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Cited by 24Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesTreatment of Major DepressionMental Health Treatment and Access

Escitalopram for Older Adults With Generalized Anxiety Disorder: A Randomized Controlled Trial

Lenze, Eric J., Rollman, Bruce L., Shear, M. Katherine, Dew, Mary Amanda, Pollock, Bruce G., Ciliberti, Caroline, Costantino, Michelle, Snyder, Sara +5 more·2009·JAMA
DOI 10.1001/jama.2008.977PMC PMC2840403
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Abstract

Results In the primary analytic strategy in which participants (n=33) were censored at the time of dropout, mean cumulative response rate for escitalopram was 69% (95% confidence interval [CI], 58%-80%) vs 51% (95% CI, 40%-62%) for placebo (P=.03). A conservative intention-to-treat analysis showed no difference in mean cumulative response rate between escitalopram and placebo (57%; 95% CI, 46%-67%; vs 45%; 95% CI, 35%55%; P=.11). Participants treated with escitalopram showed greater improvement than with placebo in anxiety symptoms and role functioning (Clinical Global ImpressionsImprovement scale: effect size, 0.93; 95% CI, 0.50-1.36;P.001; Penn State Worry Questionnaire: 0.30; 95% CI, 0.23-0.48;P=.01; activity limitations: 0.32; 95% CI, 0.01-0.63; P=.04; and the role-emotional impairment and social function: 0.96; 95% CI, 0.03-1.90; P=.04). Adverse effects of escitalopram (P.05 vs placebo) were fatigue or somnolence (35 patients [41.1%]), sleep disturbance (12 [14.1%]), and urinary symptoms (8 [9.4%]). Conclusions Older adults with GAD randomized to escitalopram had a higher cumulative response rate for improvement vs placebo over 12 weeks; however, response rates were not significantly different using an intention-to-treat analysis. Further study is required to assess efficacy and safety over longer treatment durations. Trial Registration clinicaltrials.gov Identifier: NCT00105586

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  • Older adults with anxiety often avoid pharmacotherapy and many prefer psychotherapy.

    “Although antidepressant medications have demonstrated efficacy in the treatment of geriatric GAD, anxious older adults are often wary of pharmacotherapy due to hypervigilance for side effects, worry about potential adverse effects of medications, a desire to limit the number of drugs taken, or other factors, and many prefer psychotherapeutic treatment (Gum et al., 2006; Lenze et al., 2009; Metge,”

    From Acceptance and Commitment Therapy for generalized anxiety disorder in older adults: a preliminary report. (2011) · cites this paper as Lenze et al., 2009

    The COMMENT section (page unavailable) reports escitalopram efficacy in older adults with GAD and says patients with anxiety disorders are often poorly adherent to pharmacotherapy. It does not say that older adults avoid medication because they fear side effects or that many prefer psychotherapy; poor adherence does not establish those reasons or preferences. (LLM, conf=0.84)

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Research works printed but not linked: 2

  1. [3]Hoffman DL Dukes EM Wittchen H-U Human and economic burden of generalized anxiety disorder Depress Anxiety 2008 25 1 72 90 17146763
  2. [28]First MB Spitzer RL Gibbon M Structured Clinical Interview for DSM-IV Axis I Disorders (SCID), Clinician Version: Administration Booklet 1996 American Psychiatric Press Washington, DC

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Authors
Lenze, E. J., Rollman, B. L., Shear, M. K., Dew, M. A., Pollock, B. G., Ciliberti, C., Costantino, M., Snyder, S., Shi, P., Spitznagel, E., Andreescu, C., Butters, M. A., & Reynolds, C. F.
Affiliations
  • Washington University in St. Louis (US)
  • University of Pittsburgh (US)
ORCID
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2009-01-21
Volume
301
Issue
3
Pages
295
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2008.977
PMC
PMC2840403
OpenAlex
W180334308
Cited by
5
References
50
Citations by year
2019: 1 · 2016: 1 · 2013: 1 · 2012: 1
FWCI
0.85
Type
journal article
Language
en
Open access
closed
Locations
JAMA (publishedVersion)
Funders
National Institute of Mental Health (R01MH072947, P30-MH-068579, P30-MH 71944, P30MH071944, R01MH070547)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
escitalopram, generalized anxiety disorder, older adults, selective serotonin reuptake inhibitors, antidepressant efficacy, placebo comparison, role functioning, worry, adverse effects, sleepiness, urinary symptoms

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