Prevalence of trait anxiety in a sample of depressed inpatients and its influence on response to antidepressants WTCJ Heijnen Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands. WW van den Broek Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands. PGH Mulder Department of Biostatistics and Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands. TK Birkenhäger Department of Psychiatry, Erasmus Medical Centre, Rotterdam, The Netherlands. Abstract Depression and anxiety frequently occur together or in extension of each other. According to a previous study in depressed inpatients, a high trait anxiety level correlated with a positive response to the diazepam test (DT) and a low trait anxiety level with a negative response to the test. The aim of this study is to investigate whether positive reaction to the DT is related to a positive response to fluvoxamine and whether a negative reaction to the test is related to positive response to imipramine. The DT was performed in 130 patients diagnosed with a depressive disorder. Following the DT, the patients were randomly assigned to double-blind treatment with either imipramine or fluvoxamine. Doses of both antidepressants were adjusted to attain predefined blood levels, and the outcome was evaluated 4 weeks after attaining these blood levels. Twenty-two patients had a positive response to the DT, whereas 108 patients had a negative response. Although a positive DT is correlated with a high level of trait anxiety, no differences in depressive symptomatology and antidepressant response were found between patients with a positive and a negative DT. Key words depression; diazepam test; fluvoxamine; imipramine; inpatients; trait anxiety Introduction The relationship between anxiety and depression is complex Patients with previous anxiety symptoms often develop depres- sion later in life. This applies both to anxiety disorders proper and to chronic anxiety symptoms not meeting criteria for an anxiety disorder (Moras and Barlow, 1992). Van Valkenburg, et al. (1983) made a distinction between depression occurring in patients with lifelong nervousness (anxiety as a trait without meeting criteria for an anxiety disorder) and in patients without this trait anxiety. Akiskal (1998) described a similar concept: generalized anxious temperament with lifelong high trait anxi- ety, which can develop to a full-blown anxiety disorder. Comorbid anxiety and depression is often relatively resistant to pharmacological treatment (Ballenger, 2000), and these patients carry the largest risk to develop a chronic depression (van Valkenburg, et al., 1984). It has also been hypothesized that anxiety disorders may be a precursor to depression (Ballenger, 2000). Generalized anxiety temperament is often associated with depression (Bruijn, et al., 2001). This applies to patients with high trait anxiety as well as to patients with a history of anxiety disorders (Goodwin and Gorman, 2002). A distinction is made between state anxiety and trait anxi- ety. State anxiety is the increased arousal due to environmental settings that may fluctuate over time and can vary in intensity. Trait anxiety is a generalized individual emotional predisposi- tion to be anxious, upset, careful, cautious and nervous. Trait anxiety is an aspect of personality and social behaviour. Clini- cally, it could be possible to make a distinction between patients suffering from a primary depression and patients Original Papers Journal of Psychopharmacology © for Psychopharmacology ISSN 0269-8811 SAGE Publications Ltd, Los Angeles, London, New Delhi and Singapore 10.1177/0269881108099213 Corresponding author: Tom K Birkenhäger, Department of Psychiatry, Erasmus Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Email: t.birkenhager@erasmusmc.nl 24(4) (2010) 559–563 2010 British Association at Erasmus Univ Rotterdam on February 9, 2015 jop.sagepub.com Downloaded from