Abstract
Both diagnoses of depressive disorders and anxiety disorders are commonly made in psychiatric patients on the basis of DSM-III-R criteria. Patients with this condition clinically seem to have several characteristics and recently draw a growing attention of numerous investigators. The authors gave an overview on comorbidity of depressive disorders and anxiety disorders, and presented their own clinical experiences with cases of panic disorder with comorbid depression. In summary : 1.According to an epidemiological study (ECA study), 33% of patients with affective disorders and 21% of those with anxiety disorders have the other additional diagnosis. The lifetime prevalence of comorbid depression among patients with panic disorder is estimated at about 30%, 2. The authors classified their series of patients with panic disorder into several groups in accordance with courses leading to depression. That is, with secondary depression lapped over PD(IV-1), with depression subsequent to PD (IV-2), with depression temporally independent of PD (IV-3) , and others. 3. Comorbid depressive disorders included demoralization depression (Sheehan), anxious depressive and/or hypochondriacal states (chronic neurotic states, the most common), anxiety attack-retardation type depression (Hirose), major depression without above mentioned features, and bipolar II (only one case). 4. Family history of our cases was almost not special, but a large family study (Leckman) suggests that cooccurrence of major depression and panic disorder in probands increase the risk in relatives for a number of psychiatric disorders. 5. As to the psychopharmacologic treatment for comorbid patients, combination of antidepressants and antianxiety drugs are effective. MAOIs may be available if those patients are reluctant to conventional drugs. 6. As indicated by many authors, and admitted by the author's own experiences, comorbid depressive disorders lead to increasing severity and chronicity of panic disorder, and they lead to worse response to medication and less favorable outcome. Further studies are needed to develop new methods for preventing from or coping with these unfavorable outcomes.
