Handbook of Depression and Anxiety: A Biological Approach, Second Edition, (Medical Psychiatry, 21)

853 Pages·2003·3.71 MB·English

by  Siegfried Kasper

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
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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, edi-
ted 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
Depressionand anxiety,bothexternallyexperienced andinternallyperceived,are partof
thenormalhumanrepertoireofresponsetostress.Inmyopinion,thosewhoneverexperi-
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”levelofeachisasign ofmentalhealth.Unfortunately,however,manyofus
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, thediagnosis of alife-threatening disease, orthe loss ofsomeone we love, orthey
maybeanaccumulationoftheordinarystressesoflifeatworkandathome,withfamily
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
andgenetics.Theyalsoprovideinsightintoourcurrentknowledgeofthephysiologyand
pathology of both anxiety and depression, and information about up-to-date treatment
approaches for both acute and chronic presentations.
Thisvolume shouldbekepton ourdesks, readilyaccessible forconsultationwhen
we need help with understanding the difficult issues that bring people to us in search of
relief.Itisa“vade-mecum”—ausefulmanualofwhatwenowknowaboutthebiological
andpharmacologicaltreatmentsofdepressionandanxiety,andaninvaluableresourcefor
allwhocarefortheafflicted,importantforgeneralpractitionersaswellasforpsychiatrists
andothersinthementalhealthfields.Theinternationallyrenownedgroupofcontributors
illustrate a growing consensus that anxiety and depression are both symptom and syn-
drome,and,insomeinstances,disease.Itistimetoapplythisunderstandingtothepractice
of medicine.
William A. Frosch, M.D.
Weill Medical College of Cornell University
New York, New York
iii

Preface
Anxietyanddepressionarecomplexemotionalstatesinwhichcognitiveevaluationsand
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.
Onaphenomenologicallevel,thereisahighdegreeofoverlapbetweensymptoms
of anxiety and depression as well as a high degree of comorbidity. This does not imply,
however, that bothsyndromes are merely different phenotypicalexpressions of a geneti-
callybasedconstitutionsharingsimilarbiologicalunderpinnings.Thequestionofwhether
anxietyanddepressionresultfromsimilarordifferentbiologicalabnormalitiescannotbe
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
pharmacologicalinterventions.Thus,theseconflictingfindingsfromdifferentbiomedical
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 depres-
sion.
Overthelast decade,ourknowledgeabout the biologicalunderpinningsofdepres-
sion and anxiety disorders has increased substantially, particularly for anxiety disorders,
andnewinsightsarecontinuallyemergingfromwidelydisparatefields,suchasepidemiol-
ogy, 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.
Weconsider ourselvesfortunateto havesucceeded in gettingso manyinternation-
ally renowned contributors, who lend to this volume their knowledge and expertise in
v
vi Preface
thesedisciplines.Wehopethatscientistsandcliniciansfrommanyfieldswillbeinspired
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, Depression, and Personality 91
Harald N. Aschauer and Monika Schlo¨gelhofer
5. Is There a Common Etiology for Depression and Anxiety? 111
Dean F. MacKinnon and Rudolf Hoehn-Saric
6. Measurements of Depression and Anxiety Disorders 127
Saena Arbabzadeh-Bouchez and Jean-Pierre Le´pine
7. Combining Psychotherapy and Pharmacotherapy for Depression and
Anxiety 151
Robert H. Howland and Michael E. Thase
8. Genetics of Depression 165
Wolfgang Maier and Kathleen R. Merikangas
vii