Kaufman J, Charney D
Yale University, Department of Psychiatry, New Haven, CT 06511, USA.
Depress Anxiety. 2000;12 Suppl 1:69-76. doi: 10.1002/1520-6394(2000)12:1+<69::AID-DA9>3.0.CO;2-K.
This article reviews data on the prevalence of panic, social phobia, generalized anxiety, and posttraumatic stress disorder, and research documenting the comorbidity of these disorders with major depression (MDD). These anxiety disorders are frequently comorbid with MDD, and 50-60% of individuals with MDD report a lifetime history of one or more of these anxiety disorders. The anxiety disorders are also highly correlated with one another, and approximately one-quarter to one-half of individuals with each of the anxiety disorders report a lifetime history of an alcohol or substance use disorder. Anxiety disorders rarely exist in isolation, with several studies reporting that over 90% of individuals with anxiety disorders have a lifetime history of other psychiatric problems. Implications for research are discussed, including the potential benefit of using combined categorical and dimensional rating scale approaches in future genetic, biochemical, neuroimaging, and treatment studies. The clinical implications of the findings are also discussed, and the results of recent clinical trials summarized. Available data suggests selective serotonin reuptake inhibitors are the first-line pharmacological treatment for these disorders, and that newer serotonin and norepinephrine reuptake inhibitors show significant promise, especially for comorbid cases. Comorbidity among depression and anxiety disorders is associated with greater symptom severity, and a considerably higher incidence of suicidality. Increased public awareness about these disorders and the availability of effective treatments is sorely needed.
本文回顾了关于惊恐障碍、社交恐惧症、广泛性焦虑症和创伤后应激障碍患病率的数据，以及记录这些障碍与重度抑郁症（MDD）共病情况的研究。这些焦虑症常与MDD共病，50%至60%的MDD患者报告有过一种或多种此类焦虑症的终生病史。这些焦虑症之间也高度相关，每种焦虑症约四分之一至二分之一的患者报告有酒精或物质使用障碍的终生病史。焦虑症很少单独存在，多项研究报告称，超过90%的焦虑症患者有其他精神问题的终生病史。文中讨论了对研究的启示，包括在未来的遗传学、生物化学、神经影像学和治疗研究中使用分类评定量表和维度评定量表相结合方法的潜在益处。还讨论了研究结果的临床意义，并总结了近期临床试验的结果。现有数据表明，选择性5-羟色胺再摄取抑制剂是这些障碍的一线药物治疗方法，新型5-羟色胺和去甲肾上腺素再摄取抑制剂显示出显著前景，尤其是对共病情况。抑郁症和焦虑症的共病与更严重的症状以及更高的自杀发生率相关。迫切需要提高公众对这些障碍的认识以及提供有效的治疗方法。
