The DSM-5 classifies depressive and anxiety disorders according to clinical symptoms and assesses possible correlations with a medical condition, use of psychoactive or pharmacological drugs, or substance abuse. The objective of the present review is to overview the main depressive and anxiety disorders according to the classification of the DSM-5 and to present the primary pharmacological and non-pharmacological treatments, with particular emphasis on the problem of compliance.
Literature review of recent years on depressive disorders and anxiety disorders was carried out following publication of the DSM-5 (2013).
In the DSM-5, depressive disorders include disruptive mood dysregulation, major depressive disorder, persistent depressive disorder, premenstrual dysphoric disorder, depressive disorder induced by substances/drugs, and depressive disorder due to other medical conditions. The common characteristic of these conditions is the presence of sad, empty, or irritable mood, which together with specific cognitive and somatic symptoms leads to significant distress or impairment in functioning. The anxiety disorders recognised in the DSM-5 include separation anxiety disorder, selective mutism, specific phobia, social anxiety disorder, panic disorder, agoraphobia, generalised anxiety disorder, anxiety disorder induced by substances/drugs and anxiety disorder due to another medical condition. All the disorders share characteristics of excessive fear and anxiety correlated with behavioural alterations. In anxiety disorders, the stimulus, external or internal, produces a disproportionate anxious reaction that is a source of intense distress or significant impairment of functioning. Pharmacological therapy alone, psychotherapy alone, or the combination of both are efficacious in the treatment of depression, generalised anxiety disorder, panic attacks and insomnia. It is important to involve the patient in the therapeutic course through adequate communication and information about time to therapeutic response and possible side effects. SSRIs (selective serotonin reuptake inhibitors) and SNRIs (serotonin-norepinephrine reuptake inhibitors) are first-choice agents in the treatment of depression, with demonstrated efficacy and safety. A benzodiazepine can be used in the first 4 weeks of therapy for depression in the presence of significant symptoms of anxiety, in panic disorder and insomnia to obtain rapid improvement in symptoms. In the treatment of depressive disorders, compliance is important to achieve the objectives of antidepressant therapy. In recent years, significant progress has been made in identification of risk factors for poor compliance and development of a variety of strategies aimed at increasing adherence to therapy, especially in improving communication, patient education, dose optimisation and scheduled follow-up.
In treatment of depressive and anxiety disorders, therapeutic choice should consider patient preferences and must be decided together with the patient. Compliance is an important aspect that determines the success of treatment.