Depression gets anxious.

Anxiety symptoms often coexist with severe depression, despite the separation of "anxious moods" from depression in the current manual of psychiatric diagnosis, according to a new study.

Clinicians should note that "anxious depression" proves extremely resistant to standard drug and psychotherapy treatments used for depression, psychiatrist Paula J. Clayton of the University of Minnesota in Minneapolis and her colleagues assert in the November AMERICAN JOURNAL OF PSYCHIATRY. They also urge researchers to examine more closely the effectiveness of antidepressants and electroshock therapy in individuals suffering from depression colored by anxiety.

Clayton's team prospectively evaluated 327 severely depressed people admitted to psychiatric units or outpatient care programs at five university medical centers involved in a depression study funded by the National Institute of Mental Health. The patients had experienced no prior psychiatric disturbances.

Several signs of anxiety emerged among the study participants, the researchers report. Moderate to severe worrying over unpleasant thoughts affected three-quarters of the patients. About two-thirds reported moderate to severe fearfulness and apprehension, and one-quarter experienced periodic panic attacks. More than one in three depressed individuals suffered from physical symptoms linked to anxiety, such as headaches and stomach cramps. Phobias, obsessions and compulsions turned up in smaller numbers.

Severely anxious depressed people took an average of 6 1/2 months to recover after treatment started -- twice as long as those with moderate, mild or no anxiety -- and were more likely to receive a mix of psychotherapy and anti-depressants. Study participants with "anxious depression" also were more likely to have parents, siblings and children with severe depression, the researchers note.