In a longitudinal cohort study of young adults from the Canton of Zurich in Switzerland, the course of anxiety and depressive disorders was examined in 3 interviews over a period of 7 years. The 1-year prevalence rates of panic disorders (including a milder form), generalized anxiety disorder, major depression, and recurrent brief depression were similar from age 21–28 yr. Females prevailed among all diagnoses, their preponderance being strongest for mild panic and major depression. No differential course could be found for the 3 initial diagnostic groups in 1979: the pure anxiety disorders, the pure depression, and the mixed anxiety – depression. Their courses were very similar: 41–52'% recovered, 24–41% developed pure depression, 14–15% manifested a mixed anxious – depressive syndrome, and 5–10% manifested pure anxiety. Compared to controls, all 3 groups showed a tendency to develop into mixed cases and to manifest more recurrences. When the diagnostic information of all 3 interviews was cumulated into longitudinal diagnostic groups, however, differences emerged with respect to severity and chronicity of the disorders. Cases of mixed anxiety-depression were treated more often than cases of pure anxiety or pure depression. Furthermore, in a longitudinal perspective, the mixed cases received a diagnosis more frequently than the cases of pure anxiety disorders or pure depressive disorders, and thus were found to be more recurrent or chronic. With respect to course prediction, a single diagnosis does not differentiate sufficiently and more longitudinal diagnostic information should be taken into account to enhance the certainty of prediction of course and outcome.

It is difficult to undertake field studies with non marketed psychotropic drugs because of two apparently contradictory conditions : on the one hand, the methodology has to be rigorously controlled, and on the other hand, such studies have to be carried out in their future environment by general practitioners (GPs). Bearing in mind the lack of training and experience regarding this kind of approach, the author adopted a discussion group method according to the techniques developed by M. Balint. The study group comprised five GPs, a clinical pharmacology expert and a doctor from the pharmaceutical laboratory which had developed the test drug. These persons met on a monthly basis over a one year period. In the present paper, the author indicates the benefits of such a methodology, based on six years’ experience and several trials, with special emphasis placed on the pedagogical aspects.

The comorbidity of anxiety disorders and depression, and its effect on course and outcome was examined by using data from the Munich Follow-up Study (MFS). The MFS is a prospective 7 year follow-up study in both a clinical sample of originally 291 former inpatients as well as a representative sample (N = 657) from the general population. Diagnoses were based on the Diagnostic Interview Schedule (DIS) not using the optional DSM-III exclusion rules. Based on earlier studies the temporal relationship of diagnoses was examined by using the age of onset and recency codings of the DIS, correcting for inaccuracies in patients’ judgement. The results showed: 1), Comorbidity seems to be a rather frequent and stable phenomenon in clinical and epidemiological samples. The comorbidity rates of the DIS/DSM-III diagnoses, amounted to about 50% in the epidemiological and 75% in the clinical sample. 2), The majority of the subjects with both disorders indicated an onset of anxiety disorders before that of a major depressive syndrome. None of the cases developed a major depressive episode prior to an anxiety disorder. 3), A less favorable course and outcome was generally found for subjects with both disorders (anxiety and depression), although the predictive value of the diagnostic grouping was meager. Clear differences were found for “pure” disorders (anxiety only, depression only) in the clinical and epidemiological sample. 4), Regardless of whether a depressive episode was present at the time of the follow-up investigation, the mixed group had the worst outcome of all other comparative groups.