The acute treatment of anxiety and depression.

Anxiety and depression are commonly occurring symptoms. Anxiety disorders and mood disorders usually share common symptoms and they frequently co-exist. There is a considerable body of research that has demonstrated that anxiety and depression can be distinguished from each other at the syndrome level. There is also evidence that such a distinction is arbitrary and not well substantiated. Clinically, the practitioner is often faced with the problem of treating a patient who presents with anxiety and depressive symptoms at the same time. It is well-established that the first line of treatment in major mood disorder is the used of tricyclic antidepressant in adequate dosage. The first line of treatment for the anxiety disorders is usually the administration of benzodiazepine anxiolytics. The anti-depressants have to be given for some months to the majority of patients whereas the anxiolytics are given for short periods. The tricyclics have a relatively slow onset of action compared to the benzodiazepines. Recent evidence is available about the effectiveness of the triazolo-benzodiazepines in panic disorder with or without secondary major mood disorder. There are also reports of the effects of the triazolo-benzodiazepines in primary mood disorder. In these mood disorders, the benzodiazepines caused rapid relief of both anxious and depressive symptomatology. The effects of the benzodiazepines occur even in the presence of melancholic depression. Where anxiety and depression coexist, the clinician may wish to consider beginning anti-depressant therapy with combined tricyclic antidepressant and benzodiazepine to produce rapid symptom relief. After four weeks the benzodiazepine should be faded out and therapy continued with the tricyclic medication alone.