Again, anxiety disorders were the most common comorbid condition and were present in 57% of those with any comorbid psychiatric disorder.10 A European study from Finland (the Vantaa study) also demonstrated that the great, majority (79%) of depressed patients suffered from one or more comorbid psychiatric disorder, including anxiety disorders (57%) and alcohol abuse (25%)..11 These data have recently been confirmed by the Sequenced Alternatives to Relieve Depression (STAR*D) study which enrolled 2876 outpatients from 23 Inhibitors,research,lifescience,medical psychiatrie and 18 primary care settings in the United States.7 This highly representative clinical

sample of depressed outpatients has revealed that depression is often chronic, severe, and associated with substantial general medical and psychiatric comorbidity.12 Two thirds of patients had at least one other DSM-’I'V axis I psychiatric disorder, most, often an Inhibitors,research,lifescience,medical anxiety disorder followed by drug or alcohol abuse. In fact, 40%

of patients had more than one psychiatric comorbidity. Of note, personality disorders have not been assessed in most studies. However, the NES ARC study found a comorbid personality disorder in 30% of respondents with lifetime depression, while the Vantaa study found a comorbid personality Inhibitors,research,lifescience,medical disorder in 44% of depressed patients.9,11 Therefore, psychiatric comorbidity in depression is even much higher if one considers personality disorders The role of personality disorders in depression and its role in remission will be discussed Inhibitors,research,lifescience,medical elsewhere in this issue (see thearticle by Fava and

Visani,p 461). In summary, the available studies arc remarkably consistent, with regard to comorbid axis I psychiatric disorders in depressed patients. About 60% to 70% of depressed patients have at least one comorbid condition, about 30% to 40% have two or more comorbid psychiatric disorders. Among these, anxiety disorders and alcohol abuse are the Inhibitors,research,lifescience,medical most common comorbid conditions. Anxiety disorders Anxiety disorders are common among depressed patients, representing Methisazone about 50% to 60% of all psychiatric comorbidity. There is now some evidence to suggest that the subtype of anxious depression or a comorbid anxiety disorder has a negative impact, on remission rates in major depression. In STAR*D, more than 50% fulfilled criteria of anxious depression defined at baseline. At treatment level 1 of STAR*D, which was monotherapy with citalopram, remission was significantly less likely (22% with anxious depression vs 33% with nonanxious depression) and took longer to occur in anxious patients than in those with nonanxious depression (Figure 1).13 Those patients who did not achieve Figure 1. Time to remission in 2876 patients in level 1 of STAR*D by anxious versus nonanxious depression. Brefeldin A chemical structure Adapted from ref 1 3: Fava M, Rush AI, Alpert JE, et al.