Anxious depression

Versiani, M., Ontiveros, A., Mazzotti, G., Ospina, J. et al. (1999). Fluoxetine versus amitriptyline in the treatment of major depression with associated anxiety (anxious depression) a doubleblind comparison. Int. Clin. Psychopharmacol, 14, 321-7. 

Amitriptyline is used for anxious-depressive conditions. It is easier to tolerate than imipramine. The most frequently encountered synonyms are triptizol and amiprin. 

The mechanism of action of doxepin is presumable linked to the effect on the adrenergic transmission in the CNS, in particular to the blockage of neuronal norepinephrine uptake. Doxepin is used in anxious-depressive and anxious conditions, neuroses, alcoholism, organic illnesses of the CNS, and psychoses. The most frequently used synonyms are adapin and sinequan. 

In recent years many of these primary care cases that would formerly have been seen as anxiety disorders have been portrayed as anxious-depressives and have led to treatment with antidepressants, in particular the more recent serotonin reuptake inhibitors. As part of this rebranding a variety of states such as panic disorder, post-traumatic stress disorder, social phobia and generalized anxiety disorder have appeared, along with more traditional disorders such as obsessive compulsive disorder (OCD). Many of these diagnoses are likely to lead to prescriptions of an SSRI although the evidence for benefit from SSRIs is poor except for OCD. 

Bernstein, G.A., Warren, S.L., Massie, E.D., and Thuras, P.D. (1999) Family dimensions in anxious-depressed school refusers. / Anxiety Disord 13 513-528. 

Guelfi JD, Pichot P, Dreyfus JF Efficacy of tianeptine in anxious depressed patients results of a multi-center trial versus amitriptyline. Neuropsychobiology 22 41-48, 1989... 

Van Praag HM, Asnis CM, Kahn RS, et al Monoamines and abnormal behavior a multi-aminergic perspective. Br J Psychiatry 157 723-734, 1990 van Valkenburg C, Akiskal HS, Puzantian V, et al Anxious depression clinical, family history and naturalistic outcome—comparison with panic and major depressive disorders. J Affect Disord 6 67-82, 1984... 

Nevertheless, the GABAergic properties of benzodiazepines remain their most important clinical application. Over the past 30 years, the most widely used benzodiazepine drug has been diazepam (1.6). It is an anxiolytic, sedative, and muscle relaxant the anxious, depressed person becomes more outgoing and relaxed. There have been many diazepam analogs. Oxazepam (4.177) and lorazepam (4.178) have similar effects. Temazepam (4.179), flunitrazepam (4.180), and flurazepam (4.181) are useful sedative-hypnotics. Clonazepam (4.182) is a clinically useful anticonvulsant. Brotizolam (4.183), a novel benzodiazepine analog, seems to be an effective sedative-hypnotic. Midazolam (4.184) is an imidazolo-benzodiazepine that is water soluble and thus easily injectable. It is a hypnotic sedative with marked amnestic (i.e., memory loss) properties and is used in dentistry, endoscopic procedures, and induction to anesthetics in the elderly and in... 

FIGURE 8-1. Anxiety and depression can be combined in a wide variety of syndromes. Generalized anxiety disorder (GAD) can overlap with major depressive disorder (MDD) to form mixed anxiety depression (MAD). Subsyndromal anxiety overlapping with subsyndromal depression to form subsyn-dromal mixed anxiety depression, sometimes also called anxious dysthymia. Major depressive disorder can also overlap with subsyndromal symptoms of anxiety to create anxious depression GAD can also overlap with symptoms of depression such as dysthymia to create GAD with depressive features. Thus, a spectrum of symptoms and disorders is possible, ranging from pure anxiety without depression, to various mixtures of each in varying intensities, to pure depression without anxiety. 

To discuss the five dimensions of symptoms in schizophrenia, including positive, negative, cognitive, aggressive/hostile and anxious/depressed symptoms. 

Akiskal HS, Lemmi H, Dickson H, King D, Yerevanian B, Van Valkenburg C (1984) Chronic depressions. Part 2. Sleep EEG differentiation of primary dysthymic disorders from anxious depressions. J Affect Disord 6 287-295... 

Den Boer, J. A. and Westenberg, H. G. M. Serotonergic compounds in panic disorder, obsessive compulsive disorder and anxious depression. Hum. Psychopharmacol. 10 (Suppl. 3) (1995) S173-184. 

Often a preferred freafmenf of anxious depression as well as major depressive disorder comorbid wifh anxiefy disorders... 

Often a preferred treatment of anxious depression as well as major depressive disorder comorbid with anxiety disorders Withdrawal effects may be more likely than for some other SSRIs when discontinued (especially akathisia, restlessness, gastrointestinal symptoms, dizziness, tingling, dysesthesias, nausea, stomach cramps, restlessness)... 

Fava, M., J. F. Rosenbaum, S. L. Hoog, R. G. Tepner, J. B. Kopp and M. E. Nilsson (2000). Fluoxetine versus sertraline and paroxetine in major depression tolerability and efficacy in anxious depression. J Affect Disord 59(2) 119-26. 

Brief Psychiatric Rating Scale (BPRS) Clinician-rated 18 items, 7-point severity scale score >38 indicates moderate severity The anchored BPRS provides descriptions of each severity rating to increase the interrater reliability. The BPRS has four clusters of symptoms thinking disturbance, anxious depression, withdrawal-retardation, and host i 1 ity-susp ic iou sness... 

Benzodiazepines are of value in the treatment of anxious depressions and anxiety-tension associated with schizophrenia, as well as in patients undergoing psychotherapy. They should be used only when the symptoms are disabling, not just to alleviate stress. 

Anxious Depression People with low levels of serotonin often feel fearful, inadequate, and nervous, always worried about the future and their own inability to measure up to life s demands. They tend to hold on too tightly and may become dependent in relationships. 

Air Types are most prone to the Western disorder known as anxious depression. People in this category are typically thin, wiry, and fine-boned—sensitive and quick. If you re an Air type, you re frequently on the move, like a breath of fresh air or a cooling wind. You re probably an excellent communicator, with an active mind that moves easily from one topic to the next. You may also have a tendency to be spacey and ungrounded, with difficulty digesting the knowledge you acquire—as... 

Unfortunately, no routine tests exist that can measure levels of brain chemicals—at least, not yet. But we can infer these levels by the types of depression and the clusters of symptoms that people manifest. Depending on which chemicals are imbalanced, you may tend toward anxious depression, agitated depression, or sluggish depression, each of which is a relatively distinct syndrome with its own behaviors and personality characteristics. 

Low levels of serotonin are probably implicated in all types of depression, at least to some extent. But when the major imbalance involves insufficient serotonin, you re likely to end up with some version of anxious depression, characterized by fear, anxiety, low self-esteem, and a host of related symptoms. 

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