only group and an anxious depression group based on clinically elevated scores on the Beck Anxiety Inventory. One-third of the sample was classified as having anxious depression with females being overrepresented in the anxious depressed compared to the MDD-only group. 42.2% of the anxious depressed youth met diagnostic criteria for a comorbid anxiety disorder. Anxious depressed youth were more likely to suffer recurrent depressive episodes, showed higher depression severity and a unique pattern of depressive symptoms characterized by more severe sleep problems, more somatic complaints, more severely depressed mood and more frequent suicidal ideations. Scores on a suicidal ideation scale were increased even when controlling for overall depression severity. However, when comparing depressed patients with and without comorbid anxiety disorders, no differences in depression severity, symptom patterns or suicidal ideations were observed. The results indicate that high anxiety levels in depressed youth are clinically relevant, and given the increase in suicidal ideation, anxiety symptoms during depressive episodes should routinely be screened in clinical practice even in the absence of a fully formed comorbid anxiety disorder.
KeywordsAnxious depression Adolescents Pediatric depression Depression profile
We would like to thank all members of the Omega-3 Study team, especially all members of the clinical sites for their help in recruiting patients, namely Oliver Pick and Alain Di Gallo from the Department of Child and Adolescent Psychiatry, Psychiatric University Hospitals Basel; Stefan Müller from the Child and Adolescent Psychiatric Services Baselland; Simone Heitzer and Maria Dokianaki from the Clienia Littenheid; Amir Yamini from the Child and Adolescent Psychiatric Services Thurgau; Michael Schmid from the Child and Adolescent Psychiatric Services St. Gallen; Ioannis Christodoulakis from the Klinik Sonnenhof. We also thank all our patients and their families for participating in the trial.
All authors contributed to the study conception, design, recruitment and data collection. IH ran the analysis. The manuscript was written by IH, GB and SW. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
This research was funded as an investigator initiated clinical trial by the Swiss National Foundation (SNF Grant 33IC30_166826). Furthermore, the Thalmann Foundation (University of Basel) and the Ebnet Foundation support additional PhD projects. The Research Department of Child and Adolescent Psychiatry, University Hospital of Psychiatry Zurich of the University of Zurich provides infrastructure and administrative staff support. Burgerstein, Antistress AG, and Rapperswil-Jona (SG, Switzerland) provided the study medication for the clinical trial with no restrictions regarding data analysis or publication rights. No additional industrial funding was provided throughout the study.
Compliance with ethical standards
Conflict of interest
S.W. has received in the last 5 years royalties from Thieme Hogrefe, Kohlhammer, Springer, Beltz. S.W. received lecture honoraria from Opopharma in the last 5 years. Her work was supported in the last 5 years by the Swiss National Science Foundation (SNF), diff. EU FP7 s, HSM Hochspezialisierte Medizin of the Kanton Zurich, Switzerland, Bfarm Germany, ZInEP, Hartmann Müller Stiftung, Olga Mayenfisch, Gertrud Thalmann Fonds. Outside professional activities and interests are declared under the link of the University of Zurich www.uzh.ch/prof/ssl-dir/interessenbindungen/client/web/. In the last 5 years KS has received royalties from Springer, Hogrefe and Schattauer. Since 2014, KS received no honoraria from pharmaceutical or other industrial companies. His work was supported in the last 5 years by the Swiss National Science Foundation (SNF), Swiss Ministry of Justice, University of St. Gallen, Botnar Foundation and Gertrud Thalmann Fonds. Gregor Berger was supported by the Swiss National Science Foundation, the Stanley Foundation, the Gertrud Thalmann Fonds, and the Ebnet Foundation and has received lecture honoraria from Lundbeck, Opopharma, Antistress AG (Burgerstein) in the last 5 years. The other authors declare no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee (Swissethics 2016-02116; Swissmedics 2017DR3029) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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