Separation of anxiety and depressive disorders
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# Authors' reply {#article-title-2}

EDITOR—Our article merely points to an inefficiency in drug development that seems to be driven by commercial imperatives, and as the targets are phoney diagnoses no advance is made. If we merely promote new indications for old drugs and dump existing compounds when they lose their patents is it surprising that depression and anxiety remain such major causes of morbidity?

Weeks is right to assert that there is more to the treatment of mood disorders than drugs, but the negative effects of the splitting of anxiety and depression are not just confined to drug treatments: they apply across the board, leading to such confusion that herbal and homoeopathic remedies are often the preferred treatment options.1 If we can match treatment to patterns of symptoms the outcome can be successful2; forcing them into diagnostic boxes with licensed indications is not the way forward.

First and Regier clearly believe that anxiety and depressive disorders are fundamentally different. Belief is not enough for a good classification; the evidence to date favours common genetic and psychological components to both anxiety and depressive disorders3 4 and it is a more reasonable hypothesis to consider cothymia as the core state.

It also may be true, as Joffe suspects, that this proliferation of niche diagnoses is a consequence of the failure to find new drugs, but, if so, it should be exposed for what it is, and more attention given to the sad fact that two out of five patients with anxiety and depressive disorders show no real improvement in the long term.5 We agree that we cannot make a categorical assertion that splitting anxiety and depression is the cause of failure to innovate and advance but in a parallel field, the treatment of schizophrenia, the use of more generic diagnostic terminology has been associated with greater drug innovation.6

## Footnotes

*   Competing interests PT has received support from the Mental Health Foundation to evaluate the outcome of anxiety and depressive disorders.

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