Anxiety or Depression?

My fiance has been diagnosed as having clinical depression. He went on Wellbutrin without any success or improvement. In trying to makethis brief and to the point, I felt when he went on Wellbutrin that it wasn’t the proper medication.
My fiance is a worrier and when he gets upset he has signs of anxiety not depression. I don’t disagree that all the anxiety and worry could have caused his depression. He went through a new job change, his hildren have issues that make him worry and their are many things in his ife that are not in his control. He has had a less than marginal childhood and never received recognition or praise for anyting he accomplished. He had incidents as a child of passing out being afraid to go home from school because of his father’s actions.

I had panic disorder a few years back and I read some wonderful information on all these disorders and it makes me almost convinced that his body has a difficulty dealing with things that he can’t control and therefore makes him feel like a failure and furthermore depresses him.

Do you have any suggestions on a prescription that would deal with depression caused by the underlying anxiety or anxiety caused by underlying depression. I know you need to treat the underlying cause regardless of what the symptoms are at the moment. I think that is why the wellbutrin didn’t work. He is depressed now but I don’t think that was the underlying cause. I think it is excessive worry and anxiety.

I would appreciate any help or advice since he is feeling like a failure since the wellbutrin didn’t work and he took effixor in the past that didn’t work.

thank you for your time and I look forward to your response and hope that it helps in my finance’ talking to his dr. and finding something that will work.

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Dr. Joshua’s Answer:

Your analysis of your fiance’s situation seems well though out. It is indeed true that anxiety and depression are often linked and overlapping. It is sometimes difficult even for the psychiatrist to immediately arrive at the exact correct diagnosis. The good news is that certain medication, such as SSRIs (selective serotonin reuptake inhibitors) work for both anxiety and depression.?

In your fiance’s case, psychotherapy might be beneficial. While there is no absolutely convincing clinical evidence that psychotherapy is effective, there is some evidence that cognitive-behavioral psychotherapy may be effective for both anxiety and depression. There seem to be various psychodynamic factors influencing your fiance’s mood, and I believe it could be beneficial to work these with a skilled psychotherapist. Also, the lack of clinical evidence nothwithstanding, a regular session with a psychologist, talking things out with a trusted unattached person, might be useful in his case.

Wellbutrin (bupropion) is not indicated for anxiety disorders. Effexor (venlafaxine) is indicated for both depression and anxiety, but it is not effective for everyone, and it’s often not easy to find the exact right medication for each individual. It often takes time, trials, and patience. The majority of patients respond to proven antidepressant and -anxiety medication, but in the end, the response of each individual is unique. It bears reminding that only about 50% of patients respond favorably to these treatments in large clinical trials.

Paroxetine is currently approved for the treatment of depression, generalized anxiety disorder, and social anxiety disorder. Talk to his doctor about the possibility of a trial with paroxetine. There are other alternatives, including fluoxetine (Prozac). Although Prozac is not approved for anxiety disorders, it is probably effective, and it is worth considering as an alternative.

My suggestion (of course, you’ll need to to run this by his doctor and get approval) is paroxetine combined with psychotherapy, and, if possible, continue regular sessions with a psychologist/psychiatrist.
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addition:
PS. I sat down for coffee with my friends at the psychiatry dept and discussed your fiance’s situation, and they agreed that SSRI (such as paroxetine) and psychotherapy would be a combination worth trying. They were not entirely convinced that cognitive-behavioral therapy would be better than any other form of psychotherapy, and were of the mind that the most important thing is to have a regular weekly session, preferably for 10-20 weeks to start with. Also, the psychiatrists did not seem to believe in the superiority of paroxetine over the other SSRI’s, regardless of the officially approved indications.

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