BACKGROUND: Anxiety and irritability often coexist in patients with major depressive disorder (MDD). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) added criteria for an anxious distress specifier for MDD. This study aimed at understanding the various components of anxiety and irritability, their impact, and relationships among them in MDD; and the association of anxious distress and irritability with treatment response.
METHODS: Focus groups were conducted with patients with MDD reporting symptoms of anxiety, irritability, agitation, and/or aggression. Clinical study data were pooled from open-label antidepressant treatment (ADT) phases of seven studies in patients with MDD and a history of inadequate response for the current depressive episode to one to three ADTs (N = 5,182). Post hoc criteria using study measures were applied to identify patients with symptoms of anxious distress and irritability. ADT response rates were compared for patients with and without anxious distress and irritability.
RESULTS: Symptoms of anxiety and irritability frequently coexisted for the focus group participants who often described symptoms of anxious distress (e.g., nervous, tense, restless, worry, fear, out of control, acting out). In the clinical studies, approximately 50% of patients with inadequate response to ADTs presented with symptoms of anxious distress and irritability. The presence of anxious distress was associated with lower ADT response rates.
CONCLUSIONS: Various anxiety symptoms, including those comprising anxious distress, are prevalent and meaningful in depression, and frequently associated with irritability. Symptoms of anxious distress are associated with a decreased likelihood of ADT response.
