Author: Andre Galinowski, Doctor of Psychiatry, Service Hospitalo-Universitaire De Sante Mentale & De Therapeu-tique, Paris, France
A naturalistic study of escitalopram (Lexapro medication, Forest) in depressed patients with concomitant morbid anxiety showed satisfactory control for symptoms of both conditions, according to a new study. The trial included both the high comorbidity rate for depression and anxiety and the need to see whether an agent already proven useful for each condition separately would be effective when both disorders were present. When a selective serotonin reuptake inhibitor (SSRI) has activating potential (i.e., insomnia is the most common side effect of escitalopram), the speaker said that the condition of patients who are anxious may deteriorate.
European comorbidity rates with major depression can vary between 10.2% for Social Anxiety Disorder and 33.7% for Generalized Anxiety Disorder. Among patients with depression, 50% to 70% have moderate anxiety and 20% to 25% have severe anxiety. When both anxiety and depression are present, he added, symptoms are more severe, impairment is greater, the course is more chronic with a poorer outcome, the quality of life is lower, the incidence of suicide is higher, and the utilization of health care resources is increased.
To assess the efficacy of escitalopram in patients with major depressive episodes with or without concomitant anxiety, the investigators conducted a 12-week open-label, multicenter, prospective naturalistic study in 217 French centers, mostly community psychiatry clinics. Most patients started with day, with increases to a maximum of 20 mg/day.
The primary efficacy outcome measures were change from baseline on the Hamilton Rating Scale for Anxiety (HAM-A), and Global Clinical Impression of Improvement (CGI-I) and Patient Global Evaluation (PGE) scales. After the study, the investigators stratified the 790 enrolled patients into three HAM-A groups (210 with scores of 20 or below, 286 with scores of 21-28, and 293 with scores of 29 or above). Sixty-one percent of the enrolled patients (n = 478) had at least one anxiety disorder.
MADRS scores fell from 31.5 at the time of enrollment in the study to 12.4 after 12 weeks. The responder rate (showing a decrease of 50% or greater in MADRS scores) was 72.1%. The remission rate (defined as a MADRS score of 12 or below) was 57.8%. HAM-A scores declined from 25.7 to 10.8 over the study period.
Improvement in depression and anxiety scores was significantly correlated (P < .001). However, Dr. Galinowski pointed out that when either the severity of baseline anxiety or the number of comorbid anxiety disorders was high, the therapeutic effect on anxiety symptoms was increased but was decreased slightly on depressive symptoms. canadian cialis
It was also noteworthy that the improvement in HAM-A scores was not dependent on the presence of a coexisting anxiety disorder. Approximately 71% and 68% of the subjects were “responders,” defined as very much improved or much improved on the CGI-I and PGE scales, respectively.
The withdrawal rate for treatment-emergent ADEs was 8%, with nausea (12 patients out of 63) and headache (8 patients out of 63) most common. Insomnia was reported in 3.9% of the patients.
Dr. Galinowski said that although escitalopram canadian is a more potent inhibitor of serotonin reuptake than many SSRIs and that some activating SSRIs can make patients very anxious, escitalopram appears to be a potential solution “when other SSRIs fail or when patients are anxious.” He did not have an explanation as to why escitalopram’s potency was not accompanied by increased anxiety but did speculate that relationships between monoamines other than serotonin might be involved.