Considerations in the management of the patient with comorbid depression and anxiety.

Abstract

Purpose To provide clinicians with guidelines for the assessment, evaluation, diagnosis, and manage‐ment of comorbid depression and anxiety in the primary care setting. Data Sources Research‐based articles in the medical and psy‐chiatric literature, literature reviews by experts in the field, and DSM‐IV‐TR. Conclusions Comorbid anxiety and depression occurs at a high rate in primary care, and is costly to both the individual and to society. These patients most often present in primary care settings, have more severe symptoms, and require more health care resources. The presentation of depression and anxiety together pose complicated diagnostic and treatment challenges, leading to inadequate diagnosis and treatment resulting in unnecessary patient distress and increased utilization of health care services. Implications for Practice This article is a review of comorbid depression and anxiety with a focus upon societal and patientsignificance and impact, under recog‐nition and under treatment, diagnostic chal‐lenges, medical comorbidity, treatment consid‐erations, and educational strategies. Effective assessment, evaluation, diagnosis and treat‐ment can lead to better treatment outcomes and improved quality of life inprimary care patients.