Cognitive therapy for anxious depression in STARD: What have we learned?

Amy Farabaugh, Jonathan Alpert, Stephen R. Wisniewski, Michael W. Otto, Maurizio Fava, Lee Baer, Roy Perlis, Ed Friedman, Maren Nyer, Stella Bitran, G. K. Balasubramani, Aya Inamori, Madhukar Trivedi, Michael E. Thase

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Background: Anxious depression, defined as MDD with high levels of anxiety symptoms, has been associated with lower rates of antidepressant response and remission as well as greater chronicity, suicidality and antidepressant side-effect burden. The primary aim of this study was to assess the effectiveness of cognitive therapy (CT) alone or in combination with medications for anxious versus non-anxious depression. Methods: We assessed the STARD study participants who were partial or non-responders to citalopram. Subjects were then either switched (n=696) to a new antidepressant or to CT alone, or they were kept on citalopram and augmented (n=577) with another antidepressant or CT. We compared response and remission rates, across treatment conditions, between those who met criteria for anxious depression and those who did not. Results: Those with anxious depression had significantly lower remission rates based on the QIDS, whether assigned to switch or augmentation, compared to those with non-anxious depression. Those with anxious depression, compared to those without, had significantly lower response rates based on the QIDS only in the switch group. There was no significant interaction between anxious depression and treatment assignment. Limitations: Limitations include the use of citalopram as the only Level 1 pharmacotherapy and medication augmentation option, the relatively small size of the CT arms, use of depression-focused CT rather than anxiety-focused CT, and focus on acute treatment outcomes. Conclusions: Individuals with anxious depression appear to experience higher risk of poorer outcome following pharmacotherapy and/or CT after an initial course of citalopram and continued efforts to target this challenging form of depression are needed.

Original languageEnglish (US)
Pages (from-to)213-218
Number of pages6
JournalJournal of Affective Disorders
Issue number1-3
StatePublished - Dec 15 2012
Externally publishedYes


  • Anxious depression
  • CT
  • MDD
  • Psychosocial interventions

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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