Clinical Neuropsychiatry (2017) 14, 4, 257-262 Comparing interpersonal Counseling and antidepressant treatment in primary Care patients with anxious and nonanxious major depression disorder: a randomized Control trial Mario Altamura, Salvatore Iuso, Grazia Terrone, Angela Balzotti, Rafaella Carnevale, Stefania Malerba, antonello Bellomo, annamaria petito Abstract Objective: Comorbid anxiety symptoms are common in patients with major depressive disorders and contribute to poorer response to both psychotherapeutic and pharmacologic depression treatments. The aim of the present study was to compare the efcacy of Interpersonal Counseling (IPC) with antidepressant treatments in primary care patients with anxious and nonanxious major depression. Method: Participants with depression symptoms, enrolled from primary care sites, were randomized to 8 weeks treatment with either IPC or Selective Serotonin Reuptake Inhibitors (SSRIs). Participants were eligible if they met criteria for nonpsychotic Major Depression Disorder (MDD) based on the criteria of Diagnostic and Statistical Manual of Mental Disorders (5th edition). A minimum Hamilton Depression Rating Scale (HAM-D) score of ≥8 was also required. Using the Hamilton Anxiety Rating Scale (HAM-A, score > 14) patients were classifed as anxious or nonanxious. Rates of remission (defned as HAM-D score of ≤7 over 3 consecutive weeks) and change from baseline in anxiety and depression symptoms were compared between patients with anxious depression and those with nonanxious depression. Results: In the nonanxious subgroup the proportion of patients who achieved remission was no signifcant in the IPC group compared with the SSRI group (77.78% vs 72.73%; P= 0.9). The proportion of anxious patients who achieved remission was signifcantly higher in the IPC group compared with the SSRI group (100% vs 87.5%; P<0.0001). Analyses based on continuous scores indicated a signifcant improvement over the 8 weeks in depressive symptoms in both the nonanxious and the anxious subgroups and between the initial and fnal scores in anxiety symptoms in the anxious subgroup. Conclusions: IPC can be as efective as medications for the treatment of mild to moderate major depression and is an efective treatment option for the proportion of patients with MDD who have prominent anxious symptoms. These results indicate the need to consider diferent strategies for the management of patients with anxious depression in primary care Key words: interpersonal psychotherapy, selective serotonin reuptake inhibitors, depression, anxiety, primary care Declaration of interest: none Mario Altamura ¹*, Salvatore Iuso ¹, Grazia Terrone ², Angela Balzotti ¹, Rafaella Carnevale ¹, Stefania Malerba¹, antonello Bellomo ¹, annamaria petito ¹ ¹ Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Foggia, Foggia, Italy ² Department of Humanities, Literature, Cultural Heritage, University of Foggia, Foggia, Italy Corresponding author mario altamura Department of Clinical and Experimental Medicine, Psychiatry Unit, University of Foggia Tel./fax: +39 01139/0881732285. E-mail address: m_altamura@virgilio.it Submitted May 2017, Accepted July 2017 © 2017 Giovanni Fioriti Editore s.r.l. 257 Introduction There is evidence that most patients with major depression (MDD) seen in primary care sufer from concurrent subsyndromal symptoms of anxiety (that is, depressed patients who do not meet the diagnostic criteria for anxiety disorders) (Clayton et al. 1991; Fava et al. 2006, 2008). Earlier studies have shown that the prevalence of anxiety symptoms (quantifed on a rating scale) among outpatients with MDD was in the range of 44%–46% (Fava et al. 2004). A more recent survey focusing on the prevalence of comorbid anxiety symptoms in depression has shown that an impressive 87% of elderly individuals with MDD living in the community also had subthreshold anxiety symptoms (Braam et al. 2014). Numerous studies have reported that patients with anxious depression (MDD plus anxiety symptoms) have greater illness severity (Fava et al. 2006), an increased risk of suicidality, lower quality of life (Seo et al. 2011), and poorer response to antidepressant medications (Flint and Rifat 1997, Russel et al. 2001, Davidson et al. 2002, Fava et al. 2008, Ionescu et al. 2014) and psychotherapeutic interventions (Frank et al. 2000) than depressed patients without anxiety symptoms. This evidence has led to the introduction of a new diagnostic “anxious distress” specifer in the Diagnostic and Statistical manual 5 th Edition (DSM-5) (American Psychiatric