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Emergent anxiety after antidepressant initiation: a retrospective cohort study of Veterans Affairs Health System patients with depression.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Li, Zhiguo Pfeiffer, Paul N. Hoggatt, Katherine J. Zivin, Kara Downing, Karen Ganoczy, Dara Valenstein, Marcia
Spatial Coverage	United States
Description	Country affiliation: United States Author Affiliation: Li Z ( Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina 27710, USA. zhiguo.li@duke.edu)
Abstract	BACKGROUND: Initiation of antidepressant treatment for depression may be associated with new onset (emergent) anxiety. OBJECTIVE: The purpose of this study was to assess demographic and clinical factors associated with emergent anxiety following a new antidepressant start among Department of Veterans Affairs (VA) Health System patients with depression. METHODS: Using a retrospective cohort design, we obtained data from 328,888 VA patients with depression who were newly prescribed 1 of the 7 most commonly used antidepressant drugs between April 1999 and September 2004 from the VA National Depression Registry. We examined the prevalence of emergent anxiety, defined as either a new anxiety diagnoses or by new antianxiety medication starts, during the 12 weeks following new antidepressant start. In multivariate analyses, we assessed the hazard ratios for emerging anxiety associated with patient characteristics and specific antidepressant agents. RESULTS: Approximately 3% of patients developed clinically significant anxiety within 12 weeks of starting an antidepressant drug regimen. Younger age (age <45 years and 45-64 years) was associated with higher risks for emergent anxiety than older age (≥65 years) (hazard ratio [HR] = 1.72 and 1.55; 95% CI, 1.59-1.85, and 1.38-1.72, respectively). Female gender was associated with higher risks than male gender (HR = 1.17; 95% CI, 1.10-1.26), and white and other races compared with black race were associated with higher risks of emergent anxiety (HR = 1.49 and 1.13; 95% CI, 1.30-1.59 and 1.04-1.23, respectively). Finally, filling antidepressant drug prescriptions in years subsequent to 1999 was associated with lower risks of emergent anxiety. CONCLUSIONS: Only a small proportion of patients developed emergent anxiety following a new antidepressant start, resulting in a new diagnosis or antianxiety medication use. Anxiety occurred more often in young adults, whites, and women.
File Format	HTM / HTML
ISSN	01492918
e-ISSN	1879114X
DOI	10.1016/j.clinthera.2011.11.010
Journal	Clinical Therapeutics
Issue Number	12
Volume Number	33
Language	English
Publisher	Elsevier
Publisher Date	2011-12-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Pharmacology Antidepressive Agents Adverse Effects Anxiety Chemically Induced Depression Drug Therapy Health Systems Agencies United States Department Of Veterans Affairs Anti-anxiety Agents Therapeutic Use Diagnosis Epidemiology Psychology Comorbidity European Continental Ancestry Group Proportional Hazards Models Registries Retrospective Studies Risk Assessment Risk Factors Sex Factors Time Factors Research Support, N.i.h., Extramural Research Support, U.s. Gov't, Non-p.h.s.
Content Type	Text
Resource Type	Article
Subject	Pharmacology Pharmacology (medical)

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