Research Article: Antidepressant use among Asians in the United States

Objectives: We examined the prevalence and predictors of past‐year antidepressant use in a nationally representative sample of Asian Americans and non‐Latino Whites. Methods: Analyses of 12‐month antidepressant medication use were based on data from the Collaborative Psychiatric Epidemiology Surveys that surveyed Asian (Chinese, Filipino, Vietnamese, and others; N=2,284) and non‐Latino White (N=6,696) household residents ages 18 years and older in the 48 contiguous United States and Hawaii. Results: Prevalence rates for 12‐month antidepressant use for Asians with major depression ranged from 8.7% among Vietnamese to 17% among Chinese respondents. Compared to non‐Latino Whites (32.4%), all Asians (10.9%) meeting criteria for 12‐month depressive and anxiety disorders, but especially Filipinos (8.8%) were less likely to report past‐year antidepressant use. Conclusions: We found disparities in past‐year antidepressant use among all the examined major Asian groups meeting criteria for 12‐month depressive and anxiety disorders. These disparities were not explained by mental health need or socioeconomic factors that enable access to care. Depression and Anxiety, 2010. © 2009 Wiley‐Liss, Inc.     

Retention in depression treatment among ethnic and racial minority groups in the United States

Background: Premature discontinuation of psychiatric treatment among ethnic–racial minorities is a persistent concern. Previous research on identifying factors associated with ethnic–racial disparities in depression treatment has been limited by the scarcity of national samples with adequate representation of minority groups and especially non‐English speakers. In this article, we aim to identify variations in the likelihood of retention in depression treatment among ethnic–racial minority groups in the United States as compared to non‐Latino whites. Second, we aim to identify the factors that are related to treatment retention. Methods: We use data from the Collaborative Psychiatric Epidemiology Surveys to examine differences and correlates of depression treatment retention among a representative sample (n=564) of non‐Latino whites, Latinos, African‐American, and Asian respondents with last 12‐month depressive disorder and who report receiving formal mental health treatment in the last year. We define retention as attending at least four visits or remaining in treatment during a 12‐month period. Results: Being seen by a mental health specialist as opposed to being seen by a generalist and having received medication are correlates of treatment retention for the entire sample. However, after adjusting for demographics, clinical factors including number of co‐occurring psychiatric disorders and level of disability, African‐Americans are significantly less likely to be retained in depression treatment as compared to non‐Latino whites. Conclusions: Availability of specialized mental health services or comparable treatment within primary care could improve treatment retention. Low retention suggests persistent problems in the delivery of depression treatment for African‐Americans. Depression and Anxiety, 2010.© 2010 Wiley‐Liss, Inc.     

A community survey of psychological impairment among Anglo- and Mexican Americans and its relationship to service utilization

Discussions of Mexican American mental health need have been limited to analyses of service utilization statistics, most of which have shown Mexican Americans to use mental health services proportionally less than other racial/ethnic groups. Consequently, Mexican Americans have been viewed as a group having greater unmet mental health needs. Yet, these utilization-based needs assessments make an implicit and untested assumption: that the proportion of the psychologically impaired is comparable across racial/ethnic groups. The purpose of the present investigation was, first, to contribute to a baseline measurement of psychological impairment among Mexican Americans in order to assess what utilization should be for this group and, second, to determine relationships between impairment symptomatology and sociodemographic characteristics which are unique to the Mexican American population. Anglo- and Mexican Americans (n=515) living in one of three suburban communities in Southern California were selected by way of a random-digit, multistage cluster telephone sampling procedure. Respondents gave responses to a standardized measurement of psychological impairment. Results showed that Anglo- and Mexican Americans did not differ in anxiety, psychosocial dysfunction, and depressive symptoms. Mexican Americans in the three communities, however, were found to use mental health services proportionally less than Anglos. Relationships between age and psychosocial dysfunction symptoms, and between income and anxiety problems were different for Mexican Americans than those for Anglos. Issues related to what constitutes mental health need and the use of self-report measures of impairment to estimate mental health need across culturally diverse groups are discussed.     

Prevalence of neurasthenia, comorbidity, and association with impairment among a nationally representative sample of US adults

Purpose

There are no current psychiatric epidemiological studies examining prevalence estimates of neurasthenia across different racial and ethnic groups in the US. This study compares prevalence rates of International Classification of Diseases (ICD-10) lifetime and 12-month neurasthenia across racial/ethnic groups in the US (Asians, African Americans, Latinos, and non-Latino Whites) and by levels of acculturation. We examine comorbidity of neurasthenia with DSM-IV psychiatric disorders and the association between neurasthenia and impairment.

Methods

We used a pooled sample (N?=?10, 118) from two nationally representative household surveys of adults ages 18?years and older: the National Comorbidity Survey-Replication (NCS-R) and the National Latino and Asian American Study (NLAAS).

Results

Among the total sample, the adjusted prevalence rates of lifetime and 12-month neurasthenia with exclusionary criteria were 2.22 and 1.19%. The adjusted prevalence rates for lifetime and 12-month neurasthenia without exclusionary criteria were 4.89 and 2.80%. There were significant racial/ethnic group differences in prevalence for both lifetime and past-year neurasthenia, with Asians reporting significantly lower prevalence of neurasthenia than their non-Latino White counterparts. Less acculturated individuals were at a decreased risk for lifetime and past-year neurasthenia. Lifetime neurasthenia was associated with increased odds of meeting lifetime criteria for any depressive, any anxiety, and any substance use disorder. Respondents with lifetime or past-year neurasthenia had significantly greater levels of impairment compared to those without neurasthenia.

Conclusion

Neurasthenia is a prevalent condition deserving further research attention given its comorbidity with other psychiatric disorders and its association with functional impairment.     

Racial/ethnic differences in 12-month prevalence and persistence of mood,anxiety, and substance use disorders: Variation by nativity and socioeconomic status

BackgroundDespite equivalent or lower lifetime and past-year prevalence of mental disorder among racial/ethnic minorities compared to non-Latino Whites in the United States, evidence suggests that mental disorders are more persistent among minorities than non-Latino Whites. But, it is unclear how nativity and socioeconomic status contribute to observed racial/ethnic differences in prevalence and persistence of mood, anxiety, and substance disorders.MethodData were examined from a coordinated series of four national surveys that together assessed 21,024 Asian, non-Latino Black, Latino, and non-Latino White adults between 2001 and 2003. Common DSM-IV mood, anxiety, and substance disorders were assessed using the Composite International Diagnostic Interview. Logistic regression analyses examined how several predictors (e.g., race/ethnicity, nativity, education, income) and the interactions between those predictors were associated with both 12-month disorder prevalence and 12-month prevalence among lifetime cases. For the second series of analyses, age of onset and time since onset were used as additional control variables to indirectly estimate disorder persistence.ResultsNon-Latino Whites demonstrated the highest unadjusted 12-month prevalence of all disorder types (p < 0.001), though differences were also observed across minority groups. In contrast, Asian, Latino, and Black adults demonstrated higher 12-month prevalence of mood disorders among lifetime cases than Whites (p < 0.001) prior to adjustments Once we introduced nativity and other relevant controls (e.g., age, sex, urbanicity), US-born Whites with at least one US-born parent demonstrated higher 12-month mood disorder prevalence than foreign-born Whites or US-born Whites with two foreign parents (OR = 0.51, 95% CI = [0.36, 0.73]); this group also demonstrated higher odds of past-year mood disorder than Asian (OR = 0.59, 95% CI = [0.42, 0.82]) and Black (OR = 0.70, 95% CI = [0.58, 0.83]) adults, but not Latino adults (OR = 0.89, 95% CI = [0.74, 1.06]). Racial/ethnic differences in 12-month mood and substance disorder prevalence were moderated by educational attainment, especially among adults without a college education. Additionally, racial/ethnic minority groups with no more than a high school education demonstrated more persistent mood and substance disorders than non-Latino Whites; these relationships reversed or disappeared at higher education levels.ConclusionNativity may be a particularly relevant consideration for diagnosing mood disorder among non-Latino Whites; additionally, lower education appears to be associated with increased relative risk of persistent mood and substance use disorders among racial/ethnic minorities compared to non-Latino Whites.     

Prevalence, patterns, and correlates of co-occurring substance use and mental disorders in the United States: variations by race/ethnicity

ObjectiveThis study examines racial/ethnic differences in the prevalence, patterns, and correlates of co-occurring substance use and mental disorders (COD) among Whites, Blacks, Latinos, and Asians using data from the Collaborative Psychiatric Epidemiology Studies.MethodWe first estimated the prevalence of various combinations of different co-occurring depressive and anxiety disorders among respondents with alcohol, drug, and any substance use (alcohol or drug) disorders in each racial/ethnic group. We then estimated the prevalence of different patterns of onset and different psychosocial correlates among individuals with COD of different racial/ethnic groups. We used weighted linear and logistic regression analysis controlling for key demographics to test the effect of race/ethnicity. Tests of differences between specific racial/ethnic subgroups were only conducted if the overall test of race was significant.ResultsRates of COD varied significantly by race/ethnicity. Approximately 8.2% of Whites, 5.4% of Blacks, 5.8% of Latinos, and 2.1% of Asians met criteria for lifetime COD. Whites were more likely than persons in each of the other groups to have lifetime COD. Irrespective of race/ethnicity, most of those with COD reported that symptoms of mental disorders occurred before symptoms of substance use disorders. Only rates of unemployment and history of psychiatric hospitalization among individuals with COD were found to vary significantly by racial/ethnic group.ConclusionsOur findings underscore the need to further examine the factors underlying differences between minority and nonminority individuals with COD as well as how these differences might affect help seeking and utilization of substance abuse and mental health services.     

Psychometric properties of an interviewer‐administered version of the Kessler Psychological Distress scale (K10) among Dutch,Moroccan and Turkish respondents

The Kessler Psychological Distress scale (K10) is an instrument that is widely used to screen for mental disorders, but information is lacking on its psychometric qualities in non‐Western samples. This study used a population‐based sample (N = 725) to assess the reliability and validity of the K10 across ethnic groups in an urban area. The results were generally supportive of the K10 as a reliable and valid instrument to screen for anxiety and depression in all three groups. Cronbach's alpha was high (0.93) and the results indicated the existence of a solid single factor structure. Item bias in relation to ethnic background was minor. In each group, there was good criterion validity with respect to one‐month DSM‐IV diagnosis for depressive and/or anxiety disorder. The results nevertheless highlight the importance of cross‐cultural validation, as we found different cut‐off values for ethnic subgroups to obtain optimal sensitivity and specificity for detecting depressive and/or anxiety disorders. Copyright © 2009 John Wiley & Sons, Ltd.     

Does olanzapine have antidepressant properties? A retrospective preliminary study

Objective: Mood‐stabilizing agents are ideally conceptualized as possessing antimanic and antidepressant properties. While research on olanzapine's antimanic effects is growing, data on its possible antidepressant properties are limited. We sought to determine if olanzapine is effective in the add‐on treatment of major affective disorders, particularly depressive symptoms, in a naturalistic setting.

Methods: All charts of patients meeting DSM‐IV criteria for bipolar disorder or unipolar major depressive disorder treated with olanzapine in a private psychiatric practice were reviewed and clinical response was assessed retrospectively using the Clinical Global Impression Scale for Improvement (CGI‐I).

Results: Olanzapine was moderately effective in 6/10 (60%) patients. Side‐effects were present in 8/10 (80%), most commonly weight gain.

Conclusions: Olanzapine appears to be moderately effective in open add‐on treatment in patients with mainly depressive symptoms. Accumulating evidence suggests that olanzapine, and atypical antipsychotics in general, possess mild to moderate adjunctive antidepressant properties.     

Further Consideration of the “Cold,Sick” Husband

Abstract

A number of studies have assessed the association between race and ethnicity and psychological health status following exposure to a stressful event. However, some of these studies indicate racial and ethnic minorities have poorer mental health relative to Whites, while others show no differences or that minorities may actually have better psychological health. One year after the terrorist attacks on the World Trade Center, we collected data on a random sample of city residents (N = 2368). The dependent variables were posttraumatic stress disorder (PTSD), PTSD symptom severity, major depression, panic attack, and general physical and mental well—being. We categorized our respondents as Non—Hispanic White, Non—Hispanic African American, Dominican, Puerto Rican, and Other Hispanics. Bivariate results indicated racial/ethnic differences for PTSD symptom severity, depression, general physical and mental health, and panic attack. Using logistic regression and controlling for possible confounding factors, most of these associations were rendered non—significant. That is, we found no post-disaster racial/ethnic differences for PTSD, PTSD symptom severity, or physical health. African Americans and Other Hispanics were less likely to meet criteria for major depression or to be classified as unhealthy on the self—report SF—12 mental health scale compared to Whites. Only for panic attack were African Americans and Puerto Ricans more likely to meet criteria for this outcome. Thus, our study found little support for the hypothesis that Latinos or African Americans consistently suffered from poorer psychological and physical well—being in the aftermath of traumatic events, relative to Whites.     

Mood and anxiety disorders among rural,urban, and metropolitan residents in the United States

Objective: To estimate the correlates of mood and anxiety disorders among rural, urban and metropolitan residents in the United States. Methods: We analyzed the National Co-morbidity Survey (NCS), which yields the distribution and correlates of psychiatric disorders in a probability sample of U.S. population using DSM-III-R for diagnosis. Logistic regressions of mood and anxiety disorders were stratified by geographical area. Results: We found gender differences in mood disorders among urban (O.R. = 1.8, P < 0.0001) and metropolitan (O.R. = 1.6, P < 0.0001) but not among rural residents. Rural (O.R. = 0.2, P < 0.05) and urban (O.R. = 0.5, P < 0.05) African Americans were less likely to report mood disorders compared to rural and urban Whites. Similarly, we found gender differences in anxiety disorders among urban (O.R. = 2.0, P < 0.0001) and metropolitan (O.R. = 1.7, P < 0.0001), but not among rural residents. Conclusion: Rural men reported more mood and anxiety disorders than urban men, thus erasing expected rural gender differences in these disorders. Rural male mood and anxiety disorders may be a function of diminishing resources (steady, high paying jobs) or increasing financial strain particularly among Whites, who comprise a majority of rural residents.     

Is Response to OROS‐Methylphenidate Treatment Moderated by Treatment with Antidepressants or Psychiatric Comorbidity? A Secondary Analysis from a Large Randomized Double Blind Study of Adults with ADHD

Aims: The main aim of this post hoc analysis was to evaluate whether response to osmotic release oral system (OROS) methylphenidate (OROS‐MPH) was moderated by the concomitant use of antidepressants in attention‐deficit/hyperactivity disorder (ADHD) adults stabilized on these medicines for the treatment of depression or anxiety disorders, or a history of mood, anxiety, or substance use disorders. Methods: Two hundred and ninety‐six subjects were screened for participation; 227 were randomized (112 to OROS‐MPH and 115 to placebo), and 223 were analyzed (N= 109 and N= 114 for OROS‐MPH and placebo, respectively). Subjects with anxiety disorders and depression treated with a stable medication regimen of non‐MAOI antidepressants or benzodiazepines for at least 3 months could be enrolled in the study. Subjects currently receiving pharmacotherapy for anxiety disorders or depression were required to have Hamilton‐Depression and Hamilton‐Anxiety rating scales below 15 (mild range). Results: Concomitant antidepressant use at baseline was not associated with ADHD response, OROS‐MPH dose, study completion rate, adverse effects, or exacerbation of anxiety/depression. We did find nominally significant evidence that a lifetime history of mood (P= 0.09) or anxiety (P= 0.04) disorders was a moderator of ADHD symptoms and that a lifetime history of substance use disorder (P= 0.02) was a potential moderator of dose at endpoint. Discussion and Conclusions: We found few moderating effects in this large clinical trial of OROS‐MPH in adults with ADHD, which supports the robustness of the clinical response to OROS‐MPH in adult ADHD despite variable clinical pictures.     

Social phobia in Finnish general adolescent population: prevalence,comorbidity, individual and family correlates,and service use

Background: Few studies have investigated the epidemiology of social phobia (SP) among early to middle adolescents, at the time of suggested mean onset of the disorder. The objective of this study was to investigate the prevalence, comorbidity, individual and familial correlates, and service use associated with SP among Finnish 12–17‐year‐old adolescents in general population. Methods: A sample of 784 adolescents was screened with the Social Phobia Inventory, and a sub‐sample (n=350) was interviewed with a semi‐structured clinical interview to identify SP, sub‐clinical SP (SSP), and a range of other axis I DSM‐IV disorders. Individual and familial correlates, and service use associated with SP were also inquired. Results: We found a 12‐month prevalence of 3.2% for SP, and 4.6% for SSP. The prevalence rose and the gender ratio shifted to female preponderance as age increased. SP was frequently comorbid with other anxiety disorders (41%) and depressive disorders (41%). Adolescents with SP/SSP were impaired in their academic and global functioning, and reported more parental psychiatric treatment contacts. Two thirds (68%) of adolescents with SP reported having been bullied by peers. Only one fifth of adolescents with non‐comorbid SP had been in contact with a mental health professional. Conclusions: We conclude that adolescent SP is a relatively frequent, undertreated and highly comorbid condition, associated with educational impairment, depression and anxiety in parents, and peer victimization. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Immigration and lifetime prevalence of DSM-IV psychiatric disorders among Mexican Americans and non-Hispanic whites in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

BACKGROUND: There exist no national prevalence data on specific DSM-IV Axis I psychiatric disorders among foreign-born and US-born Mexican Americans and non-Hispanic whites. OBJECTIVE: To present nationally representative data on the prevalence of DSM-IV lifetime psychiatric disorders among foreign-born and US-born Mexican Americans and non-Hispanic whites. DESIGN: Face-to-face survey conducted in the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions. SETTING: The United States and District of Columbia, including Alaska and Hawaii. PARTICIPANTS: Household and group-quarters residents, aged 18 years and older (n = 43 093). MAIN OUTCOME MEASURES: Prevalence of DSM-IV substance use disorders and mood and anxiety disorders. RESULTS: With few exceptions, foreign-born Mexican Americans and foreign-born non-Hispanic whites were at significantly lower risk (P<.05) of DSM-IV substance use and mood and anxiety disorders compared with their US-born counterparts. Although the risk of specific psychiatric disorders was similar between foreign-born Mexican Americans and foreign-born non-Hispanic whites, US-born Mexican Americans were at significantly lower risk (P<.05) of psychiatric morbidity than US-born non-Hispanic whites. CONCLUSIONS: Data favoring foreign-born Mexican Americans with respect to mental health may extend to foreign-born non-Hispanic whites. Future research among foreign-born and US-born Mexican Americans and the foreign-born and US-born of other origins and descents is needed to understand what appears to be the protective effects of culture and the deleterious effects of acculturation on psychiatric morbidity in the United States.     

Anxiety disorders among Mexican Americans and non-Hispanic whites in Los Angeles

This report from the Los Angeles site of the NIMH Epidemiologic Catchment Area study reveals significant ethnic and national origin differences in lifetime prevalence rates for three out of six specific, DSM-III-defined anxiety disorders. In the case of simple phobia, United States-born Mexican Americans report higher rates than native non-Hispanic whites or immigrant Mexican Americans, the latter two groups having similar rates. Mexican Americans born in the United States had higher rates of agoraphobia than immigrant Mexican Americans, and non-Hispanic whites reported higher lifetime rates of generalized anxiety disorder compared with both immigrant and native Mexican Americans. Neither ethnic nor national origin differences in lifetime prevalence rates were found for panic disorder, social phobia, and obsessive-compulsive disorder. Selective migration is postulated as a potential factor influencing prevalence differences between native and immigrant Mexican Americans.     

Sleep problems and their relation to cognitive factors,anxiety, and depressive symptoms in children and adolescents

Background: Existing research indicates sleep problems to be prevalent in youth with internalizing disorders. However, childhood sleep problems are common in the general population and few data are available examining unique relationships between sleep, specific types of anxiety and depressive symptoms among non‐clinical samples of children and adolescents. Methods: The presence of sleep problems was examined among a community sample of children and adolescents (N=175) in association with anxiety and depressive symptoms, age, and gender. Based on emerging findings from the adult literature we also examined associations between cognitive biases and sleep problems. Results: Overall findings revealed significant associations between sleep problems and both anxiety and depressive symptoms, though results varied by age. Depressive symptoms showed a greater association with sleep problems among adolescents, while anxiety symptoms were generally associated with sleep problems in all youth. Cognitive factors (cognitive errors and control beliefs) linked with anxiety and depression also were associated with sleep problems among adolescents, though these correlations were no longer significant after controlling for internalizing symptoms. Conclusions: Results are discussed in terms of their implications for research and treatment of sleep and internalizing disorders in youth. Depression and Anxiety, 2009. Published 2008 Wiley‐Liss, Inc.     

Major depression: the importance of clinical characteristics and treatment response to prognosis

Background: This article analyzed data from the intervention arm of a large treatment trial to demonstrate the importance of clinical severity, course, comorbidity, and treatment response in patient prognosis. Methods: This is a secondary analysis of data from a large primary care‐based geriatric depression treatment trial that analyzes outcomes from the measurement‐based stepped‐care intervention arm ( N =871 patients) to determine: whether increasing severity levels of depression at baseline were linked with other factors associated with poor depression outcomes such as double depression, anxiety, medical disorders, and high levels of neuroticism and pain; and whether patients with increasing levels of depressive severity would have more intervention visits and treatment trials based on a stepped‐care algorithm, but would be less likely to reach remission and have a greater likelihood of re‐emerging depression in the year after intervention. Results: Increasing levels of depression severity were a robust predictor of lack of remission and were associated with other clinical variables that have been associated with lack of remission in earlier studies such as double depression, anxiety, medical comorbidity, high neuroticism levels, and chronic pain. Patients with higher levels of severity received significantly more intervention visits, more months of antidepressant treatment and more antidepressant trials, but had fewer depression‐free days during the 12‐month intervention and in the postintervention year. Conclusion: Patients with higher levels of depression severity had worse clinical outcomes despite receiving greater intensity of treatment. A new classification of depression is proposed based on clinical severity, course of illness and treatment experience. Depression and Anxiety, 2010. © 2009 Wiley‐Liss, Inc.     

Mental health among Hispanics and Caucasians: risk and protective factors contributing to prevalence rates of psychiatric disorders

The current study examined the one-year prevalence of psychiatric disorders for Hispanics and Caucasians in a large population sample (N=4559) and explored factors that contributed to group differences. Hispanic participants (predominantly Mexican Americans) were more likely than Caucasian participants to have met the criteria for a psychiatric diagnosis in the past year, had higher one-year prevalence rates of several anxiety disorders, had greater problems meeting their basic needs, and better interpersonal functioning. Hispanic participants' problems meeting basic needs partially mediated their higher prevalence of psychiatric disorders compared to Caucasian participants. Better interpersonal functioning protected Hispanic participants against depression, panic, and substance use disorders. These findings are discussed in terms of the importance of psychosocial variables for the prevalence of psychiatric disorders.     

The 7-year course of depression and anxiety in the general population

Rhebergen D, Batelaan NM, de Graaf R, Nolen WA, Spijker J, Beekman ATF, Penninx BWJH. The 7‐year course of depression and anxiety in the general population. Objective: Insight into the long‐term course of depression and anxiety. Method: Data were derived from Netherlands Mental Health Survey and Incidence Study/Netherlands Study of Depression and Anxiety, epidemiologic surveys in the adult population in the Netherlands. Three hundred and three respondents with depressive and/or anxiety Composite International Diagnostic Interview (CIDI) disorder were interviewed, examining the 7‐year course of depression (n = 141), anxiety (n = 102) and the comorbid state (n = 60) and possible prognostic factors. Outcomes were CIDI diagnostic status after 7 years and percentage of time during 7 years with depressive and/or anxiety symptoms, retrospectively assessed by the Life Chart Interview (LCI). Results: After 7 years, 60.7% of the subjects were free from a 12‐month CIDI depression or anxiety diagnosis. The odds were higher for subjects with anxiety and comorbidity compared to subjects with depression. Low physical functioning and high neuroticism predicted the presence of a diagnosis after 7 years. During 7‐year follow‐up, 37.3% of the subjects were free from depressive and anxiety symptoms according to the LCI, 51.8% had symptoms <50% of the time, and 10.9%≥50% of the time. (Comorbid) anxiety resulted in a poorer course. High neuroticism and childhood adversity predicted more follow‐up time with symptoms. Conclusion: Course trajectories were more favorable than expected, although comorbidity resulted in poorer course. Neuroticism, physical functioning, and childhood adversity predicted an unfavorable course.     

Panik i Norden

Supplement No. 9 of this journal was devoted to the biology of anxiety and inter alia described the classification of anxiety disorders in DSM-IH and the effect of antidepressant drugs in «panic disorder» (PD). This has incited Professor Thorkil Vanggaard to discuss critically DSM-III in relation to the classical diagnose «anxiety neurosis» (AN) and the use of antidepressant drugs in anxiety that is not part of a depressive syndrome

In this reply the scientific support for separating anxiety states with and without panic attacks, as in DSM-III, is reviewed (mainly studies on outcome of drug therapy and genetic influence). The evidence showing that PD is discriminated from typical and atypical and hence that antidepressant drugs have true antipanic effects is also discussed (mainly that biological markers for depression are not found in PD and that depressive symptoms are by definition excluded in PD)

Finally it is underlined that a thorough discussion of facts, experiences and theories related to PD and AN is urgent. □ Panic disorder, anxiety neuroses, antidepressant treatment.