Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Dec 22, 2015; 5(4): 366-378
Published online Dec 22, 2015. doi: 10.5498/wjp.v5.i4.366
Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches
Jeremy D Coplan, Cindy J Aaronson, Venkatesh Panthangi, Younsuk Kim
Jeremy D Coplan, Department of Psychiatry, Division of Neuropsychopharmacology, State University of New York Downstate Medical Center, New York, NY 11203, United States
Cindy J Aaronson, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Venkatesh Panthangi, Younsuk Kim, State University of New York Downstate Medical Center, New York, NY 11203, United States
Author contributions: Coplan JD and Kim Y contributed to the psychopharmacological approaches; Aaronson CJ contributed to the psychosocial approaches; Coplan JD and Aaronson CJ both contributed to the review of literature, discussion and conclusion of this paper; Panthangi V contributed specifically to the psychosocial approaches.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Cindy J Aaronson, MSW, PhD, Assistant Clinical Professor of Psychiatry, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1230, New York, NY 10029, United States. cindy.aaronson@mssm.edu
Telephone: +1-212-2413169
Received: August 20, 2014
Peer-review started: August 24, 2014
First decision: September 28, 2014
Revised: September 26, 2015
Accepted: November 3, 2015
Article in press: November 4, 2015
Published online: December 22, 2015
Processing time: 485 Days and 9.5 Hours
Core Tip

Core tip: A comprehensive diagnostic assessment is a critical first step in treating patients with mixed anxiety and depression. Practitioners should be alert to the possibility that this may be a concealed bipolar disorder since misdiagnoses rates can be 70%. Treatment in the patient with uncomplicated non-substance-abusing unipolar disorder may be quite straight forward. However patients are in all likelihood treatment-resistant with probable bipolarity and substance abuse. In the latter instance, more complex regimen of medications with combinations of pharmacotherapy are required. Finally, a “stacking” approach, to cover the full spectrum of available receptors targeted by current pharmacotherapy regimens is recommended.