How to manage anxious patients who are depressed.

According to the official nomenclature and the approved indications for psychotropic drugs, anxiety and depression are mutually exclusive, and antidepressants and anxiolytics have a single indication. In clinical settings, however, anxiety and depressive symptoms frequently coexist, and the effects of psychotropic drugs often overlap. Both diagnosis and treatment may be complicated by uncertainty about the primary disorder and the optional therapeutic approach. Available treatment strategies include antidepressants, benzodiazepines, azapirones, and combined antidepressant/anxiolytic therapy. Considerations in reflecting a particular treatment strategy include drug side effects, patient age and medical status, and patient expectations. Recent studies have suggested that antidepressants are effective anxiolytics and that some anxiolytics produce antidepressant effects. Ultimately, any selection should be made based on relative benefits and risks of each approach.