CNS drugs

Additional Drug Treatments for Major Depression with Anxiety: From Traditional Brain Chemicals to New Clinical Findings

Updated

Abstract

Anxiety symptoms are common in patients with major depressive disorder (MDD) and may indicate greater depression severity.

  • The presence of anxiety symptoms is associated with a higher comorbidity burden and increased risk of suicidality.
  • Patients with MDD and anxiety symptoms may experience lower levels of functioning and poorer quality of life.
  • Clinical data for treatments such as olanzapine, risperidone, cariprazine, lithium, modafinil, and triiodothyronine in this population are scarce or lacking.
  • Atypical antipsychotics (aripiprazole, brexpiprazole, quetiapine XR) and ketamine/esketamine may improve symptoms, though evidence is primarily short-term.
  • There is an unmet need for prospective clinical trials with anxiety-specific endpoints for patients with MDD and anxiety symptoms.

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Funding

Competing interests

Declarations. Funding: This work was financially supported by Otsuka Canada Pharmaceuticals Inc. (Saint-Laurent, Quebec, Canada) and Lundbeck Canada Inc. (Saint-Laurent, Quebec, Canada). The sponsors were involved as authors in the concept development of this narrative review, the writing and reviewing of this article, and the decision to submit the article for publication. The sponsors paid the open access fee. Conflicts of Interest: Dr. Roger S. McIntyre has received research grant support from CIHR/GACD/National Natural Science Foundation of China (NSFC) and the Milken Institute; speaker/consultation fees from Lundbeck, Janssen, Johnson & Johnson, Alkermes, Neumora Therapeutics, Boehringer Ingelheim, Bristol Myers Squibb, Sage, Mitsubishi Tanabe, Purdue, Pfizer, Otsuka, Takeda, MindMed, Neurocrine, Neurawell, Supernus, Bausch Health, Axsome, Novo Nordisk, Kris, Sanofi, Eisai, Intra-Cellular, NewBridge Pharmaceuticals, Viatris, Abbvie and Atai Life Sciences. Masaki Kato has served as a consultant for Sumitomo Pharma Co., Ltd., Shionogi & Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Lundbeck Japan K.K., and Takeda Pharmaceutical Co., Ltd.; received payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from Sumitomo Pharma Co., Ltd., Otsuka Pharmaceutical Co., Ltd., Meiji Seika Pharma Co., Ltd., Eli Lilly Japan K.K., MSD K.K., Pfizer Japan Inc., Janssen Pharmaceutical K.K., Shionogi & Co., Ltd., Mitsubishi Tanabe Pharma Corporation, Takeda Pharmaceutical Co., Ltd., Lundbeck Japan K.K., Viatris Inc., Eisai Co., Ltd., Kyowa Pharmaceutical Industry Co., Ltd., and Ono Pharmaceutical Co., Ltd. Michael E. Thase has served as an advisor/consultant for AbbVie (Allergan), Acadia, Alkermes, Axsome, Clexio, H. Lundbeck A/S, Johnson & Johnson (Janssen), Merck & Company Inc., Novartis, Otsuka, Pfizer, Sage Pharmaceuticals, Sunovion Pharmaceuticals Inc., and Takeda; received grant support from Acadia, Axsome, Clexio, Janssen, National Institute of Mental Health, Otsuka, Patient-Centered Outcomes Research Institute (PCORI), and Takeda; and royalties from American Psychiatric Foundation, Guilford Publications, Herald House, Wolters Kluwer, and WW Norton & Company Inc.; and his spouse is employed by Peloton Advantage, which does business with most major pharmaceutical companies. Matthieu Boucher is an full-time employee of Otsuka Canada Pharmaceutical Inc., Saint-Laurent, Quebec, Canada. Francois Therrien was a full-time employee of Otsuka Canada Pharmaceutical Inc., Saint-Laurent, Quebec, Canada at the time of the submission and resubmission of this manuscript. A. Marilise Marrache is a full-time employee of Lundbeck Canada Inc., Saint-Laurent, Quebec, Canada. Kenta Ikehara is a full-time employee of Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan. Ferhat Ardic is a full-time employee of H. Lundbeck A/S, Valby, Denmark. Availability of Data and Materials: Not applicable – manuscript has no associated data. Ethics Approval: Not applicable. Consent to Participate: Not applicable. Consent for Publication: Not applicable. Code Availability: Not applicable. Author Contributions: All authors met the ICMJE criteria and all those who fulfilled these criteria are listed as authors. All authors contributed to the conceptualisation and refining of the scope of the review, analysis and interpretation of the literature, and critically reviewed the manuscript for intellectual content. All authors have read and approved the final manuscript and accept accountabilities for all aspects of the work including accuracy and integrity.
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