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| 1 | Treating comorbid anxiety and depression: Psychosocial and pharmacological approaches显示文摘Comorbid anxiety with depression predicts poor outcomes with a higher percentage of treatment resistance than either disorder occurring alone. Overlap of anxiety and depression complicates diagnosis and renders treatment challenging. A vital step in treatment of such comorbidity is careful and comprehensive diagnostic assessment. We attempt to explain various psychosocial and pharmacological approaches for treatment of comorbid anxiety and depression. For the psychosocial component, we focus only on generalized anxiety disorder based on the following theoretical models:(1) 'the avoidance model';(2) 'the intolerance of uncertainty model';(3) 'the meta-cognitive model';(4) 'the emotion dysregulation model'; and(5) 'the acceptance based model'. For depression, the following theoretical models are explicated:(1) 'the cognitive model';(2) 'the behavioral activation model'; and(3) 'the interpersonal model'. Integration of these approaches is suggested. The treatment of comorbid anxiety and depression necessitates specific psychopharmacological adjustments as compared to treating either condition alone. Serotonin reuptake inhibitors are considered first-line treatment in uncomplicated depression comorbid with a spectrum of anxiety disorders. Short-acting benzodiazepines(BZDs) are an important 'bridging strategy' to address an acute anxiety component. In patients with comorbid substance abuse, avoidance of BZDs is recommended and we advise using an atypical antipsychotic in lieu of BZDs. For mixed anxiety and depression comorbid with bipolar disorder, we recommend augmentation of an antidepressant with either lamotrigine or an atypical agent. Combination and augmentation therapies in the treatment of comorbid conditions vis-à-vis monotherapy may be necessary for positive outcomes. Combination therapy with tricyclic antidepressants, gabapentin and selective serotonin/norepinephrine reuptake inhibitors(e.g., duloxetine) are specifically useful for comorbid chronic pain syndromes. Aripiprazole, quetiapine, risperidone and other novel atypical agents may be effective as augmentations. For treatment-resistant patients, we recommend a 'stacking approach' not dissimilar from treatment of hypertension In conclusion, we delineate a comprehensive approach comprising integration of various psychosocial approaches and incremental pharmacological interventions entailing bridging strategies, augmentation therapies and ultimately stacking approaches towards effectively treating comorbid anxiety and depression. | Jeremy D Coplan Cindy J Aaronson Venkatesh Panthangi Younsuk Kim | 2015 | World Journal of Psychiatry2015，5，4： | 7 |
| 2 | Anxiety disorders in adults treated by hemodialysis:a single-center study显示文摘 | Cukor D Coplan J Brown C | 2008 | Am J Kidney Dis2008，52，1： | 1 |
| 3 | Modeling the long-term outcomes and costs of HIV antiretroviral therapy using I-IIV RNA levels: application to a clinical trial显示文摘 | Cook J Dasbach E Coplan P | 1999 | AIDS Res Hum Retroviruses1999，15，6： | 1 |
| 4 | Analysis of microphthalmia transcription factor expression in normal tissues and tum-ors,and comparison of its expression with S-100 protein,gp100,and tyrosinase in desmoplastic malignant melanoma显示文摘 | Busam K J Iversen K Coplan K C | 2001 | Am J Surg Pathol2001，25，2： | 1 |
| 5 | Being alone, playing alone, and acting alone: Distinguishing among reticence and passive and active solitude in young children显示文摘 | COPLAN R J RUBIN K H FOX N A | 1994 | Child Development1994，，65： | 1 |
| 6 | Interpretation of 3He abundance variations in the solar wind 显示文摘 | Coplan M A Ogilvie K W Bochsler P Geiss J | 1984 | Solar Physics1984，93，2： | 1 |
| 7 | Anxiety disorders in adults treated by hemodialysis: A single-center study 显示文摘 | Cukor D Coplan J Brown C | 2008 | Am J Kidney Dis2008，52，： | 1 |
| 8 | Counseling parents regarding prognosis in autistic spectrum disorder显示文摘 | Coplan J | 2000 | Pediatrics2000，105，5： | 1 |
| 9 | Social withdrawal in childhood显示文摘 | Rubin K H Coplan R J Bowker J C | 2009 | Annual Review of Psychology2009，60，： | 1 |
| 10 | Paying attention to and not neglecting social withdrawal and social isolation显示文摘 | RUBIN K H COPLAN R J | 2004 | Merrill-Palmer Quarterly2004，50，4： | 1 |
| 11 | Plasma anti - serotonin and serotonin anti - idiotypic antibodies are elevated in panic disorder显示文摘 | Coplan J D Tamir H Calaprice D | 1999 | Neuropsychopharmacology1999，20，4： | 1 |
| 12 | Depresssion and anxiety in urban hemodialysis patients显示文摘 | Cukor D Coplan J Borwn C | 2007 | Clin J Am Soc Nephrol2007，2，3： | 1 |
| 13 | The noradrenergic system in pathological anxiety: a focus on panic with relevance to generalized anxiety and phobias显示文摘 | SULLIRAN G M COPLAN J D KENT J M | 1999 | Biol Psychiatry1999，46，9： | 1 |
| 14 | Dep ression and anxiety in urban hemodialysis patients显示文摘 | Cukor D Coplan J B rown C | 2007 | Clin J Am Soc Nephrol2007，2，3： | 1 |
| 15 | Parenting and pro- crastination: gender differences in the relations between procrastination, parenting style and self-worth in early ad- olescence 显示文摘 | Pychyl T A Coplan R J Reid P A M | 2002 | Personality and Individual Differences2002，33，1： | 1 |
| 16 | Bing alone,playing alone,and acting alone:Distinguishing among reticence and passive and active solitude in young children显示文摘 | Coplan R J Rubin K H Fox N A | | 0，，： | 1 |
| 17 | A pilot study of hippocampal volume and N-aeetylaspartate (NAA) as re- sponse biomarkers in riluzole-treated patients with GAD 显示文摘 | ABDALLAH C G COPLAN J D JACKOWSKI A | 2013 | Eur Neuropsychopharmacol2013，23，4： | 1 |
| 18 | Ri- luzole effect on occipital cortex: A structural and spectroscopy pi- lot study显示文摘 | ABDALLAH C G COPLAN J D JACKOWSKI A | 2012 | Neurosci Lett2012，530，1： | 1 |
| 19 | Depression and anxiety in urban hemodialysis patients显示文摘 | Cukor D Coplan J Brown C | 2007 | Clin J Am Soc Nephrol2007，2，3： | 1 |
| 20 | Depression and anxiety in ur- ban hemodialysis patients 显示文摘 | Cukor D Coplan J Brown C | 2007 | Clin J Am Soc Nephrol2007，2，3： | 1 |
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