The Potential Role of Iatrogenic Comorbidity in the Interaction between Pharmacotherapy and Psychotherapy in Anxiety Disorders

The combination of pharmacotherapy and psychotherapy in the setting of anxiety disorders is often viewed as a potential source of augmentation of clinical effects, with little attention to the potential occurrence of negative events. In most of the studies, however, if benefits ensued they were modest and likely to fade. Further, four high quality and well-designed individual studies suggest that addition of a benzodiazepine or an antidepressant to cognitive behavioral treatment of anxiety disorders could be detrimental compared to placebo at follow-up. The aim of this review was to outline a novel hypothesis, which needs to be adequately tested, but may shed some new light on this interaction. Any type of psychotropic drug treatment, particularly after long-term use, may increase the risk of experiencing additional psychopathological problems that do not necessarily subside with discontinuation of the drug or of modifying responsiveness to subsequent treatments. The changes are persistent and not limited to a short phase, such as in the case of withdrawal reactions, and cannot be subsumed under the generic rubrics of adverse events or side effects. The term “iatrogenic comorbidity” refers to unfavorable modifications in the course, characteristics and responsiveness of an illness that may be related to treatments that were administered previously. The likelihood of iatrogenic comorbidity needs to be considered in clinical practice: the concurrent use of pharmacotherapy and psychotherapy may yield advantages in the short-term, but its costs at some later point in time may largely outweigh such benefits.