우울장애와 불안장애의 공유 특성

Abstract

This paper reviews the historical background of current concept of depressive and anxiety disorders, their comorbidity and pharmacological treatment of depressive and anxiety disorders to identify shared characteristics of both disorders. There is not only an overlap of symptoms but also high comorbidity between depressive and anxiety disorders. In US National Comorbidity Survey, 58% of respondents with life time major depressive disorder also had a history of anxiety disorders. Although there was a differential comorbidity of depressive disorders among the subtypes of anxiety disorders, 37-62% of anxiety disorders had a history of lifetime major depressive disorder. Comorbid depressive disorders were more prevalent in generalized anxiety disorder, obsessive compulsive disorder, panic disorder and agoraphobia, but much less in social phobia and simple phobia. The fact that antidepressants are effective not only for depressive disorders but also for anxiety disorders suggests common biological processes shared by both disorders. The organization of emotional response systems is founded on two basic motivation systems, defensive and appetitive. Limbic system and frontal lobe playa central role in the emotional response systems. Among the models of depression and anxiety, a tripartite model of negative affect factor, positive affect factor, and arousal-tension factor gains recent popularity. In this model, negative affect factor is manifested in nonspecific distress in depression and anxiety, low positive factor in lack of pleasure and interest in depression, and autonomic arousal in fear/panic. There has been a rapid progress in our understanding of neural modulation of emotion, and this progress will enhance our success in the treatment and prevention of depressive and anxiety disorders.