Despite the large number of psychopharmacologic and psychotherapeutic treatment options abvailable to patients suffering from Major Depressive Disorder, patients routinely struggle with persistent, refractory symptoms that cause substantial morbidity. Even patients considered to have achieved "remission" (typically defined in clinical trials as having a HAM-D score <7) commonly experience persistent symptoms. In the STAR*D trial, for example, of the 35% of patients achieving remission, up to half continued to experience one or two residual symptoms.

Anxiety is among the most common persisting, refractory symptoms in depression. Its presence is associated with significant impairment, including interpersonal and occupational dysfunction and increased risk of depressive relapse. Despite its prevalence and substantial morbidity, evidence shows that anxiety in depression is under-recognized and undertreated.

This activity is a Computer Simulation Assessement Tool (CSAT) that will address how to identify, with accuracy, the presence of anxiety in depressed patients in addition to the use of evidence-based pharmacotherapy to treat comorbid anxiety and depression.

To download the DASS Rating Scale, visit:

Learning Objectives

At the end of this educational activity, participants should be able to:

  • Recognize the limitations of current antidepressant therapy, and monitor patients for persisting, residual symptoms.
  • Identify with accuracy the presence of anxiety in depressed patients.
  • Use evidence-based pharmacotherapy to treat comorbid anxiety and depression.

Target Audience

Psychiatrists, psychologists, primary care/family physicians, nurses and nurse practitioners, and allied healthcare professionals.


  • Director, Postgraduate Medical Education, Massachusetts General Hospital
    Assistant Professor of Psychiatry, Harvard Medical School
  • Lead Editor/Medical Writer
    Postgraduate Medical Education
    Massachusetts General Hospital
    Clinical Instructor in Psychiatry, Harvard Medical School

CME Information

Release Date: September 23, 2013
Expiration Date: September 23, 2014

To receive credit for this activity, view the presentation and complete the post-test and activity evaluation.

Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of McLean Hospital and the Massachusetts General Hospital Psychiatry Academy. McLean Hospital is accredited by the ACCME to provide continuing medical education for physicians.

McLean Hospital designates this enduring material for a maximum of 1 AMA PRA Category 1 Credit(s)TM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Credit Designation

Psychologists: The Massachusetts General Hospital Department of Psychiatry is approved by the American Psychological Association to sponsor continuing education for psychologists. The Massachusetts General Hospital Department of Psychiatry maintains responsibility for this program and its content. This offering meets the criteria for 1 Continuing Education (CE) credit per presentation for psychologists.

Nurses: This program meets the requirements of the Massachusetts Board of Registration in Nursing (244 CMR 5.00) for 1 contact hour of nursing continuing education credit.

Policy on Faculty and Provider Disclosure

It is the policy of McLean Hospital that faculty and providers disclose real or apparent conflicts of interest relating to the topics of this educational activity. McLean Hospital has established policies in place that identify and resolve all conflicts of interest prior to this educational activity.

Planner Disclosures

The following planners and/or their spouse/partner have reported no relevant financial relationship with a commercial interest:

Tristan Gorrindo, MD, reviewer

Jane Pimental, MPH

Speaker Disclosures

The following speaker and/or his spouse/partner have reported no relevant financial relationships with a commercial interest:

Michael Hirsch, MD


This program has received support in the form of educational grants from the following companies:

  • Lilly USA, LLC
  • Takeda Pharmaceutical International, Inc. and Lundbeck

Hardware/Software Specifications:
This internet-based CME activity is best experienced using Internet Explorer 8+, Mozilla Firefox 3+, Safari 4+. This Web site requires that JavaScript and session cookies be enabled. Certain activities may require additional software to view multimedia, presentation, or printable versions of the content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Adobe Acrobat, Microsoft PowerPoint, and Windows Media Player.

Optimal System Configuration:
Flash Player: Adobe Flash Player 10.1+
Browser: Firefox 3+, Internet Explorer 8.0+, Safari 4.0+, or Google Chrome 7.0+
Operating System: Windows XP+ or Mac OS X 10.4+
Internet Connection: 1 Mbps or higher

Minimum Requirements:
Windows PC:
500-MHz Pentium II; Windows XP or higher; 128 MB RAM; Video Card at least 64MB of video memory; Sound Card at least 16-bit; Macromedia Flash Player 10 or higher, audio playback with speakers for programs with video content; Firefox 1.1+, Internet Explorer 7.0+, Safari 1.0+, Google Chrome, or Opera
Mac OS X 10.3 or higher with latest updates installed; 1.83MHz Intel Core Duo or faster; RAM: 128MB or more; Video Card: at least 64MB of video memory; Sound Card: at least 16-bit

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This program has received support in the form of educational grants from the following companies: