• anxious
• depression

DSM-5 describes different specifiers relating to major depressive disorder. Many studies indicate anxious distress specifier as a negative prognostic factor: patients have greater severity of depression, chronicity, greater functional impairment, more suicidal ideation, self harm and complete suicide, poor treatment outcome, and greater frequency of side effects during antidepressant treatment.
The aim of this study was to assess the presence of anxious distress specifier in a sample of 241 patients with major depressive episode with Mdd, BP-I or Bp-II, and to evaluate a longitudinal predictive validity of the specifier.
Diagnostic assessment was performed with SCID-5, SIMD, HAM-D, YMRS, CGI, Brief TEMPS-M, and GAF.
In the sample, the anxious distress specifier was present in 58,9%, and compared with the group without this specifier had a correlation with BD-II diagnosis, previous hypomanic episodes, mixed features, seasonal pattern, family history of bipolar disorder and significant higher scores of YMRS, HDRS and CGI-S.
The two groups differed significantly in use of SSRIs, antipsychotics (both typical and atypical), which was higher in the group with anxious distress.
The patients were followed for 12 weeks and the response from baseline to the end of the study was a significant reduction of HDRS and an increase for the YMRS score.
These results indicate a worse outcome for patients with anxious distress specifier, and a possible relationship with bipolar spectrum.