Relationships between major depressive disorder and comorbid and personality disorders B Amy Farabaugh * , Maurizio Fava, David Mischoulon, Katie Sklarsky, Timothy Petersen, Jonathan Alpert Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA Abstract Objective: The aim of the study was to examine whether comorbid anxiety disorders influence depressed patients’ likeliho criteria for a personality disorder (PD) and whether comorbid anxiety disorders influence the stability of the PDs in patient depression. Methods: The initial sample consisted of 373 outpatients who met criteria for major depressive disorder (MDD) (by Structured Clinica Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition—Patient Edition) and who were 8-week acute treatment phase of a study of fluoxetine for MDD. Sixty-four subjects who responded to fluoxetine treatmen metcriteria for remission throughout a 26-week continuation phase during which they remained on fluoxetine with or without cognitive behavioral therapy. Stability of PDs was defined as meeting criteria for a PD at both beginning and end point of the contin phase. Results: Before fluoxetine treatment, anxious depressed patients (defined as meeting criteria for MDD as well as atleastone comorbid anxiety disorder) were significantly more likely to meet criteria for any comorbid PD diagnosis compared with depressed p comorbid anxiety disorders. In particular, there was a significant relationship between the presence of Cluster A and C PD of anxious depression at baseline before antidepressant treatment. After successful treatment of MDD, we found a significant relationship between anxious depression diagnosed at baseline and the stability of a Cluster C PD diagnosis. Conclusion: Anxious depression may place patients at greater risk of having a PD diagnosis, especially one from Cluster A depression remits, patients who initially met criteria for anxious depression may be more likely to maintain a Cluster C PD diagnosis compared with patients initially diagnosed with MDD alone. D 2005 Elsevier Inc. All rights reserved. 1. Introduction Research suggests a complex relationship between major depressive disorder (MDD), anxiety disorders, and person- ality disorders (PDs). In some cases, meeting criteria for MDD as wellas atleastone comorbid anxiety disorder is referred to as anxious depression [1],which appears quite prevalent. For example, Fava and colleagues [2] found that 44.7% of255 outpatients with MDD metcriteria fora comorbid anxiety disorder, whereas Melartin and colleagues [3] found that 57% of 269 patients with MDD met criteria for a comorbid anxiety disorder. Some investigators have examined the impact of anxious depression on the treatm of MDD, with variedresults.Most studiesreporta decreased likelihood of response to antidepressant treatm if a patientmeetscriteria foranxiousdepression [4 - 6], although not all studies support this view [7]. As part of the Harvard/Brown Anxiety Research Project, Dyck and colleagues [8] found that whereas generalized anxiety disorder, socialphobia, and MDD were positively associated with the presence of one ormore PDs,panic disorder with agoraphobia was not positively associated w the presence of PDs. Zlotnick and colleagues [9] examined the relationship between borderline personality disorder (BPD) and posttraumatic stress disorder. They found that women having both disorders were likely to have more general dysfunction and increased risk of hospitalization. 0010-440X/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.comppsych.2004.10.005 B The study wassupported by grant 5RO1MH56057-02 from the National Institute of Mental Health, Bethesda, Md. * Corresponding author. Tel.: +1 617 726 1629; fax: +1 617 724 3028. E-mail address: afarabaugh@partners.org (A. Farabaugh). Comprehensive Psychiatry 46 (2005) 266 – 271 www.elsevier.com/locate/comppsych